Abstract

The United States has experienced prolonged severe shortages of vital medications over the past two decades. The causes underlying the severity and prolongation of these shortages are complex, in part due to the complexity of the underlying supply chain networks, which involve supplier-buyer interactions across multiple entities with competitive and cooperative goals. This leads to interesting challenges in maintaining consistent interactions and trust among the entities. Furthermore, disruptions in supply chains influence trust by inducing over-reactive behaviors across the network, thereby impacting the ability to consistently meet the resulting fluctuating demand. To explore these issues, we model a pharmaceutical supply chain with boundedly rational artificial decision makers capable of reasoning about the motivations and behaviors of others. We use multiagent simulations where each agent represents a key decision maker in a pharmaceutical supply chain. The agents possess a Theory-of-Mind capability to reason about the beliefs, and past and future behaviors of other agents, which allows them to assess other agents' trustworthiness. Further, each agent has beliefs about others' perceptions of its own trustworthiness that, in turn, impact its behavior. Our experiments reveal several counter-intuitive results showing how small, local disruptions can have cascading global consequences that persist over time. For example, a buyer, to protect itself from disruptions, may dynamically shift to ordering from suppliers with a higher perceived trustworthiness, while the supplier may prefer buyers with more stable ordering behavior. This asymmetry can put the trust-sensitive buyer at a disadvantage during shortages. Further, we demonstrate how the timing and scale of disruptions interact with a buyer's sensitivity to trustworthiness. This interaction can engender different behaviors and impact the overall supply chain performance, either prolonging and exacerbating even small local disruptions, or mitigating a disruption's effects. Additionally, we discuss the implications of these results for supply chain operations.

Highlights

  • Over the past two decades there has been an epidemic of drug shortages affecting the United States

  • In this paper we focus on three driving factors behind disruptions in pharmaceutical supply chains: (i) joint adaptation of trustworthiness beliefs, (ii) how sensitive beliefs about trustworthiness are to recent actions taken by other agents, and (iii) disruption characteristics

  • We ran different simulations with different levels of sensitivity factors and report changes in the costs of both healthcenters with a Moderate in S1 Fig. Both industry leaders and healthcare providers agree that variability in orders and supply quantities are negatively affecting the performance of supply chains and the drug shortage crisis

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Summary

Introduction

Over the past two decades there has been an epidemic of drug shortages affecting the United States. According to the American Society of Health-System Pharmacists (ASHP), the rate of new shortages is increasing in recent years and the number of active shortages in the second quarter of 2019 reached a height of 282 products [2]. In cases where a drug can be substituted with another product, drug shortages result in greater costs incurred by an already burdened healthcare delivery system [6]. These shortages directly translate into a risk to public health and safety

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