Authors: Anthony McDonnell, Kalipso Chalkidou, Prashant Yadav and Dan Rosen (Maisha Meds Head of Data Insights) This blog was written in partnership with the Centre for Global Development who published the following blog first here. We are grateful for contributions from IQVIA for this piece. The COVID-19 pandemic has triggered unprecedented measures by national governments around the world, trade disruptions, and a deep and global economic crisis. All of these factors are, in turn, threatening the supply of essential medicines and other commodities. This is felt most acutely in developing countries (for example, early discussions highlight how Kenya is exposed to medicine shortages), but also in wealthy nations. The widespread nature of these problems reflects a highly complex and highly globalised supply chain for medicines and healthcare commodities. In this blog we outline some of the challenges in the global supply of medicines and introduce a methodology that will enable countries to spot early challenges in supply, allowing them as well as global development partners and industry to plan ahead and pre-empt falling short. The COVID-19 pandemic has triggered a number of challenges that have led to shortages and price hikes, and could potentially fuel an epidemic of fake and substandard medicines, including: severe supply chain blocks caused by significant decreases in air cargo capacity, sea freight, and transport logistics; export restrictions by supplier countries related to both COVID-specific commodities, but also non COVID ones (for example India has banned a number of essential active pharmaceutical ingredients (APIs) and finished products, though some of these bans have since been reversed, the UK has banned parallel exports, and EU has restricted exports of protective equipment.) the slowdown in production of medicines in affected countries. This began in China with API production (which has now all but resumed there) but also in India, and other key manufacturing bases. Drawing on the work of the international Decision Support Initiative (iDSI) and CGD’s earlier procurement work, in partnership with colleagues from IQVIA, MaishaMeds, and other in-country partners, a we have set out to better understand the current supply chain crisis. We are working to identify solutions to current pressing problems in order to make the global system more resilient in the future. We are collaborating closely with inter-agency groups focussed on medicines procurement to ensure our analytical work is strongly embedded in the policy context. Key: 1,3 social distancing measures have impacted manufacturing 2,5,7 Export bans have impacted the flow of goods across borders. 2,5,7,9 Logistical problems and disruptions have disrupted transportation of goods. 4,6 delays at ports Scoping the extent of the problem For medicines financed and/or procured by global agencies (including medicines for HIV/AIDS, TB, and malaria, or contraception) there are multiple efforts underway by agencies such as the Global Fund, USAID, and Global Drug Facility to manage global supply chain risks from COVID-19. However, for essential medicines which are procured by countries using domestic resources, there is relatively little in terms of globally coordinated efforts to understand and mitigate shortages. In order to understand the extent and nature of the problem, we are looking at non-COVID products that fall into the category of very essential [...]

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, [...]