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National Academies of Sciences, Engineering, and Medicine; Health and Medicine Division; Board on Health Sciences Policy; Committee on Security of America's Medical Product Supply Chain; Shore C, Brown L, Hopp WJ, editors. Building Resilience into the Nation's Medical Product Supply Chains. Washington (DC): National Academies Press (US); 2022 Mar 3.
Building Resilience into the Nation's Medical Product Supply Chains.
Show detailsAt the request of the U.S. Congress, the National Academies of Sciences, Engineering, and Medicine (the National Academies) convened the Committee on Security of America’s Medical Product Supply Chain to examine the security of America’s medical product supply chains and provide recommendations to improve the resilience of medical product supply chains. The sponsor of this report was the U.S. Department of Health and Human Services (HHS) Office of the Assistant Secretary for Preparedness and Response (ASPR).
COMMITTEE EXPERTISE
The National Academies formed a committee of 13 experts to deliberate on and respond to the statement of task for the study (Box 1-1). The committee comprised members with expertise in crisis standards of care, emergency and critical care medicine, drug and device development and manufacturing, drug shortages, regulatory policy, health economics, medical logistics, supply chain management, risk and emergency management, operations research, public health preparedness and response, and state and local public health. Appendix E provides biographical information for each committee member.
MEETINGS AND INFORMATION-GATHERING ACTIVITIES
The committee held five virtual full committee meetings from September 2020 to September 2021. The committee held six meetings that included portions open to the public as well as one virtual, public workshop. A summary of this workshop is captured in a Proceedings of a Workshop—In Brief.1 The agendas for these six open sessions are included at the end of this appendix.
To inform its deliberations, the committee gathered information through a variety of mechanisms including reviews of the literature on medical product supply chains and medical product shortages. Targeted literature reviews were conducted as novel issues arose throughout the committee’s deliberations. All written information provided to the committee from external sources is available by request through the National Academies’ Public Access Records Office.
Literature Search Strategy
Search Parameters:
- Date Parameters: All
- English only
- Peer-reviewed articles
- Trade publications
- Opinion publications
- Comments
- Editorial
- Reviews
- Proceedings
- Geographic region: International with a subset for the U.S.
- Humans research only
Databases:
- PubMed
- Legistorm
Search Strategy:
Part I: Essential drugs/equipment AND supply chains
Database: PubMed
Date of Search: 09/08/2020
Filters: Humans, English
Results before deduplication:
- International: 98
- U.S.: 21
# | Query |
1 | “critical devices”[Title/Abstract] OR “critical drugs”[Title/Abstract] OR “critical medication”[Title/Abstract] OR “critical medicine”[Title/Abstract] OR “priority medical devices”[Title/Abstract] |
2 | “drugs, essential”[MeSH Terms] |
3 | “active pharmaceutical ingredient”[Title/Abstract] OR “finished dosage form”[Title/Abstract] OR “health commodities”[Title/Abstract] OR “medical commodities”[Title/Abstract] OR “medical devices”[Title/Abstract] OR “medical products”[Title/Abstract] OR “drug products”[Title/Abstract] |
4 | #3 AND #2 |
5 | #1 OR #2 OR #4 |
6 | “equipment and supplies/supply and distribution”[MeSH Terms] OR “prescription drugs/supply and distribution”[MeSH Terms] |
7 | “domestic manufacturing”[Title/Abstract] OR “supply chain”[Title/Abstract] OR “supply chain capacity”[Title/Abstract] OR “supply chain contingency planning”[Title/Abstract] OR “supply chain information gaps”[Title/Abstract] OR “supply chain redundancy”[Title/Abstract] OR “supply chain sustainability”[Title/Abstract] OR “drug industry/organization and administration”[MeSH Terms] |
8 | “drug shortage”[Title/Abstract] OR “manufacturing disruption”[Title/Abstract] OR “supply chain disruption”[Title/Abstract] OR “supply chain information gaps”[Title/Abstract] OR “supply chain vulnerability”[Title/Abstract] |
9 | #6 OR #7 OR #8 |
10 | #9 AND #5 |
11 | “economic impact”[Title/Abstract] OR “trade impact”[Title/Abstract] OR “socioeconomic factors”[MeSH Terms] |
12 | #11 AND #9 |
13 | #12 AND #5 |
14 | “disease outbreaks”[MeSH Terms] OR “epidemics”[MeSH Terms] OR “pandemics”[MeSH Terms] OR “public health”[MeSH Terms] OR “health security”[Title/Abstract] OR “national security”[Title/Abstract] |
15 | “disaster medicine/organization and administration”[MeSH Terms] OR “disaster planning/organization and administration”[MeSH Terms] OR “disaster planning/trends”[MeSH Terms] OR “emergency medicine/organization and administration”[MeSH Terms] OR “emergency medicine/standards”[MeSH Terms] OR “emergency medicine/trends”[MeSH Terms] OR “risk management/organization and administration”[MeSH Terms] |
16 | #14 OR #15 |
17 | #16 AND #5 |
18 | (“united states”[MeSH Terms] OR “united states”[Title] OR “u.s.”[Title] OR “american”[Title] OR “america”[Title] OR “united states”[Title/Abstract] OR “u.s.”[Title/Abstract] OR “u.s.a.”[Title/Abstract]) NOT (“americas”[Title/Abstract] OR “latin america”[Title/Abstract] OR “south america”[Title/Abstract] OR “central america”[Title/Abstract] OR “latin america”[MeSH Terms] OR “south america”[MeSH Terms] OR “central america”[MeSH Terms]) |
19 | #10 OR #13 OR #17 |
20 | #19 AND #18 |
21 | “ambulatory”[Title] OR “animal model”[Title] OR “biological assay”[Title] OR “blood”[Title] OR “cbrn exposure”[Title] OR “dose-response”[Title] OR “drills”[Title] OR “eye care”[Title] OR “gain of function”[Title] OR “glucose”[Title] OR “licensure”[Title] OR “liver injury”[Title] OR “mass dispensing”[Title] OR “mass vaccination”[Title] OR “meter”[Title] OR “mice”[Title] OR “mouse”[Title] OR “neglected disease”[Title] OR “one health”[Title] OR “pathophysiology”[Title] OR “points of dispensing”[Title] OR “post-exposure”[Title] OR “schools”[Title] OR “transfusion”[Title] OR “veterinary”[Title] |
22 | #20 NOT #21 |
23 | #10 OR #17 |
24 | #23 NOT #21 |
Part II: Essential drugs/equipment AND Standards of care
Database: PubMed
Date of Search: 09/08/2020
Filters: Humans, English
Results before deduplication:
- International: 21
- U.S.: 1
# | Query |
1 | “critical devices”[Title/Abstract] OR “critical drugs”[Title/Abstract] OR “critical medication”[Title/Abstract] OR “critical medicine”[Title/Abstract] OR “priority medical devices”[Title/Abstract] |
2 | “drugs, essential”[MeSH Terms] |
3 | “active pharmaceutical ingredient”[Title/Abstract] OR “finished dosage form”[Title/Abstract] OR “health commodities”[Title/Abstract] OR “medical commodities”[Title/Abstract] OR “medical devices”[Title/Abstract] OR “medical products”[Title/Abstract] OR “drug products”[Title/Abstract] |
4 | #3 AND #2 |
5 | #1 OR #2 OR #4 |
6 | (“crisis”[Title/Abstract] OR “crises” [Title/Abstract]) AND “standards of care”[Title/Abstract] |
7 | “critical care”[Title/Abstract] OR “emergency care”[Title/Abstract] OR “emergency management”[Title/Abstract] OR “risk management”[Title/Abstract] |
8 | “standard of care”[MeSH Terms] OR “delivery of health care/standards”[MeSH Terms] |
9 | #6 OR #7 OR #8 |
10 | #9 AND #5 |
11 | (“united states”[MeSH Terms] OR “united states”[Title] OR “u.s.”[Title] OR “american”[Title] OR “america”[Title] OR “united states”[Title/Abstract] OR “u.s.”[Title/Abstract] OR “u.s.a.”[Title/Abstract]) NOT (“americas”[Title/Abstract] OR “latin america”[Title/Abstract] OR “south america”[Title/Abstract] OR “central america”[Title/Abstract] OR “latin america”[MeSH Terms] OR “south america”[MeSH Terms] OR “central america”[MeSH Terms]) |
12 | #10 AND #11 |
13 | “ambulatory”[Title] OR “animal model”[Title] OR “biological assay”[Title] OR “blood”[Title] OR “cbrn exposure”[Title] OR “dose-response”[Title] OR “drills”[Title] OR “eye care”[Title] OR “gain of function”[Title] OR “glucose”[Title] OR “licensure”[Title] OR “liver injury”[Title] OR “mass dispensing”[Title] OR “mass vaccination”[Title] OR “meter”[Title] OR “mice”[Title] OR “mouse”[Title] OR “neglected disease”[Title] OR “one health”[Title] OR “pathophysiology”[Title] OR “points of dispensing”[Title] OR “post-exposure”[Title] OR “schools”[Title] OR “transfusion”[Title] OR “veterinary”[Title] |
14 | #12 NOT #13 |
15 | #10 NOT #13 |
Part III: Essential drugs/equipment AND Accessibility/Equity
Database: PubMed
Date of Search: 09/08/2020
Filters: Humans, English
Results before deduplication:
- International: 716
- U.S.: 72
# | Query |
1 | “critical devices”[Title/Abstract] OR “critical drugs”[Title/Abstract] OR “critical medication”[Title/Abstract] OR “critical medicine”[Title/Abstract] OR “essential medicines”[Title/Abstract] OR “medical countermeasures”[Title/Abstract] OR “priority medical devices”[Title/Abstract] |
2 | “drugs, essential”[MeSH Terms] |
3 | “active pharmaceutical ingredient”[Title/Abstract] OR “finished dosage form”[Title/Abstract] OR “health commodities”[Title/Abstract] OR “medical commodities”[Title/Abstract] OR “medical devices”[Title/Abstract] OR “medical products”[Title/Abstract] OR “drug products”[Title/Abstract] |
4 | #3 AND #2 |
5 | #1 OR #2 OR #4 |
6 | “access to health care”[Title/Abstract] OR “accessibility”[Title/Abstract] OR “accessibility of health services”[Title/Abstract] OR “distribution”[Title/Abstract] OR “equity”[Title/Abstract] OR “health care delivery”[Title/Abstract] |
7 | “delivery of health care”[MeSH Terms] OR “health equity”[MeSH Terms] OR “health services accessibility”[MeSH Terms] |
8 | #6 OR #7 |
9 | #8 AND #5 |
10 | (“united states”[MeSH Terms] OR “united states”[Title] OR “u.s.”[Title] OR “american”[Title] OR “america”[Title] OR “united states”[Title/Abstract] OR “u.s.”[Title/Abstract] OR “u.s.a.”[Title/Abstract]) NOT (“americas”[Title/Abstract] OR “latin america”[Title/Abstract] OR “south america”[Title/Abstract] OR “central america”[Title/Abstract] OR “latin america”[MeSH Terms] OR “south america”[MeSH Terms] OR “central america”[MeSH Terms]) |
11 | #9 AND #10 |
12 | “ambulatory”[Title] OR “animal model”[Title] OR “biological assay”[Title] OR “blood”[Title] OR “cbrn exposure”[Title] OR “dose-response”[Title] OR “drills”[Title] OR “eye care”[Title] OR “gain of function”[Title] OR “glucose”[Title] OR “licensure”[Title] OR “liver injury”[Title] OR “mass dispensing”[Title] OR “mass vaccination”[Title] OR “meter”[Title] OR “mice”[Title] OR “mouse”[Title] OR “neglected disease”[Title] OR “one health”[Title] OR “pathophysiology”[Title] OR “points of dispensing”[Title] OR “post-exposure”[Title] OR “schools”[Title] OR “transfusion”[Title] OR “veterinary”[Title] |
13 | #11 NOT #12 |
14 | #9 NOT #12 |
Part IV: Medical countermeasure/Stockpile AND Supply
Database: PubMed
Date of Search: 09/08/2020
Filters: Humans, English
Results before deduplication:
- International: 19
- U.S.: 18
# | Query |
1 | “medical countermeasures”[Title/Abstract] OR “stockpile”[Title/Abstract] OR “strategic stockpile”[Title/Abstract] |
2 | “strategic stockpile”[MeSH Terms] OR “strategic stockpile/organization and administration”[MeSH Terms] OR “strategic stockpile/trends”[MeSH Terms] |
3 | #1 OR #2 |
4 | “domestic manufacturing”[Title/Abstract] OR “supply chain”[Title/Abstract] OR “supply chain capacity”[Title/Abstract] OR “supply chain contingency planning”[Title/Abstract] OR “supply chain information gaps”[Title/Abstract] OR “supply chain redundancy”[Title/Abstract] OR “supply chain sustainability”[Title/Abstract] OR “drug industry/organization and administration”[MeSH Terms] |
5 | “equipment and supplies/supply and distribution”[MeSH Terms] OR “prescription drugs/supply and distribution”[MeSH Terms] |
6 | #4 OR #5 |
7 | #3 AND #6 |
8 | (“united states”[MeSH Terms] OR “united states”[Title] OR “u.s.”[Title] OR “american”[Title] OR “america”[Title] OR “united states”[Title/Abstract] OR “u.s.”[Title/Abstract] OR “u.s.a.”[Title/Abstract]) NOT (“americas”[Title/Abstract] OR “latin america”[Title/Abstract] OR “south america”[Title/Abstract] OR “central america”[Title/Abstract] OR “latin america”[MeSH Terms] OR “south america”[MeSH Terms] OR “central america”[MeSH Terms]) |
9 | #7 AND #8 |
10 | “ambulatory”[Title] OR “animal model”[Title] OR “biological assay”[Title] OR “blood”[Title] OR “cbrn exposure”[Title] OR “dose-response”[Title] OR “drills”[Title] OR “eye care”[Title] OR “gain of function”[Title] OR “glucose”[Title] OR “licensure”[Title] OR “liver injury”[Title] OR “mass dispensing”[Title] OR “mass vaccination”[Title] OR “meter”[Title] OR “mice”[Title] OR “mouse”[Title] OR “neglected disease”[Title] OR “one health”[Title] OR “pathophysiology”[Title] OR “points of dispensing”[Title] OR “post-exposure”[Title] OR “schools”[Title] OR “transfusion”[Title] OR “veterinary”[Title] |
11 | #9 NOT #10 |
12 | #7 NOT #10 |
Part IV: Legislation from the U.S. Congress (both House and Senate), Government Accountability Office, the Executive Office (Executive Orders), and Congressional Research Service
Database: Congress.gov AND Legistorm
Date: April-May 2021
Results:
- U.S.:19
1 | “medical” AND “supply chain” |
2 | “medical supply chain” AND “data sharing” |
3 | “medical supply chain” AND “medical devices” |
4 | “medical supply chain” AND “PPE” |
5 | “medical supply chain” AND “Personal Protective Equipment” |
6 | “medical supply chain” AND “drug shortages” |
PUBLIC AGENDAS
AGENDA
Monday, September 21, 2020 Zoom Webinar
SESSION I DISCUSSION ON THE SCOPE AND CONTEXT OF THE STUDY CHARGE
Session I Objective: To hear from the sponsor of the study regarding their perspectives on the charge to the committee
11:00 a.m. |
|
11:10 a.m. |
|
| |
11:25 a.m. |
|
11:30 a.m. | Discussion with Committee |
12:15 p.m. | Break (30 mins) |
SESSION II ADDITIONAL CONTEXT FOR THE STUDY
Session II Objective: To hear from the sponsor of the study regarding their perspectives on the charge to the committee
12:45 p.m. | Stakeholder and Regulatory Perspectives Panel
|
| |
| |
| |
1:15 p.m. | Discussion with Committee |
2:00 p.m. | ADJOURN |
AGENDA
Monday, December 1–2, 2020
Zoom Webinar
Workshop Objectives
- Discuss key considerations for the formulation of a unified list of critical medical products;
- Examine current lists of critical/essential medical products with attention to how these lists were developed and how they are used to inform decisions;
- Consider tactical approaches for improving supply chain resilience;
- Consider on-the-ground perspectives from end users of the medical supply chain (e.g., patients, clinicians, health systems) when it comes to:
- what makes a medical product critical; and
- outcome measures that matter to end users.
Day 1: December 1, 2020 (12:00 p.m.–3:30 p.m. ET)
12:00 p.m. |
|
SESSION I KEY CONSIDERATIONS FOR ESTABLISHING A FRAMEWORK FOR CRITICAL MEDICAL PRODUCTS
Session I Objectives: To discuss key considerations for the formulation of a unified list of critical medical products as it relates to this study; discuss how these considerations relate to
- Demand surge and supply shocks;
- The severity of effects on an individual affected by a shortage versus the number of people potentially affected by a shortage;
- Outcome measures that matter to end users; and
- Products that are most at risk (e.g., difficulty of manufacturing).
12:15 p.m. |
|
| |
| |
| |
| |
12:45 p.m. | Discussion with Committee |
1:30 p.m. | Break (45 minutes) |
SESSION II CRITICAL/ESSENTIAL MEDICAL PRODUCTS LISTS
Session II Objectives: To examine current lists of critical/essential medical products with attention to how these lists were developed and how they are currently being used to inform decisions; discuss lessons learned and/or generalizable approaches for the formulation of a unified list of critical medical products for purposes of this study.
2:15 p.m. |
|
| |
| |
| |
| |
2:45 p.m. | Discussion with Committee |
3:30 p.m. | ADJOURN WORKSHOP DAY 1 |
DAY 2: DECEMBER 2, 2020 (11:30 A.M.–3:30 P.M. ET)
11:30 a.m. |
|
SESSION III PRACTICAL AND TACTICAL APPROACHES FOR EXECUTING A FRAMEWORK FOR CRITICAL MEDICAL PRODUCTS
Session III Objectives: To discuss generalizable lessons learned when it comes to implementing a resilient supply chain for critical medical products; consider practical and tactical approaches for executing a framework for critical medical products.
11:45 a.m. |
|
| |
| |
| |
| |
12:15 p.m. | Discussion with Committee |
1:00 p.m. | Break (45 minutes) |
SESSION IV END USER PERSPECTIVES: WHAT MAKES A MEDICAL PRODUCT CRITICAL?
Session IV Objective: Consider on-the-ground perspectives from end users of the medical supply chain (e.g., patients, clinicians, health systems) when it comes to
- What makes a medical product critical;
- Outcome measures that matter to end users when it comes to supply chain resilience and success.
1:45 p.m. |
|
| |
| |
| |
| |
| |
2:30 p.m. | Discussion with Committee |
3:15 p.m. |
|
3:30 p.m. | ADJOURN WORKSHOP DAY |
AGENDA
Monday, April 23, 2020
Zoom Webinar
Meeting Objective
- To gather information on issues related to improving the resilience of medical product supply chains including: innovation and technology; geopolitical risks and national security; and on-shoring
12:30 p.m. |
|
SESSION I INNOVATION AND TECHNOLOGY CONSIDERATIONS
Session I Objective: To gather information on innovation and technology (e.g., blockchain, artificial intelligence, continuous manufacturing) applications that can improve transparency, risk assessments, and manufacturing capacity, and ultimately improve the resilience of medical product supply chains.
12:45 p.m. |
|
| |
| |
| |
| |
1:05 p.m. | Discussion with Committee |
1:45 p.m. | Break (15 minutes) |
SESSION II GEOPOLITICAL, NATIONAL SECURITY, AND ON-SHORING CONSIDERATIONS
Session II Objective: To gather information on the totality of geopolitical and national security risks to U.S. medical product supply chains and whether on-shoring manufacturing of critical drugs and devices would protect U.S. medical product supply chains.
2:00 p.m. |
|
| |
| |
| |
2:15 p.m. | Brief Discussion with Committee |
2:30 p.m. |
|
| |
2:45 p.m. | Full Discussion with Committee Regarding Geopolitical Risks, National Security, and On-Shoring |
4:00 p.m. | ADJOURN OPEN SESSION |
AGENDA
Wednesday, June 9, 2021
2:30 p.m.–5:00 p.m. ET
Zoom Webinar
Meeting Objective
- To gather information on issues related to medical device supply chains
2:30 p.m. |
|
SESSION I MEDICAL DEVICE SUPPLY CHAIN CONSIDERATIONS
Objective:
- To gather information on medical device supply chains including, the current landscape, issues related to resilience (e.g., characteristics of device shortages, the management of device shortages, the effects of device shortages, tools for preventing device shortages), and similarities and differences between the drug and device supply chains.
2:45 p.m. |
|
| |
| |
3:00 p.m. | Discussion with Committee |
4:00 p.m. | Break (15 minutes) |
SESSION II UPDATE ON COMMISSIONED ECONOMIC ANALYSIS
4:15 p.m. |
|
4:30 p.m. | Discussion with Committee |
5:00 p.m. | ADJOURN OPEN SESSION |
AGENDA
Wednesday, August 18, 2021
1:30 p.m.–2:30 p.m. ET
Zoom Webinar
Meeting Objective
- To gather information on current FDA and ASPR activities related to increasing the resilience of medical product supply chains
1:30 p.m. |
|
SESSION I FEDERAL UPDATES
Objective: To gather information on current FDA and ASPR activities related to increasing the resilience of medical product supply chains
1:35 p.m. |
|
1:45 p.m. |
|
1:55 p.m. | Discussion with Committee |
2:30 p.m. | ADJOURN OPEN SESSION |
AGENDA
Wednesday, October 6, 2021
1:00 p.m.–3:00 p.m. ET
Zoom Webinar
Meeting Objectives
- Open session to gather additional information on trade policy as it relates to
- Restrictions on export bans of medical products; and
- International information sharing on the details of medical product supply chains
1:00 p.m. |
|
1:05 p.m. |
|
| |
1:50 p.m. |
|
| |
| |
3:00 p.m. | Adjourn Meeting |
Footnotes
- 1
- COMMITTEE EXPERTISE
- MEETINGS AND INFORMATION-GATHERING ACTIVITIES
- SESSION I DISCUSSION ON THE SCOPE AND CONTEXT OF THE STUDY CHARGE
- SESSION II ADDITIONAL CONTEXT FOR THE STUDY
- SESSION I KEY CONSIDERATIONS FOR ESTABLISHING A FRAMEWORK FOR CRITICAL MEDICAL PRODUCTS
- SESSION II CRITICAL/ESSENTIAL MEDICAL PRODUCTS LISTS
- SESSION III PRACTICAL AND TACTICAL APPROACHES FOR EXECUTING A FRAMEWORK FOR CRITICAL MEDICAL PRODUCTS
- SESSION IV END USER PERSPECTIVES: WHAT MAKES A MEDICAL PRODUCT CRITICAL?
- SESSION I INNOVATION AND TECHNOLOGY CONSIDERATIONS
- SESSION II GEOPOLITICAL, NATIONAL SECURITY, AND ON-SHORING CONSIDERATIONS
- SESSION I MEDICAL DEVICE SUPPLY CHAIN CONSIDERATIONS
- SESSION II UPDATE ON COMMISSIONED ECONOMIC ANALYSIS
- SESSION I FEDERAL UPDATES
- Study Methods and Public Agendas - Building Resilience into the Nation's Medical...Study Methods and Public Agendas - Building Resilience into the Nation's Medical Product Supply Chains
- Preface - Building Resilience into the Nation's Medical Product Supply ChainsPreface - Building Resilience into the Nation's Medical Product Supply Chains
- Ballerus ballerus voucher NRM:46859 16S ribosomal RNA gene, partial sequence; mi...Ballerus ballerus voucher NRM:46859 16S ribosomal RNA gene, partial sequence; mitochondrialgi|651209281|gb|KJ128678.1|Nucleotide
- Halichoeres garnoti 12S ribosomal RNA gene, partial sequence; mitochondrialHalichoeres garnoti 12S ribosomal RNA gene, partial sequence; mitochondrialgi|1321303753|gb|MG665324.1|Nucleotide
- Abramis ballerus internal transcribed spacer 1 and 5.8S ribosomal RNA gene, part...Abramis ballerus internal transcribed spacer 1 and 5.8S ribosomal RNA gene, partial sequencegi|238820464|gb|FJ945326.1|Nucleotide
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