Capacity to manufacture key pharmaceuticals in New Zealand after a global catastrophe

There is concern among experts about global catastrophic risk,¹ and the United States (US) Government recently requested a report that has detailed the following threats: “artificial intelligence; asteroid and comet impacts; sudden and severe changes to Earth’s climate; nuclear war; severe pandemics, whether resulting from naturally occurring events or from synthetic biology; and supervolcanoes.”² The risk of some of these may also be increasing, including for pandemics^2,3 and nuclear war. In particular, there have been repeated implied threats around nuclear weapons by the Russian leadership⁴ and deteriorating international relations between some of the nuclear weapon states (e.g., the US and Russia; and the US and China). There is also the possible expiration of a key nuclear weapons treaty in 2026⁵ and a general lack of meaningful progress with nuclear disarmament in recent years.⁶ Furthermore, nuclear weapon states are typically either modernising and/or expanding their arsenals (e.g., China,⁷ North Korea⁸ and Pakistan⁹).

Some island nations may be better placed than other nations to survive catastrophes such as a nuclear winter or a volcanic winter.^10–12 But major challenges would likely include maintaining key aspects of modern society that depend on international trade (e.g., food, liquid fuels and industrial supplies), given that such trade could be severely disrupted or end entirely. In this study, we look at just one such aspect: the supply of key pharmaceuticals.

In recent years, high-income nations have recognised the vulnerability of their pharmaceutical supply chains. These concerns were particularly highlighted by the COVID-19 pandemic, with nations discovering high-level dependencies on both imported active pharmaceutical ingredients (APIs) and finished medications. In response, the US in 2021 announced establishing public–private partnerships to identify and domestically manufacture 50–100 critical medications.¹³ Furthermore, the European Union (EU) has proposed a Critical Medicines Act to address severe shortages.¹⁴ Some countries within the EU have taken more concrete steps, with France implementing a “Pharmaceutical Sovereignty” initiative that includes restarting domestic paracetamol production (with production due to start in 2026).¹⁵ Similarly, Sweden in 2024 proposed state-run pharmaceutical manufacturing for essential medicines.¹⁶ Nevertheless, the dependency on international trade for APIs remains very high with Europe, for example, obtaining 60–80% of its APIs for generic medicines from China.¹⁷ For the US, local manufacture of active ingredients is only 15% for its brand medicines and 12% for its generic medicines (the rest come from the EU, India, China and other countries).¹⁸ With much smaller countries, such as New Zealand, the economic barriers to any significant level of pharmaceutical independence are particularly substantial.

Previous work by government agencies in New Zealand has considered the threat of such catastrophes as nuclear war,^19,20 pandemics²¹ and, more recently, severe space weather events that could damage the national electrical grid.²² But this country still remains extremely unprepared for such catastrophes as recent studies on nuclear war/winter indicate.^23,24 Although in some global catastrophe scenarios it is plausible that some level of trade between New Zealand and Australia might continue, this is far from guaranteed given New Zealand’s complete dependence on imported liquid fuel for aircraft and cargo shipping.²³ Furthermore, this country may have relatively little to offer Australia in terms of critical trade (that Australia doesn’t already produce), and it is also relatively far away from all other trading partners.

One of the major threats to health of New Zealanders from a global catastrophe could be in terms of food security, given the extreme dependency of industrial agriculture on imported liquid fuels.²⁴ This is despite the apparent current national self-sufficiency in food.²⁵ New Zealand research has started to consider this threat in terms of estimating local biofuel production to keep agricultural machinery running,²⁴ optimal crop selection²⁶ and optimal use of urban and near-urban agriculture.²⁷ But other threats to health from such global catastrophes have only been explored in relatively outdated work from the 1980s.^19,20,28 In particular, the topic of key pharmaceuticals has not been studied in detail, even though this is a likely area of high vulnerability since:

• The existing pharmaceutical industry in New Zealand does not currently produce major pharmaceuticals from source ingredients. Instead, it is focussed on secondary manufacturing and formulation, packaging of imported active ingredients and quality control and testing.
• The recent ending of oil refining in the country²⁹ (despite continuing to produce and export crude oil extracted in Taranaki), has curtailed potential domestic production of petroleum-derived ingredients for pharmaceutical manufacture. There are also no industrial plants using coal-to-chemicals or coal-to-liquids technologies. Methanol is, however, manufactured from natural gas in Taranaki,³⁰ and there is a wood pyrolysis plant in Timaru.³¹ However, the latter only produces charcoal and not chemical by-products potentially relevant to pharmaceutical production (e.g., phenolics and furans).
• Industrial production of other chemicals relevant to the pharmaceutical industry is also relatively limited. Nevertheless, hydrogen gas is produced at various sites (e.g., from a geothermal plant³²), and sulphuric acid is produced as part of fertiliser production (superphosphate).³³

Methods

The most extensively used pharmaceuticals in New Zealand by annual numbers of dispensed prescriptions³⁴ were first selected for consideration. These were then categorised to produce a list of 10 that can be used for acute treatment, as opposed to just chronic disease management (Table 1). Our particular focus on pharmaceuticals relevant to acute treatment was to reflect two potential post-catastrophe factors: 1) a likely greater focus by clinicians on potentially life-saving treatments as opposed to chronic disease management and 2) difficulties with manufacturing that could limit the volume of any locally produced pharmaceuticals (given that courses for acute treatment typically involve lower per person volumes than for chronic disease management). We did not consider the “essential medicines” in the World Health Organization’s list³⁵ as this is very extensive (591 drugs and 103 therapeutic equivalents) and has no prioritisation within the listed medicines.

We then conducted Google Scholar searches in December 2024 to identify modern methods of synthesis and the associated ingredients for each of the 10 selected pharmaceuticals. These ingredients were then assessed in terms of the New Zealand capacity to supply them (e.g., if particular minerals that are used for ingredients or catalysts are mined in the country³⁶).

View Table 1–3.

Results

Results for each of the 10 most extensively prescribed pharmaceuticals that can be used for acute treatment in New Zealand are shown in Table 2 and Table 3. These 10 covered the therapeutic groups (as classified by the national Pharmaceutical Management Agency of the New Zealand Government [Pharmac]) of: analgesics (n=2), alimentary (n=1), anti-infectives (n=1), antithrombotic (n=1), cardiovascular (n=2), respiratory (n=1), hormones (n=1) and antihistamines (n=1). Of note, however, is that some of these pharmaceuticals have roles in multiple groups (e.g., aspirin also for analgesia and prednisone also for the respiratory group and for rheumatological conditions, etc.).

The median year at which these pharmaceuticals were first available in the market anywhere in the world was 1971 (Table 3). But the range for these years was wide, at 1874 for aspirin in powder form and 1998 for omeprazole.

A summary of the results in Table 2 suggests that none of these 10 pharmaceuticals could probably be manufactured using modern synthesis methods after a trade-ending catastrophe since New Zealand has no petrochemical refining capacity (other than methanol production). In addition, the modern synthesis of seven of the 10 pharmaceuticals would also probably not be possible due to catalysts or other specific chemical ingredients not being mined or otherwise produced in New Zealand (Table 2). Nevertheless, some of the catalysts may only be required in small amounts and so could potentially be scavenged in the post-catastrophe period within New Zealand, e.g., from vehicle catalytic converters.

Discussion

Main findings and interpretation

This study suggests that after a trade-ending catastrophe, none of these 10 pharmaceuticals relevant for acute treatment could be manufactured using modern synthesis methods in New Zealand. This is primarily because this country has no petrochemical refining capacity, but also because it does not produce all the necessary catalysts or other specific chemical ingredients. Therefore, after such catastrophes, and once imported pharmaceutical stocks had run out, there would probably be increased deaths from infections, heart disease, stroke and asthma as well as increased morbidity (e.g., from pain and prolonging the relevant illnesses detailed in Table 1). In terms of the health loss from untreated infectious disease, this burden would probably disproportionately fall on Māori, Pacific peoples and socio-economically deprived New Zealanders (who already have higher current relative burdens⁵⁷). Such inequities also exist for Māori and Pacific peoples for cardiovascular disease burdens.⁵⁸ Furthermore, the infectious disease burden could be worse after catastrophes if there were major disruptions in: reticulated chlorinated water, sewerage systems and food supplies to urban areas (i.e., if there was malnutrition).

It is conceivable that New Zealand, after a trade-ending catastrophe, could attempt to produce some of its own ingredients for pharmaceutical production. For example, it could modify the current wood pyrolysis plant in Timaru to produce phenols and furans; or modify the Glenbrook steel plant to produce benzene/phenol from coke gas. Even more expensive options would be building a micro-refinery for oil extracted in Taranaki or from coal tar using coal from West Coast mines. But all these actions could be very difficult to achieve if there was some level of societal collapse associated with an end of New Zealand’s export economy. In any such a collapse, the central government might be too pre-occupied with addressing basic needs (e.g., food and energy supply), and there may be shortages of parts for converting existing infrastructure and shortages of relevant experts (e.g., if industrial chemists and chemical engineers could not be paid or had left the cities).

Nevertheless, one possibility for relatively simple post-catastrophe production is aspirin given that alternative (non-petroleum) sources for salicylic acid include plants containing salicin e.g., willow (Salix species) and meadowsweet (Filipendula ulmaria),⁴⁶ with the former commonly found in New Zealand. Aspirin manufacture is relatively simple once salicylic acid is available (at about high-school student level).⁵⁹ But if manufacturing involved plant-sourced salicylic acid, it would probably be far less efficient and much more expensive than modern-day synthesis methods. For example, there was a drop to a “tenth of the price” with industrial synthesis in 1874, relative to when extraction from willow was used.⁴⁶

Other options for producing pharmaceuticals in New Zealand could include growing opium poppies (Papaver somniferum) for manufacturing morphine and codeine (although re-establishing trade with Australia might be more feasible as its opium poppy farms are already the source of 37% of the world’s licit morphine supply⁶⁰). Another option is growing the Madagascan periwinkle (Catharanthus roseus) in frost-free areas for the production of vinca alkaloids (from which chemotherapy agents such as vinblastine and vincristine can be derived). Also extracting animal glands at freezing works for producing hormones (adrenal, parathyroid, pituitary, thyroid and pancreas [for insulin], etc.) is a possibility, as done in New Zealand⁶¹ prior to more modern synthesis methods. However, these processes typically need high levels of organisation for production at scale and potentially complex processes for purification and product standardisation.

Study strengths and limitations

Although preliminary in nature, a strength of this study is that it is the first to look in any detail at the issue of pharmaceutical production after trade-ending global catastrophes (to our knowledge). Nevertheless, the following limitations apply:

• The 10 selected pharmaceuticals were based on the number of prescriptions dispensed for medicines that had roles in treating acute conditions. But this was simplistic given that: 1) prescriptions numbers are only a crude indicator of volume and also do not account for non-adherence and other wastage; 2) some of the selected pharmaceuticals are also used for non-acute treatments (e.g., aspirin, metoprolol and amlodipine—see Table 1) and 3) some of them can be purchased over-the-counter (e.g., six of those in Table 1) and so are not counted in the “prescription data” that we considered. There was also no quantified consideration of life-saving potential as opposed to ongoing management for non-fatal conditions.
• As discussed for aspirin, this study focussed on modern synthesis methods for these pharmaceuticals and did not systematically explore alternative less efficient methods and historic methods. In particular, although some catalysts can be considered indispensable, substitute catalysts for many chemical reactions are often possible with trade-offs in terms of reaction efficiency.⁶² Also of note is that artificial intelligence is assisting with chemical substitution,⁶³ as are “green chemistry” developments.⁶⁴ Indeed, a recent study reports that E. coli can be adapted to convert plastic waste into paracetamol.⁶⁵
• Options for the post-catastrophe scavenging of minerals not mined in New Zealand were not fully explored, and yet this might be feasible if only small amounts of catalysts are required. For example, platinum and palladium could potentially be scavenged from vehicle catalytic converters (and platinum also from electrical equipment and jewellery). Nickel could be scavenged from stainless steel items and various industrial equipment. Also, where relevant minerals had previously been mined in New Zealand (e.g., bauxite, chromite and platinum⁶⁶), mining operations could potentially be restarted if some ores still existed at recoverable levels. There may also be stockpiles of imported bauxite available if these were diverted from those held by the Tiwai Point aluminium smelter in Southland (relevant for ibuprofen, prednisone and salbutamol production). Similarly, stockpiles of imported fertiliser could be used as a source of boron (for cetirizine production) and stockpiles of imported fluoride, used for water fluoridation, could be used to produce hydrogen fluoride (for ibuprofen production). Even then, the capacity to turn such minerals and chemicals into usable ingredients in pharmaceutical manufacture would depend on the available expertise, refining capacity and manufacturing capacity, all of which could be severely limited in a post-catastrophe environment.
• This analysis did not consider alternative treatments to modern pharmaceuticals. For example, rongoā Māori (traditional healing system) provides a range of alternative treatments based on rākau (plants).⁶⁷ Also, in the European tradition, an example is the use of “medicated cigarettes” containing plants in the nightshade family (Solanaceae) for treating asthma, as used in the nineteenth and twentieth centuries.⁶⁸ Indeed, a review published in 2013 considered the effectiveness of Datura stramonium in treating asthma.⁶⁹ However, such plants have toxicity risks⁶⁹ and misuse potential,^70,71 so might need medical supervision with administration.

Potential further research and planning responses

In this unfunded research we took a fairly simple approach to pharmaceutical selection that involved prescription numbers of medicines that can be used for acute treatments. If there was government-funded research in the future, then a more sophisticated approach could prioritise a larger number of commonly prescribed pharmaceuticals (along with anaesthetics, etc.). Possible prioritisation could be informed by modelling the annual deaths prevented or annual quality-adjusted life years (QALYs) saved by different pharmaceutical treatments. If input from a citizens’ panel/assembly was included in the prioritisation process, then it could start to capture societal values, e.g., perhaps prioritising the production of antibiotics for saving the lives of essential workers over production of statins to manage risk factors such as elevated blood lipids.

All the issues raised in this preliminary analysis would suggest that one of the best approaches to resilience in this area might be for the New Zealand and Australian governments to jointly plan for shared post-catastrophe production of key pharmaceuticals and the ability to trade them between each other by ship or aircraft. This trans-Tasman approach has already been suggested in terms of mRNA vaccine development for responding to future pandemics.⁷²

Australia is much better positioned than New Zealand for pharmaceutical production since it has a pharmaceutical industry that produces some vaccines and generic medicines⁷³ (albeit still importing 90% of its medicines⁷⁴), it still has oil refining capacity and it mines a wider range of minerals (including three critical ones listed in Table 2: bauxite, lithium and nickel). The New Zealand government could contribute funding for any Australia-based preparations and potentially provide some ingredients, but it could also focus on ensuring the viability of post-catastrophe trans-Tasman trade. For example, New Zealand-produced biofuels (e.g., from canola cropping)²⁴ could be used to keep cargo ships functioning in the absence of imported liquid fuels.

If the Australian government was not interested in such joint planning, the New Zealand government could still explore working with other Southern Hemisphere countries with pharmaceutical industries, e.g., Indonesia⁷⁵ and Brazil.⁷⁶

Going it alone would be very expensive for New Zealand, but if so, the government could explore domains where some local production may be more feasible (e.g., aspirin and morphine production from locally grown plant-based sources). However, all these responses would need to be balanced relative to other post-catastrophe priorities: keeping agriculture functioning for food security, maintaining reticulated water and sewerage systems and keeping basic preventive medicine and primary healthcare working.

Conclusions

This preliminary analysis suggests that none of these 10 extensively used pharmaceuticals could be produced using modern synthesis methods in New Zealand after a trade-ending catastrophe. This is primarily because the country does not refine petrochemicals. To address this and other domains lacking in resiliency (e.g., liquid fuel supply), planning for building shared resiliency with other neighbouring nations (e.g., Australia) could be considered.