The question of how to ensure cost-effective access to high-quality medicines is one faced by all countries around the globe. Pacific Island Countries, including Fiji, Papua New Guinea and the Solomon Islands, all share challenges in medicines access which contributes to insecurity across the supply chain right through to the point of care for citizens. These issues have gained prominence and been sustained through the COVID-19 pandemic. Alex Bongers with Procurelink, an agency focused on purpose-driven procurement for pharmaceuticals and medical supplies, explores some of the fundamental issues and opportunities to strengthen medicines access.

Supply of medicines in the Pacific

The supply of medicines in Pacific Island Countries (PICs) has significant challenges, mostly driven by their geographical isolation and limited buying power of countries in the region. To ensure the supply of quality goods and realise value for money, national procurement agencies in PICs often conduct annual tenders for annual quantities of medicines. Procuring medicines annually (which are often, but not always, delivered annually as well) facilitates reduces medicine pricing, longer expiry dates and quality control.

The lead time from procurement to delivery of medicines using this approach is often between 6-12 months. This time frame consists of quantification, tendering, negotiations, contract management and delivery. Whilst the process of annual ordering carries benefits highlighted above, there are also challenges with this approach. The most obvious challenge is that if the incorrect quantity of medicine is not ordered and monitored appropriately, medicine shortages or stock-outs will occur and patients won’t have access to the treatment they require when they need it.

When medicine stock-outs occur in the Pacific, agencies have several options, depending on the impact of the stock-out and budget available. The first option is for the agency to place emergency orders for medicine, but in this scenario small quantities are likely to be available at high prices and quality is more difficult to ascertain. The second option is for the agency to procure medicines from the same supplier as the annual tender to have access to quality items at lower prices. This challenge with this option is a lead time of 6-12 months will result in an extended stock-out and impact healthcare delivery. Other options include switching patients to available alternatives until the stock-out is resolved or placing a mix of orders from the options above.

In this context, additional support from international organisations to facilitate access to quality medicines is warranted.

Supply chain challenges from COVID-19

During the COVID-19 pandemic, there were countless examples of supply chain disruptions resulting from extremely high demand (including personal protective equipment, vaccines, ventilators), impact on freight cost and availability (resulting from worker isolation, lockdowns, reduced airfreight capacity) as well as manufacturing disruptions.

The result of the factors above significantly increased prices of essential health supplies and extended lead times. For PICs that forecast quantities and budgets in advance, there has been a significant impact on medicine quality and availability.

The Pacific Medicines Testing Program, managed by the Australian Government Department of Health Therapeutic Goods Administration, allows countries from the Pacific to test medicines from their country at an internationally recognised testing laboratory in Australia. It is concerning to note that during the 2020-21 year, 43% of medicines tested failed compared with 16% the year prior. On availability, the author of this article works in several countries across the Pacific and has seen stock-outs increase by greater than 20% during the COVID-19 pandemic.

This means that the COVID-19 pandemic has made a difficult task of ensuring access to quality medicines in the Pacific even harder, with many countries experiencing issues with availability and quality of medicines in the region.

What countries should do to improve access

In addition to ensuring that core procurement functions (i.e. quantification, annual tendering, contract management.) continue as efficiently as possible, procurement agencies in PICs can adopt a range of additional mitigation strategies to reduce the risk of stock-outs. These include:

Scenario model and secure adequate health financing for medicines. Procurement agencies in PICs have had to draw on similar budgets despite significant price increase and the expansion of their portfolio to include the procurement of products to support the response to COVID-19. In many cases, orders must be significantly decreased or completed cancelled as a result. Governments should ensure expedited access to increased baseline funding, ensure robust scenario modelling, and assure additional contingency funding as needed to support the procurement of all commodities.
Expedite procurement processes. With extended lead times due to the delays in manufacturing and freight, it is essential that procurement processes are completed as scheduled and shortened to accommodate delays in the procurement cycle. In certain scenarios, and according to local procurement laws, single source or emergency procurement should be considered.
Increase buffer stock to reduce risk of stock-outs on subsequent deliveries. With lead times for products increasing, it is appropriate to increase buffer stock to accommodate this. A phased approach where additional buffer stock is held for critical items could also be considered.

Australian Government support in the region

The Australian Government has provided significant support for PICs during the COVID-19 pandemic. This includes donations of COVID-19 vaccines, support for the implementation of COVID-19 vaccination programs, delivery of critical medical supplies, financing for regional air travel to facilitate delivery of health supplies across the region and more. These activities built on the widespread bilateral partnerships and Pacific Step-Up initiatives.

With greater access to quality medicines, a developed pharmaceutical market and a robust medicines registration system, there is an argument that leveraging the benefits of the Australian market could improve access and quality of medicines in the Pacific region. Any initiative would need to be considered against the potential impact of supply in the domestic market.

Alex Bongers is a Project Director at Procurelink, a purpose-driven procurement agency for pharmaceuticals and medical supplies based in Geelong, Victoria with public and private clients across Australia and the Asia-Pacific region. Alex is a Pharmacist and Procurement Specialist with broad experience and understanding of supply chain complexities in Australia and the Asia-Pacific region, having worked with governments and NGOs on various development projects in the Pacific Islands, Timor-Leste, PNG, Central West Asia and Cambodia, as well as corporate roles in Australia. He can be contactable on alex@procurelink.io.

Moderator: Jade Hart

Ensuring safe and timely access to medicines in the Pacific