As a result of hurricane damage in Puerto Rico, where 80 plants manufacture drugs and medical devices, the United States could face a shortage of medical products that “are critical to Americans,” Scott Gottlieb, commissioner of the Food and Drug Administration, told a congressional panel, according to The New York Times. “A loss of access could have significant public health consequences.”

Pharmaceuticals and medical devices are the island’s leading exports; in fact, 13 of the world’s top-selling brand-name drugs are manufactured in Puerto Rico. These include meds for treating HIV, cancer, diabetes and heart disease, as well as medical devices and important products such as bags of saline solution that hospitals use to mix medicines for patients.

“We have a list of about 40 drugs that we’re very concerned about,” Gottlieb said last week. “It reflects maybe about 10 firms.” What’s more, 13 of the drugs—including HIV meds—are manufactured by only one company (such meds are referred to as “sole source”).

The challenge, the Times reports, isn’t that the factories are damaged by the hurricanes but that they have no electricity, they have to rely on diesel fuel, their phone lines are down and employees aren’t showing up for work.

A spokesperson for Johnson & Johnson, which produces Tylenol and the HIV med Prezista in Puerto Rico, told the Times that its team is working through local challenges and seeing progress daily.

But Gottlieb suspects that optimistic statements by the pharmaceutical industry may be intended to assure nervous shareholders. “We know that the grid is going to be unstable for a long period of time,” Gottlieb said. “The generators were never meant to operate for months and months on end.”

It’s a challenge to accurately assess the situation because drugmakers don’t typically disclose where their factories are located, viewing such information as a trade secret. There is an additional worry that if the factories aren’t up and running soon, they’ll move elsewhere.

For related coverage, read the POZ articles “Hurricanes Threaten HIV Progress in Puerto Rico” and its current cover story, “Island Fever,” about living with HIV in Puerto Rico.