Building Resilience into the Nation's Medical Product Supply Chains (2022) / Chapter Skim
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9 Response Measures for Resilient Medical Product Supply Chains
9 Response Measures for Resilient Medical Product Supply Chains
Pages 221-238
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From page 221... ...
Various institutional measures can be implemented to cultivate a general awareness of emergency preparedness actions, enable the right people to talk to one another in a productive manner, provide resources for adapting to medical product shortages, and facilitate steps for reducing harm to people from the shortages while they persist. As described in Chapter 5 and in the medical product supply chains resilience framework (reproduced in Figure 9-1)
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Having the ability to implement response measures and adapt to a current disaster situation or shortage until supply chains have returned to normal is critical to protecting public health and human life. Indeed, it is common for the most difficult and complex part of supply chains to exist in the final delivery and distribution of medical products to end users, so it is logical that disruptions to medical product supply chains often arise in, or are worsened by, problems in the last mile of distribution.
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What makes sense in an isolated emergency can be severely damaging in a global crisis. Such measures disrupt supply chains, depress production, and misdirect scarce, critical products and workers away from where they are most needed.
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For example, in response to the 2007-2008 global food crisis, temporary export bans and other trade restrictions implemented by major rice exporters contributed to record high global rice prices, which exacerbated hoarding, panic buying, food riots, and a breakdown of food supply chains (FAO, 2020)
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. As discussed in Chapter 6, publicly available medical product supply chain data would enable stakeholders to proactively detect and respond to supply chain disruptions, improve coordination on a national and global level, and enhance situational awareness.
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Recommendation 5: Facilitating information sharing among international medicines regulators. Regulatory authorities should determine whether current limitations on sharing regulatory work products with other regulatory authorities are still fit-for-purpose to help protect and promote public health; reduce the bur den of regulatory redundancy on patients, industry, and regulators; allow regula tors globally to best utilize the limited technical and financial resources currently available to them to meet their public health mandates; and to bring needed quality medicines to patients domestically and globally as efficiently as possible.
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Given the globalization of U.S. medical supply chains, information sharing across international borders will also be essential for stakeholders -- including government and the private sector -- to mount effective response measures to future supply chain disruptions.
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Hence, using the treaty as the basis for collaboration, major medical product exporting countries could further cooperate on providing capacity buffering for medical products likely to be in short supply during global emergencies. RESPONSE MEASURES FOR LAST-MILE DELIVERY AND END USERS At a global level, supply chains focus on matching total supply to total demand.
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This provided a large and necessary "cushion" while global supply chains struggled to increase production. As this example illustrates, end users of medical supplies such as hospitals, clinicians, pharmacies, and patients have important roles to play in addressing disruptions to medical product supply chains.
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. A National Framework for Scarce Medical Product Allocation Local resource sharing can work if the end users know and trust one another, but sharing resources on a larger scale, where personal relationships cannot be relied on, is extremely challenging.
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Given the variety of frameworks to choose from and the lack of guidance around which one to use and when, it is clear that a standard ethical framework for scarce medical product allocation is needed at the national level if outcomes like those seen during COVID-19 are to be avoided. Such a framework must be designed in a way that is acceptable to all major actors -- distributors, producers, end users -- without undue burden placed on any one entity, and it must be flexible enough to provide guidance for decision making and deliberation within and across health sectors, health institutions, and health professionals in response to medical product shortages (Gibson et al., 2012)
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For instance, a contingency plan that identifies supplemental producers for specific supply chain critical medical products and readiness steps, such as sharing supplier and bill-of-material information with these producers, would make ramping up capacity in an emergency faster and more reliable. Yet beyond a narrow role in devising a framework for scarce medical product allocation, end users must be involved more broadly in planning for medical product shortages.
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Practicing clinicians and the leaders of health care delivery organizations can and should be encouraged to participate in planning for disruptions of medical product supply chains. This can be achieved in part by recognizing that supply chain disruptions, unlike pandemics and most other public health emergencies, are remarkably common.
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b. Develop a standard national ethical framework for allocating scarce medical products, building in previous crisis standards of care work, including attention to equity, efficiency, and ad ditional ethical values.
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2021. How COVID‐19 medical supply shortages led to extraordinary trade and industrial policy.
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2020. IMF and WTO heads call for lifting trade restrictions on medical supplies and food: World Trade Organization.
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2020. Essential institutional supply chain management in the setting of COVID-19 pandemic.
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