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HELSEVEL-Gode og effektive helse-, omsorgs- og velferdstjenester

MIA - Measures for Improved Availability of medicines and vaccines

Alternative title: MIA - Hvordan sikre god nok tilgjengelighet for vaksiner og medisiner?

Awarded: NOK 12.0 mill.

Project Manager:

Project Number:

300867

Application Type:

Project Period:

2020 - 2024

Location:

Subject Fields:

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 off-patent (generic) medicine shortages. When medicine supply chains break down, it can lead to serious injury and death. While policymakers 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 and few buffers in 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. The project 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, RSM, and Jimma University (Ethiopia), BI take a system-wide approach to understanding medicine supply chains. Particularly we provide knowledge concerned with the type of interventions used to avoid shortages in normal and abnormal times and the role of policymakers in selecting and implementing these interventions. We have brought the government perspective into OSCM and vice versa and demonstrated the need for a cross-disciplinary approach to medicine shortage. We have provided insights on how to prepare medicine and medical equipment supply chains for future epidemics/pandemics in the long-term and presented practical conclusions and implications with recommendations for policymakers and direct supply chain members. A key finding is the need to combine preparedness with adaptability in response through process modularity; resource interaction in cross-sectorial/disciplinary collaboration; the interplay between temporary and permanent organizing; and the use of a mixed set of risk mitigation strategies. Policymakers can use our frameworks, tools and findings to improve the availability of generic medicines in (ab)normal times. 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 -2023 additional thirteen scientific articles were 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 137 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

Funding scheme:

HELSEVEL-Gode og effektive helse-, omsorgs- og velferdstjenester