Qualitative study with subject experts on the causes and consequences of antibiotic shortages through a PESTELI (political, economic, sociological, technological, ecological, legal, industry) lens

Lack of access to antibiotics has been identified as a major contributor to the emergence of antibiotic resistance. The drivers for antibiotic shortages are complex. We conducted interviews with key stakeholders involved in national and global antibiotic supply chain management, to explore the main drivers for current shortages and existing solutions to manage antibiotic shortages in different regions of the world. Participants were interviewed using a semi-structured interview guide developed using the PESTELI (political, economic, sociological, ecological, technological, legal, industry) framework. Political engagement on antibiotic shortages was reported to facilitate effective strategies. Legal measures have also been used; for example, pharmacists in the UK given rights to use alternative agents without referring to the prescriber. Pharmaceutical companies need to provide greater transparency on manufacturing issues that cause shortages. Economic incentives are required at all levels and are currently missing, as are technological solutions to predict antibiotic shortages. Sociological elements include adopting appropriate communication to not cause panic buying and hoarding of antibiotics by healthcare systems when there is an impending shortage. Understanding context specific factors contributing to antibiotic shortages can aid in the development and adoption of strategies and tools for forecasting shortages and their optimised management.