US Health Care Earns an "F" for poor flu supply chain practices
Scott McPherson
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America's struggles with a major flu epidemic (my words, but I will be borne out) have produced several revelations. The first is the complete lack of institutional memory when it comes to pandemic supply chain preparations. If I taught this mantra once, I taught it a hundred times, in a hundred lectures and seminars, from coast to coast, over a period of eleven years: Check your upstream and downstream suppliers for their pandemic preparedness. If they are unprepared, find new or secondary suppliers.
This is not just a health care warning. It is intended for any organization that does anything, makes anything, or services anything. If you search my blogsite, you will find previous references to this need. I have spoken to people all over America about it. I have had conversations with organizations as large as 3M -- and people as well-known and important as Michael Dell -- about pandemic supply chain management.
In my lectures, I also point out that Nature has a way of piling on disasters. For instance, 75% of all flu pandemics occur outside of flu season. We are coming up on the 100th anniversary of the 1918 Spanish Flu pandemic, the worst flu pandemic in recorded history. It is commonly believed to have started on a farm in Kansas in the spring of 1918.
Well, Nature really piled on this time. Difference is, it piled on in ways we were not thinking about. Puerto Rico used to (pre-Hurricane Maria) manufacture the overwhelming majority of IV bags that are used in American hospitals. I am sure you have read, heard or seen the news stories. Because those facilities are only now getting their power back, there are severe shortages of those IV bags everywhere. Here are two stories:
http://wgntv.com/2018/01/16/iv-bag-shortage-has-hospitals-scrambling-to-treat-flu/
http://www.cnn.com/2018/01/16/health/iv-bag-shortage/index.html
But the warning signs were there, as early as last October. My friend Dr. Michael Osterholm of CIDRAP and one of the world's leading experts on infectious disease said as much. In a Newsweek story dated October 12, 2017:
Michael Osterholm, director of the Center for Infectious Disease Research and Policy at the University of Minnesota tells Newsweek that the United States relies on foreign trade for many medical needs. About 30 essential items, these include hospital supplies like IV bags and everyday drugs, are made outside of the U.S. A pandemic in India or China could keep people home from work, which would impact manufacturing.
“If anything happens to disrupt the supply, we wouldn’t have any of it,” Osterholm asserts. “We would suddenly see a tremendous amount of collateral damage,” he warns, stressing that it’s not the flu infection itself that could be deadly, but rather the consequences that follow. “The flu will accentuate all of the other health problems that we have.”
Bingo, Mike. As usual, you hit the nail on the head. Another warning shot was fired in October by Modern Healthcare, http://www.modernhealthcare.com/article/20171004/NEWS/171009964 . An excerpt:
Sodium chloride and dextrose are vital drugs used every day in hospitals around the country, said Chris Snyder, drug information pharmacist at Cleveland Clinic who manages shortages and recalls.
"We're talking about two manufacturers that support nearly the entire U.S. and one of them is out and the other manufacturer doesn't have enough supply to make up for it," he said.
While the Cleveland Clinic has the benefit of a drug compounding facility on-site that will partially insulate it from the shortage, Chief Pharmacy Officer Scott Knoer said he is waiting for the other shoe to drop as other suppliers are exhausted.
"The whole country will be scrambling," Knoer said. "I'm waiting for the cascade effect of this. This has major implications for hospitals everywhere."
The latest shortage is one of many in recent years resulting from manufacturing delays. Experts blame a lack of competition among drug manufacturers, which are increasingly consolidating to offset high production and compliance costs.
Baxter and ICU Medical—which acquired Hospira from Pfizer in February—provide the bulk of IV fluids, while B. Braun provides a much smaller share.
We knew we were going to have shortages of IV bags two full months before this year's flu epidemic erupted. And yet the wheels turned slowly in Washington, with only recent movement toward permitting the importation of IV bags and saline from nations such as Switzerland.
But the hospital industry is suspiciously sounding like the Claude Rains character from Casablanca. They are shocked -- shocked! -- to find there are supply chain problems with IV bags, blaming others (perhaps accurately) while not accepting a measure of blame themselves for allowing such conditions to thrive. No one had a problem buying IV bags on the cheap from Baxter, manufactured in one location (what I call "castling oneself into checkmate"). That is, until Maria. Putting all your IV bags into one basket was a terrible and possibly fatal strategy.
Now we are also seeing spot shortages of antivirals such as Tamiflu and its generic equivalent. From WSB Atlanta:
How we have drifted (flu people get the pun) from the razor-sharp pandemic preparedness mindset of 2006-2009 into the funk we are currently in today. We had a pandemic in 2009, but it was not nearly as lethal as we feared. For that we say Thank the Maker!
I thought we had retained that knowledge and those lessons and cautionary tales. That is one reason why I ceased writing blogs about pandemic preparations. Seems I was wrong. We need a complete reboot of the awareness and education efforts from the last decade.
The effort begins anew for me, today.
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