Measures for Improved Availability of medicines and vaccines (MIA)
Ensuring availability of essential medicines, vaccines and health commodities is one of today’s critical societal challenges
Ensuring availability of essential medicines, vaccines and health commodities is one of today’s critical societal challenges
In this Q&A Interview, Marianne Jahre, Professor at Lund University and BI Norwegian Business School introduces her current research and shares personal and professional lessons learned during the COVID-19 pandemic.
13 September 2023, Dagens Medisin
Legemiddelverket har økt prisene på en rekke eldre antibiotika for å gjøre det lønnsomt å selge dem i Norge. Seniorforsker ved Folkehelseinstituttet (FHI) Christine Årdal og Kjetil Berg i Farma Norge er glade for tiltaket, men de tror at flere tiltak kan bli nødvendig.
In March and April, MIA had a pilot teaching operations and supply chain management to students in pharmacy. This is part of developing a full MSc-Course with the purpose of teaching the pharmacist to bridge demand and supply.
Already in 2015, research pointed out that pharmacy students should be educated about drug shortages and global management strategies. OSCM is listed as an essential aspect in future pharmacy education and practice (Aruru et al. 2021). Nevertheless, an online search for pharmaceutical supply chain management training/teaching concludes with a void of such training.
On April 19 and 20, the MIA consortium came together at the Rotterdam School of Management for a workshop in which the diverse set of MIA sub-projects were discussed. MIA researchers from BI Oslo, the Norwegian Institute of Public Health, Lancaster University, INSEAD, and Tilburg University presented their latest work and provided feedback on how to proceed.
Specific projects discussed included strategic agility in medicine supply chains, policies for stockpiling of medicines, antibiotic standardization, narrow-spectrum antibiotics, overlap of drug shortages across European countries, teaching supply chain risk management to Pharma students, and the development of a framework to recommend what “intervention” to use for which medicine.
MIA researchers held three presentations and participated in 2 panels during the conference in May,
Submitted to RCN GLOBVAC in January and presented to NMFA, Norad, RCN and others in a workshop organized by RCN.
Kim van Oorschot developed a simulation game to use in teaching on the effect of collaborating across countries during a crisis. It shows the effect on the pandemic curve in Norway by linking system dynamics models of epidemiology, supply chain and policy.
Using shortage and demand data from Norway over 5 years, the tool can be used for multiple analyses on linkages between diverse medicines and effects of shortages. It was developed by Lorenzo Gaviano in cooperation with Kim van Oorschot and Joe Viana using data from multiple databases.
The MIA partners met for a two day project meeting in Lancaster in November. Constructive discussions on collaborative projects and plans going forward took place in wonderful surroundings at Lancaster University campus. We have so much ongoing and more ideas to follow up in the coming months.
Thanks to Kostas, Nonhlanhla, Thomas, Iman, Luk, Harwin, Stef, Christine, Joe, Kim and Marianne for fruitful discussions and a lot of fun.
How do we ensure people in Ethiopia and across the world have access to the medicines they need?
On October 12th 2022, six MSc students who wrote a MSc thesis about medicine shortages gave a short summary of their findings in a “MIA thesis research seminar”. The students were supervised by researchers affiliated to the MIA project and came from BI Oslo and Rotterdam School of Management (RSM). The audience included academics, students, and representatives from various stakeholders such as Ministries of Health and the pharma industry.
The presentations covered a wide range of topics. Mikal Pettersen and Andreas Wangen (BI Oslo) discussed and reflected upon non-price criteria in pharmaceutical tenders. Overly focusing on prices has been argued to induce several side-effects, including reduced supply security. The second presentation, by Azura Ngoc (RSM), discussed barriers and drivers for re-shoring of the production of APIs to European countries. She based this on interviews, and highlighted that incentives are presently too low for this to happen on a large scale, while barriers are significant.
Amalie Julsvoll and Marla Sickenberger (BI Oslo) subsequently discussed several use cases for blockchain technology and how these can support supply chain risk management in pharma supply chains. The final presentation was about the thesis written by Rune Hiort (RSM) on the relationship between prices and shortages. Rune used data from The Netherlands, Germany, and Norway to show that cheaper medicines have a higher risk of shortages, and that a decrease in prices increases the likelihood of a shortage.
26th October to 5th November, researchers from Jimma, Norwegian Institute of Public Health and BI met for project meetings, workshops and seminars. Finally, after working together for more than two years through zoom, we could meet with the whole team including Prof. Zeleke, Assoc.prof. Gudina and Assist.prof. Tsegaye.
During the week we discussed impacts from COVID-19 on availability of chronic disease medicines and paracetamol in Ethiopia, antimicrobial resistance, setting environmental requirements in procurement and medicines and how to finish publications. We visited NORAD and NIPH, had visitors from the Global Health Centre at UIO to discuss future projects and what we have learned so far.
EUROMA Conference 2022
September 2022.
June 16. Seminar in Frontiers in Supply Chain Management Series
Production and Operations Management Society [POMS] conference, April
NOFOMA Iceland, 2022
POMS Conference
Seminar for Region Stockholm
Meeting with the Dutch Ministry of Health, Feb 14.
On April 27th, stakeholders from the UK, Netherlands, and Norway along with researchers from France, UK, Netherlands, Norway, and Sweden gathered for a seminar on medicine shortage in Europe and the US to address their causes and solutions.
Production and Operations Management Society [POMS] conference) April.
NOFOMA Iceland, June.
EUROMA Conference 2022
Suggestion for a Special Issue in Journal of Operations Management.
POMS Conference, 2022.
Production and Operations Management.
Testing for COVID-19 is a key intervention that supports tracking and isolation to prevent further infections. However, diagnostic tests are a scarce and finite resource, so abundance in one country can quickly lead to shortages in others, creating a competitive landscape. Countries experience peaks in infections at different times, meaning that the need for diagnostic tests also peaks at different moments. This phase lag implies opportunities for a more collaborative approach, although countries might also worry about the risks of future shortages if they help others by reallocating their excess inventory of diagnostic tests. This article features a simulation model that connects three subsystems: COVID-19 transmission, the diagnostic test supply chain, and public policy interventions aimed at flattening the infection curve.
Journal of Health Economics, 83, 102613
Two-part pricing (the Netflix model) has recently been proposed instead of uniform pricing for pharmaceuticals. Under two-part pricing the health plan pays a fixed fee for access to a drug at unit prices equal to marginal costs. Despite two-part pricing being socially efficient, we show that the health plan is worse off when the drug producer is a monopolist, as all surplus is extracted. This result is reversed with competition, as two-part pricing yields higher patient utility and lower drug costs for the health plan. However, if we allow for exclusive contracts, uniform pricing is preferred by the health plan. The choice of payment scheme is also shown to influence on the incentives to spend resources on drastic innovations relative to incremental, me-too innovations.
From the 10th-11th of November a long-awaited physical meeting took place at BI Norwegian Business School to discuss our progress and the strategy moving forward in the project.
We exchanged thoughts, had discussions, and workshops to gather input for each sub-project. We had great dinners and interacted socially, which further strengthened our connection. The two days generated exiting thoughts for collaborative efforts on both academic and pedagogical outputs.
On October 13th 2021, eight MSc students who wrote a MSc thesis about medicine shortages gave a short summary of their findings in a “MIA thesis research seminar”. The students were supervised by researchers affiliated to the MIA project, and came from BI Oslo, Lancaster University (LU), and Rotterdam School of Management (RSM). The audience included academics, students, and representatives from various stakeholders such as Ministries of Health and the pharma industry.
The presentations covered a wide range of topics. Andreas Moe and Harald Wright (BI Oslo) discussed availability of antibiotics in Norway and provided recommendations for improving supply security. The second presentation, by Max Olivier (RSM), showed that shortages in European countries have limited overlap (i.e., it is not too common that a given medicine is in shortage in many countries at the same time), which provides a strong argument for pooling strategic stocks across countries. Hanne Bastholm and Shan Trau (BI Oslo) subsequently discussed PPE preparedness in Norwegian public hospitals and how to improve this. Kieran Arron (LU) discussed the findings from his qualitative research on secondary care tendering in the NHS, e.g., on the criteria being considered in the tendering process. Next, Mustafe Jama and Stian Taalesen (BI Oslo) presented a system dynamics model to explain how data science can advance knowledge about drug shortages, and illustrated that with results from a cluster analysis. Finally, Lineke Bruijnooge (RSM) summarized the results from her interviews on how tendering impacts the availability of generic medicines in the Netherlands. They do so among others by affecting the number of manufacturers active in a market, demand uncertainty, and inventories.
7. September, 2021, Forskning.no
July 12, 2021
July, 7, 2021
November. 26, 2021
Unpublished Report, January 18 2021
No. 1 – 2021, Series of Research Reports, BI Norwegian Business School
August 2021
Keynote Speech, NOFOMA, September 30
Teaching Case on the Norwegian Paracetamol Supply Chain
Decision Sciences Institute (DSI) 53rd annual conference, November 19.
2021 Winter Simulation Conference Proceedings
NOFOMA, Iceland, 2021
Presenters were Victoria Ahlqvist and Marianne Jahre. 100 participants from crisis preparedness and strategic public procurement functions.
Short of Drugs? Call Upon Operations and Supply Chain Management (2021), forthcoming in International Journal of Operations and Production Management, DOI (10.1108/IJOPM-03-2021-0175).
Meeting with the Dutch Ministry of Health
This research seminar focused on the UK medicine supply system and provided an overview of issues and practices with respect to the management of supply and observed shortages. In the first part of our presentation we summarised the key issues emerging from our ongoing, exploratory research in the UK, both in ‘business-as-usual’ situations and in crisis events such as COVID-19 and Brexit.
We highlighted a number of common themes across relevant UK stakeholders, including supply chain actors and other governmental and NHS England-affiliated organisations. We subsequently discussed a number of focused research projects to potentially undertake moving forward, all of which are informed by our engagement with UK stakeholders and our empirical research thus far. We concluded the seminar with a few thoughts on research methodology and design, notably the potential use of intervention-based research strategies to investigate specific aspects of the medicine shortages problem. Participants in the seminar contributed their comments, questions and reflections throughout, making it a highly interactive and fruitful event.
Production and Operations Management Society [POMS] conference. May 3. Revise and submit to journal.
Unpublished, BI Norwegian Business School.
2021 Winter Simulation Conference Proceedings
The objective of the proposed hybrid simulation modeling framework is to improve the understanding and operation of medicine supply chains, to strengthen their resilience to ensure the availability of medicines. The framework draws upon hybrid simulation, supply chain resilience and medicine supply chain literature. The utility of the proposed framework is presented through the development of a case model of a generic (off-patent) case medicine in the Norwegian system to perform scenario-based experiments on disruption events and interventions.
Tendering systems are frequently being mentioned as a cause of drug shortages in high-income countries. The reasons include that tendering drives down prices and increases revenue uncertainty for market authorization holders (MAHs) of medicines. This, in turn, drives many MAHs out of the market and disincentivizes them to invest in inventories, slack production, and production quality. Each of these consequences enhances the risk of drug shortages.
The question that arises is: how might we redesign a tendering system in such a way that it strikes the right balance between affordability (i.e., the capability of the tendering system to keep prices low) and availability (i.e., the capability of the tendering system to attract a diverse and reliable supply base)?
To address this question, MIA researchers Christine Årdal (Norwegian Institute of Public Health), Harwin de Vries (Rotterdam School of Management), Dag Morten Dalen (BI Oslo), and Kostas Selviaridis (Lancaster University) organized a seminar with experts on the hospital medicines tendering systems in Belgium (Thomas de Rijdt), Denmark (Flemming Sonne), France (Jonathan Rodrigues), Norway (Eirik Sverrisson), Sweden (Ulf Törnqvist) and The Netherlands (Peter Dohmen, Prof. Erik van Raaij), which took place on April 8th, 2021. The participants shared how the system in their country works and discussed how the characteristics of these systems affect drug shortages. The latter include the level of centralization, the number of winners, and the duration of the contracts. The findings will form the basis for research on the link between tendering and shortages and optimal tendering system design.
International Journal of Operations and Production Management
This “impact pathways” paper argues that operations and supply chain management (OSCM) could help address the worsening drug shortage problem in high-income countries. This significant societal problem poses difficult challenges to stakeholders given the complex and dynamic nature of drug supply chains.
Sharing information on progress (SIP) 2018-2020
25 November: The purpose of the workshop was to provide each other with knowledge on how to map supply chains, what data and tools are available, and the specifics of the Ethiopian context. Participating presenters included Marianne Jahre, Tsegaye Melaku and Emily Gooding.