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Before Florence pummeled the East Coast, ultimately killing at least 17 people and causing untold millions in damage, some of the world’s largest pharmaceutical companies wrestled with a major dilemma: Should they suspend operations at manufacturing plants in North Carolina, South Carolina, and Virginia, risking shortages of important drugs and vaccines?

GlaxoSmithKline chose to close a plant that makes asthma inhalers, while Novartis shut down a facility that manufactures oral-dosage generic drugs. Pfizer and Merck, meanwhile, decided to scale back operations at multiple North Carolina facilities, closing some entirely.

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