The Nation's Medical Countermeasure Stockpile Opportunities to Improve the Efficiency, Effectiveness, and Sustainability of the CDC Strategic National Stockpile: Workshop Summary (2016) / Chapter Skim
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6 Potential Supply-Chain Opportunities and Lessons from the Commercial Sector and Government Partners
6 Potential Supply-Chain Opportunities and Lessons from the Commercial Sector and Government Partners
Pages 85-102
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From page 85... ...
The paper also looked at lessons from responses to events such as natural disasters, naturally occurring outbreaks, and the 2001 anthrax attacks. She commented: We view the public health response supply chain really as an effort that involves not only procurement and distribution of medical and pharma ceutical supplies but more broadly, we think it is about the personnel involved in response and information.
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From page 86... ...
Commercial supply chains are very efficient in managing inventories and inventory flows, explained Brandeau. However, she advised that the public health response supply chain may well need a more robust network
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From page 87... ...
requiring a transportation network Flow of information Flow of people (may require a different kind of transportation network than for material) Organizations/Businesses Buildings/Physical spaces People FIGURE 6-1 Public health response supply chain.
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From page 88... ...
A related issue is that the very lean level of inventory favored by commercial supply chains may not be as desirable in public health supply chains (which also very often have items needed for response that may need to be quickly manufactured -- another key aspect of planning)
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From page 89... ...
Brandeau maintained that even though the public health response supply chain is rarely activated, "we can and must learn from experience." BOX 6-1 Supply-Chain Surge Capacity Monique Mansoura, head, Medical Countermeasures and Government ffairs, A Americas, Novartis Influenza Vaccines, raised the issue of surge capacity for systems that are designed for efficiencies under very different circumstances. If commercial supply chains are designed for efficiencies and yet there is surge of 2×, 10×, 100×, 1,000×, or even 1,000,000×, Mansoura asked at what point the Strategic National Stockpile (SNS)
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From page 90... ...
Perpetual inventory files are electronically transmitted on a weekly basis to identify and report any inventory discrepancies, which are then investigated and reconciled. Internal warehouse product movement files are electronically transmitted on a daily basis to ensure the integrity of product location within the facility.
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From page 91... ...
Frederick described how a dedicated team of employees at Custom Critical is responsible for working with CDC. Shipments are moved for CDC as required, but the team's primary focus is carrying out regularly scheduled drills (monthly, with a major drill yearly)
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From page 92... ...
The VHA is the largest integrated health care system in the country, comprising 167 medical centers and 1,026 outpatient clinics.3 He outlined several ways that the VA stockpile differs from the SNS. It is primarily intended to ensure easy accessibility and rapid access to large quantities of commonly used medical supplies and countermeasures as determined by hazards vulnerability assessments at the national, regional, and local levels; 2 This practice eliminates the "hourglass effect" that occurs when too many employees are attempting to pull product from the same aisle.
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From page 93... ...
It is integrated and can be replenished quickly through routine supply chains, as necessary, and is scalable to meet small surge needs for routine care at the local level or larger-scale crises at the regional or national level. Radonovich explained that the VA stockpile is designed for response to CBRN events and, as such, its content categories include antibiotics, antivirals, emergency medications, chemical countermeasures, intravenous (IV)
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From page 94... ...
Noting that the VA stockpile is used regularly to relieve drug shortages, Carlin asked about the decision-making process and how the potential negative consequences are balanced with the benefits. Radonovich explained that it is needs based, not a formula.
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From page 95... ...
Zotomayor explained that prior to the 1990s, medical troop support was a stockpile-heavy organization, but during Operations Desert Shield and Desert Storm, the support provided was not optimal due to both the lack of responsiveness to time lines and the fact that the items being pushed out were not actually needed or used by deployed forces. That forced DLA to reorganize, realizing the warehousing and depot strategy was not optimal.
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From page 96... ...
Surge Requirements and Readiness Contracts During a surge requirement, Zotomayor explained that the military forces maintain a limited amount of stock in their own units and are supported with AMMA sites. Beyond that, DLA relies primarily on readiness contracts with the health care industry through which they purchase guaranteed access to materiel or production capability with time-phased deliveries that minimize DLA's requirement to stockpile and maintain material at our distribution depots (see Figure 6-3)
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From page 97... ...
Looking at R03033 things from a broader government perspective and incorporating other gov raster -- not editable ernment partners regarding procurement of medical supplies is important because of competition in sources of supply. DLA is currently conducting industrial preparedness planning assessments, a collaborative effort among DLA Medical Troop Support, the Armed Services, and the health care industry to assess industrial capabilities of manufacturers and distributors to provide materiel to meet the time-phased mobilization and sustainment requirements of the Services.
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From page 98... ...
Mansoura suggested that relationships with industry need more attention, as the notion of developing products with an indefinite shelf life, for example, would likely be detrimental from the perspective of the manufacturer: "things that are upside and cost-efficient on the government side are potentially the opposite on the other side of the partnership." She noted that vaccines, for example, are a particularly fragile system; expanding production will require looking at some of the broader, strategic, and systemlevel issues in the vaccine industry. Khan suggested the use of reverse inventory contracts such that SNS materials can be returned to industry partners if requested for distribution through their routine supply chains in order to address nationwide need, and then replenished with new materials.
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From page 99... ...
SNS Role in Fiscally Sustaining the MCM Industry Referring to economic tension between the Division of Strategic National Stockpile's (DSNS's) desire for lower-cost countermeasures and the limited market viability of some of the products it stockpiles, Sosin maintained that the SNS's role in fiscally sustaining the MCM production is a legitimate one, but pointed to the question of whether that optimizes the use of resources for the spectrum of risk: "Does it buy down the most risk?
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From page 100... ...
Pharmaceutical supply-chain security will pose an issue going forward, but again, he noted that the SNS does not have the financial capability to move into that space except for specifically targeted concerns that must be addressed. POTENTIAL OPPORTUNITY FOR IMPROVED ELECTRONIC DATA INTERCHANGE Mattingly highlighted areas for improvement with respect to EDI issues.
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From page 101... ...
However, for localities that have contracted with private-sector vendors who are accustomed to receiving electronic data, it would be relatively easy for DSNS to provide them with EDI information in addition to the bill of lading. Petersen related that during H1N1, his department received the product from CDC but did not get the expected electronic files; instead they received many pages of physical bills of lading that they had to input manually into the inventory management system.
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From page 102... ...
Judith Robinson, supervisory public health analyst, District of Columbia (DC) Department of Health, asked if in addition to the bill of lading, it would be possible to also send a flat file that could be imported into the inventory management system.
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