Procurement of critical medical supplies during a major infectious disease outbreak is complicated by a number of factors. The PSCN and its participants are engaged in several areas of work aimed to ensure the availability of supplies during a pandemic. Our work involves identifying a list of critical medical items, developing methods and software to calculate supply estimates, and mapping both publicly-held physical reserves and privately-held virtual supplies.
WHO, with the support of the WFP Logistics Cluster and the PSCN , has developed a detailed list of the top 60 critical product categories essential for the medical response to 10 Public Health Emergencies of International Concern. This list is crucial as to overcome the challenges posed during the Ebola response where partners did not know exactly which products were needed nor the appropriate product standards and specifications of items such as personal protective equipment (PPE). The list is a key first step for developing planning, sourcing, and delivery strategies. Once the public and private sectors are equipped with a pre-agreed list of critical items, work can begin to collect information about product sourcing and lead times and to determine the required balance between virtual stocks and strategic reserves.
In partnership with the PSCN, the WHO is updating an existing software tool to estimate quantities needed of the pre-identified critical items according to various parameters. The Operational Planning Application for Logistics and Supply (OPALS) tool is designed to assist health professionals and emergency responders tasked with operational planning for pandemic preparedness and response. OPALS is a web application that utilizes a SIR model (susceptible, infectious, and recovered) and allows users to enter model parameters related to the affected population, epidemiology of the disease, and disease severity. The underlying OPALS model was developed for influenza A(H1N1) and work to expand it to other diseases with pandemic potential is planned for the future.
Physical and Virtual Supplies
To ensure that critical items required for a pandemic response are available at the time of an outbreak, it is necessary to have clear information about and access to supplies. The PSCN and its participants have made progress collecting key information about publicly-held physical reserves and privately-held virtual supplies.
The concept of virtual supplies includes visibility of commercial stocks and production capacities. A good overview of producers of critical items around the globe, their capacities and the supply lead times facilitates information sharing and coordination of pandemic supply chains. It is also fundamental to determining which items, and how many of them, should be maintained in publicly-owned physical reserves. Work by the PSCN in this area has involved mapping out where required stocks of critical items exist and who/where the suppliers are. While only a very few private firms are willing to release potentially sensitive supply and capacity information, the top 60 items can be analyzed with regard to regularity of demand and the geographic spread of production capacities and inventories. The PSCN is also analyzing exhibitors at medical trade fairs and suppliers registered in the United Nations Global Marketplace (UNGM) portal to identify additional sources of critical items, and assess, evaluate and map their suppliers.
Additionally, UNGM has the potential to serve as a valuable resource for the PSCN. As all vendors interested in doing business with UN agencies are required to be registered on UNGM, discussions are ongoing between the PSCN and the UNGM steering committee to create an identifier that will flag vendors that are able to provide items that are on the PSCN critical items list. As a preparedness measure, a procuring organization such as UNICEF or WHO will have to approve the vendors to ensure that they are able to meet the specification requirements of the top 60 critical items. In the event of a Public Health Emergency of International Concern, vendors who can provide critically needed items can be contacted through a direct mailing system or through the Tender Alert Service. The knowledge centre can provide a central repository of all procurement related information corresponding to the emergency response.
National governments, international organizations and other actors already maintain significant physical reserve stocks that can be deployed during pandemic crises. The PSCN and its participants, including the United Nations Office for the Coordination of Humanitarian Affairs, are working to increase the visibility of these valuable strategic reserves. Pre-positioning items such as PPE can help to improve both the speed and the effectiveness of an outbreak response. Additionally, it may be appropriate to hold reserve stocks of certain items for additional reasons, including that the product is not in demand under normal circumstances, the product is available commercially, but not in the quantities required, or the product is available in the quantities needed, but it cannot reach the affected populations in time.
Examples of these strategic reserves include the United Nations Humanitarian Response Depots (UNHRDs), WHO’s global strategic stockpile, UNICEF warehouses for emergency materials, and national emergency stockpiles. Unfortunately, at present, knowledge about public reserves around the globe is very limited. Reasons include:
- Humanitarian organizations see little value in sharing stock information
- NGOs fear their stocks may be commandeered by others
- Providing up-to-date stock information is labour-intensive, particularly during an acute crisis when resources are needed elsewhere
- Security concerns can limit sharing of information on national stockpiles
- Sharing stock information publicly could lead to speculation or collusion among suppliers
- Publicly-available information on major UN organizations’ stock levels could be misread, and could constrain in-house prioritization of allocations
- There is no metric to judge adequacy of stock levels