Vulnerability of the medical product supply chain: the wake-up call of COVID-19

Abstract

The COVID-19 pandemic has brought the long-standing vulnerability of the medical product supply chain into sharp focus. Global shortages of medical products accompanied the global spread of the disease, joined by high prices, the proliferation of suspect dealers and dramatic interventions by governments, philanthropy and industry in oftentimes-unsuccessful attempts to secure solutions. Much attention has focused on personal protective equipment (PPE). But reported shortages have extended much further—to testing supplies, dialysis materials, pharmaceuticals and a wide range of commodities essential for daily care delivery—both for patients with and without COVID-19.1 2 PPE shortages have received particular attention because they endanger the healthcare workforce.3 But all product shortages endanger patients due to delays in care, rationing or denial of care, the use of substandard products, or heightened risk of error when using replacement products—risks that extend to increased mortality.4 Medical product shortages threaten the goal to deliver the right care to the right person at the right time—and have done so for decades.5 The COVID-19 pandemic has highlighted more than ever that these systemic risks can no longer be ignored. It may also mean that new solutions have become more possible. ### Why care about medical supply chains? Unexpected shortages of medical products do not fit neatly into any single quality domain, but can affect all of them. We cannot provide effective, efficient or timely care when medicines and other supplies required for crucial elements of care become difficult or impossible to acquire. Many shortages seen during the COVID-19 crisis clearly affect safety, and they can exacerbate widespread problems with equity. Just as critical incidents afford the opportunity to identify not just obvious active errors but also latent safety problems,6 crises such as COVID-19 expose general supply chain weaknesses. In fact, product shortages often exhibit the combination of active and latent errors (or …

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