MIA - Measures for Improved Availability of medicines and vaccines

The COVID-19 pandemic led to initial medicine supply shocks worldwide, exposing the vulnerability of medicine supply chains at full scale. Medicine shortages were already an increasing global problem in normal times before the pandemic. Particularly, there has been a large-scale increase in off-patent (that is, generic) medicine shortages in recent years. When medicine supply chains break down, it can lead to serious injury and death. While policymakers in numerous countries had discussed strategies to address shortages, few had implemented them by the time the pandemic struck. Presently, we see increased governmental interest in the vulnerability of supply and the level of preparedness. However, the numerous stakeholders differ in goals and incentives in terms of focusing cost, quality, service, and/or sustainability. The supply chains are complex with many actors involved, global, and vulnerable due to specialization in and leaning of (few buffers) the supply chain and outsourcing to low-cost countries. Focus on low prices for generics, while reducing public budgets for medicine and improving access for more people, have led to many medicines with very few suppliers. This in addition to lack of transparency and sharing of information means that fixing the causes of shortage problems is easier said than done. These are some of the overall results from our research so far. MIA (Measures for Improved Availability of medicines and vaccines) combines expertise from Operations and supply chain management (OSCM) with global/public health, pharmacy, and health economics for the purpose of providing policymakers with evidence-based decision-support, data, and tools. Together with partners from the Norwegian Institute of Public Health, INSEAD, Lancaster University and Erasmus, BI take a system-wide approach to understanding medicine supply chains. Shortages lead to costs for patients, health systems and society at large. To prevent this supply chains must be able to withstand both smaller and bigger disruptions. Hence, aiming to design supply chains that function both under normal conditions and in crises, MIA includes governments' and supply chain members’ perspectives to provide a better understanding of competition and cooperation among the stakeholders. By building comprehensive models of the networks, different methods of supply chain preparedness are compared to see what works best under different circumstances. Governments must be able to make decisions in the context of difficult trade-offs between availability, quality, delivery time and cost. MIA contributes by providing decision makers and others with better knowledge about how and why these supply systems work (or not). The focus countries are Norway and the UK, but we also do comparative studies with Ethiopia and an additional 4 European countries: Belgium, France, Netherlands, and Sweden to get a broader European perspective. The first peer-reviewed paper was published in 2021 as an Impact Pathways paper suggesting a research agenda for use of operations and supply chain management (OSCM) in the study of shortages. During 2022 additional five scientific articles have been published. Results demonstrate and quantify how collaboration among countries on sharing of test-kits during the first phases of the pandemic would have contributed to flattening the curve. We have quantified and illustrated direct and indirect short-and long-term effects of policymakers’ decisions to reduce shortages, showing that decisions aiming to reduce shortage can have the opposite effect in the long-term. We discuss future roles of procurement and supply chain risk management research regarding opportunities and learning arising from abnormal situations such as COVID-19. We have studied and are studying different types of medicines such as paracetamol and antibiotics. Ongoing research include sub-projects on consequences of setting environmental requirements in procurement of medicines, cost-effectiveness of implementing buffer-stocks for essential medicines, and how contracts should be designed to mitigate shortages. All sub-projects are set up in collaboration between two or more partners and make use of mixed research methods combining qualitative and quantitative data with modelling such as simulation and optimization. Pedagogical tools are developed based on the results and the analytical models to be used in teaching and discussion with stakeholders. As of now outputs include numerous seminars, workshops, presentations and reports, podcasts and blogs, popularised publications, 15 master theses, and tools in addition to peer-reviewed articles. We are developing modules on pharmaceutical supply chain management for graduate education in pharmacy. A total of 78 outputs has so far resulted from our work, most of them publicly available, see The MIA Project | BI.

Due to increasing shortages, ensuring availability of medicines and vaccines is a key societal challenge. Complex and vulnerable global supply chains, manufacturing problems, product recalls, short product shelve life, new digital technology, a few suppliers dominating markets, funding limitations, and high demand volatility are among the causes of this worldwide problem. In response, countries are developing strategies to safeguard against smaller (e.g. price increase) and larger disruptions of supply (e.g. health system breakdowns) and/or demand (e.g. pandemics). Extant literature on medicine and vaccine supply chains has failed to conceptualise and model them as systems that must adapt from stable situations to crises and back to stability again. Existing models tend to exclude patients, treating demand as exogenous, and not accounting for market behaviour. There is limited understanding of private-public-partnerships, procurement and contracting, and regulation for improving supply security. The purpose is to help key stakeholders make evidence-based decisions that sustainably reduce shortages ensuring future health and care services.. We will provide rigorous analyses of costs and benefits of measures, and a basis for comparative studies in other countries by developing baseline data, research design, analytical and pedagogical models and tools. Findings will inform ongoing strategy work and collaboration initiatives within Norway, the UK and Europe more broadly. We will draw policy implications and put forth recommendations for supply chain design, procurement strategies and alignment of economic incentives. We will develop training resources and tool kits and embed these into higher education curricula in pharmaceutical education, risk management and operations/supply chain management, thus increasing cooperation in educational programmes across sectors, stakeholders, and disciplines including health, social science and economics.

Publications from Cristin

Future business and the role of purchasing and supply management: Opportunities for «business-not-as-usual» PSM research

Challenging the throwaway culture in hospitals: Scheduling the mix of reusable and Single-Use bronchoscopes

Drug shortages: A systems view of the current state

Simulation of IT Data Integration to Optimize an Antibiotics Supply Chain with System Dynamics

Paying for pharmaceuticals: uniform pricing versus two-part tariffs

Collaboration–competition dilemma in flattening the COVID-19 curve

Short of Drugs? Call Upon Operations and Supply Chain Management

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FHI-forsker om antibiotikatiltak: - Nå haster det

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What companies being hammered by supply chain disruptions can learn from humanitarian logistics.

Defining resilience: implications on humanitarian operations research

Promoting resilience in medicine supply chains: An exploration of the role of contracting

Policies for National Medicine Stockpiles

Initiativer for å sikre tilgang til antibiotika, inklusiv barneformuleringer

Hvordan stimulere til utvikling av nye antibiotika – når de helst ikke skal brukes

Predictable access to narrow spectrum penicillins

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Perceptions of non-price criteria in pharmaceutical tenders

How can Blockchain Technology be used to support Supply Chain Risk Management in Drug Supply Chains?

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Software tool for comparison of medicine shortages and medicine sales

How good is Europe’s access to medicines? Why Norway and other European countries struggle to ensure equitable and financially sustainable access to medicines. Teaching Case on the Norwegian Paracetamol Supply Chain.

Measures for Improved Availability of medicines and vaccines (MIA)

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