Care of the Critically ill and Injured During Pandemics and Disasters: Results
Periodic disruptions in medical supply chains can occur along the continuum of the manufacturing process from the availability of raw materials to final packaging and distribution. Although large-scale disasters can result in large and far-reaching shortages of a wide array of manufactured goods, substantial supply chain disruptions can be caused by seemingly benign events, such as normal fluctuations in materials and labor or even a manufacturing platform upgrade.’ An example of the dramatic impact of seemingly unrelated events on availability of medical supplies was the global shortage of medical examination gloves in the summer of 2008 due, in large part, to the temporary scheduled closure in China of one of the world’s largest manufacturers of medical examination gloves in an effort to improve air quality during the 2008 Beijing Olympic Games.”
The increased global manufacturing interdependence also introduces quality assurance variability to medications and medical supplies. Lapses in quality assurance have led to fatal hypersensitivity reactions caused by manufacturing defects in IV heparin and fatal fungal meningitis caused by contamination of IV methylprednisolone acetate.
There have been fewer companies globallyproducing key components of medical supplies and of active pharmaceutical ingredients (APIs), most notably sterile, injectable medications. The global reliance on fewer manufacturers may not be readily apparent to health-care institutions, as APIs are often reformulated, compounded, and packaged by several different companies, resulting in the finished product being available from several sources, despite the limited number of key ingredient manufacturers. As examples, a single plant in Demark is the source for more than 40% of the world’s supply of insulin; China is the API source for 90% of the world’s vitamins and nutritional supplements, 70% of the world’s penicillin, 50% of the world’s aspirin, and 35% of the world’s acetaminophen; and Indian and Chinese companies supply 40% of the APIs used in US-made pharmaceuticals. The US Food and Drug Administration and American Society of Health-System Pharmacists both maintain updated lists of medication shortages that are available online.