COVID-19 Supply Chain Research Group - MIA Task Force

The COVID-19 pandemic led to initial medicine supply shocks worldwide, exposing the vulnerability of medicine supply chains at full scale. The strain on global supply chains was not limited to Personal Protection Equipment (PPE), tests and ventilators. It spread to other critical goods, including generic medicines. Medicine shortages were already an increasing global problem in normal times before the pandemic. There is 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. The COVID-19 MIA Task Force project has investigated how the pandemic impacted medicine and medical equipment supply chains and evaluated the efficacy of a range of interventions to ensure better supply security. We have studied paracetamol in seven countries, chronic disease medicines and immunization supplies in Ethiopia, ventilators in three European countries, and test kits in Norway. Neither country experienced more paracetamol shortage during COVID, and our study indicates reasons for that in terms of how policy makers quickly adapted to a new situation. Ethiopia experienced more shortage except for paracetamol. One reason might be their national production of this drug, and we are looking further into this. Substantial data were collected in all studies despite challenges related to the pandemic as well as the conflict in Ethiopia. Additionally, we have published a conceptual study of the importance of collaboration and resourcing in supply chain risk management and an empirical study of how Doctors Without Borders used modularity and standardization during their response to the pandemic. The project has combined expertise from Operations and supply chain management (OSCM) with global/public health, and pharmacy for the purpose of providing policymakers with evidence-based decision-support, data, and tools. Together with partners from the Norwegian Institute of Public Health, partner universities Jimma University, Institute of Health and St. Pauls Hospital Millennium Medical College in Ethiopia, BI Norwegian Business School take a system-wide approach to understanding these supply systems. All studies were set up in collaboration between two or more partners and made use of mixed research methods combining qualitative and quantitative data with modelling such as simulation and optimization. Pedagogical tools have been developed based on the results and the analytical models to be used in teaching and discussion with stakeholders. Outputs include numerous seminars, workshops, presentations and reports, podcasts and blogs, popularised publications, 3 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 56 outputs has so far resulted from our work, most of them publicly available, see The MIA Project | BI.

Contributed to SDGs: 1) Research groups combining OSCM and health should involve pharmacists. Public-private partnerships within and cooperation across countries are necessary to cope with shortage and thus improve health (SDG 3; 17); 2) Include OSCM training in pharmaceutical science education; Innovative solutions in public-private partnerships (SDG 9; 11) Expanded knowledge base: 1Evidence-based system view; 2) Brought the government perspective into OSCM and vice versa; 3) Demonstrated the need for a cross-disciplinary approach to medicine shortage; 4) How to prepare medicine and medical equipment supply chains for future epidemics/pandemics in the long-term; 5) Practical conclusions and implications with recommendations for policymakers and direct supply chain members; 6) 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 including strategic stock, flexible supply base, repurposing, flexible contracts, flexible transportation, make and buy, economic supply incentives and postponement. Developed an innovative approach: 1) Introduced equifinality in supply chain resilience; 2) Mixed-methods approach, combining quantitative with qualitative data from a large range of sources; 3) Collaborative research process to ensure a high level of involvement from practitioners and researchers, better data quality, contextualization, and relevance of the results; 4) Multiple case study design comparing medicine supply chains, procurement organizations, and health centres within and across countries Drawn practical conclusions and implications: 1) Public buying organizations have a pivotal role to play in fostering cross-sectoral collaboration; 2) Joint risk management between policymakers and supply chain professionals to allocate resources strategically; 3) Modularization of processes; 4) Policymakers can use our frameworks, tools and findings to improve the availability of generic medicines in (ab)normal times and offer guidance to policymakers regarding (a) how to influence the behaviour of supply chain actors to achieve specific goals and (b) how and when to engage with supply chain actors to jointly seek solutions to unprecedented challenges. Clarified challenges and trade-offs: 1) Medicines should be characterized in terms of the supply chain risk as well as the clinical risk regarding shortage: Both are important for decisions on which interventions to choose and prioritize; 2) Cost of preparedness vs. increased cost of response because of lack of preparedness: Systems must develop abilities to quickly adapt to a crisis when it occurs in addition to develop better preparedness due to the trade-offs between cost, risk, and responsiveness (shortage).

The current scramble under COVID-19 for PPE and other critical goods is reminiscent of the Ebola epidemic in 2014. The strain on global supply chains resulting from COVID-19 is not limited to PPE, tests and ventilators. There is a real risk it can spread to other critical goods, including generic medicines. Similarly, the demand for antibiotics may outstrip production as COVID-19 causes serious secondary bacterial infections such as pneumonia. This complex and poorly understood dynamics interconnectedness requires a global system perspective and analysis. Extant literature on medicine and health commodities supply chains has failed to conceptualise and model such supply chains as systems that must adapt from stable situations to crises and back to stability again. There is limited understanding of private-public-partnerships, procurement, contracting, and regulation. To combat the problem of lacking coordination and preparedness, we need to look beyond single countries and single crises to the complex system of global supply chains capable of producing, stockpiling and distributing essential supplies. By establishing and coordinating global preparedness stockpiles of critical goods, framework agreements with suppliers, surge capacities that can be made quickly operational, flexible transport solutions and multiple suppliers of critical goods, we may be able to ensure sufficient slack is built into the system so it can handle stress without breaking down. This project intends to explore these solutions and others to allow governments to prepare and react nimbly. The COVID-19 Supply Chain Task Force constitutes of more than 20 researchers/practitioners from Jimma University Institute of Health, BI Norwegian Business School, St. Pauls Hospital in Ethiopia, and Norwegian Institute of Public Health with strong backgrounds in medicine, health supply chains and analytics and two decades of research in humanitarian logistics, particularly preparedness issues.