Bicillin L A, the only antibiotic approved in the United States to treat syphilis during pregnancy, has been in short supply since 2025.
A pregnant patient in Gila County, Arizona, was diagnosed with syphilis in late March. Her doctor called Pfizer's emergency line for the only antibiotic approved in the United States to treat syphilis during pregnancy. Pfizer confirmed the next business day. Ten days later, when the baby was born, the drug had not arrived. Her newborn was diagnosed with a preventable case of congenital syphilis, a disease that can cause miscarriage, stillbirth, bone deformities, brain damage, blindness, and deafness.
That sequence, not the broader national shortage, is the heart of a STAT Plus investigation by Eric Boodman published June 15. Bicillin L-A, Pfizer's brand-name long-acting injectable penicillin, has been in short supply since 2025, with the company telling STAT that demand has outrun the supply it can produce. To keep treatment available for the patients who need it most, Pfizer set up an emergency allocation line explicitly for confirmed or imminent congenital syphilis cases, with the understanding that those requests would move in days, not weeks.
In the Gila County case, the timeline did not hold. A clinician submitted the request on Friday, March 27. Pfizer confirmed it the following Monday, March 30, according to email chains obtained by STAT. As of April 7, the day the baby was born, the shipment had not landed. The newborn's diagnosis turned what should have been a controlled, protocol-driven outcome into what healthcare quality specialists call a "never event": a medical harm so preventable that systems are built specifically to keep it from happening.
The structural problem runs deeper than a single missed shipment. STAT's reporting draws on interviews with 10 state health departments, 8 local health agencies, 6 health-system pharmacists, current and former CDC officials, infectious disease specialists, OB-GYNs, and representatives of Pfizer and the online pharmacy Cost Plus Drugs. Across those sources, the same pattern recurs: a well-publicized emergency protocol, slow confirmations, opaque criteria for what counts as an emergency, and a National Coalition of STD Directors that has effectively had to broker access between desperate clinics and a manufacturer that controls the only approved supply.
Congenital syphilis, the condition the protocol exists to prevent, is not a static backdrop. CDC tracking has documented a multi-year rise in adult syphilis cases, and vertical transmission, from a pregnant patient to a baby, has grown with it. Local and state health departments are sometimes the only line of defense when a manufacturer's allocation logic fails, and the Gila County case is what happens when that line breaks too. In its response to STAT, Pfizer described the emergency line as a way to triage the most urgent cases; it declined to discuss the specifics of the Gila County case, citing patient privacy.
Cost Plus Drugs enters the picture because, when a clinic cannot get Bicillin L-A through normal channels, it sometimes turns to alternative distributors or compounded penicillin products. The current crisis has turned that workaround from a curiosity into a recurring feature of prenatal syphilis care, with state and local health officers describing ad hoc coordination that, in a functioning system, should not be anyone's job.
What the Gila County case shows is that the bottleneck is no longer simply a question of how much Bicillin L-A Pfizer can make. The bottleneck is the procedural layer between a confirmed syphilis diagnosis in a pregnant patient and a dose arriving in their arm inside the clinical window to prevent transmission. A drug that is "available" in the abstract is not available if a clinician has to spend ten days chasing it through an emergency line, then watches a patient deliver without it. That gap, between protocol and execution, is now a documented, named harm. The question for federal and state health authorities, and for Pfizer, is whether the next Gila County case will be the one the emergency line was actually built to prevent.