Early in the year, there were fears that supply chain disruptions caused by the COVID-19 pandemic could impact the ability to provide essential healthcare products to people suffering from existing disease burdens such as HIV/AIDS, tuberculosis, pneumonia, malaria, hypertension and diabetes.
Our worst fears are now slowly coming to life.
According to a survey conducted by WHO in July 2020, more than 70 countries were at risk of HIV drug shortages due to the coronavirus pandemic. 24 countries had a critically low stock of antiretroviral medication (ARVs) as a result of supply chain disruptions. The survey was conducted after a modelling exercise put together by WHO and UNAIDS in May 2020, forecasting a six month disruption in the supply of ARVs in sub-Saharan Africa.
Antiretroviral medication is used for controlling HIV (the virus known to cause AIDS) and preventing further transmission to other people. Shortages could lead to more than 500,000 extra deaths from AIDS-related illnesses such tuberculosis, doubling the number of deaths in the region. With the existence of COVID-19, fatality rates could get much higher.
This is not just about AIDS. In May 2020, another study by Stop TB Partnership indicated that millions of people are yet to develop tuberculosis due to the current restrictions imposed on their lives. In some areas, overburdened healthcare facilities with shortages of health workers have stopped tuberculosis services so they can focus on treating COVID-19.
It is estimated that between 2020 and 2025, 6.3 million people may develop the disease and about 1.4 million people may die as cases go undiagnosed or untreated. The study was based on a three-month lockdown period and an extended ten-month period as life gets back to normal in three high-incidence countries; Kenya, India and Ukraine.
This is a clear indication that the COVID-19 pandemic is greatly affecting the global response to AIDS and other existing disease burdens like tuberculosis, a disease recognized as the ‘top infectious killer’ in developing and underdeveloped countries.
An Alarming Case of Drug Shortages
Various public hospitals have now run out of antiretroviral drugs. In Kenya, as at September 9, 2020, it is reported that about 2 million Kenyans who rely on public hospitals for antiretroviral drug supply have not had access to medication for four months. Some have been forced to purchase the drugs from private hospitals while those who cannot afford this expensive option choose to live without medication.
As at August 17, 2020, three of the most crucial drugs; Cotrimoxazole 960mg tablets (septrin), — Zidovudine/La mivudine (AZT/3TC) FDC (60/30mg) tablets and Ritonavir 100mg oral powder were out of stock. Cotrimoxazole (Septrin) has been out of stock in all public healthcare facilities for seven months. Other drugs used for managing the virus are currently in low stock. Part of the ordered packs of Zidovudine have arrived but the consignment is yet to be cleared by the government. The remaining order is yet to be shipped into the country.
The United States President’s Emergency Plan for AIDS Relief (PEPFAR), the largest funder of Kenya’s HIV/AIDS response reduced its funding and this is stated as the main reason why Septrin, one of the most crucial drugs, is out of stock. In February 2020, the Ministry of Health had procured 4.7 million packs under the Universal Healthcare programme but it is reported that drugs have still not yet been delivered.
Responding to the Challenges
It is obvious that healthcare supply chain systems in developing countries like Kenya are facing some major challenges that will be harmful to its citizens both in the short term and long term. Healthcare facilities have an obligation to ensure consistent supply of essential health products to their patients efficiently and in the most affordable price possible.
Given the situation, how can stakeholders in the healthcare industry mitigate the impacts caused by COVID-19’s disruption of healthcare supply chains?
Delivery timeline delays by suppliers is mainly due to operational and logistical issues in manufacturing plants. This can be solved by ensuring that both suppliers and manufacturers have digitized systems that assist in planning for future demands and reduce unnecessary steps that cause delays.
Government’s excessive regulations lengthen the process of clearing imported consignment. When this happens to healthcare products, there are shortages that increase illnesses and deaths. This can be solved through the government working with buyers/suppliers to streamline the regulation processes and buyers planning for any possible unpredictable delays.
Reduced donor funding is known to stall disease response progress and strain other sources of finance. An effective way of fixing this is financial resource mobilization through collaborating with a wide variety of financing institutions and organizations to ensure that there will always be resources for emergency response and management of existing disease burdens.
Inefficient procurement processes are a major cause of delays, shortages and reduced patient safety. Solving this requires building resilient supply chain management systems that allow healthcare providers to forecast disease burdens, predict the demand for essential healthcare products, manage inventory efficiently and ensure transparency in procurement processes.
Lack of commitment to Universal Health Coverage is the reason why governments allocate a small percentage of the national budget to healthcare. It is also the reason why some stakeholders in the healthcare industry feel the need to divert resources needed for essential healthcare products to other projects. This can only be fixed when national governments and donor organizations realize the importance of health security and provide all the resources needed.
The Future Could be Bright
Experiencing the COVID-19 pandemic with all its disruptions could be a good thing for Africa. It has tested the continent’s social, economic and political resilience, forcing governments and healthcare stakeholders to rethink their current approaches to health security and find new ways to manage the existing pandemic and future health threats.
National governments and development partners need to do everything they can to ensure people who need essential healthcare products can access them as easily as possible. Stakeholders must stay laser-focused on building resilient supply chain systems and actively participate in interventions needed while dealing with the current disruptions.