One of the many lessons learned from the devastation of Hurricane Katrina in 2005 was the existence of catastrophic gaps in protecting patients’ access to healthcare. Not only was the direct provision of care interrupted as hospitals, nursing homes and pharmacies closed, but government officials and business leaders were reminded of how important effective global supply chains are central to ensuring continued access to healthcare for patients.
Katrina was a vivid example of how the impact of a public health emergency can be made immeasurably worse by disruptions in the supply chain, at the point of manufacture or on the road for a delivery. Since then, the healthcare industry has worked to foster the creation of a stronger, more resilient healthcare supply chain that is empowered to act as efficiently and proactively as possible.
During disaster or disease outbreak, seamless coordination between the public and private sectors is critical to ensuring supply chains stay strong and patients continue to receive access to critical medicines and treatments. Yet, the reaction that we too frequently hear when coordinating with state and local government is “why would I help a company stay up and running just so they can make money?”
With nearly 90% of critical healthcare in the United States owned by the private sector, the only systemic way to ensure patients’ continued access is to ensure the private sector remains strong. Of course, many of the things the supply chain requires during disasters—like safety, fuel, access, professional license transfers and more—need to be coordinated with the government. This allows industry to focus on the movement of goods and provision of services, something at which it excels, while the government focuses on its core services. Public sector health and emergency management has come a long way in understanding the critical role of the pharmaceutical supply chain, but there are still fundamental misunderstandings on how it works and how to best coordinate with each other. Breaking down these kinds of mindsets and silos through extensive outreach and education needs to be a greater systemic priority.
For example, during disease outbreaks, public health can have a direct impact on supply chain issues. In early 2015, the Centers for Disease Control sent a letter to all hospitals in the United States stating it had observed elevated levels of flu and recommended that hospitals stock up on Tamiflu (oseltamivir phosphate). However, that letter was only shared with hospitals, not distributors, so they didn’t have time to prepare inventory or communications on the issue.
Very shortly after, Healthcare Ready started to receive calls about spot shortage issues throughout the US. While the outbreak of flu also led to increased demand for Tamiflu, there’s no doubt in my mind the CDC letter exacerbated already short supplies. An alternative approach would have been to look at the problem more holistically and engage Healthcare Ready, or another independent actor, to communicate with distributors, pharmacists and others to prepare the entire network for the surge in demand.
Just before the flu outbreak was the concern over the Ebola virus, and today we’re confronting the Zika virus. Disease outbreaks and natural disasters are not one-time occurrences.
It’s not all bad news. In the past decade, many states have created private sector offices in their emergency management agencies. FEMA has created a National Business Emergency Operations Center (NBEOC). The Department of Health and Human Services (HHS) has a healthcare focused critical infrastructure group dedicated to coordinating with the supply chain.
These groups didn’t exist at the time of Hurricane Katrina. That they do now shows a seismic shift in how public-private coordination is improving. However, efforts can still be disjointed and difficult to navigate for national or global organizations. In recognition that healthcare resilience can’t be achieved in silos or on a solely reactive basis, conversations about resiliency and preparedness must expand to an ever-widening group of healthcare providers and suppliers.
Together we can move to a collective understanding that preparedness is centered on the need to strengthen healthcare systems, rather than building contingencies that may or may not ever be needed. That resilience requires maximizing assets in hand and introducing flexibility sufficient to meet all eventualities.
Creating a truly resilient healthcare system cannot be built and sustained unless all stakeholders—including public health, the private sector, local law enforcement, emergency services, and state and federal government authorities—are connected and coordinated. Getting to such a system does not happen overnight, but fortunately we have a good start on the effort. Unfortunately, we have too many instances—often caused by tornadoes or hurricanes—to test our progress. It is for this reason that we must continue to make sure our health systems are ready to respond and resilient when needed.
ABOUT THE AUTHOR
Emily Lord is executive director of Healthcare Ready (founded in 2006 as Rx Response), a nonprofit dedicated to building healthcare resilience by strengthening healthcare supply chains through collaboration with the public health and private sectors to address pressing issues before, during and after disasters.