Expect more supply chain shortages in things we need
It’s my baby or theirs,” NatashaMarie Kohler told the Greeley Tribune. “I feel like I’m on a terrible show that makes you choose what baby gets to eat and which doesn’t.” Recently, families across the United States have been desperately searching for baby formula, with racial minority, rural and low-income families among the hardest hit.
This was the latest — and the most public — chapter in the failure of the U.S. medical supply chain. The reason it broke down? For far too long, leanness and efficiency have been prioritized over redundancy and resilience.
And the crisis was worse than most of the public knows. The Food and Drug Administration (FDA) has listed shortages in dozens of medical devices and 118 drugs, such as the blood thinner heparin and the anesthetic lidocaine.
There is a particularly acute shortage of intravenous (IV) contrast, a vital component of medical imaging and hospital care, used to help doctors find everything from blood clots to tumors. “Someone, somewhere, is going to show up with a stroke or a torn blood vessel,” Penn State radiologist Shervin Dean said, “and we’re not going to be able to diagnose it properly and they’re going to have a terrible outcome or die.”
This story has played out before. In 2017, Hurricane Maria destroyed Puerto Rico’s electrical grid, disrupting manufacturing for 30 critical pharmaceuticals produced solely or primarily on the island — 14 of which had no other substitute.
Because of this over-reliance on the Puerto Rican medical industry, the hurricane put the U.S. “on the brink of a significant public health crisis,” according to a congressional letter from the American Hospital Association. In the aftermath, however, little federal action was taken to secure our medical supply chains, leaving them vulnerable to further fracture.
Unfortunately, medical supply chains are rife with vulnerability through single points of failure. With the baby formula shortage, it’s a shared monopoly. Four U.S. companies control about 90% of the market, so the shutdown of one Abbott Nutrition factory in Sturgis, Michigan, shocked the entire national market.
For IV contrast, a COVID-19-related shutdown of a GE Healthcare plant in China caused similar shortages across the U.S. Supplies reportedly ran 20% below normal levels in New York.
Recently President Biden invoked the Defense Production Act to address the shortage of formula. While short-term measures can resolve an acute crisis, securing the medical supply chain will require significant long-term investment.
First, supply chains must be diversified, so that single-point failures are minimized by distributing risk and increasing emergency capacity. As the dual shortages of baby formula and IV contrast reveal, we must take care not to swing the pendulum too far toward production entirely domestically or overseas.
Second, healthcare systems should build toward an end-to-end approach for their supply chains to cut through intermediary vendors and ensure greater quality control. For instance, the University of Pittsburgh Medical Center ( UPMC) leased a 150,000 square foot warehouse to serve as a medical supply and device fulfillment center, giving UPMC greater command over its supply chain.
Finally, greater data integration of hospital consumption and manufacturers’ sources, locations and volumes could allow healthcare systems to better predict and respond to shortages. This will require data transparency from manufacturers, which could be encouraged through federal contracting and Medicare requirements.
The beginning of the pandemic saw shortages of personal protective equipment. Now we face shortages in a laundry list of medical products. In healthcare, there has always been insufficient political will behind prevention, so we can’t underestimate the challenges behind securing the medical supply chain.
But if the federal government and medical industry don’t proactively improve preparedness and resilience, the country will suffer even worse, and deadlier, shortages than formula and contrast.