Looking Beyond Supply Chains to Assess Health System’s Response to Outbreaks

Whenever there is a global health emergency, those of us who live and breathe disaster preparedness are asked a lot of questions about health supply chains and their connection to health care operations. Questions include: “How many of our drugs are made outside the U.S.?” “How much of drug X is available in the United States right now?” and “What does this mean for hospitals?” 

The crux of these queries is related to understanding the linkage between the health supply chains and public health, especially considering current increased demands on health care during an intense flu season and a looming possible pandemic. These lines of questioning do little to illuminate the actual challenges faced in a large-scale health emergency impacting the entire health care sector. 

In this moment, when many folks are stepping up and doing their best to understand a response that is already in motion, it would be most helpful to look at the bigger picture and ask how health care supply chains work when most effective, and whether the preparedness measures and investments already in place are sufficient to ready the system for inevitable emergencies.

The good news is that we have health care supply chains that work well most days, for most products. Under normal circumstances, our health care supply chain and related logistics function so efficiently that average people do not think about how the medicines they or their loved ones need get to the health care facility they depend on — until there is a potential strain. During a disaster or disease outbreak, reliance on medicines and medical supplies becomes more evident, which spurs questions such as those listed above.

In reality, there is no “one-size-fits-all” answer for health sector preparedness or supply chain resilience. The demands on the entire sector — including the medical-surgical and pharmaceutical supply chains — vary significantly by the type of crisis and the resulting health care and public health needs.

We see this when looking at the medical products needed for a catastrophic hurricane (where chronic care and acute care medicines are needed most for survivors) compared to those needed for a disease outbreak (where personal protective equipment and medical countermeasures such as vaccines and treatments are essential). These different product needs impact health care supply chains in different ways.

When a catastrophic event impacts a few large jurisdictions, suppliers can rapidly shift product and deliver it to responding health care facilities. At that point, the logistics, coordination and dispensing is focused on distribution and the last mile, to include the very important dispensers and providers that are needed to deliver supplies and care.

Disease outbreaks create a different set of adjustments, as additional medical products and equipment are necessary to assist with mitigation and containment of the outbreak, while also preparing health care facilities with the products they need should the outbreak persist. This demand does not shift the existing demand for routine medical products required for health care operations. This compiled, or compounded, demand during disease outbreaks contributes to the heightened focus on manufacturing, especially as the uncertainty of the progression of a disease outbreak can shift the expected demand for medical products.

Preparedness for the health care sector, including the supply chain, is not as simple as an assembly line, where, if each component just does its part, we end up with a fully prepared system at the end. Our health care system is too complex and interdependent for that. Rather, successful integration of these efforts is a recognition that key players in the sector — health care facilities and supply chain owners and operators — are part of our nation’s critical infrastructure and need to be involved in planning and response to ensure a safe, coordinated, rapid response capacity.

The COVID-19 outbreak is a reminder that the best way to manage an emergency is with a well-resourced preparedness plan and accompanying capabilities that are sustainably supported through stable funding for all components of the health care and public health system. While we build plans to respond to this outbreak, we should also be intentional about assessing the mechanisms that require better investment to prepare the system for future outbreaks.

It is crucial that we collectively have a grasp on this holistic understanding of health care and public health preparedness and view the health care supply chain as an integral part of this system. As critical decision-making on funding at the federal level is underway, and as focus on the health care supply chain sharpens, there is an opportunity to educate and advocate for an integrated understanding of health care infrastructure that includes the roles of hospitals and health systems, pharmacies, clinics and other types of ancillary care, manufacturing, supply chain, transportation, and care delivery.

For many years, experts in preparedness and response warned of a time when we would see continuous extreme events that could strain our system — a “new normal.” Since 2017, it is fair to say that we have seen events that have exposed our vulnerabilities and strained our systems in various ways, requiring response and recovery funding to meet the needs of communities (and survivors) after those events.

At some point, we have to concede that this is the “new normal” that we once warned about, and investments in mitigation and readiness will do more to protect communities than a cyclical (and uncertain) series of response/recovery investments. If we are serious about protecting communities, we have to look for ways to invest in health care and public health preparedness and response in ways that move us toward a stronger, more resilient system.


Dr. Nicolette Louissaint serves as the executive director of Healthcare Ready, where she leads organizational initiatives to meet the most pressing patient needs before, during and after natural disasters, disease outbreaks and catastrophic events.

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