Saline is an Essential Medicine (as defined by the World Health Organization). It costs between $0.60 and $4.20 per liter, wholesale. It’s so ubiquitous in orthopedic surgery that we hardly give it a second thought.
Until we can’t get it.
Hospitals across the United States have been reporting shortages of saline and IV fluids since 2014. It got worse in late 2017.
Saline—which is essentially salt and/or dextrose in sterile water—how does that become a shortage?
Baxter and Pfizer Control 90% of the Saline Sold in the U.S.
Baxter International Inc. and Pfizer Inc. subsidiary Hospira Inc. control about 90% of the $1.2 billion a year saline solution market in the United States according to a lawsuit which was filed against the two firms by hospitals in New York and Pennsylvania in 2017.
In April 2017, the federal government subpoenaed a Baxter International employee as part of a criminal investigation related to the nationwide shortage of saline (source: SEC filings by Baxter) asking for documents about pricing, sale, manufacture and shortage of IV solutions.
The issue, in fact, was a shortage of large saline bags—most of which are manufactured by Baxter in Puerto Rico.
Five months after that subpoena, Hurricane Irma hit Puerto Rico. Six weeks after that, Hurricane Maria blasted through.
Puerto Rico is still devastated. As of the December 28, half the island did not have stable power.
And saline bag production is way down.
