Summary : Maisha Meds is a healthcare technology firm based in Kenya. We have been working to identify potential medicine shortages in the country to help support the response to COVID-19 in Africa. Based on our initial findings we have identified four major types of medicine shortage that are likely to affect the Kenyan market and have supplied thoughts on how to map these shortages, and possible responses to moderate the impact of shortages.
Preparing for the impact of COVID-19 on Kenya’s health commodity supply chain
Kenya’s coronavirus case tally as of April 20 hit 281, with 14 deaths, and the addition of 11 new cases. Kenya has East Africa and the Horn of Africa’s third highest tally currently.[1] That Kenya has not yet seen the same scale of outbreak as other countries is good news, we hope that it remains that way. But regardless of the size of the outbreak the health of Kenyan citizens is already under threat by challenges to the health commodity supply chain.
COVID-19 has led to a slowdown in the manufacture of active pharmaceutical ingredients (API) in China that will have repercussions for the supply of essential medicines across the world.[2] China is the world’s leading producer and exporter of API (the chemicals used to make medicines) by volume, accounting for 20%-40% of total global API output, including 26% of organic chemical exports to Kenya.[3],[4] China produces over 2,000 API drug products, with annual production capacity exceeding 2 million tons. Chinese API producers also supply a good part of the Indian pharmaceutical market.[5]
In addition to concerns about Chinese supply, local manufacturers in Kenya have reported that there are currently issues in the Indian pharmaceutical supply chain; while factories are still operational it’s becoming harder to obtain finished pharmaceuticals and API as a result of the virus’ impact on logistics. India supplies 37% of Kenya’s finished pharmaceuticals by value and a greater proportion of sales volume.[6] India implemented a social distancing shutdown on March 24th, as well as a ban on the exports of 26 health commodities on March 3rd. Though these export bans were subsequently relaxed for all molecules except for paracetamol on April 6th.[7]
Kenya is exposed to medicine shortages
At the time of writing this blog Kenya has reported relatively few confirmed coronavirus cases compared to the global burden, though the number of cases continues to rise. However, the country is at a high risk of health commodity shortages due to price sensitivity of patients paying cash for their healthcare and the likelihood of procurement departments being outbid for essential commodities by more developed, richer countries.
In addition, the relatively small local manufacturing industry does not make API, and private wholesalers and manufacturers are unlikely to have stockpiled health commodity reserves beyond a 3-4 month time horizon due to capital constraints.
To ensure that patients do not die from the economic and healthcare related consequences of the virus it is important to understand where there are likely to be health commodity shortages, as well as the cause of stockouts. Based on this information, donors or governments might be able to intervene to inform, advise, and in some cases possibly subsidise, the most essential health commodities. In addition, the global health community might be able to coordinate with API manufacturers, drug manufacturers, governments and wholesalers to help them understand where shortages are likely and more capacity is required.
Using data to forecast future shortages
Maisha Meds is currently collecting data at the pharmacy level for 244 facilities in Kenya, 18 in Tanzania, 10 in Uganda and 2 in Nigeria. Our technology platform is an android based point of sale system that runs on tablet computers and is used by private and public pharmacies to manage their sales and inventory, generating a real-time dataset of healthcare products distributed throughout the region while simultaneously contributing to the improved efficiency of our clients’ businesses.
Using the data captured from these pharmacies, as well as other available data sources, we are able to build a picture of changing medicine consumption and availability patterns.
Conceptual framework for health commodity shortages in Kenya
| Demand side shortages | Supply side shortages | |
| Local factors | Pharmacies in the Maisha Meds network are already seeing large increases in demand for face masks, soap and handwash. | Local manufacturers and wholesalers are increasing their prices as commodities become more scarce in each country and procurement costs increase. |
| Global factors | Countries with severe COVID-19 outbreaks are currently experiencing a massive increase in demand for: Personal protective equipment (PPE), Ventilators, Sedatives, Asthma / COPD medications. |
China and India are both experiencing supply side disruptions that will affect all developed and developing countries. |
Local medicine shortages or price increases caused by demand side factors
Data Source: Maisha Meds facility level point of sale data, or other pharmacy or hospital chain level data. An example of this data is below, showing the products at Maisha Meds facilities that have experienced the greatest increase in price and volume consumption in the past month. Using this data it is possible to view spikes in consumption as well as subsequent stockouts and drops in consumption that could result from a market level shortage.
Products with greatest increases in patient demand and price month-over-month
Example commodities: face masks, hand sanitizer, soap, latex gloves
Hypothetical response: Promoting the local manufacture of these basic PPE supplies is likely to be the most appropriate measure to boost availability in Kenya in the short term.
Local medicine shortages or price increases caused by supply side factors
Data source: Private wholesaler and manufacturer price lists will show price increases where future supply shortages are likely. An example of this data is below, as you can see in the week ending April 12th there was a continuation of the upwards trend we have seen in rising prices of health commodities, with face masks, metronidazole, tinidazole, aceclofenac and povidone most affected by price increases, though this does not appear to have been driven by demand side trends. This would suggest that these products are at greatest risk of supply side shortages in Kenya.
Changes in wholesaler pricing in the past week
Example commodities: aceclofenac, povidone, ciprofloxacin, certain WHO prequalified brands of artemether / lumefantrine and chlorpheniramine
Hypothetical response: private and public stakeholders should look to resupply key medicines where shortages are already starting to show in the private sector. These are products that might not be in a global shortage but where the market is reacting as if there is a shortage. If these are identified quickly it should be possible to secure supply internationally to prevent future price increases.
Global shortage or price increases caused by demand side factors
Data sources: The EMA and FDA have already been coordinating with pharmaceutical manufacturers to build a picture of the pharmaceutical and medical devices that are most at risk of shortage due to increased demand and shortages in raw ingredient supply. The FDA’s list of medicines currently experiencing a shortage is available here – https://www.accessdata.fda.gov/scripts/drugshortages/default.cfm and the EMA’s country shortage lists are available here – https://www.ema.europa.eu/en/human-regulatory/post-authorisation/availability-medicines/shortages-catalogue.
Example commodities – Midazolam, propofol, dexmedetomidine, morphine, fentanyl, hydromorphone, ketamine, epinephrine, rocuronium, norepinephrine, albuterol and salbutamol
Hypothetical response: Consolidate existing supply in-country, cancel all non-essential surgeries, seek to preserve commodities for intubation of future COVID-19patients. Available supplies should increase in time as manufacturers ramp up production globally.
Global shortage or price increases caused by supply side factors
Data sources: International trade databases with shipment level data can be used to view changes in international API prices and volumes.
Maisha Meds is able to use international trade data to view the upstream changes in health commodity supply of API from China to India and the US, which can provide a leading indicator of possible medicine shortages ahead of time. We are currently working on analyses using this data. If manufacturers, wholesalers, public procurement experts or donor organisations are interested in seeing the results of this work they can contact us directly.
Example commodities: Paracetamol, tinidazole, ornidazole, metronidazole, clindamycin, neomycin, progesterone, acyclovir, Vitamins B1, B6 and B12, chloramphenicol, erythromycin, hydroxychloroquine
Hypothetical response: Take an inventory of available stock in the public and private sectors. Prepare for the possibility of a 3-4 month shortage, explore alternative treatments and shortage mitigation strategies.
[1] www.africanews.com/2020/04/20/enforcement-of-coronavirus-lockdown-turns-violent-in-parts-of-africa/
[2] www.aljazeera.com/ajimpact/china-coronavirus-outbreak-hurt-global-drug-industry-200220051840577.html
[3] China Guide 2016.
[4] The United Kingdom’s Medicines and Healthcare products Regulatory Agency.
[5] Patricia Van Arnum, Tracking Pharmaceutical and API Growth in China, PharmTech.com, 12 July 2011.
[6] UN Comtrade Data 2018, assuming 25% local manufacturing
[7] www.nytimes.com/reuters/2020/04/06/world/asia/06reuters-health-coronavirus-india-drugs.html