Global Health Commodities Supply Chain in the Era of COVID-19 Pandemic: Challenges, Impacts, and Prospects: A Systematic Review

Figures & data

Figure 1 PRISMA flow diagram showing screening and selection of published articles.

Table 1 Summary of Reviewed Articles on Global Health Commodities’ Supply Chain in the Era of COVID-19 Pandemic: Challenges, Impacts, and Prospects: A Systematic Review, June 2021

Authors	Study Design	Methods of Data Collection/ Source	Study Location	Targeted Category of Health Commodities	Identified Challenges	Identified Impacts on the Supply Chain	Prospects Indicated
[13]	Modeling	Epidemiological prevalence data	South, East, and West Africa; South America	HIV, TB, and Malaria treatments	Yes	Yes	Yes
[22]	Geospatial modeling analysis	Baseline epidemiologic data from the database	Malaria endemic African countries	Malaria Treatments	Yes	Yes	Yes
[8]	Cross-sectional	Qualitative information collected via email	India	HIV Treatments	Yes	Yes	Yes
[23]	Cross-sectional	Data collected via Electronic Questionnaire	Nigeria	Essential Medicines for Chronic & Acute Diseases Treatment	Yes	Yes	Yes
[24]	Modeling	Real data collected from centers in northern Iran	Iran	Medical Wastes	Yes	Yes	Yes
[25]	Cross-sectional	Data collected via Electronic Questionnaire	Kenya	Drugs for self-medication	Yes	Yes	Yes
[26]	Modeling (Interrupted time series analysis)	Texas Prescription Monitoring Program	Texas, USA	Opioids and Benzodiazepines	Yes	Yes	Yes
[27]	Modeling	Data was from 12 countries of sub-Saharan Africa	Sub-Saharan Africa	HIV drugs	Yes	Yes	Yes
[28]	Mathematical Modelling	Publically available Prevalence data	Sub-Saharan Countries (South Africa, Malawi, Zimbabwe, and Uganda)	HIV drugs	Yes	Yes	Yes
[29]	Cross-Sectional Survey	Data collected via Electronic Questionnaire	USA	Personal protective equipment and infection prevention supplies	Yes	Yes	Yes
[30]	Modeling (IF-DEMATEL)	Expert Interview, Self-administered Questionnaire	LMICs	COVID-19 vaccine	Yes	Yes	Yes
[31]	Retrospective Cross-Sectional	Data from Electronic Database (Drug shortage Canada)	Canada	All medicines	Yes	Yes	Yes
[32]	Cross-sectional study	Online Self-administered questionnaire	Saudi Arabia	Essential medicine and personal protective equipment (PPE)	Yes		Yes

Figure 2 Regional distribution of published articles used for final analysis.

Figure 3 Class of essential medicines addressed in the reviewed articles.

Table 2 Summary of Challenges, Opportunities, and Prospects for Global Health Commodities’ Supply Chain

Authors	Targeted Health Commodities	Identified Challenges	Identified Impacts on Supply Chain	Future Prospects Indicated
[13]	HIV, TB and Malaria Treatments	HIV interruption to antiretroviral therapy Decrease timely diagnosis and treatment of TB Malaria disruption of supply and planned net campaigns	Deaths due to HIV, TB, and malaria over five years could increase by up to 10%, 20%, and 36%, respectively, compared with if there was no COVID-19 pandemics	Improving the resilience of the health system Long-term suppression and intervention for COVID-19 Pandemic
[22]	Malaria Treatments	Supply chain disruption of effective antimalarial drug treatment	Disruption of medicines in Africa could almost double malaria mortality in 2020 and lead to even more significant increases in the forthcoming years	Fighting and averting the Pandemic must remain an integrated priority
[8]	HIV treatments	International shipping interruption Delay (increased lead times) Rising costs Shortage of workforce in manufacturing plants Forecast for a return to normality Lack of active pharmaceutical ingredients and excipients to manufacture HIV drugs	Inflate AIDS-related deaths worldwide Transmission to someone else will increase due to high viral load in people receiving ART	Improve the resilience of the generic ARV drug supply system Initiate long-term orders for multi-month dispensing Consider safety stocks in the facilities Use real-time information with computerized inventory management system Stakeholders collaboration
[23]	Essential Medicines for Chronic & Acute Diseases Treatment	Poor means of transportation availability Income decrement Increase in the price of drugs Healthcare workers refusal to treat patients in fear of getting the virus.	35.2% of participants with chronic diseases had challenges for getting essential drugs vs 10.6% before lockdown. Due to problems in getting their medicines, 84% experience worsening chronic health conditions	If the people cannot get to healthcare facilities, design strategies such as community-based responses Initiate sustainable and large-scale drug manufacturing initiatives
[24]	Medical Wastes	An abrupt increase in the volume of generated medical wastes Lack of adoptable reverse logistics network design for Infection Medical Waste (IMW) during pandemics	Decreasing per person Medical Waste to 15% can decrease the total cost and risk with 7.5% and 15%, respectively. Installing Temporary Treatment Centers took up to 50% of the cost, and the transportation cost of IMW and the treated waste cost was 16% and 10%, respectively.	Efficiently forecast the amount of generated waste using real-time data to precisely predict. Proper management of Covid-19 IMW can decrease the transmission and might have minimized an extra cost. Using portable treatment machines to reduce transporting waste The discovery of curative drugs or remedies can reduce the amount of total generated wastes
[25]	Drugs for self-medication	Professionals are working in stressful Covid-19 treatment centers Feeling different pain symptoms including headache, migraine, joint, and muscle pains, and running nose	Self-medication prevalence increased to 60.4% (n = 229) as compared to 36.2% (n = 137) before the pandemic. Perceived adverse drug reactions reported from 22.4% (n = 85) of self-medication users.	Sensitization and awareness creation could help to reduce self-medication practices among health professionals in panic pandemics.
[26]	Opioids and Benzodiazepines	Restriction on routine outpatient procedures and other medical procedures Supply interruption opioid or benzodiazepine treatments	A substantial decrease in patients filling new opioid prescriptions (β = −6029, 95% CI = −8810.40, −3246.72). Decrease number of new opioid prescriptions following the executive order (β =−2784, 95% CI =−3671.09, −1896.19) Patients’ quality of life decrement Healthcare systems, and economies had significant cost burden to patients	Monitor Controlled Substance Prescription filling and patients’ access to care in a pandemic disaster. Public health officials must access Prescription Drug Monitoring data in real-time for rapid policy change
[27]	ART drugs	Overstretched health systems due to Covid-19 Supply interruption of ART drugs Interruption of other HIV prevention programs	Supply disruption for 50% of people for six months is expected to lead to a 1.63 times [1.39; Optimal HIV model–1.87; HIV Synthesis model] increase in HIV-related deaths over 1 year compared with no disruption. The six months of HIV disruption for 50% of persons are projected to increase 1.15–.1.29 times the current annual number of deaths for the next five years. Transmission of HIV from mother-to-child may increase due to interruption of ART drugs by approximately .16 times.	Governments, donors, suppliers, and communities should focus on maintaining a continuous supply of ART drugs at the time of pandemics to avoid additional HIV-related deaths. To prevent any increase in HIV incidence, other HIV prevention measures are also essential.
[28]	ART drugs	Disruption of HIV drug supply No new ART enrolments Decrease in viral suppression	Interruption for 3 months to 40% of those on ART could lead to a similar number of additional deaths compared to those saved from COVID-19 via social distancing. Disruption to ART for 9 months could lead HIV deaths to exceed the number of COVID-19 deaths for 60–90%. If ART supply is maintained and other HIV prevention methods cease for three months, rises in HIV deaths would be limited to <2% over 5 years.	Under reasonable worst-case assumptions, HIV deaths could increase substantially during the COVID-19 Pandemic High-burdened countries should give urgency to ensure steadiness of ART during the pandemics.
[29]	Infection Prevention Supplies and Personal Protective Equipment (PPE)	Health professionals have lengthy exposure with infected patients without wearing PPE. In the first month of the pandemic, there was lack of sufficient infection prevention supplies The critical shortage of masks, N95 respirators, isolation gowns, face shields, goggles, hand sanitizer, and disinfection supplies Less than half (45.4%) have adequate disinfection supplies Only 13.6% and 18.2% of health professionals had sufficient Face shields and N95 respirators, respectively (P < 0.001 for all)	High risk of illness for healthcare workers when providing care to COVID-19 patients Healthcare-acquired infection transmission increased Causing unsafe patient care and work environments.	Before the next major pandemic wave, gaps in stockpiling and planning need to be addressed Failure to do so will result in excess occupational exposures and healthcare-associated infections
[30]	COVID-19 Vaccines	Inadequate number of vaccine manufacturing industries Infrastructure problems for transportation and cold chain system Tracking vaccinated population is difficult Inappropriate local organization coordination Absence of vaccine monitoring bodies Financial constraint Challenges in vaccine demand forecast accuracy Lack of willingness to vaccinate Volunteers are not interested in vaccine trials	Low vaccine coverage and access, which in turn affects at least 9 of the 17 SDGs.	Stakeholders should define, map, and give significant attention to key challenges for the successful execution of VSC. Study challenges of COVID-19 vaccine development, production, distribution, and administration both from developed and LMIC perspectives.
[31]	All Medicines	Shortage of an active and inactive ingredient Challenges related to good manufacturing practices Shipping of the drugs delay Critical medical supplies temporary export restrictions	Two months shortage increased by 32% compared from the previous years Demand increased for the drug by 108% Disruption of drug supply by the manufacturer increased by 65%	To re-establish supply chains, stakeholders should work together Give the greatest focus for single-source non-patented medicines and patented medicines Strengthen supply chain resilience in the face of global shockwaves
[32]	Essential medicines and PPE	Shortage of essential medicines and PPE There is poor communication among public and private health institutions Local drug manufacturers were unable to meet the local need	Highly increased the price of PPE Healthcare workers at the front are at danger of catching transmittable infections Reuse of disposable PPE	Price gouging needs implementation of policy changes To inform concerned parties, establish warning systems of expected shortages proactively Incentivize local industries Establish national stockpile for essential health commodities Create multilateral communication Establishing centralized procurement Design medication sharing and exchange network Initiate reconciliation and medication education by pharmacists

Figure 4 Challenges for global health commodities’ supply chain interruption during COVID-19 Pandemic.

Figure 5 Challenges of COVID-19 vaccines’ supply system presented with the prominence-relation map.

Note: Adapted from Int J Prod Econ, volume 239 (April), Alam ST, Ahmed S, Ali SM, Sarker S, Kabir G, ul-Islam A. Challenges to COVID-19 vaccine supply chain: implications for sustainable development goals. 108193, copyright 2021, with permission from Elsevier.³⁰

Figure 6 Impacts of COVID-19 Pandemic on the global health commodities’ supply chain system.

Figure 7 Prospects indicated by researchers for improving the global health commodities’ supply chain system.

Figure 8 Challenges, impacts, and prospects of COVID-19 pandemic on global health commodities’ supply system.

Hogan AB, Jewell BL, Sherrard-Smith E, et al. Potential impact of the COVID-19 pandemic on HIV, tuberculosis, and malaria in low-income and middle-income countries: a modelling study. Lancet Glob Heal. 2020;8(9):e1132–e1141. doi:10.1016/S2214-109X(20)30288-6

 PubMed Web of Science ®Google Scholar

Weiss DJ, Bertozzi-Villa A, Rumisha SF, et al. Indirect effects of the COVID-19 pandemic on malaria intervention coverage, morbidity, and mortality in Africa: a geospatial modelling analysis. Lancet Infect Dis. 2020;3099(20):1–11. doi:10.1016/s1473-3099(20)30700-3

 Google Scholar

Rewari BB, Mangadan-Konath N, Sharma M. Impact of COVID-19 on the global supply chain of antiretroviral drugs: a rapid survey of Indian manufacturers. WHO South-East Asia J. 2020;9(2):126–133. doi:10.4103/2224-3151.294306

 Google Scholar

Awucha NE, Janefrances OC, Meshach AC, Henrietta JC, Daniel AI, Chidiebere NE. Impact of the COVID-19 Pandemic on Consumers. Acc Ess Med Nig. 2020;103(4):1630–1634. doi:10.4269/ajtmh.20-0838

 Google Scholar

Kargar S, Pourmehdi M, Paydar MM. Science of the Total Environment Reverse logistics network design for medical waste management in the epidemic outbreak of the novel coronavirus (COVID-19). Sci Total Environ. 2020;746:141183. doi:10.1016/j.scitotenv.2020.141183

 PubMed Web of Science ®Google Scholar

Onchonga D, Omwoyo J, Nyamamba D. Assessing the prevalence of self-medication among healthcare workers before and during the 2019 SARS-CoV-2 (COVID-19) pandemic in Kenya. Saudi Pharm J. 2020;2(xxxx). doi:10.1016/j.jsps.2020.08.003

 Google Scholar

Downs CG, Varisco TJ, Bapat SS, Shen C, Thornton JD. Impact of COVID-19 related policy changes on filling of opioid and benzodiazepine medications. Res Soc Adm Pharm. 2020;10–13. doi:10.1016/j.sapharm.2020.06.003

 Web of Science ®Google Scholar

Jewell BL, Mudimu E, Stover J, et al. Potential effects of disruption to HIV programmes in sub-Saharan Africa caused by COVID-19: results from multiple mathematical models. Lancet HIV. 2020;7(9):e629–e640. doi:10.1016/S2352-3018(20)30211-3

 PubMed Web of Science ®Google Scholar

Jewell BL, Smith JA, Hallett TB. Understanding the impact of interruptions to HIV services during the COVID-19 pandemic: a modelling study. EClinicalMedicine. 2020;26:100483. doi:10.1016/j.eclinm.2020.100483

 PubMedGoogle Scholar

Rebmann T, Vassallo A, Holdsworth JE. Availability of personal protective equipment and infection prevention supplies during the first month of the COVID-19 pandemic: a national study by the APIC COVID-19 task force. Am J Infect Control. 2020. doi:10.1016/j.ajic.2020.08.029

 Web of Science ®Google Scholar

Alam ST, Ahmed S, Ali SM, Sarker S, Kabir G, ul-Islam A. Challenges to COVID-19 vaccine supply chain: implications for sustainable development goals. Int J Prod Econ. 2021;239(April):108193. doi:10.1016/j.ijpe.2021.108193

 PubMedGoogle Scholar

Gaudette É. COVID-19’s limited impact on drug shortages in Canada. Can Public Policy. 2020;46(3):S307–S312. doi:10.3138/CPP.2020-107

 Google Scholar

Aljadeed R, AlRuthia Y, Balkhi B, et al. The impact of covid-19 on essential medicines and personal protective equipment availability and prices in Saudi Arabia. Healthc. 2021;9(3):290. doi:10.3390/healthcare9030290

 Google Scholar