Measures for Improved Availability of medicines and vaccines (MIA)

2022

• Productive research meeting between in Lancaster University

  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.

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  Thanks to Kostas, Nonhlanhla, Thomas, Iman, Luk, Harwin, Stef, Christine, Joe, Kim and Marianne for fruitful discussions and a lot of fun.

  

• Monday, 21 November 2022 - BI Tsegaye Melaku – Researcher of the Month

  How do we ensure people in Ethiopia and across the world have access to the medicines they need?

• Master thesis student seminar

  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.

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  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.

  

• Visiting researchers from Institute of Health, Jimma University, Ethiopia

  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.

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  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.

  

• Selviaridis, K., De Vries, H., Dube, N., and Aardal, C.

  Promoting resilience in medicine supply chains: An exploration of the role of contracting

  EUROMA Conference 2022

• Selviaridis, K.

  Video produced on “Medicine supply chains”, as part of showcasing Lancaster University Management School’s research on the theme “Innovation in Place”.

  September 2022.

• de Vries, H.

  De-risking global supply chains

  June 16. Seminar in Frontiers in Supply Chain Management Series

• Oorschot, K.E. van, Van Wassenhove, L., Jahre, M.

  Riding the Waves of the pandemic in supply chain management

  Production and Operations Management Society [POMS] conference, April

• Jahre, M., van Oorschot, K., Pettersen, M.S., Wangen, A. and Årdal, C.

  Serendipity of Procurement for Sustainable Medicine Supply Chains: Finding Transparency When You Were Least Expecting It

  NOFOMA Iceland, 2022

• De Vries, H. and Lemmens, S.

  Policies for National Medicine Stockpiles

  POMS Conference

• Jahre, M.

  The MIA Project: what have we done and what do we plan going forward?

  Seminar for Region Stockholm

• Moolenaar, D., De Vries, H., and Lemmens, S.

  Strategic Medicine Stocks

  Meeting with the Dutch Ministry of Health, Feb 14.

• Seminar on medicine shortage in Europe and the US - causes and solutions

  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.

• Jahre, M., Van Oorschot, K., Årdal, C. (2022) Developed two modules for MSC Master in Pharmacy with OsloMET on Pharmaceutical SCM to be piloted spring 2023.

• Van Oorschot, K., Årdal, C. (2022) Developed two modules for MSc Major in Supply Chain and Operations Management on Pharmaceutical SCM.

• de Vries, H. (2022) Session on Access to Medicine in RCN MSc course Health & Humanitarian Logistics 2022.

• Stakeholder meetings RSM: February 2022: Meeting on strategic stocks with policy makers from the Dutch MoH

• Oorschot, K.E. van, Van Wassenhove, L., Jahre, M.

  Riding the Waves of the pandemic in supply chain management

  Production and Operations Management Society [POMS] conference) April.

• Viana, J., Jahre, M., Årdal, C. and van Oorschot, K

  Generic medicine shortage interventions – comparative cost effectiveness analysis

  NOFOMA Iceland, June.

• de Vries, H., Dube, N., Selviaridis, K. and Aardal, C.

  Promoting resilience in medicine supply chains: An exploration of the role of contracting

  EUROMA Conference 2022

• de Vries, H. Jahre, M., Selviaridis, K., van Oorschot, K. and Van Wassenhove, L.N.

  A Systems View of Medicines and Vaccines Supply Chain Management

  Suggestion for a Special Issue in Journal of Operations Management.

• de Vries, H. and Lemmens, S.

  Policies for National Medicine Stockpiles

  POMS Conference, 2022.

• Oorschot, K.E. van, Van Wassenhove, L., Jahre, M.

  Collaboration-competition dilemma in flattening the COVID-19 curve

  Production and Operations Management.

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  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.

• Brekke, K.R., Dalen, D.M. and Straume, O.R.

  Paying for pharmaceuticals: uniform pricing versus two-part tariffs

  Journal of Health Economics, 83, 102613

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  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.

2021

• MIA physical meeting

  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.

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  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.

  

• MIA workshop

  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.

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  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.

• Jahre, M. (2021) Short of Drugs? Call Upon Operations and Supply Chain Management, Keynote Speech, NOFOMA, September 30.

• Mathisen, G.

  Pasienter får ikke behandling fordi helsevesenet mangler medisiner, Interview with Marianne Jahre among others

  7. September, 2021, Forskning.no

• Viana, J., Jahre, M., Årdal, C. and van Oorschot, K.

  Medicine supply chain resilience: A hybrid simulation cost effectiveness analysis study of disruption intervention strategies, (European Conference on Operational Research [EURO])

  July 12, 2021

• Viana, J. Jahre, M., Årdal, C., and van Oorschot, K.

  Defining measures, identifying, and obtaining data to conduct (cost) effectiveness analysis of medicine supply chains, (Operational Research Applied to Health Services [ORAHS] conference)

  July, 7, 2021

• Viana, J.

  Reflections on healthcare applications of hybrid simulation modelling in the UK and Norway (Invited seminar Simon Fraser University, Complex Systems Modelling Group)

  November. 26, 2021

• Jahre, M., van Oorschot, K., Soldal, O.B., Viana, J. and Årdal, C.

  Summary Explorative Interviews Norwegian Stakeholders

  Unpublished Report, January 18 2021

• de Vries, H. Jahre, M., Selviaridis, K., van Oorschot, K. and Van Wassenhove, L.N.

  A review of scientific and grey literature on medicine shortages and the need for a research agenda in Operations and Supply Chain Management

  No. 1 – 2021, Series of Research Reports, BI Norwegian Business School

• Breugen, T., Van Wassenhove, L. and Jahre, M.

  MIA Report Work Package 2, Unpublished Report, MIA

  August 2021

• Jahre, M.

  Short of Drugs? Call Upon Operations and Supply Chain Management

  Keynote Speech, NOFOMA, September 30

• Breugem, T., Jahre, M., Van Oorschot, K., Viana, J., Van Wassenhove, L., Årdal, C.

  How good is Europe’s access to medicines? Why Norway and other European countries struggle to ensure equitable and financially sustainable access to medicines

  Teaching Case on the Norwegian Paracetamol Supply Chain

• Dube, N. and Jahre, M.

  Defining resilience: implications on humanitarian operations research

  Decision Sciences Institute (DSI) 53rd annual conference, November 19.

• Viana, J., Van Oorschot, K., Årdal, C.

  Assessing Resilience of Medicine Supply Chain Networks to Disruptions: A Proposed Hybrid Simulation Modeling Framework

  2021 Winter Simulation Conference Proceedings

• Ahlqvist, V., Dube, N., Jahre, M., Melaku, T., Moe, A., Olivier, M., Selviaridis, K., Viana, J. and Årdal, C.

  Proactive and Reactive Interventions to Mitigate Medicine Shortages in (Ab)Normal Times

  NOFOMA, Iceland, 2021

• MIA pre-covid study and cross-country paracetamol project presented at seminar for Region Stockholm, Sweden, in connection with the CRITFLOW-project

  Presenters were Victoria Ahlqvist and Marianne Jahre. 100 participants from crisis preparedness and strategic public procurement functions.

• De Vries, H., Jahre, M., Selviaridis, K., van Oorschot, K. and Van Wassenhove, L.

  Paper accepted for publication:

  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).

• Bruijnooge, L. and De Vries, H.

  The Impact of Tendering on Drug Shortages

  Meeting with the Dutch Ministry of Health

• Medicines supply and shortages: A UK perspective. Kostas Selviaridis & Nonhlanhla Dube

  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.

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  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.

• Viana, J., Jahre, M, and Årdal, C.

  Risk, Resilience and Sustainability in Paracetamol Supply Chain Networks: A Norwegian Case Study

  Production and Operations Management Society [POMS] conference. May 3. Revise and submit to journal.

• Ahlqvist, V., Dube, N., Jahre, M., Melaku, T., Moe, A., Olivier, M., Selviaridis, K., Viana, J. and Årdal, C. (2021), Proactive and Reactive Interventions to Mitigate Medicine Shortages in (Ab)Normal Times, NOFOMA Conference Proceedings, Iceland, 2021.

• Jahre, M. (2021) How to lead (research) projects during the pandemic – experiences from MIA and COVID-19 research projects, To BI management.

• Jahre, M. (2021) Implications of resilience on humanitarian logistics research, Decision Science Institute conference, November 19. Panel chair.

• de Vries, H. (2021) Session on Access to Medicine in RCN MBA course Health & Humanitarian Logistics 2021.

• Jahre, M. (2021) Developed a course concept for pharmaceutical supply chain management based MIA and MIA+research.

• Van Oorschot, K., Breugem, T., Jahre, M., Viana, J., Van Wassenhove, L., Årdal, C.

  How good is Europe’s access to medicines? Why Norway and other European countries struggle to ensure equitable and financially sustainable access to medicines. Teaching Case on the Norwegian Paracetamol Supply Chain

  Unpublished, BI Norwegian Business School.

• Viana, J., Van Oorschot, K., Årdal, C.

  Assessing Resilience Of Medicine Supply Chain Networks To Disruptions: A Proposed Hybrid Simulation Modeling Framework

  2021 Winter Simulation Conference Proceedings

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  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.

• Hospital medicines pricing and procurement workshop

  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.

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  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.

• de Vries, H. Jahre, M., Selviaridis, K., van Oorschot, K. and Van Wassenhove, L.N.

  Short of Drugs? Call Upon Operations and Supply Chain Management

  International Journal of Operations and Production Management

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  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.

2020

• Sustainability and Responsibility Management Report 2020

  Sharing information on progress (SIP) 2018-2020

• Mapping workshop: for the researchers involved in the COVID project

  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.