How ‘triple illness’ restricts the supply of cold and flu medicine – and what to do if you’re infected

This winter has been one of the worst on record for the NHS. Ambulance and ER wait times are at an all-time high, and many are struggling to access emergency treatment.

Patients are now reporting difficulties accessing some over-the-counter medicines used to treat colds and flu from pharmacies and retail outlets. Although drug shortages were a common phenomenon in previous years, they were often the result of supply chain issues due to global events, such as the pandemic or Russia’s invasion of Ukraine. But these are not the same reasons people report when experiencing shortages in over-the-counter and prescription products.


Several countries, including the UK, US and Canada, are said to be in the midst of a “triple pandemic” this winter – meaning they are experiencing higher-than-expected cases of COVID, influenza and RSV simultaneously.

In England alone, it is estimated that one in 25 people currently has COVID. Flu cases are also on the rise, with hospitalizations at the highest level since the winter of 2017-2018. Besides, there were also outbreaks of streptococcus A and seasonal diseases.

Since this viral infection causes symptoms such as fever, cough, and sore throat, many people turn to over-the-counter medications to treat it. Some may also make proactive purchases in case of illness.

In Canada, pharmacists are reporting empty shelves, with shortages of cold and flu medicines for children and adults. Concerns about shortages can lead to hoarding and panic buying. In the United States, some pharmacies have chosen to restrict sales due to increased demand by capping the number of certain medications people can buy at one time.

In the UK, popular pain and fever products are said to be running low on stock, and there is also a shortage of cough mixtures and lozenges.

Not enough stock?

UK manufacturers said stocks are already in place and they are working to respond to higher-than-usual demand. In Canada, pharmacies receive supplies, but stocks sell out as soon as they hit shelves. Many people are finding it difficult to get the medicines they need – with some places running out of stock completely.

Some believe that inadequate government planning may explain the UK’s inventory shortage. But again, there is no clear evidence for this.

The early onset of the seasonal flu caused problems in Canada, as manufacturers did not have time to build up basic stocks in the summer and the increase in seasonal illnesses drove up demand for the products. In early January 2023, the Canadian government announced that it was aware of supply restrictions for products used to treat cold and flu symptoms. Similarly, the UK government has confirmed that it is aware of issues with the availability of some branded cold and flu medicines.

Supply chain issues may be one of the reasons for shortages in some countries.

There is also a possibility that the stock may not be evenly distributed. Some pharmacies may have more stock than others, and can help support areas with low stock. Pharmacies with multiple locations will know what stock levels are in their stores and can move inventory between locations. The UK government has said that availability issues with some branded cold and flu medicines are temporary and localized, and that it is working with suppliers to investigate these issues.

Another issue that may feed into supply issues is the forecast used to inform inventory production. If the inventory forecast for winter 2022-23 is based on prior years’ utilization numbers, it may be skewed. During a pandemic, many preventative measures (such as wearing masks) protect us from common germs and viruses as well, reducing levels of illness and reducing demand for cold and flu remedies. In light of this, manufacturing quantities may have been adjusted to avoid wasting stock, without knowing that an early surge of seasonal illnesses would occur this year.

What can you do

If you develop symptoms of a cold or flu, you should seek advice on treatment from your pharmacist and, where needed, from your doctor or healthcare provider.

If you’re finding it hard to get your usual over-the-counter cold and flu products, you may want to try alternatives — including generic (non-branded) products. For example, if you are having trouble finding products like Lemsip to manage cold and flu symptoms, paracetamol and vitamin C are great alternatives as these are often the main ingredients in cold and flu products. The same is true for throat lozenges, with many alternatives on offer.

If a single formulation of the product is not available, your pharmacist may be able to recommend an alternative form – eg substituting Calpol Children’s Syrup for Calpol dissolve-in-oral tablets (depending on age appropriate).

COVID and flu vaccines are still recommended to prevent dangerous viruses, so people are encouraged to get them as soon as possible. While the optimal time to book a flu shot is in the fall or early winter, before the flu starts circulating, it will still provide protection if you get it now.

The UK’s Health Security Agency has warned that winter illnesses including influenza, coronavirus, RSV and streptococcus A are circulating at high levels with no immediate sign of abating. If you are among the millions of people currently suffering from one of these diseases, talk to your pharmacist to find out what treatment options are available to you.

Medicines shortages have occurred in the UK for many years – and will continue to do so. But current shortages of cold and flu products show escalating issues with UK drug supply chains, making it clear that weaknesses in the system need to be urgently addressed.

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