COVID-19: Healthcare supply chain problems expose need for real-time data flow
Lack of real-time information from healthcare supply chains hamper effective decision-making and resource allocation.
The COVID-19 pandemic has forced governments to acknowledge the unpleasant problems with healthcare supply chains as many countries, including the richest ones on the planet, were battered with shortages of critical pharmaceuticals and medical supplies needed to fight back against the outbreak.
China and India are critical for the smooth functioning of healthcare supply chains with the former playing a more dominant role as even India's pharmaceutical companies source about 70% of their ingredients from Chinese factories. While many Indian factories had stockpiled ingredients in view of the lunar new year in China, those supplies also dwindled soon as the outbreak spread much wider than predictions.
India is one of the world's largest producers and exporters of generic drugs, with the US and European countries heavily reliant on its pharma companies for their supply. A significant portion of the production of drugs in the country is made only for exports and cannot be sold domestically.
But as COVID-19 gained a grip, both India and China restricted exports of certain medical supplies to prevent domestic shortages.
A pandemic heightens the healthcare needs of the population and without a sustainable supply of medicines, equipment, and other basic amenities, health facilities of any country can't serve the population effectively. The same thing happened in rich countries, at least in part, due to shortages of critical supplies including personal protective equipment which further compromised healthcare and its workers. A survey by British Medical Association (BMA) revealed that 40% of doctors believed that "current or expected shortages of medicines had at some stage left them with no option but to provide treatment for patients they felt was less effective than the treatment they would normally use."
US healthcare supply chains are also heavily reliant on foreign countries with imports making up for 80% of Active Pharmaceutical Ingredients (APIs) used in the country. The US has also been the largest importer of medical products for the last three years, accounting for 19% of the world's total medical import kitty of $1.01 trillion in 2019.
With global trade making up the majority of medical supply chains, shortages are a common occurrence and many developed countries also maintain a publically-available and regularly updated list of drugs in shortage. But the pandemic has inflated those lists and many drugs are newly experiencing shortages as they are being tested for COVID-19 so are likely experiencing higher-than-usual demand.
Hydroxychloroquine and azithromycin, which were widely touted as treatments for COVID-19, have been in high demand by both institutions and individuals even as professional regulatory bodies have issued warnings about taking these medicines without prescriptions. Originally used for a range of diseases from malaria to rheumatoid-arthritis, medicines in these classes of drugs have been in shortage in many countries, making it difficult for those in need.
But the shortages are not limited to drugs and equipment related to COVID-19. UNAIDS has recently warned that stocks of medication for HIV patients could also run out in the next two months, blaming it on higher costs linked to restrictions imposed to contain the pandemic.
As of June 25, the American Society of Health-system Pharmacists (ASHP) also reports 208 drug shortages in the US but it is not just patients with COVID-19 who are affected. One example of a drug currently with short supply is Erwinia asparaginase, a life-saving chemotherapeutic agent for both children and adults with cancer.
As globalization surged in the past few decades, supply chain issues had been among the most significant challenges to pandemic preparedness. A disruption at any level of healthcare supply chains could pose grave challenges for healthcare facilities of many countries. But despite the risk, not much effort has been put towards integrating these supply chains with health management information systems or a similar information system at a global scale which can be used to better predict future demand as well as disruptions with real-time data.
In the official checklist for pandemic influenza risk and impact management issued by World Health Organization in 2018, the essential measures include identifying and developing items and quantities of medicines, supplies, and medical devices needed to maintain essential health services including pandemic influenza health services at each level of health care.
Projecting additional needs for pandemic influenza medicines, supplies, and medical devices according to different pandemic scenarios has also been deemed essential. Apart from that, WHO suggests that countries must coordinate with custom authorities for quick receipt and deployment of medicines and supplies, develop plans to manage stocks, taking into consideration possible transport disruptions during a pandemic.
The checklist includes only one desirable measure that suggests countries should consider measures such as advance purchase agreements and stockpiling arrangements for securing access to essential and pandemic medicines, supplies, and medical devices.
WHO also maintains a list of Essential Medicines which is being updated every two years since 1977. The current versions are the 21st WHO Essential Medicines List (EML) and the 7th WHO Essential Medicines List for Children (EMLc) updated in June 2019.
While WHO supports member countries and stakeholders in identifying supplies to maintain essential health services, not much has been done to monitor demand and supply at a global level with automated IT platforms. Pandemic preparedness or Health Management Information System (HMIS) guidelines without such a platform keep policymakers away from utilizing real-time data for making effective health policy decisions.
It's worth noting that WHO has, at various points of time, acknowledged the potential of technology in streamlining healthcare supply chains and a few initiatives have also been supported or facilitated by the intergovernmental organization.
- Health Data Collaborative
Health Data Collaborative is a joint effort by multiple global health partners including the WHO that aims to strengthen country health information systems to meet the challenge of monitoring the health and health-related Sustainable Development Goals and boost the development of robust sustainable national health monitoring systems by aligning financial and technical resources.
The initiative is expected to decrease reporting burden, increase innovation as well as the adoption of new technologies, and enhance the usability of data generated from health information systems.
The engagement of member states, however, will largely be country-led and country-driven with limited scope to go beyond national boundaries and encompass regional networks. Besides that, only a handful of countries have become part of the initiative and only one progress report up to 2018 has been released yet.
Primarily used for emergency response in conflict-hit regions, HeRAMS (Health Resources and Services Availability Monitoring) is an electronic system for monitoring health facilities, services, and resources. It is supported by an online application called Prime by WHO which enables seamless data entry and management to provide real-time analysis of the situation by engaging all actors involved in the health sector.
The system was developed to tackle challenges arising from lack of information during emergencies which hampers effective decision-making and resource allocation.
HeRAMS is also supported by WHO's Health Emergency Program and is being used to guide emergency responses in countries including the Central African Republic, Fiji, Mali, Nigeria, the Philippines, the Syrian Arab Republic, and Yemen.
- Policy brief on traceability of health products
WHO has also recently released a policy brief on traceability of health products recognizing that traceability systems and technologies could be leveraged to ensure the integrity and efficiency of healthcare supply chains.
In the policy brief, WHO has encouraged member states to use global standards for product identification, automatic identification and data capture (AIDC) and data exchange to reduce the creation and operating system costs and maximize interoperability.
Traceability technologies offer the technical possibility to track or trace health products along the supply chain – from their point of manufacture to the point of dispensing or the ultimate place where the medicine is administered to a patient – with a view to strengthening the real-time monitoring of the integrity of a given pack.
A draft "policy brief on traceability of health products" has been published by WHO for public comment. The final version of this policy brief will be submitted to the 9th meeting of the Member State mechanism on substandard and falsified medical products which will take place the week of 26-30 October 2020.
The policy brief is in very initial stages of development and mentions that "a global framework or guidelines have yet to be developed".
While WHO has acknowledged the potential of technology and interconnected information systems to tackle increased challenges of global, complex supply chains of health products. An IT platform that synchronizes all the actors involved in the health sector is still lacking. Utilizing real-time data flow from all levels of supply chains as well as usage in health facilities across the world, policymakers can identify pitfalls beforehand and make timely decisions to avoid shortages of critical supplies.
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