MIA - Measures for Improved Availability of medicines and vaccines

COVID-19 caused immediate problems for medicine supply worldwide and exposed the full-scale vulnerability of these supply chains. Medicine shortages were already a growing global problem in normal times before the pandemic, especially medicines that are no longer on patent (generic). When supply chains for medicines break down, it can have serious consequences in the form of illness and, in the worst case, death. Despite the fact that policy makers in many countries had discussed strategies to deal with the problem, few measures had been put in place by the time the pandemic was upon us. Now we see increased interest from the authorities in the vulnerabilities and the level of preparedness. But the many stakeholders have different goals and incentives when it comes to the focus on costs, quality, service and sustainable solutions. The supply chains are complex with many actors involved, they are global and vulnerable due to specialization and 'slimming' (few buffers) in the chains and moving production to low-cost countries. The focus on low prices for generic medicines has reduced public expenditure and enabled more people to buy them, but has also resulted in fewer manufacturers of many medicines. This, in addition to a lack of transparency and information sharing, means that 'fixing' the causes of the problems is easier said than done. The project combines knowledge from supply chain management (SCM) with public global health, pharmacy and health economics to contribute to the decision makers with data, decision support and tools. Together with partners from the Institute of Public Health (FHI), INSEAD Business School in France, Lancaster University in Great Britain, RSM and Jimma (Ethiopia), BI takes a systems approach to the chains. We contribute with knowledge of the types of solutions used to avoid shortages in (ab)normal times and the decision-makers' role in selection and implementation. We have brought the authorities' perspective into OSCM and vice versa and have demonstrated the need for an interdisciplinary approach to medicine shortages. We have contributed insights on how to prepare drug and medical device supply chains for future epidemics in the long term and presented practical conclusions and implications for decision makers. A key finding is the need to combine preparedness with adaptability through modular processes; resource linkages across sectors and disciplines; the interaction between temporary and permanent organisation, and combining risk management strategies. The decision makers can use our frameworks, tools and findings to improve the availability of generics in (ab)normal times The first peer-reviewed article was published in 2021 where we present a research agenda for applying theory in supply chains and logistics (OSCM) to the problem of drug shortages. During 2022-2023, we have published a further 13 articles. The results demonstrate and quantify how cooperation between countries on sharing tests during the early stages of COVID-19 would have helped to flatten the curve. We have quantified and illustrated the direct and indirect short- and long-term consequences of decisions to reduce medicine shortages, and show that decisions taken to reduce shortages can have the opposite effect in the longer term. We have studied and are studying different types of medication such as paracetamol and antibiotics. Ongoing research includes sub-projects on the consequences of setting environmental requirements in the procurement of medicines, cost-effectiveness in implementing emergency stocks for critical medicines, and how contracts should be set up to reduce shortages. All sub-projects are set up in collaboration between two or more partners, combining different research methods and qualitative and quantitative data with modeling 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, the results include many seminars, workshops, presentations and reports, podcasts and blogs, popularized articles, 15 master theses and tools in addition to the peer-reviewed articles. We develop modules for master's education in pharmacy. In total, the project has so far produced 137 results, most of which are publicly available, see The MIA Project | BI.