In May, clinics and patients at the University of Arizona Health Network had to delay non-urgent CT scans, which require contrast media, a type of dye injected into the body to make organs and blood vessels more visible. It is used to help diagnose a variety of diseases, including some serious conditions such as cancer and blood clots.
A strict COVID-19 lockdown in Shanghai, China shut down a plant that makes the contrast, and the 30-hospital medical center, like many others, suddenly found itself short of the vital diagnostic agent.
“The shortage has hit us very hard,” says Jeffrey Rubin, MD, chairman of the Department of Medical Imaging at the Arizona College of Medicine in Tucson and chief of clinical services for medical imaging at Banner University Medicine in Tucson.
In response, Rubin and his colleagues quickly mobilized to create a hierarchical protocol that prioritized the most critical medical procedures. If it makes sense to the patient, some tests are done using alternative equipment such as CT scans or MRIs without contrast.
Additionally, the health system sources its contrast media from two companies, only one of which was affected by the Shanghai lockdown and whose supply was not completely cut off.
But this was not the case everywhere.
Contrast media is used in 50 million exams a year in the United States, and about half of the market buys its contrast from GE Healthcare, which sources most of its products in Shanghai, says Matthew Davenport, vice chairman of the American College of Medicine. Commission on Quality and Safety in Radiology (ACR) and Professor of Radiology and Urology at Michigan Medicine, Ann Arbor.
“There was an immediate crisis for health systems that had been using GE Healthcare as their preferred vendor for iodinated contrast media,” says Davenport.
According to a GE Healthcare spokesperson, the company is currently working to restore its supply and continues to evaluate its global footprint to build resilience.
Contrast media with world events affecting supply chains, from COVID-19 lockdowns in China and manufacturing errors in the United States to rising fuel costs, just one item on a growing list of medical supplies. The war in Ukraine.
The Food and Drug Administration lists more than two dozen medical items, including personal protective equipment (PPE) such as surgical gloves and gowns, reagents for laboratory testing, and many dialysis-related products.
“[Health systems are experiencing] 8-10 times more shortages than before the pandemic,” says Kyle McKinnon, senior director of operations excellence at group purchasing company Premier. “We’re seeing more short-term shortages than ever before.”
History of deficiency
Shortages of vital medical supplies in the United States due to supply chain problems date back to World War II, when supplies of a common malaria drug originating in the Japanese-occupied East Indies were cut off. Since then, the United States has faced persistent and acute shortages in 2021, according to a study by researchers from Baylor College of Medicine in Houston, Texas.
In 2017, Hurricane Maria wiped out a major supplier of saline solution in Puerto Rico, creating a critical shortage. At the start of the COVID-19 pandemic, as deliveries of Chinese-made goods slowed, health care workers resorted to reusing PPE and making gowns from trash.
The country has also faced shortages of various types of drugs like anesthetics, antibiotics and chemotherapy agents for decades. Often, famines are exacerbated by local disasters that disrupt supply chains.
Currently, in addition to shortages caused by COVID-19 lockdowns and disruptions, the war in Ukraine has the potential to exacerbate shortages of helium, used in MRIs and CT scans, and neon, which is essential for making semiconductors used in MRIs. , pacemakers, blood pressure monitors, and other common medical devices.
As Russia no longer exports natural gas to some European countries, other countries have begun replenishing that supply via pipeline, reducing the need to convert the gas into liquid form. Because liquefaction helps extract helium from natural gas, this change blocked some helium production processes. This is on top of several helium plants that have been shut down in recent months due to safety concerns.
“What a turning point for medical supplies to be disrupted by the war in Ukraine,” says Wally Hope, a professor at the University of Michigan Rose School of Business in Ann Arbor who chairs the National Academies of Sciences, Engineering and Medicine Task Force. To study medical supply chain resilience. “These supply chains are so complex, so long, so intertwined, you get such crazy side effects.”
In addition, Ukraine is a major global supplier of neon, which may further exacerbate shortages as the war drags on.
“Right now, we haven’t seen an outright shortage of semiconductors,” MacKinnon says, but “access to it is becoming an issue.”
While the contrast media plant in Shanghai is now fully operational and hospitals across the country are gradually returning to regular supplies of its product, supply chain disruptions for this and other medical supplies are likely to continue to be affected by world events. Tinglong Dai, Ph.D., professor of operations management and business analytics at Johns Hopkins University Carey Business School.
This means that people in the medical industry, from medical students to administrators, must be prepared to adapt to disruptions as they occur and work to prevent them from occurring.
“This crisis gave us the opportunity to think through the protocol when we had contrast constraints and deficiencies,” says Rubin. “We have never experienced this before. Now we have a set of guidelines.
For affected health systems, this required various interventions, including lower dosing, performing CT scans without contrast, using alternative imaging strategies when appropriate, and triaging to perform the most urgent examinations first. Although there is no acute shortage now, Davenport suspects that if research shows that low-dose or unenhanced scanning is as effective as pre-shortage procedures, the use of iodinated contrast media will decrease.
“We have to be very attentive to what is happening around the world, especially [when it comes] to health care.”
Tinglong Dai, Ph.D
Johns Hopkins University Carey Business School
During the shortage, Rubin held a meeting with his radiology residents to discuss everything from why it’s happening to how the health system is responding. He believes that doctors need to learn to be more adaptable to whatever shortcomings and challenges their field faces.
“Often, there is much to learn in medicine [that] People in training – medical students – focus on the domain of the specialty. The macro-level operations that allow health care to operate are not really the focus,” says Rubin. “I think it’s more accepted [that] Medical students, residents and fellows [should] Should they turn more of their attention to these macro-level issues?
Dai says hospital administrators, especially procurement officers, need to be more aware of geopolitical issues and how they affect the supply chain.
“We really have to pay attention to what’s going on around the world,” he says. “Especially in the [when it comes] to health care.”
Strengthening future supply chains
In response to a request by the US Congress in the Coronavirus Aid, Relief, and Economic Security (CARES) Act of 2020, the National Academies of Sciences, Engineering, and Medicine convened a committee to assess the security of the nation’s medical product supply chain. In a report released in March, the committee made several recommendations to improve supply chain resilience.
“Medical supply chains lag behind other industries in terms of building supply chain resilience,” says Hope, who led the writing of the report.
Hurricane Katrina in 2005 caused unexpected supply chain shortages because companies didn’t realize the goods they were buying originated from the Gulf Coast. This realization has led many in supply chain logistics to better track where the various materials needed to manufacture their products come from.
But it’s still not common in the medical industry, at least in part because of a lack of transparency in the production of pharmaceuticals and other medical supplies, Hope says. Procurement officers in health systems often do not know where the companies they contract with buy and manufacture their goods.
This is especially problematic when health systems contract primarily with one company to get the best price.
“Transparency should be a step,” says Hope, explaining the committee’s basic recommendation to create a public database documenting where materials are sourced and manufactured so that experts can better analyze risk and make further recommendations to strengthen supply chains.
In addition to being aware of possible natural disasters, Dai emphasizes the importance of geopolitical awareness.
“A large part of the medical supplies comes from China. Most of the generic drugs are manufactured in India,” says Dai. “We depend on countries that are geopolitically incompatible [with] us.”
He says America can protect its future supply chain by focusing more on sourcing and manufacturing closer to home, not just in the United States, but in Canada and Latin America, or by strengthening our supply chain relationships with countries that are part of it. The North Atlantic Treaty Organization (NATO) has moved away from relying on countries with more political problems.
Hope cautions against the idea of focusing solely on “on-shoring,” the manufacturing of goods within the United States.
“It’s difficult to manufacture every raw material, every intermediate step within the U.S., [and] In some cases it is expensive to do,” he says.
Instead, there should be a variety of responses, including stockpiling raw materials, mapping supply chains to assess risk, and building contracts that force companies to minimize the risk of outright disruption, Hope says.
Many of these steps need to be taken by the federal government and manufacturers, but health care system administrators can make a difference by demanding better transparency and reliability from manufacturers and rethinking their stockpiling strategies, Hope suggests.
Another key to securing the future of the US medical supply chain is ensuring the country is at the forefront of developing innovative ideas that improve the supply chain.
“If we lose the ability to innovate, that is [would be] Devastating,” he says. “Government can play an active role [by] Invest in research and development, investing in universities and national labs and supporting new ideas.