Critical Supplies Research Articles

The effect of visibility on forecast and inventory management performance during the COVID-19 pandemic

During the COVID-19 pandemic, healthcare facilities faced significant shortages of critical supplies like personal protective equipment, with dire repercussions. This study evaluates the potential role of decreased data visibility on these shortages, analysing different forecasting methods integrated with a periodic review inventory system (i.e. a base stock policy) on semi-simulated data encompassing several visibility issues. The forecasting methods chosen pertain to different data types: Holt and naïve methods are used as demand-based predictors, while a modified epidemiological model utilises pandemic data for demand forecasting. We scrutinise three prevalent data visibility issues through specifically crafted scenarios examining the effects of delayed, temporally aggregated, and erroneous data on system performance. Generally, our research illustrates that data visibility issues have a detrimental impact on the healthcare supply chain's efficacy. Interestingly, the system performance sees an uptick when these issues spur significantly oversized over-forecasts, e.g. when employing an epidemiological compartmental model for predictions.

Critical Minerals for India's Clean Energy Transition

This paper unpacks the meaning of the term “critical” in “critical minerals” by highlighting the vulnerabilities that affect the availability of these minerals in India. It maps the critical mineral scenario for India by examining the domestic vulnerabilities of India’s critical mineral supplies and unpacking the political economy of global mineral resource flows while contextualizing them for India’s energy transition. Finally, based on these observations, it suggests a way forward for India to secure its critical minerals economy.

When Are "Paraphernalia" Critical Medical Supplies?

Evidence of harm reduction interventions' morbidity and mortality benefits is abundant and of high quality, so there are good reasons for regional and national groups to advocate for more widespread distribution of legally regulated "drug paraphernalia," including needles, syringes, and fentanyl test strips. But lack of consistency among states' laws means that patients' interstate travel can subject them to being charged with possession of illegal items. This commentary on a case offers guidance to clinicians looking to help patients understand legal risks of interstate travel with supplies that are prescribed or recommended to reduce harms of their drug use and explores the ethical responsibilities of physicians in jurisdictions that legally prohibit these harm reduction interventions.

Institutional implications for science and industrial capacity: policy lessons from the UK’s pandemic response

Abstract Global shortages of critical equipment and supplies induced by COVID-19 forced countries to rapidly build and ramp up their indigenous testing and production capacities. However, the many ways in which institutional and organizational change occurred has not been sufficiently captured. Building domestic capacity requires the leveraging and repurposing of existing domestic scientific and technological capabilities, coupled with intensified global outreach to new and existing partners and suppliers. Using the framework of institutional variety, this paper looks at two facets of the UK’s COVID emergency industrial response: (1) building its laboratory testing capabilities and (2) for increasing production of personal protective equipment; assessing the institutional capacities and relations that were leveraged in this regard. It uses these findings together with observations of ‘innovation processes under emergency conditions’ and the potential uses of a ‘critical equipment policy’ to sharpen some of the recommendations made in the UK’s post-COVID Research and Development Roadmap.

Using electric vehicles to enhance power outage resilience – An agent-based modeling approach

Power outages can cause severe disruption to critical infrastructure. With the predicted increase in the electrification of the transport sector, society will become even more vulnerable to the effects of power outages. While increased electric vehicle (EV) adoption will contribute to the electrification process, EVs can also offer capabilities to provide services during an outage. This paper studied the use of a fleet of EVs during the aftermath of a disaster to provide disaster relief by donating power to a shelter, delivering critical supplies and people in need, and providing transport for personnel or performing inspections. While the bulk of the past work has focused on using EVs to increase the resilience of the distribution grid, or individual buildings, to a power outage, this paper was novel in its use of an agent-based model to study EVs that are performing functions to increase the resilience of a community to an outage. The fleet of EVs were provided access to a microgrid with a solar array, one or two EV fast chargers, and three possible sizes of a storage. Useful outputs were produced and studied for such features as daily energy donated to a shelter, daily energy used at the microgrid, and the length of outages that can be supported before the energy is depleted at the microgrid. Results showed that increasing storage size at the microgrid led to substantial increases in the outage length that could be support. Additionally, it was found that focusing a fleet on delivery and transport tasks, as opposed to energy donation, could also increase the length of outages that could be supported.

Need for standardization and compliance to treatment protocols for COVID-19 within the African Region of the World Health Organization

COVID-19 pandemic changed the face of global health and brought about new issues in global health security and economy. The World Health Organization published guidelines for clinical management of COVID-19 four months after declaration of COVID-19 as a pandemic. Scholarly reviews and studies from member states within WHO AFRO reveals significant deviation from the WHO published protocols on COVID-19. Assessment of national treatment protocols of 30 of 47 WHO AFRO member states showed widespread inappropriate use of antimicrobial agents for patients, which may worsen the global and concerning threat of antimicrobial resistance. There is need for adopting interventions that optimize antimicrobial use in the context of pre- and post-pandemic preparedness to ensure long-term effectiveness and sustainability for antimicrobials. Treatment guidelines are to be adopted or adapted depending on best clinical evidence available. Non-compliance with guidelines might lead to mismanagement of infectious diseases with attendant negative consequences including antimicrobial resistance and misdirection of critical resources and supplies amongst others.

Why modify or terminate contracts for critical supplies? Evaluating federal purchasing of PPE following COVID-19

Contract managers change contracts to respond to unforeseen events and to improve the likelihood of securing critical supplies. This study employs data from the General Service Administration’s SAM.gov Data Bank on over 8,000 contracts to examine the prevalence, reasons for, and timing of contract modifications and terminations in federal purchasing of personal protective equipment (PPE) in the first year of the COVID-19 public health crisis. Results show that modifications that transform transactional contracts to more collaborative designs were utilized for some of the highest-risk contracts and were associated with increased obligations, indicating that collaborative designs led to more purchasing of PPE. Competitive selection increased the likelihood of termination, the rate at which terminations occurred, and deobligations, indicating that the approach increased the costs of administration without improving the likelihood of securing supplies. A substantial portion of modifications and terminations occurred within the first forty days of delivery, revealing how contract management capacity was needed in the early stages of critical supply acquisition.

Contributing to health system resilience during pandemics via purchasing and supply strategies: an exploratory system dynamics approach

BackgroundHealth systems worldwide struggled to obtain sufficient personal protective equipment (PPE) and ventilators during the COVID-19 pandemic due to global supply chain disruptions. Our study’s aim was to create a proof-of-concept model that would simulate the effects of supply strategies under various scenarios, to ultimately help decision-makers decide on alternative supply strategies for future similar health system related crises.MethodsWe developed a system dynamics model that linked a disease transmission model structure (susceptible, exposed, infectious, recovered (SEIR)) with a model for the availability of critical supplies in hospitals; thereby connecting care demand (patients’ critical care in hospitals), with care supply (available critical equipment and supplies). To inform the model structure, we used data on critical decisions and events taking place surrounding purchase, supply, and availability of PPE and ventilators during the first phase of the COVID-19 pandemic within the English national health system. We used exploratory modelling and analysis to assess the effects of uncertainties on different supply strategies in the English health system under different scenarios. Strategies analysed were: (i) purchasing from the world market or (ii) through direct tender, (iii) stockpiling, (iv) domestic production, (v) supporting innovative supply strategies, or (vi) loaning ventilators from the private sector.ResultsWe found through our exploratory analysis that a long-lasting shortage in PPE and ventilators is likely to be apparent in various scenarios. When considering the worst-case scenario, our proof-of-concept model shows that purchasing PPE and ventilators from the world market or through direct tender have the greatest influence on reducing supply shortages, compared to producing domestically or through supporting innovative supply strategies. However, these supply strategies are affected most by delays in their shipment time or set-up.ConclusionWe demonstrated that using a system dynamics and exploratory modelling approach can be helpful in identifying the purchasing and supply chain strategies that contribute to the preparedness and responsiveness of health systems during crises. Our results suggest that to improve health systems’ resilience during pandemics or similar resource-constrained situations, purchasing and supply chain decision-makers can develop crisis frameworks that propose a plan of action and consequently accelerate and improve procurement processes and other governance processes during health-related crises; implement diverse supplier frameworks; and (re)consider stockpiling. This proof-of-concept model demonstrates the importance of including critical supply chain strategies as part of the preparedness and response activities to contribute to health system resilience.

Healthcare supply chains: critical supplies during the pandemic

Healthcare supply chains: critical supplies during the pandemic

The European Union's forced labour regulation: Putting the ‘brussels effect’ to work for international labour standards

In September 2022, the Commission adopted a proposal for a Regulation on prohibiting products made with forced labour on the Union market. This arises in a context of rising concern over many years about breaches of workers’ fundamental rights and core standards of the International Labour Organization in supply chains of products that are marketed in Europe, particularly where multinational corporations have offshored production to states without the high labour standards enforced in the EU. There has also long been widespread concern, particularly from trade unions, that such offshoring enables manufacturers to undercut labour protections of European workers. Furthermore, the offshoring of manufacturing has enabled certain third countries to develop their industrial and technological capacities in ways that create geostrategic risks for the EU and its Member States, as these third countries become ‘systemic rivals’ of the Union. First, this article argues that the proposed Regulation fits with Anu Bradford's theory of the ‘Brussels Effect’ exposited in her 2019 book of that name, and that the Union should take advantage of Bradford's insights in developing the Regulation and future legal instruments. Bradford established the Brussels Effect as an empirical reality; this article makes a normative case that, in this instance, the EU institutions should actively embrace it as a means to advance its goals. The proposed Regulation is an example of the Union leveraging market power to accomplish normative goals, by exporting its values to third countries. This offers room for the EU to be a force for good in the world, answering some of the qualms raised in Bradford's work about the potential ‘imperialism’ of the Brussels Effect. The present article argues the Union should go further, try to ‘externalise’ more of the social acquis in the field of labour law, leveraging its international market power to both improve labour standards around the globe. This article challenges Bradford's original contention that the Brussels Effect does not apply to labour standards, arguing instead that it is possible, and normatively desirable, for the Union to follow this Regulation with a broader suite of measures aimed at globalising European labour standards, with benefits for both third-country nationals and citizens of the Union. Second, the article links the proposed Regulation to concern about the geostrategic vulnerability of Member States and the Union as a whole, where essential products are manufactured in third countries. This became apparent during the Covid-19 pandemic, with many critical supplies predominantly manufactured outside the Union. The ‘strategic autonomy’ agenda of the EU implies re-shoring of important industry, which is more easily accomplished where EU regulation lessens the ability of third countries to undercut the EU with low labour standards. This will have long-term economic benefits for the Union and its citizens, as well as depressing the potential for systemic rivals to the Union to develop their industrial and technological capacities at the expense of the Union and its Member States, and deprive governments that disregard fundamental rights of workers of revenues from investment, manufacturing and exports to the Union.

Implications of trust, preparedness, risk perceptions, and local context on deprivation costs and disaster relief planning

Deprivation Costs Functions (DCFs) are key to designing effective relief distribution operations after disasters. In this paper, data are collected in Colombia and Ecuador to estimate DCFs for water and food, considering the influence of individuals' attitudes on preparedness, risk perception, and trust in response agents. Hybrid Choice Models are used to analyze and compare the estimated DCFs. The analyses confirm that DCFs differ by commodity. Additionally, socioeconomic characteristics of individuals influence their willingness to pay for critical supplies to reduce their own suffering. Preparedness, risk perceptions and trust in response agents impact individuals' behavior in disaster situations. The results also show that community and religious groups are considered the most trusted response agents in both countries. As a result, their involvement in official relief efforts should be more articulated. Colombia and Ecuador show significant differences in their estimated DCFs, confirming that deprivation costs are context-specific by nature. As such, DCFs should not be directly transferred among disaster locations. The findings from this study will support decision-makers in designing effective preparedness and response plans that are based on trust relationships that serve as foundations for community resilience.

A High-interaction Physics-aware ICS Honeypot for Industrial Environments

Industrial Control Systems (ICSs) are control systems that automate and control industrial processes. ICSs have a high-security risk since most of them are connected to the Internet for remote monitoring and controlling purposes. Compromising ICS can disrupt critical infrastructure supplies, such as water supply, power supply, transportation systems, and manufacturing systems. Programmable Logic Controllers (PLCs) are special computers used in ICSs. Many PLCs do not have built-in security systems. Many ICS application layer protocols are not designed with security in mind. Therefore, external security systems are needed to protect ICSs from cyber-attacks. Identifying the vulnerabilities, malware, and attacking patterns is useful in designing defense-in-depth security systems for ICSs. Honeypots can be used for research purposes as a way of collecting data and can also be used to protect the systems from attackers. In this paper, we present a high-interaction physics-aware ICS research honeypot that has been extended to a production honeypot using Software Defined Networking.

Moving forward through consensus: a national Delphi approach to determine the top research priorities in prostate cancer in Uganda

ObjectiveTo identify key areas for research in prostate cancer (PC) in the Ugandan context by establishing the major health system, socioeconomic and clinical barriers to seeking, reaching and receiving high-quality...

Navigating the Global IV Contrast Shortage: The Experience of a Comprehensive Cancer Center

In March 2022, a COVID-19 associated lockdown at an intravenous (IV) contrast production facility resulted in global shortages. We report our experience as a comprehensive cancer center navigating the IV contrast shortage through the development of an IV contrast triage team. A triage prioritization system was established to serve as a guideline for ordering clinicians to reduce contrast use (Table 1). The triage team reviewed all requests and made final determination based on patient history, treatment plan, prior imaging, possible alternative modalities, and competing requests. Our institution performed a median of 194 CT studies per day. Contrast utilization as a percentage of all CTs ordered was approximately 80% prior to the shortage, nadired at 9% during peak shortage, and has since returned to pre-shortage levels. While most requests for contrast were changed to non-contrast by the ordering clinician, 132 requests were reviewed by the triage team. Fifty studies (38%) were approved by the team for contrast administration, 56 (42%) were recommended to be performed without contrast, 15 (11%) for a change in modality, and 11 (8%) were felt suitable for delay. There was overall general concordance between the recommendations of the triage team and studies conducted without significant distributional differences (χ2 = 4.004, two-tailed p = 0.2610). We did not note any instances of patient harm associated with the lack of contrast or from the utilization of an alternative imaging modality. The concept of resilience involves the development of system-based practices that allow for sustained operations during periods of sudden change, or loss of critical supplies. The effort to optimally allocate limited supply of contrast was an extensive effort across the organization including from senior leadership, IT, radiology, nursing, physicians, and APPs. Defaulting to an automatic cancelation of contrast requests, followed by review from an interdisciplinary triage team was effective in safely reducing contrast utilization. Decisions made by the team appeared to be sound without any known patient harm.

Go Science Drone Med Box – Medical Emergency Drone for Emergency Healthcare Management

The Medical Emergency Drone Box stands as a transformative development in healthcare technology, designed to address a spectrum of emergency medical needs. This paper delineates the comprehensive capabilities of the device, which ranges from its potential role in rural healthcare support to its utilization in critical emergencies, road accidents, and even organ transportation. The device integrates advanced sensors, such as body temperature and pulse detection units, to facilitate real-time monitoring and data-driven decision-making during medical interventions. It also incorporates a WiFi module and microcontrollers for efficient data transmission and seamless connectivity. To ensure the maintenance of required medical standards, the drone box includes a heating and cooling system for preserving critical medical supplies. The cloud-based storage of sensor data allows healthcare professionals to remotely access vital information in real-time. Moreover, the device is built to operate effectively even in regions with limited electrical access, courtesy of its robust battery backup system. Additional features include charging units and an assortment of essential medical equipment like portable defibrillators and drilling machines. Solar Panels are also added as a redundant power support. This paper aims to showcase the multifaceted features, data-centric functionalities, and the enormous potential the Medical Emergency Drone Box holds in revolutionizing emergency healthcare delivery across diverse settings. Developed by Go Science Technical Team. IndexTerms – Go Science, Medical Emergency Drone Box, Healthcare Innovation, Critical medical Interventions, Sensor Technology, Real-Time Data Monitoring, Data Transmission, Battery Back-up, Rural healthcare, Road Accidents, Organ Transportation, Cloud Data Storage, Portable Medical Equipment.

Artificial intelligence as an enabler of quick and effective production repurposing: an exploratory review and future research propositions

The outbreak of Covid-19 created disruptions in manufacturing operations. One of the most serious negative impacts is the shortage of critical medical supplies. Manufacturing firms faced pressure from governments to use their manufacturing capacity to repurpose their production for meeting the critical demand for necessary products. For this purpose, recent advancements in technology and artificial intelligence (AI) could act as response solutions to conquer the threats linked with repurposing manufacturing (RM). The study’s purpose is to investigate the significance of AI in RM through a systematic literature review (SLR). This study gathered around 453 articles from the SCOPUS database in the selected research field. Structural Topic Modelling (STM) was utilised to generate emerging research themes from the selected documents on AI in RM. In addition, to study the research trends in the field of AI in RM, a bibliometric analysis was undertaken using the R-package. The findings of the study showed that there is a vast scope for research in this area as the yearly global production of articles in this field is limited. However, it is an evolving field and many research collaborations were identified. The study proposes a comprehensive research framework and propositions for future research development.

A two-stage stochastic post-disaster humanitarian supply chain network design problem

We consider the planning problem of designing and operating humanitarian supply chain networks (HSCN) after natural disasters. Specifically, we focus on the design of a three-layer network under demand and capacity uncertainty to support short-term recovery, i.e., to distribute critical supplies to the affected population. We aim to analyze the effect of unmet demand accumulating over the planning horizon in order to better understand and respond to natural disasters. To this end, we explicitly consider the impact of unmet demand through time under uncertain conditions by introducing a spread factor. We develop a two-stage stochastic model that retains the uncertainty pertaining to the demand along with the transportation and storage capacities of the HSCN. Then, we apply our model to a case study using real-world data from the 2018 earthquake in Indonesia. Various aspects of the problem are studied over a set of experiments, including the importance of modeling uncertainty, the effect of the budget on the solution performance, and the role of the spread factor in the accurate understanding of the crisis. According to the results obtained, considering lower values for the spread factor parameter can irreparably misguide the decision-makers by an inaccurate presentation of the crisis’ depth and consequently increase the damage caused to people’s health

Emerging technologies' role in reducing under-five mortality in a low-resource setting: Challenges and perceived opportunities by public health workers in Makonde District, Zimbabwe.

Under-five mortality (U5M) remains a global challenge, with Sub-Saharan Africa being the hardest hit. The coronavirus disease 2019 (COVID-19) has strained healthcare systems, threatening to reverse current gains in U5M health outcomes. It threatened progress made towards achieving United Nations Sustainable Development Goal 3 due to its strain on healthcare systems, resource reassignment and its prioritisation by health authorities globally. Low-resource settings inherently face unique challenges in fighting U5M and providing quality healthcare to under-fives, like understaffing, drug shortages, underfunding, skills gaps and lack of specialised healthcare equipment, contributing to high U5M rates. This study explored public health facilities' challenges in reducing U5M in a low-resource setting in Zimbabwe and public health workers' perceptions of emerging technologies' role in addressing those challenges. Twenty public health workers participated in interviews and a focus group. They perceived emerging technologies (ETs) as a panacea to the challenges by supporting data-driven healthcare, improving follow-up outcomes through automated reminders of medication and clinic visits, aiding diagnosis, continuous monitoring, health education, drug supply monitoring, critical supplies delivery and skills development. In this paper, emerging technology is any information and communication technology that has not been utilised to its full potential in Zimbabwe's public health domain. Findings indicate that public health workers in Makonde would welcome ETs to improve under-five health and well-being.

Responding to Environmental Uncertainties in Critical Supply Acquisition: An Examination of Contracting for Personal Protective Equipment (PPE) in the Aftermath of COVID-19

Abstract While prior research has long identified the centrality of critical supply acquisition to the government’s response to a crisis, there is less understanding of how to secure critical supplies that depend on global supply chains. The acquisition of personal protective equipment (PPE) in the immediate aftermath of the coronavirus disease 2019 outbreak (COVID-19) proved challenging not only due to threats of contractor deception but also due to disruptions in contractor supply chains. This research analyzes primary interview data with contracting officials involved in purchasing PPE in the early stages of the COVID-19 crisis. The results indicate the ways that contractor relationships were perceived useful in anticipating risks surrounding a contractor’s behavior (behavioral uncertainties), but insufficient in anticipating disruptions that can result from a contractor’s supply chains (environmental uncertainties). Contractor relations were perceived to help in predicting industry disruptions, but such relations were likely to be formed alongside transactional and short-term contract designs—and likely to require comparison with other data sources. The results indicate that improving the reliability of critical supply acquisition for future crises is likely to depend on developing expertise in supply chain analysis, especially as the U.S. government increasingly relies on global supply chains in critical supply acquisition.

The African Union and Emerging Patterns of Global Health Governance

Abstract During the global COVID-19 pandemic, the shortcomings and inequities in the global health system were amplified. International actors lost faith in the major global health institutions, and there was intense competition amongst states for critical supplies and vaccines. During these challenging circumstances, the African Union (AU) and its specialized technical institute (now autonomous agency) the Africa Centres for Disease Control and Prevention (Africa CDC), led a multi-faceted response to combat COVID-19 in Africa and advocate for the African region globally. Beyond responding to the immediate crisis, the AU and Africa CDC recognized that Africa would need to build its capacity to respond to future public health security threats. They embraced the idea of the New Public Health Order for Africa to build public health institutions and workforces, expand manufacturing of critical medical supplies, increase public health resources, and build balanced and respectful partnerships ("Call to Action: Africa's New Public Health Order" 2022). In the years since the emergence of COVID-19, the AU and Africa CDC seized on the momentum created by the pandemic to build public health institutions and to take concrete action to begin to implement their vision for a New Public Health Order for Africa. This article focuses on how the response of the AU and Africa CDC to COVID-19 is driving an evolution in public health within Africa and the emerging impacts on global health governance more generally. It demonstrates that Africa is creating a space between state-based public health and global health governance by regionalizing public health to enhance Africa’s capacity and agency.