HRT: inside the complex global supply chain behind a $20bn market
In the centre of the factory stand 31 reactors: giant metal globes that can hold up to 10,000 litres of liquid each. Every week, gleaming stainless steel drums arrive by truck at this plant on the outskirts of Oss, in the Netherlands. Their contents are poured into the reactors through a funnel, dissolved, and then heated to boiling point. Standing by one of the vast containers, the factory manager, Robert Dam, compares it to a “cooking pot”. Peering inside, we can see the light liquid bubbling away.
At Dam’s factory, a white powder distilled from soya beans and shipped from China is turned into a precious commodity: strong synthetic oestrogen. The plant at Oss, owned by the Dutch subsidiary of South Africa’s largest drugmaker Aspen Pharmacare, produces the most potent variant of oestrogen, known as oestradiol, destined for the UK market. It will be added to gels, sprays and patches used by more than 1 million women in Britain to manage the symptoms of menopause.
Stretching from the fields of Heilongjiang in north-east China to the shelves of British pharmacies, the chain of agricultural, industrial and chemical labour involved in producing medicines for hormone replacement therapy (HRT) is as complex and global as for the manufacture of iPhones or cars. And like all supply chains, it is vulnerable to disruption.
In May of this year, reports of a shortage of HRT medicines, in particular oestradiol gel, began to surface. As economies reopened after the pandemic, shipping routes became jammed, compounded by shortages of materials, lorry drivers and many other workers. At the same time, demand in Britain surged, following a 2021 documentary produced by the TV presenter Davina McCall, which debunked concerns about the safety of
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