Aurelia Butler

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Part way through her 23-year-old son’s chemotherapy, Kristin Caparra was told that one of the drugs key to his treatment — methotrexate — was running out. Used at high doses in cancer care, the drug is part of common chemotherapy to treat paediatric cancers. There is often no good alternative to the treatment. The shortage led Caparra’s son to miss a dose of methotrexate for treatment of a rare, malignant bone cancer at Pennsylvania Hospital in Philadelphia. Caparra immediately contacted elected officials and cancer organisations, one of which helped arrange an alternative source. For other patients, shortages can mean switching to less effective drugs and facing worse outcomes.“I know my son is one of thousands using this treatment. To know that children in particular would be affected by this is devastating,” says Caparra.Medicine shortages like the one affecting methotrexate recently reached record highs across countries in Europe and hit a 10-year peak in the US last year. The problem is recurrent and widespread: in 2022 and 2023, national pharmacy bodies across 26 European countries all reported shortages, with the picture worsening last year.While big pharma companies focus on developing innovative drugs that they can sell under patent and at high margins, recouping research and development costs, off-patent generic medicines such as methotrexate make up the backbone of pharmaceutical care. Ninety-one per cent of drugs prescribed in the US and 70 per cent in Europe are generics and biosimilars, a more complex off-patent drug.Despite their essential role in global healthcare, manufacturing issues, weak supply chains and low pricing have combined to create a “broken market” for these medicines that makes them unattractive to produce and vulnerable to supply shocks, quality defects or surges in demand, say industry leaders and analysts.You are seeing a snapshot of an interactive graphic. This is most likely due to being offline or JavaScript being disabled in your browser.“The whole system has a just-in-time principle and any rupture in that causes a downstream shortage,” says Rob Moss, a hospital pharmacy consultant in Utrecht, the Netherlands. “But the quality measures are so high and it’s so regulated that if there’s a quality defect, it’s harder for other suppliers to step in than in other industries.” In the UK, 99 generic drugs were short in January, double the number counted two years ago, according to the British Generic Manufacturers Association, a trade body. This has affected supplies of drugs like hormone replacement therapies and medicines for ADHD, partly due to spikes in demand.There is limited data to track shortages in lower- and middle-income countries. But they are unable to compete on price with richer nations. “Where there is scarcity of supply of the product, almost without exception the scarce supply will go to the highest bidder,” says Claudia Martinez, head of research at the Access to Medicine Foundation, a European NGO.For patients, shortages ultimately translate into less effective treatment. Clinicians in a 2021 Pakistani study reported that shortages led to treatment delays, disease complications and even risk of death. In richer countries, systems are often better equipped to adapt to shortages by sourcing drugs from elsewhere or using alternative treatments. Yet three quarters of European national pharmacy groups surveyed last year said that shortages had led to worse treatment, and 15 per cent said they had led to adverse events such as more side effects.Dario Trapani, a doctor at Milan’s European Institute of Oncology, says that when he heard that a drug called paclitaxel, a “backbone for curing women with breast cancer”, was running short in Italy, he was scared. He has few good alternatives to the drug.Trapani, who also chairs the cancer medicines committee of the European Society for Medical Oncology, says in the past six months ESMO members have reported shortages in “very cheap drugs” of the sort that “they use every day” across the continent. “They are told they shouldn’t use [a drug] anymore or to use alternatives,” he says. “This is really shocking and distressing for all parties.”The first phase of drugs manufacturing involves making active pharmaceutical ingredients (APIs) through processing, refining and purifying chemical compounds. The API and other inactive ingredients such as preservatives are then converted into finished dosages during the second stage of manufacturing, typically at separate facilities. The finished drugs are then shipped to distribution centres.For both manufacturing stages, the world relies heavily on Indian and Chinese factories, due in part to lower production costs and a higher skills base. FT analysis of a European database has found that Indian and Chinese manufacturers own over half of the quality certificates needed for drug APIs to be used in Europe and 48 per cent of the certificates for those used in key oncology drugs.Like globalised supply chains for other goods, this adds an element of uncertainty. “The more you are dependent on a producer far away, the more vulnerable you are to facing medicine shortages. Multiple things can happen from production until it arrives at the final distribution point,” says Mujaheed Shaikh, a professor of health governance at Berlin’s Hertie School.Reliance on Chinese factories for active pharmaceutical ingredients contributed to sustained shortages of antibiotics in Europe in 2022, partly due to zero-Covid restrictions in China. Faults at an Indian finished dosage factory were instrumental in the recent shortage of methotrexate experienced by the Caparra family. You are seeing a snapshot of an interactive graphic. This is most likely due to being offline or JavaScript being disabled in your browser.While each shortage has different causes, the hit to methotrexate underlines several problems with the generic medicines industry.First used to treat cancer in children in 1949, methotrexate is also used for psoriasis, rheumatoid arthritis and Crohn’s disease. But the highest doses that have most frequently been in shortage are for cancer care, including for acute lymphoblastic leukaemia and non-Hodgkin lymphoma, a cancer of the lymphatic system.Unusually, around 80 per cent of methotrexate API is made in Europe, says Jürgen Bank, general manager at German manufacturer Excella, which supplies large makers of the drug. “There is, and was, no shortage for methotrexate API,” he adds.An Indian pharmaceutical manufacturer, Intas, is a major supplier of finished dosage methotrexate to the US through its subsidiary Accord Healthcare. In 2022, Accord provided 35 per cent of the US’s methotrexate supply as well as more than half of the US supply of other key cancer drugs: carboplatin and cisplatin. When FDA inspectors visited the Intas plant in Ahmedabad making methotrexate and other oncology drugs in November 2022, it found a “cascade of failure”. An employee had rushed to destroy sheets of data ahead of the arrival of inspectors by throwing acid on torn pieces of paper. After the inspection, Intas suspended production to address shortcomings. Within six months, this had sparked a scramble for the key cancer drugs produced by the plant. Shortages then rippled through global markets, as the US sought to find supply from elsewhere. In August last year, the European Medicines Agency reported shortages of methotrexate in 11 EU countries. Monica Dias, the body’s head of supply and availability of medicines and medical devices, says that manufacturing issues at several European suppliers lay behind shortages rather than the Intas outage.But the incident revealed “inherent structural weaknesses” in the market for sterile injectable drugs such as methotrexate, says Vimala Raghavendran, a pharmaceutical supply chain expert at US Pharmacopeia, an NGO.“If you look at the data, you can see that one manufacturer had very aggressively gained market share over the last several years and they did it by competing on price,” Raghavendran says.You are seeing a snapshot of an interactive graphic. This is most likely due to being offline or JavaScript being disabled in your browser.The price of a methotrexate injection in the US was $21.80 when FDA inspectors visited the Intas plant in December 2022, down from $26.30 at the beginning of 2019. Methotrexate’s list price has since risen to $28.40 per dose but the price of an average sterile injectable drug is $90. In Europe, prices are lower still. The Dutch list price for 50mg is around €10, says Moss, in line with other prices in Europe, and prices have not risen in step with recent inflation.Intas has since resumed supply of oncology drugs to the US but Valerie Jensen, associate director of the FDA’s drug shortages staff, says the company and its competitors have not been able to ramp up capacity and shortages will not be resolved for several months.Pfizer, a supplier of methotrexate to 40 countries, is increasing production at sites in Australia, but this requires investing in more staff, specialist equipment and manufacturing capacity, measures that can take 12 to 18 months to affect supply.Meanwhile, low prices have pushed out competition and prevented newcomers from entering the market. “Because the pricing was so appalling, no one else bothered to invest capital to enter that space because it wasn’t an attractive market,” says Richard Saynor, chief executive of Sandoz, a generics manufacturer spun-out from Novartis last year that does not make the drug.The shortage has also led to scrutiny of how healthcare systems buy drugs. The Federal Trade Commission last month launched an inquiry into the role played in the shortage by so-called group purchasing organisations, which buy generic drugs for US hospitals and other healthcare providers. The FTC will assess whether these “opaque drug middlemen”, in FTC chair Lina Khan’s words, disincentivise suppliers of generics.In Europe, most systems rely on tendering for contracts to supply drugs, meaning the lowest bidder can often secure large amounts of supply, according to one industry executive who did not wish to be named for commercial reasons. “You literally plug in the price, not many other factors are considered and the product is awarded,” they say.In Europe, tendering based solely on price or in a “winner takes all” agreement can create “monopolies in the market and you can rely entirely on one particular company,” says Shaikh. “The moment something goes wrong, whether it’s a quality recall or a manufacturing issue or they can’t meet demand, everything goes bust.” In both markets, price rather than security of supply is the most important metric, say industry executives. You are seeing a snapshot of an interactive graphic. This is most likely due to being offline or JavaScript being disabled in your browser.The severity of the methotrexate shortage has since abated. Caparra was able to secure supplies for her son with the support of a non-profit organisation, Angels for Change, that focuses on drug access.But experts say that more people will probably be affected by drug shortages in the near term, as the underlying causes remain unaddressed.FDA inspections of international plants dropped sharply during the Covid-19 pandemic. While Jensen says the FDA has “no set goal regarding the number of foreign inspections”, several experts expect a rebound will identify more quality issues.“The FDA has not been inspecting facilities during Covid that much outside of the USA. If they go to a [foreign] generic facility, the chances are pretty good that they are going to find issues,” says Marta Wosińska, a health economist at the Brookings Institution.Longer term, as populations age and chronic conditions rise, global growth in demand for medicines is likely to put further strain on supply chains.An unanticipated boom in demand from China, Latin America, the Middle East and north Africa for alteplase, an off-patent drug used to treat strokes, has led to a shortage of supplies, according to Torsten Mau, head of supply chains at the drug’s German manufacturer Boehringer Ingelheim.“The advancement of diagnosis and understanding [in stroke care] was . . . triggering a demand which, with all our historical data and all our expertise, we couldn’t foresee,” he says.Because the drug must be grown from enzymes, rather than produced synthetically, it is complex to manufacture and in Europe, generics companies have decided against creating biosimilar alternatives, adds Mau. This means the German company is the sole supplier of a treatment that has become a standard of care in recent years. The drug has been in shortage since 2022, with doctors forced to ration its use for non-critical alternative uses, such as clearing catheters. Boehringer Ingelheim is building a new manufacturing plant but, says Dias of the EMA, “you don’t build a new site overnight”. The EMA and the company have agreed to extend the shelf life of the product by a year and are encouraging use of lower doses where possible to avoid waste.Lower-middle-income and upper-middle-income countries, such as India and China, will also make up the vast majority of demand for methotrexate doses in the years ahead, according to Scott Howard, global development officer at Hospital Sant Joan de Déu Barcelona, who has studied increased demand for drugs.“Drug shortages . . . disproportionately affect people living in low-income countries, where shortages of personnel and funding limit capacity to promptly identify shortages, acquire emergency supplies and register new products,” he says.You are seeing a snapshot of an interactive graphic. This is most likely due to being offline or JavaScript being disabled in your browser.Problems with supply are likely to continue as generics companies do not have a commercial interest in making older, complex drugs like alteplase and methotrexate. Sandoz, for instance, is focused instead on developing generic versions of more profitable, innovative drugs that are approaching the end of their patent, Saynor says.Over 6 per cent of prescription sales will lose patent protection in 2028, the highest level since 2015, according to data provider Evaluate. While doctors raise concerns about the effects of supply bottlenecks on patients, and manufacturers underline the unattractive economics of generic drugs, policymakers are discussing the geopolitical risks of Chinese and Indian supply. A goal of an upcoming Critical Medicines Act from the European Union is to reshore some supply and encourage drug stockpiling.Currently, there is little incentive for manufacturers not to source from cheap factories in Asia using just-in-time supply mechanisms. “It has surprised me that there is a lot of talk of “strategic autonomy” around chips and all sorts of digital technologies [in Europe] but not so much around drugs,” says Diederik Stadig, a healthcare economist at Dutch bank ING.To reshore manufacturing, healthcare systems will ultimately have to pay more for their drugs, at a time when national budgets are increasingly stretched.Bank, from Excella, the German maker of methotrexate API, is doubtful that this will happen any time soon. “During Covid, we had a lot of political talk about bringing manufacturing back to Europe to avoid these kinds of shortages,” he says. “When this problem was finally resolved, pricing rules again.” More

The EU has the most advanced green legislation in the world. But the bloc is not on track to meet its climate targets, even as it approaches deadlines for delivering detailed road maps on how it will achieve them.EU climate commissioner Wopke Hoekstra said this week that EU countries would cut emissions by 51 per cent by 2030 compared with 1990 levels — falling short of a 55 per cent goal. This follows more than three decades of hard-won progress in decreasing greenhouse gas emissions from their 1990 peak.“I am confident that given the conversations we are having . . . that we will make [55 per cent] but there is a bit of homework to be done by a range of us around the table,” he told ministers.EU governments must submit their plans on how to reduce their share of emissions by June. But Hoekstra’s calculation, based on draft plans put forward by EU member states, appears optimistic. The European Environment Agency has estimated that a 48 per cent reduction is likely.The difference of what seems like just a few per cent is critical when the world is gradually nearing the 1.5C global warming threshold enshrined by the 2015 Paris Agreement on climate change, as the lower limit of a rise in temperatures since pre-industrial times.The European continent is heating at twice the global average, according to the World Meteorological Organization. As part of a midterm review of climate progress published this month, the European Commission said that the pace of emissions reductions should “almost triple the average annual reduction rate achieved over the past decade” in order to meet its climate goals.But as a global race for clean technology gathers pace, the EU is struggling to compete and sell its ambitious climate agenda to an industrial sector suffering fatigue from high inflation, trade tensions and increasing regulation.“We decided the policy measures. We have the instruments in hand. And now we need to implement,” said Austrian climate minister Leonore Gewessler. “Despite it being really hard work and a fight every day, you can see that green climate policies deliver. Emissions are going down. Are we there? Have we done everything? No, of course not.”You are seeing a snapshot of an interactive graphic. This is most likely due to being offline or JavaScript being disabled in your browser.Data from the Brussels-based Bruegel think-tank shows that Europe is falling behind some of its global competitors in the rollout of the clean technologies central to decarbonisation — despite its pioneering role.“Subsidies for renewable energy deployment have been among the greatest in the world for the past 20 years and that has positioned Europe as a first mover but that has now been taken up by China,” said Simone Tagliapietra, senior fellow at Bruegel.Energy think-tank Ember found that despite EU countries installing a record 56GW of additional solar capacity last year, compared with 41GW in 2022, national plans are not yet sufficient to meet renewable power needs by 2030 for their entire populations. Wind power deployment had to increase at 15 per cent per year, it said.Policymakers in Brussels are particularly concerned about the bloc’s solar panel manufacturers, which have been mothballing operations in part due to oversupply from China.Yet, Tagliapietra cautioned, the EU should not attempt to “defy gravity” by introducing trade barriers. “China has built economies of scale to an extent that it will be extremely difficult for us and Europe to catch up on manufacturing of solar panels vis-à-vis China.”Underlying concerns that EU companies will be lured to the US by the $369bn Inflation Reduction Act’s package of tax credits and subsidies also cast a shadow.Jutta Paulus, a German Green MEP, said EU countries had to be “smarter” about how they spent money, because they had less to offer than China and the US.Even where investments in clean technology are made, the Bruegel data shows it has not always been the most effective or consistent.In technologies such as heat pumps, which rely on consumer uptake, roll- out has slowed as subsidies have dried up due to stretched national budgets and a shortfall in skilled labour to install them. Heat pump sales in 14 European countries fell by about 5 per cent in 2023 compared with 2022, according to the European Heat Pump Association, reversing a decade of growth.You are seeing a snapshot of an interactive graphic. This is most likely due to being offline or JavaScript being disabled in your browser.Policies that touch everyday lives have become political flashpoints. Germany, for example, was forced to water down rules that would have outlawed new gas boilers this year after the poorly executed policy almost caused Berlin’s coalition government to implode.As EU elections approach in June, lawmakers fear that green policies could become a lightning rod for far-right political sentiment and backlash. Farmers have been protesting about red tape from environmental legislation across the bloc, while a landmark law to protect nature is on the verge of collapse after Hungary and the Netherlands voiced sudden opposition this month. Germany’s liberal FDP has contested several EU green policies, including a far-reaching supply chain law and a ban on combustion engines from 2035, as a way to rejuvenate its dire position in the polls.Gewessler said the transition would not work without the right incentives. The introduction of a carbon tax system in Austria as part of its “eco-social” reform programme meant the carbon cost was balanced by a “climate bonus” to compensate low-income households.“When we introduced [carbon pricing], we said: ‘OK, we need an answer for how to make this fair.’ It was never meant as a way to collect money, but . . . as a policy to steer towards the more climate-friendly solutions, through pricing.”Policymakers in Brussels are discussing whether to set an interim target to cut emissions in the bloc by 90 per cent by 2040 as a road marker towards achieving net zero emissions in 2050, even though target-weary business and industrial associations complain this could be a stretch too far.But Hoekstra argues that voters want climate action: “It is not easy but it is doable. We will rise to that challenge and it is what our citizens demand.”Data visualisation by Steven BernardClimate CapitalWhere climate change meets business, markets and politics. Explore the FT’s coverage here.Are you curious about the FT’s environmental sustainability commitments? Find out more about our science-based targets here More

TOKYO (Reuters) – The U.S. dollar received a boost against major currency peers on Thursday, as a Federal Reserve official said he wasn’t in a hurry to cut rates amid sticky inflation, and as traders braced for key economic data.Meanwhile, although still not far from the 152 mark, the yen was holding its ground against the greenback after Japan’s top monetary officials on Wednesday suggested they were ready to intervene.Speaking during late U.S. trading hours on Wednesday, Federal Reserve Governor Christopher Waller said recent disappointing inflation data affirms the case for the U.S. central bank holding off on cutting its short-term interest rate target.”There is no rush to cut the policy rate” right now, Waller said in a speech prepared for delivery before an Economic Club of New York gathering.The dollar index, a measure of the greenback against major peer currencies, ticked up in the wake of Waller’s comments and last held mostly unchanged at 104.41. It’s gained around 3% so far in 2024.Market expectations for the first rate cut to occur at the Fed’s June meeting have eased somewhat, currently pricing in a 60% chance compared to 67% around this time last week, according to the CME FedWatch tool.Waller’s speech is a “clue that the Fed is more wary of stickier inflation, perhaps even a re-acceleration in price growth, said Kyle Rodda, senior financial market analyst at Capital.com.While the central bank has signalled willingness to look through some bumps along the way to some extent, Rodda perceives the case for rate cuts has on balance weakened.”A strong inflation read tomorrow could throw into question whether market pricing for three cuts in 2024 is justified,” which would be a positive for the dollar, he added.Traders await key U.S. core inflation figures due on Friday, following a bigger-than-expected jump in U.S. durable goods orders on Tuesday that has already boosted the dollar against the yen.The greenback reached 151.975 yen on Wednesday, its strongest against the yen since mid-1990.The yen gained a little after Japanese authorities held a meeting on Wednesday on the currency’s weakness, and top currency diplomat Masato Kanda said he “won’t rule out any steps to respond to disorderly FX moves.”Finance Minister Shunichi Suzuki said earlier on the same day that authorities could take “decisive steps,” language he hasn’t used since Japan last intervened in 2022.That’s put the market on edge for any signs that authorities are backing up words with action. “It’s unlikely anyone will pay 152.01 yen for USD/JPY today because of this risk,” Ray Attrill, head of currency strategy at National Australia Bank (OTC:NABZY), wrote in a note.”But in the absence of intervention before the weekend, we strongly suspect someone will next week.”Japan intervened in the currency market three times in 2022, selling the dollar to buy yen, first in September and again in October as the yen slid towards a 32-year low of 152 to the dollar.The Japanese currency was last pinned at 151.37 against the dollar.Meanwhile, a summary of opinions at the Bank of Japan’s March meeting released on Thursday showed policymakers were divided on whether the economy was strong enough to handle an exit from ultra-easy monetary policy.Elsewhere, the euro was down 0.11% at $1.0814.. Sterling fell 0.17% to $1.2616.In cryptocurrencies, bitcoin last rose 1.14% to $69,648.86. More

TOKYO (Reuters) – Bank of Japan policymakers were divided on whether the economy was strong enough to weather an exit from ultra-loose monetary policy, a summary of opinions at the bank’s March meeting showed, suggesting the next interest rate hike may take time.The BOJ ended eight years of negative interest rates and other remnants of its unorthodox policy last week, making a historic shift away from its focus on reflating growth with decades of massive monetary stimulus.At the meeting, some policymakers said recent data, such as bumper wage hikes offered by big firms, justified ending ultra-loose policy as sustained achievement of the bank’s 2% inflation target was in sight, the summary showed on Thursday.But several in the nine-member board called for more scrutiny on whether wage gains will spread to smaller firms, and the extent to which expectations of rising labour costs were pushing up services prices, the summary showed.”Even if the BOJ ends negative rate policy, it would need to emphasize its cautious stance as the economy is not in a state where rapid interest rate hikes are necessary,” one member was quoted as saying.The decision at the March 18-19 meeting to exit ultra-loose policy was made by a 7-2 vote with former academic Asahi Noguchi and ex-corporate executive Toyoaki Nakamura dissenting. More

Scotland has lost up to £100mn a year in salmon exports to the EU because of red tape and increased costs associated with Brexit, according to data from trade body Salmon Scotland.The volume of Scottish salmon exports to the EU last year dropped 17 per cent to 44,000 tonnes from 53,000 tonnes in 2019. The export value fell 3 per cent to £356mn because strong global demand raised prices.But Salmon Scotland said sales of the fish, the UK’s biggest food export, would have reached £430mn last year if volumes had been sustained at 2019 levels. That equates to about £75mn-£100mn less than would have been expected on growth rates recorded before leaving the EU, the trade body said.“Brexit red tape continues to hold back the potential of Scottish exports, despite the hard work and investment put in by farmers to address the issues,” said Salmon Scotland chief executive Tavish Scott. “We need the next UK government — whatever formation it is — to ease the burden on exporters.”His comments came ahead of a Scottish parliamentary inquiry on Thursday into the EU-UK Trade and Cooperation Agreement, when MSPs are scheduled to take evidence from agricultural trade bodies.“We fully recognise the importance of Scottish salmon to the UK economy and are committed to supporting the sector,” the Department for Environment, Food and Rural Affairs said. Scott said the salmon sector was seeking a veterinary agreement between the UK and EU to align sanitary and phytosanitary regulations and strengthen supply chains on both sides of the Channel. The UK is not seeking a veterinary agreement with the EU, Defra said, adding it was open to steps to reduce trade friction but not through future alignment with EU rules that “would compromise UK sovereignty”.Other issues cited by Salmon Scotland include paperwork causing delays to consignments, border controls that will next month bring new import requirements for the feed sector, and an outdated system for health export certificates that is costing salmon farmers £3mn a year. Defra said it was building a digital service for such certificates to reduce costs.The economic benefit to Scotland’s maritime economy from salmon production is second only to oil and gas. International sales of the fish last year rose 0.5 per cent to £581mn, with sales to Asia jumping 22 per cent and to the US by 7 per cent.While France remains Scotland’s largest overseas market for salmon, Salmon Scotland said that reducing trade friction with the EU could boost access to other member states, such as the Netherlands and Spain, where the fish has become increasingly popular.The Scottish National party-led government in Scotland, where 62 per cent of voters rejected Brexit, has made rejoining the EU the centrepiece of its plan for post-independence economic sustainability.Many Scottish coastal communities voted to leave the EU on the prospect of larger fishing quotas, but opinion is now divided within the sector about the benefits of leaving the bloc. More

South Korea, a U.S. ally, also imposed sanctions on four of the same six individuals and the two entities.A U.S. Treasury Department statement and South Korea’s foreign ministry said the action was taken in coordination between the two countries.It named the six individuals as Yu Pu Ung, Ri Tong Hyok, Han Chol Man, O In Chun, Jong Song Ho and Jon Yon Gun.The entities to be hit with sanctions were Alis LLC, based in Vladivostok, Russia, and UAE-based Pioneer Bencont Star Real Estate. The statement said both firms were subordinate to Chinyong Information Technology Cooperation Co, an entity associated with North Korea’s armed forces.Seoul’s foreign ministry said the sanctions target not only individuals directly involved but also those who aided North Korea’s illegal financial activities, particularly those earning foreign currency in the information technology sector abroad. Yu Pu Ung, who laundered money and supplied sensitive materials used to develop North Korea’s nuclear and missile programs, was responsible for managing the funds, the ministry said in a statement. The Treasury Department said Chinyong, which was placed under U.S. sanctions in May 2023, uses a network of companies and representatives to manage delegations of North Korean IT workers operating in Russia and Laos. The announcement came after the United States and South Korea this week launched a new task force aimed at preventing North Korea from procuring illicit oil, as a deadlock at the United Nations Security Council casts doubts over the future of international sanctions on Pyongyang.Years of U.S.-led international sanctions have failed to halt North Korea’s nuclear weapons and missile programs, and many North Korea watchers and sanctions experts consider the U.N. regime moribund, if not already dead. More

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