A ‘never event’ becomes more common as Pfizer’s Bicillin L-A runs short

The request was an emergency. In late March, a woman in Gila County, Arizona, was diagnosed with syphilis, and she was pregnant. She needed an injection of penicillin — if possible, 30 days before delivery — but the bacteria corkscrewing through her body increased her risk of delivering early. Without timely treatment, her pregnancy could end in miscarriage, stillbirth, or infant death, and if the infant survived, the child might live with bone deformities, brain damage, blindness, and deafness, among other complications. 

All of that could be prevented with one of the oldest antibiotics in the book — specifically, an injectable form of penicillin sold under the brand name Bicillin L-A.

It was the only treatment approved in the United States for syphilis during pregnancy, and there’d been a national shortage since July 2025. But Pfizer, the only company that sells it, had a protocol in place for exactly this scenario: an emergency request system “to be used for confirmed congenital and risk of congenital syphilis patients only.”

That was what was unfolding in Gila County — and on Friday, March 27, public health officials submitted a request. Pfizer confirmed receipt the next Monday, according to emails obtained by STAT. But over a week after that, on April 7, the medication still hadn’t arrived.

“What can be done to get bicillin for this patient ASAP? These are the kind of delays that make the emergency request line not a viable option for public health response,” a leader at the National Coalition of STD Directors wrote to a Pfizer representative, stepping in to help secure the drug. 

“Did they submit a medical request form first? I checked with Customer Service and they can’t locate. If we can get this medical request we will get it processed,” the Pfizer representative wrote back that same day.

But by the time this exchange was taking place, it was already too late. “Mom has delivered and we have missed our opportunity to prevent congenital syphilis,” wrote an official at the Arizona Department of Health Services, adding, “Yes, the county completed the medical request form.”

It was the outcome everyone was trying to avert. In February, the National Coalition of STD Directors had asked Pfizer to donate a fraction of its Bicillin L-A reserves to state health departments, so they’d have it on hand as a backstop in case this kind of emergency arose. But Pfizer hadn’t — and in early June, nearly four months after the coalition’s proposal, the company said it was still evaluating the idea of proactively sending out doses. This case in Arizona was a realization of the fears that had spurred the suggestion in the first place.