Measures for Improved Availability of medicines and vaccines (MIA)

The COVID Project

The project was finalized December 2022. The aim of the project has been to help key stakeholders make evidence-based decisions that improve availability of medicines and health commodities during times of crisis. The focus has been on supply chain interventions so that countries can prepare for potential pandemics in a cost-effective manner as well as react effectively during a crisis to maintain critical supply of life-saving medicines and commodities. The scope included both advanced supply chains in high-income European countries as well as more rudimentary systems in low-income countries.  We posed three research questions:

1. How does COVID-19 impact supply chains (both the direct effects on commodities used for the response and the indirect effects to the response such as access to chronic disease medicines)?
2. How do a range of interventions impact the supply chain and consequently, the epidemic, and under which circumstances (e.g. HIC vs. LIC context) are somehow more effective than others and what are the main trade-offs between costs, risks, and availability?
3. What are the differences and similarities between the 7 countries in the study? What general conclusions can we draw?

To answer the research questions, we conducted the following studies:

1. How the pandemic impacted on the availability of paracetamol (500 mg. tablet) in seven countries – France, Belgium, Netherlands, Sweden, Norway, the UK and Ethiopia: Ahlqvist, V., Dube, N., Jahre, M., Melaku, T., Moe, A., Olivier, M., Selviaridis, K., Viana, J. and Årdal, C. (2022), Supply chain risk management strategies in normal and abnormal times: Policymakers’ role in reducing generic medicine shortages, International Journal of Physical Distribution and Logistics Management, DOI 10.1108/IJPDLM-12-2021-0511.
2. The availability of chronic disease medicines in Ethiopia before and during the pandemic: Mekonnen, Z., Terefe, G., Mecha, M., Årdal, C., Jahre, M. and Melaku, T. The knock-on effects of COVID-19 pandemic on supply and availability of chronic disease medicines and paracetamol products in Ethiopia: a phenomenological study, under review in Health Policy and Systems.
3. The availability of vaccine supplies during the pandemic: Adilo, T.M., Zegeye, S., Demie, T.G. and Dinka, R.G. (2022) The Impact of COVID-19 on supplies of routine childhood immunization in Oromia regional state, Ethiopia: A mixed method study, Risk Management and Healthcare Policy,15, p. 2343–2355.
4. How countries adapted to the pandemic and the need for availability of ventilators through public-private partnerships in three European countries: the UK, Germany and Switzerland: Dube, N., Li, Q., Selviaridis, K., Jahre, M. (2022) One Crisis, Different Paths to Supply Resilience Case study on Securing Ventilator Supply for the Covid-19 Pandemic, Journal of Purchasing and Supply Management; https://doi.org/10.1016/j.pursup.2022.100773
5. How Doctors Without Borders used modularity and standardization during their response to the pandemic: Saïah, F., Vega, D., de Vries, H., & Kembro, J. (2022). Process modularity, supply chain responsiveness, and moderators: The Médecins Sans Frontières response to the Covid‐19 pandemic. Production and operations management, https://onlinelibrary.wiley.com/doi/epdf/10.1111/poms.13696
6. A conceptual study on supply chain governance: Ahlqvist, V., Norrman, A. and Jahre, M. (2020) Supply Chain Risk Governance: Towards a Conceptual Multi-Level Framework, Operations and Supply Chain Management, 13(4), 382-395. Best Paper Award OSCM, 2019.
7. A conceptual study on the importance of collaboration and resourcing in supply chain risk management: Bygballe, L., Dubois, A. and Jahre, M. (2023) The importance of resource interaction in strategies for managing supply chain disruptions, Journal of Business Research, 154, 113333, https://doi.org/10.1016/j.jbusres.2022.113333.

Pedagogical tools have been developed based on the results and the analytical models for use in teaching and discussion with stakeholders. A total of 56 outputs has so far resulted from our work. Among these are 14 disseminations to users, one guest lecture, four academic lectures in own institutions, 10 articles in business/trade/industry journals, four lectures in academic conferences, four dissemination measures for the general public (podcast, blog, etc.), four new publications in media, 2 reports, 3 master theses and 1 pedagogical tool.

The summarized answers to the three research questions are that COVID-19 impacted highly on the supply chains both directly and indirectly but varied in terms of impact on availability, i.e. shortage, of medicines and health commodities. The studied countries did not experience shortages of the paracetamol 500 gr. due to their adaptability to the situation (the six HIC European countries) or national production (LIC Ethiopia), thus using various interventions in response to the pandemic to avoid shortage. Ethiopia experienced shortages in essential chronic disease medicines as well as vaccine supplies. Ventilator challenges were overcome due to countries’ innovative efforts to expand production, use existing prepositioned stocks and/or national production. Accordingly, there are differences, but also similarities between the seven countries.

The project 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. All studies were set up in collaboration between two or more partners and made use of mixed research methods combining qualitative (for example through news reports, interviews, and surveys) and quantitative (stock reports, databases, and evaluation reports) data with modelling such as simulation and optimization. The core team consisted of one researcher from the Norwegian Institute of Public Health, three researchers from Jimma University, Institute of Health, four researchers from St. Pauls Hospital Millennium Medical College in Ethiopia, and three researchers from BI Norwegian Business School. In addition, ten data collectors (mostly master students) and six researchers from 4 other universities participated in the paracetamol-study.