Michael Acott, Baird's CMC, specialist health consultancy, explains how supply chain improvements move medicines more efficiently to poor countries
Neglected tropical diseases (NTDs) are the focus of a global effort to control or eliminate them by 2020. Billions of people are at risk of these diseases, which cause deformities, blindness, incapacitation and life long suffering. But, it’s no good manufacturing and donating huge supplies of treatments for devastating neglected tropical diseases (NTDs) unless you can get them to where they are most needed, quickly and efficiently.
Six multi-national pharmaceutical companies have now come together in the NTD Supply Chain Forum to speed up the increasing drug donations and streamline delivery of medicines to people at risk or suffering from one or more of these diseases in poor and often remote parts of the world. It is a partnership with the World Health Organization (WHO), the Bill & Melinda Gates Foundation, public health organisations and logistics providers
The pharmaceutical industry donates more than a billion doses of medicines each year across more than 70 countries. The industry effort has also become more focused through the enhanced collaboration of pharmaceutical companies which are more usually commercial competitors. In 2012, they came together with the WHO, public health NGOs and other partners to pool their expertise. They signed the London Declaration on NTDs, committed to increasing donations of medicines and set timelines and objectives, including the control or elimination of 10 neglected tropical diseases by 2020.
The members of the the NTD Supply Chain Forum include six multinational pharmaceutical companies which signed the declaration – Eisai, GSK, Johnson & Johnson, Merck , Merck KGaA, Pfizer and logistics company DHL. It is co-funded by the pharmaceutical companies and the Gates Foundation. They collaborate on logistics, both in terms of direct coordination as well as sharing of best practices.
Some companies donate medicines for the same diseases – sometimes in different countries, sometimes in the same country where medicines are given in combination. They also donate different medicines for different diseases in the same country.
Progress has included improvements in drug production timelines, changes in national drug application mechanisms and better distribution and delivery to destination countries.
“When it comes to countries, programmes are starting to be a lot more integrated. We have a huge interest in trying to deliver some of these medicines at a similar time to a specific country,” said Tijana Duric, who has chaired the NTD Supply Chain Forum since its inception.
“There’s a real sense of collaboration in terms of how and when we deliver,” said Duric, director of supply planning and finances at the Global Health Programmes Unit, GlaxoSmithKline.
The pharmaceutical companies started the forum and have brought in other organisations where they can help, such as on logistics or software development.
Deliveries of several donated medicines are co-ordinated through the DHL “control tower” at the headquarters of its humanitarian operations in Copenhagen. As the control tower also handles shipments for United Nations agencies, government organisations and other NGOs, the staff are familiar with humanitarian supply logistics, and country-specific requirements on issues such as customs regulations.
DHL’s involvement has also enabled priority bookings with certain shipping lines, reduced port charges for humanitarian shipments at the point of entry and longer periods for clearance before demurrage charges apply.
With the help of another international organisation, RTI, the forum is also developing a web based management tool for forecasting and planning. This will handle everything from the initial application for drugs from countries to delivering it all the way through the supply chain.
A large part of the supply chain focus has been on what is known as the “first mile” – from manufacture to delivery to a warehouses in the country concerned. This includes manufacturing, packaging, shipment, customs clearance and delivery. Efforts are also underway to improve the “last mile” – from the warehouses to local distribution points and then delivery to small communities in sometimes remote districts.
While the first leg is controlled by the donors, the second is in the hands of national and local governments, communities and NGOs in the country concerned. Work on ‘last mile’ improvements is more difficult, but Duric is optimistic.
“We have achieved tremendous results in our ‘first mile’ collaboration. As soon as people get in the same room and discuss these things, and share best practices, there is significant change and improvement. We have seen that cascade down, with things being standardised and implemented across companies,” she says.