Experts have warned that Britain could be only “a few weeks away” from shortages of medicines, from everyday pain relief to cancer therapies, if the war with Iran continues. They also caution that the price of many drugs may increase.

The conflict has already disrupted supplies of essential raw materials such as oil, gas, fertilisers and helium, and the pharmaceutical sector could soon feel the impact.

David Weeks, director of supply chain risk management at analytics firm Moody’s, described the situation as a “perfect storm”. He explained that fighting in the Gulf has led to the closure of the Strait of Hormuz, a crucial trade route. At the same time, India — often called the world’s pharmacy — manufactures a significant share of generic, off‑patent medicines and active pharmaceutical ingredients (APIs). With mounting geopolitical tensions, exporting these products has become increasingly difficult.

Major aviation hubs in Dubai, Doha and Abu Dhabi were initially shut and are now operating on limited schedules. As a result, pharmaceutical companies have been forced to reroute air shipments, and in some cases shift to sea freight, extending delivery times.

Maritime shipping, which carries the majority of medicines globally, is also under pressure due to the near-total shutdown of the Strait of Hormuz.

Mark Samuels, chief executive of Medicines UK — the body representing manufacturers of low-cost generic drugs that account for 85% of NHS prescriptions — said the situation is serious but not yet critical. “We’re not in a crisis currently, but it is a serious situation,” he said.

However, he warned that if the conflict persists, shortages could surface within weeks. Distributors typically maintain six to eight weeks of stock to guard against supply interruptions, and hospital suppliers in England are required to hold around eight weeks’ worth.

During the Covid pandemic, Britain and other countries experienced shortages of paracetamol and other common painkillers, as Indian manufacturers — responsible for roughly 60% of the world’s generic medicines and half of US supply — struggled to meet surging demand.

Currently, the UK produces about half of its medicines domestically. Around one third are imported from India, with a significant portion also coming from EU countries.

The war involving the US, Israel and Iran has driven air freight costs to double their previous levels. “One in five NHS medicines arrives by air, and for now manufacturers are absorbing these extra costs,” Samuels said. “But margins are already extremely tight, and there’s a real risk that some products could become financially unviable to supply to the NHS.”

Although long-term pricing agreements are in place between suppliers and NHS hospitals, companies have more flexibility in pricing medicines supplied to GP practices and pharmacies, where price increases could occur.

Wouter Dewulf, professor at Antwerp Management School and a specialist in pharmaceutical logistics, said that medicine supply chains are “not disrupted, but disturbed” at present. If the conflict continues, he expects manufacturers to pass on rising costs through modest, single-digit price increases. “Much depends on the duration of the war,” he noted.

Frank Van Gelder, healthcare and pharmaceutical supply chain strategist and secretary general of Pharma.Aero, explained that the disruption of Middle Eastern airspace has heavily affected the pharmaceutical industry because of its reliance on frequent flights. Before the outbreak of war, approximately 3,700 passenger flights — many carrying cargo — transited the region daily.

Earlier this month, air cargo volumes dropped by 80% and remain significantly reduced, he said.

Certain medicines must be transported by air due to their urgency or fragility. These include high-cost cancer and infectious disease treatments, advanced cell and gene therapies, biologic medicines requiring cold storage, and drugs used in clinical trials.

Dewulf emphasised that healthcare shipments would be prioritised over consumer goods. While stable generic medicines can be shipped by sea, vessels must now reroute around the Cape of Good Hope, adding around 14 days to transit times and roughly $1m (£750,000) in additional fuel costs.

Beyond transport expenses, higher crude oil and natural gas prices are increasing the cost of petrochemical materials such as methanol and ethylene. These substances are essential for producing APIs — the active components of medicines — as well as medical supplies including syringes, vials, tubing, protective gowns and goggles.

Van Gelder said the broader ripple effect across industry, particularly within life sciences and pharmaceuticals, is substantial. “The key question is who will bear the cost,” he said. Ultimately, he suggested, patients are likely to shoulder the burden, either directly or through publicly funded systems such as the NHS, which rely on taxpayer support. “In the end,” he concluded, “we all end up paying more.”