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Measures for Improved Availability of medicines and vaccine (MIA 2020-2025)

Ensuring a consistent supply of essential medicines and vaccines is a crucial global challenge.

The COVID-19 pandemic exposed the vulnerabilities of supply chains, but shortages of off-patent (generic) medicines had been an increasing issue long before the pandemic. These shortages can result in severe consequences, including injury and death. MIA aimed to assist key stakeholders, such as governments and supply chain managers, in making evidence-based decisions to reduce these shortages sustainably. The specific objectives were:

1. To improve access to medicines and vaccines in countries like Norway and the UK.
2. To provide policymakers with a detailed analysis of the costs and benefits of various interventions aimed at enhancing supply security.
3. To create a framework for comparative studies in other countries by developing research protocols, models, and tools.

The study found that while policymakers were aware of the risks of supply shortages, few had implemented strategies to prevent them before the pandemic. Interest in the vulnerability of supply chains increased following the COVID-19 crisis, but stakeholders often had differing priorities, such as cost reduction, quality control, service levels, and sustainability. Global supply chains are complex and vulnerable, particularly due to the focus on low-cost generics, which has led to a concentration of suppliers. This, along with a lack of transparency, makes resolving shortages more challenging.

The research highlighted several key strategies and recommendations for addressing shortages. Policymakers can apply the findings to improve the availability of generic medicines, both in normal and crisis situations. The key areas of research and their findings are listed below.

1. Normal Situations (Pre-Pandemic). A review of academic literature and industry reports identified three primary approaches to addressing shortages: market-driven solutions, alternative sourcing, and regulatory flexibility. Research showed that integrating supply chain risk management with government policies could improve resilience and lead to more effective interventions.
2. Abnormal Situations (Crisis Management). During crises like COVID-19, cross-national collaboration on resource sharing (e.g., diagnostic tests) demonstrated the importance of coordinated efforts to reduce shortages and ensure equitable distribution. We also analyzed how decision-makers navigated the challenges posed by the Brexit and the COVID-19 pandemic, developing theories on strategic agility and adaptation.
3. Strategic Stockpiling. A tailored approach to minimum stock policies, based on the characteristics of different medicines, can reduce both inventories holding costs and shortages. Research in the Netherlands suggested a potential 20% reduction in shortages through smarter stock management.
4. Procurement Strategies. Tendering, while helping to reduce drug prices, may inadvertently increase shortages by concentrating the market. This was confirmed through models using Dutch datasets. We also explored how including environmental criteria in procurement processes might affect the supply chain and found that certain purchasing strategies can contribute to resilience during disruptions.
5. Applications in Low- and Middle-Income Countries. In sub-Saharan Africa, pathogen genomic sequencing for disease surveillance faced operational challenges, especially regarding dependency on in-kind donations. Long-term improvements are best achieved by building local supply chain management capabilities. Vaccine supply chains in countries like Ethiopia were also examined, particularly their vulnerabilities during the COVID-19 pandemic.
6. Tools for Managing Shortages. The "Access for Drugs (A4D)" framework was developed as a simple, visual tool to help stakeholders mitigate drug shortages. It focuses on aligning supply chain actors and prioritizing interventions based on the criticality and risk associated with different drugs. This tool helps ensure that resources are focused where they can have the greatest impact. Additional tools include data analytics for analyzing shortages and simulating the effects of collaborative interventions during crises.

The research underscores the complexity of medicine supply chains and the importance of a coordinated, flexible approach to managing shortages. A major conclusion was the need for supply chains to balance preparedness with adaptability, using modular processes, cross-sector collaboration, and risk management strategies tailored to different drug types. This work also provides valuable insights into how cross-national collaboration, tailored stockpiling, and strategic procurement can strengthen the global supply chain, ensuring more equitable access to essential medicines and vaccines, especially in times of crisis.