Shital Parikh Mars, CEO at Progressive Media and speaker at FlyPharma US earlier this year, reveals how a fragmented, highly competitive industry like pharma can – and should – work together to prepare for a disaster response. Identifying pharma and logistics priorities, finding realistic solutions, and consulting every supply chain player is critical, as Shital explains.
On 16 September 2017, Hurricane Maria was only a tropical storm just east of the Lesser Antilles. In less than two days, it was a Category 5 storm striking Dominica and 36 hours later it was a high Category 4 storm hitting already hurricane-battered Puerto Rico. Hurricane Michael, in October 2018, intensified rapidly, providing residents of the US Gulf Coast a scant four days to prepare for the third strongest storm to make landfall in the US. Residents in California earlier this year were given mere hours’ notice to evacuate their homes and escape the destructive power of wildfires charring hundreds of thousands of acres. Recent earthquakes in Haiti and Mexico, and floods in India, Sierra Leone, and China, are some of the deadliest on record and provide families and disaster relief workers no notice to prepare.
Society often waits until the last minute to prepare for misfortune. As everyday citizens, we fill our gas tanks, buy water and batteries, and leave for safer shelter just before an anticipated natural disaster. But what if there is no notice? What if the storm is too large to escape? This is the reality of a natural disaster in the modern world. To prepare, healthcare institutions, including the pharmaceutical industry, must be held to a higher standard. When communities are imperiled, the first area of need is medicine and healthcare.
So how does a fragmented, highly competitive industry prepare for disaster response? Identify weaknesses and priorities, evaluate solutions, and make sure when disaster planning is undertaken by relief agencies, logistics leaders, pharmacies, and pharmaceutical manufacturers have seats at the table.
In most cases where there is a breakdown in disaster response, it is because planning and preparedness are inadequate for the realities of life on the ground in the aftermath. In the case of Puerto Rico, the Puerto Rican government had failed to update disaster preparedness plans for years and the relief agencies had not considered the logistical hurdles of delivering aid to a territory with infrastructure so devastated that planes could not land, roads were impassible, and an entire island was left without power or communications capability. Such a scenario was predictable, yet at every turn, it was not prepared for.
Pharmaceutical companies must anticipate not only delivery of necessary medications to the surrounding area of a disaster zone for eventual deployment, but how those medications will get into the hands of patients in need. In many cases standard power, communication, and delivery mechanisms are unavailable. Below are major areas of concern for medication disbursement:
Prioritizing need is a necessary evil when planning for the worst. The pharmaceutical and logistics industries must identify which medications are the most needed, what are the proper storage and delivery requirements for each, and how best to deploy those medications so that they actually end up in the hands of patients.
Pharmaceutical manufacturers, distributors and pharmacies should work together to identify priorities within a patient population. For many patients, access to proper medications can mean the difference between needing a few hundred dollars in health aid as opposed to thousands of dollars, but even further than that could be the difference between life and death itself. Life-saving drugs come in all forms: pills, capsules, drops, injections, etc. Some medications need to be taken immediately upon diagnosis (e.g. antibiotics, beta-blockers, ACE inhibitors, anti-retroviral); some need to be taken consistently (diabetes medications and insulin, diuretics, statins, antipsychotics); some need to be kept cold (insulin, vaccines, biologics) in order for the patient to achieve results.
The pharmaceutical industry can prioritize certain classes of medications that will be most needed in the 72 hours following a disaster: antibiotics, analgesics, insulin, beta-blockers, antihistamines, corticosteroids, oxygen, antiseptics and any other drug class needed for immediate and acute trauma care. These medications are often in high demand by healthcare professionals and the population, in general, to stave off escalation to more critical health conditions.
Pharmacies may be well stocked with these life-saving drugs, but access to these drugs is often uncertain. Pharmacies are often so badly damaged and/or isolated by destroyed transportation routes that using these facilities as hubs of distribution can be problematic. Pharmacies that are able to function struggle with staffing to resume normal operations. Rather, the industry should prioritize operational hubs for effective distribution of medications.
Logistics companies play a vital role in pharmaceutical distribution. FedEx and UPS handle nearly 20 million packages a day. Large-scale manufacturer transport by air of pharmaceutical products accounts for less than 20% of all pharmaceutical transport. But after a disaster, high-speed air and ground transport are essential to last mile delivery mechanisms. Logistics companies know community roadmaps and infrastructure integrity better than nearly anyone. They know the areas that need logistical improvement and the best and most efficient routes to navigate a community. So it stands to reason that logistics would be prioritized during a disaster. These institutions must prioritize the functionality of their facilities post-disaster including hangers, planes, runways, trucks, fuel, and staffing to ensure that they clear on-site debris and mobilize quickly. This is a tall ask of an industry, given that these facilities are just as vulnerable to destructive force as any other in a disaster zone. But that said, they are still in the best position to help guide and structure delivery of relief efforts.
There are a number of ideas that can be researched and examined that can improve disaster preparedness plans. Cost-effectiveness is the main concern in all areas; however, this issue must be balanced by the health needs of a population. Here are some proposals to consider for future implementation:
The truth about disaster planning and relief is that a lot of individuals can do the right thing, but if they cannot work together from start to finish, it won’t matter. There are many agencies, governments, industries and people on the ground that must coordinate their efforts together to ensure that the right aid is reaching the right people. It won’t matter if the right medications are ready to be deployed in an off-site location if the town is flooded out and nothing can get in. It won’t matter if the temperature is controlled until it reaches the patient if there is no power and no means for the patient to maintain the medicinal integrity of the product. So everyone must work together to get it right.
The only way to accomplish true coordination is if all the players in healthcare delivery are consulted and valued during the planning, preparation and executions process. Relief organizations and governments can discuss needs and pain points, and pharmaceutical and logistics industries can work together to solve problems. By understanding reality, planning for the future, and working together, we will save lives imperiled by modern-day disasters.