**Key Summaries: Medication & Medical Supply Shortages and System Responses (2021–2024)**

- **Global Vulnerability and Need for Resilient Supply Chains**: The ongoing medication shortages reveal that both developed and developing regions are vulnerable to supply chain breakdowns, often exposed during pandemic surges (e.g.

COVID-19 and seasonal flu spikes), which highlight the universal risk and the urgent need for robust, coordinated international preparedness.

- **Medication Shortages—Case Examples**:
    - **Ireland (2022/23)**: Suffered paracetamol shortages as COVID-19 and flu cases spiked; calls for official government response and transparency.

- **United States (2023)**: Ongoing shortages of critical cancer drugs such as carboplatin and cisplatin caused hospitals to ration care, with providers forced to tell patients potentially lifesaving treatment was unavailable.

Federal action was prompted, with the White House exploring strategies to strengthen the drug supply chain.

- **Botswana**: COVID-19 disruptions led to shortages not just in essential medicines but also basic supplies like condoms, indicating broader disruption across sexual/reproductive health commodities.

- **Some African countries**: Importers' inability to source foreign currency led directly to critical drug shortages, compounding problems with substandard and ineffective medications.

- **Underlying Causes**:
    - **Supply chain disruptions**: Resulted from pandemic-driven logistics blockages, export restrictions, and spike in global demand outpacing production—impacting shipment and delivery of both raw materials and finished drugs.

- **Manufacturing delays**: Increased demand for specific drugs (e.g., paracetamol, carboplatin, and cisplatin), plus limited manufacturing capacity, led to backlog and delayed supply.

- **Foreign currency shortages**: In resource-constrained countries, restricted access to foreign currency prevented timely import of required pharmaceuticals, creating consistent shortages.

- **COVID-19 Impact**: Health programs for diseases such as HIV/AIDS experienced service interruptions and a slower rate of improvement in infection control, particularly affecting key and vulnerable populations.

- **Healthcare System Responses**:
    - **Emergency Adaptations**: Health programs developed new models to continue care during disruptions (e.g., remote delivery of HIV services, new distribution methods).

- **Institutional Strengthening**: There is a call for investment in public health infrastructure and regional bodies (e.g., Africa CDC, regional pharmaceutical manufacturing) to improve resilience.

- **Policy and Planning Initiatives**: Reports stress the importance of switching to tax-funded universal healthcare approaches, sustainability roadmaps (e.g., via PEPFAR and AU partnership), and international collaboration (e.g., UICC's ATOM Coalition for cancer drug access).

- **Leadership Accountability**: Urging better government oversight, transparency, and competence in supply management; recognizing that investing in systemic, not just emergency, solutions is essential.

- **Advocacy & Partnerships**: Civil society (e.g., BONELA) and international agencies advocate for accountability, support, and coordinated responses rather than piecemeal interventions.

- **Key Takeaway**: Medication shortages—sparked by supply, manufacturing, and financial bottlenecks—directly threaten patient care worldwide.

System resilience depends on diversified supply sources, reformed funding and procurement mechanisms, empowered local manufacturing, and coordinated international efforts to anticipate, prevent, and rapidly respond to health system shocks.

Here are summarized nuggets capturing core information from the extract provided, suitable for illustrating how supply chain disruptions, demand spikes, and manufacturing delays have affected medication access around the world, especially from 2021–2024:

---

**Global Nature of Medication Shortages**
- Medication shortages are a growing concern globally, affecting both developed and developing countries.

Small and poorer nations face particular vulnerability, with less publicly available data on their situations.

**Demand Spikes Overwhelm Supply Chains**
- When demand for certain drugs surges sharply (e.g., due to pandemics like COVID-19), existing distribution chain stocks are insufficient to cover the sudden increase (“hype”), leaving patients unable to access needed medications at critical moments.

**Specific Drugs Affected**
- In the United States, shortages have affected conventional antibiotics and anesthetics, raising concerns about national security and patient care continuity.

- Broader trends show new antibiotics and many advanced drugs are often in short supply, due in part to limited domestic production capabilities.

**Manufacturing and Import Challenges**
- Many countries, including Russia and India, identified over-reliance on imported Active Pharmaceutical Substances (APS) as a core weakness.

- India launched large-scale programs to build domestic APS production (2021).

- Russia, after initial resilience during the COVID-19 crisis, began focusing on reestablishing full-cycle drug production lost since Soviet times.

- Losing access to imports, including raw materials and finished medications, severely strains local pharmaceutical industries.

**Industry Barriers and Delays**
- Advanced pharmaceutical manufacturing requires multi-level expertise: from synthesis to quality analytics, to regulatory approval—hindering rapid scaling.

- Even with government incentives, creating domestic capacity and reducing import dependence is a long-term (decades-long) task.

**Governmental and Health System Responses**
- Many governments have moved to subsidize domestic production, implement or consider bans on medical sanctions, or reduce customs duties to stabilize supply.

- Strategic national programs, such as Russia’s “Pharma 2030”, focus on ensuring domestic “drug security” for essential medicines, particularly antibiotics and antivirals.

- Authorities in Russia, for example, pointed to forming strategic reserves of pharmaceuticals and rapid crisis interventions as key COVID-19 lessons.

- International initiatives (World Economic Forum) encourage digital platforms and partnerships to monitor and sustain health system supply chains.

**Concerns and Unintended Consequences**
- Policy measures (trade barriers, customs changes) risk unintended effects, such as price increases at pharmacy counters, impacting patient affordability.

- The overall market, including exports, is influenced by these domestic policy choices.

**Recent Country Examples**
- Estonia and other nations have reported worsening drug supply problems, indicating the broad pervasiveness of such disruptions beyond just large economies.

**Broader Health System Evolution**
- The pandemic elevated health system resilience and technology adoption to top government agendas, prompting reform efforts—like better electronic health records, telemedicine expansion, and centralized health funds.

---

These points present a broad picture of the dynamics underlying recent global medication and supply shortages, the specific impacts seen at the patient level (unavailability of key drugs), and the types of policy responses (industrial, regulatory, and strategic) by national health authorities.

**Summary of Key Points on Medication and Medical Supply Shortages (2021–2024):**

- **Global Health System Vulnerabilities:**
  The reports highlight a persistent deficit in global healthcare systems' ability to withstand crises, with "resilience of health systems and pandemic preparedness" cited as critical areas needing urgent investment.

The COVID-19 pandemic notably strained both supply chains and healthcare infrastructure worldwide.

- **Causes of Shortages:**
  - **Supply Chain & Manufacturing Issues:** Disruptions and downtime in manufacturing, along with supply chain gaps, were key contributors.

Pandemic-related transportation interruptions and border closures particularly constrained the movement of medical goods.

- **Demand Surges:** Certain medicine shortages were aggravated by sudden spikes in demand, as seen with popular weight-loss drugs and COVID-19 treatments.

- **Economic Instability:** Economic crises increased pressure on health systems, raising costs and straining already limited resources.

- **Drugs & Supplies Affected:**
  - **Insulin:** Despite being discovered a century ago, insulin access remains limited—"one in two people who need medication does not get it," especially in low- and middle-income countries where diabetes rates are rising.

- **Vaccines:** During the H1N1 pandemic, vaccine development outpaced equitable access—by the time poor countries received doses, the crisis had waned.

This pattern repeated to some extent during COVID-19.

- **General Medicines and Medical Supplies:** Multiple unnamed medicines and supplies have experienced shortages, with authorities in some regions (e.g., Egypt, as stated by their Health Minister) denying deficits, while working on consumption rationalization.

- **Health System Responses:**
  - **International Aid & Multilateral Cooperation:** Organizations like WHO and countries such as the UAE responded with rapid dispatches of medical supplies to crisis zones (e.g., Sudan), utilizing global logistics hubs to support acute needs.

- **Policy and Financial Support:** Initiatives by actors like the European Investment Bank (EIB) pledged financing (e.g., €500M) towards health-related Sustainable Development Goals and system resilience.

- **National Initiatives:** Some countries have focused on developing local vaccine production (e.g., Egypt) to mitigate dependency on external sources.

- **Broader Implications:**
  - The gap in global perspectives—between developed and developing countries—risks exacerbating inequities in access to health technologies during crises.

Insulin and vaccines stand as prominent examples.

**Key Summaries: Medication & Medical Supply Shortages and System Responses (2021–2024)**

- **Global Vulnerability and Need for Resilient Supply Chains**: The ongoing medication shortages reveal that both developed and developing regions are vulnerable to supply chain breakdowns, often exposed during pandemic surges (e.g.

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Content: HealthIn-Depth AnalysisSocial Affairs
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In-depth: A Dollar a Dose, a Life Saved: The search for safer pharmaceuticals amid the challenge of widespread substandard medications

By Million Beyene @MillionBeyene

Addis Abeba – In the world of illicit trade, a dangerous threat looms in the form of substandard and illegally sold pharmaceuticals that endanger millions of lives worldwide.

A recent study conducted by the World Health Organization (WHO) has uncovered the massive scale of this problem, revealing that the illicit drug trade generates nearly a trillion dollars annually.

Surprisingly, this makes it the second-largest illicit financial stream globally, coming in just behind arms sales. However, the true impact of this hidden industry extends far beyond just monetary value.

In sub-Saharan Africa, including Ethiopia, the cost is counted in human lives.

Every year, almost half a million individuals fall victim to the dangerous consequences of using substandard and counterfeit medical products.

The ramifications of this issue are severe, as individuals often unwittingly procure and consume medications that prove to be ineffectual or even detrimental to their well-being.

The recent experience of Getachew Belay, a resident of Addis Abeba, serves as a poignant illustration of the predicament faced by such individuals.

He told Addis Standard about the distressing ordeal of procuring medications at a substantial cost of 90,000 birr, only to find them ineffective in treating his mother’s liver disease.

Regrettably, despite the doctor’s acknowledgment of the ineffectiveness of the “albumin” medication and subsequent refusal to administer it, this intervention was belated.

“Consequently, my mother succumbed to her condition shortly after discontinuing the ineffective treatment and before a suitable alternative could be provided,” recounted Getachew, reflecting on the most devastating experience of his life.

Dr. Mehari Tesfaye (name changed), a prominent medical director at a public hospital in Addis Abeba, shared insights with Addis Standard regarding Ethiopia’s escalating issue of substandard medications.

According to him, a notable example is “albumin,” a vital medicine employed in treating liver disease.

“The substandard variants of this medication are not only ineffective but also potentially harmful,” he emphasized, underscoring the peril associated with such drugs.

A nationwide study conducted in 2013 found that 7.8% of medications in Ethiopia were substandard.

Nevertheless, medical experts interviewed by Addis Standard disclosed that the incidence of substandard drugs has notably increased in Ethiopia over the past decade.

This observation aligns with research findings.

According to a study published last year, 21.8% of the drugs sampled in Ethiopia exhibited failures in one of the product quality parameters: dissolution, disintegration, identity, or chemical assay.

An anonymous medical expert disclosed the extensive availability of substandard, illicitly manufactured, or imported drugs in numerous pharmacies throughout Addis Abeba.

The expert highlighted a particularly troubling trend: the heightened involvement of licensed drug importers in the illicit drug trade, particularly over the past two years.

In Ethiopia, a particularly troubling issue arises from the presence of ineffective medications, even among those legally imported.

Medical experts have apprised Addis Standard of instances where drugs lack medicinal properties, aligning with public grievances about medications failing to provide therapeutic benefits.

Dr. Solomon Tezera (name changed), an infectious disease specialist, is among the medical professionals who express profound concern regarding the prevalence of ineffective medications.

“These concerns extend beyond smuggled drugs to encompass medications legally imported by some organizations,” he states. “Patients diagnosed through lab tests and prescribed medication often fail to experience improvement due to these defective products, resulting in a frustrating situation for both patients and medical staff.”

Patients diagnosed through lab tests and prescribed medication often fail to experience improvement due to substandard medications.”

An infectious disease specialist

Dr. Solomon further emphasizes the critical role of effective medications in managing chronic conditions such as diabetes, hypertension, and heart disease. He underscores that substandard medications for these illnesses can lead to a rapid exacerbation of symptoms.

“Medical professionals have recently identified and reported these problematic drugs to the appropriate regulatory bodies,” he added.

Recently, the Ethiopian Diabetic Association (EDA) also raised concerns about the efficacy of a medication named ‘Galvanez’.

Tackling substandard medications

The Ethiopian Food and Drug Authority (EFDA), a governmental regulatory body responsible for ensuring the safety, quality, and efficacy of medicines, has addressed these concerns.

Officials from the EFDA have stated that no official reports regarding the specific medication in question have been filed.

Gezahegn Endale, the head of the EFDA’s South East Addis Abeba Branch Office, affirmed, “No reports of substandard or defective medications related to Galvanez have been presented to the authority thus far.”

While no issues with Galvanez have been reported, the EFDA has noted a concerning trend of unauthorized drugs entering the country. These drugs often lack registration, approval from their country of origin, and information about their manufacturers.

Additionally, the EFDA recognizes the ongoing challenge of smuggled medications, particularly those targeting critical areas such as cancer treatment. The Authority has stated its active efforts to strengthen controls at border entry and exit points.

In a recent statement, the EFDA underscored its commitment to “identifying and removing any smuggled drugs to safeguard public health.” The authority highlighted its rigorous protocols for ensuring the safety and efficacy of all medications entering the Ethiopian market.

This includes thorough pre-market registration checks, which meticulously examine a drug’s production methods, ingredient lists, and accompanying scientific documentation before granting a market license.

Furthermore, to ensure quality, imported medications undergo extensive sampling, testing, and verification procedures beyond registration. Additionally, the EFDA conducts physical inspections at entry and exit points to enhance its safeguards.

Acknowledging the challenge of precisely quantifying the volume of smuggled drugs, officials at the EFDA assert that their regulatory measures are more stringent compared to those of neighboring countries. They underscore their “continuous endeavors to ensure the quality, safety, and efficacy of medications” across the entire supply chain.

However, stakeholders emphasize that the shortage of legally imported medications has compelled certain private pharmacies, licensed drug importers, and domestic drug producers to resort to smuggled alternatives.

Dr. Mehari underscored the challenges Ethiopia encounters in securing an adequate supply of legal medications.

“This susceptibility exposes the population to the hazards of smuggled drugs,” he elucidated. “Patients who unwittingly depend on substandard medications are at an elevated risk of complications.”

Gezahegn acknowledges the potential vulnerabilities within the distribution system and unethical practices by some wholesalers, such as auctioning off medications of dubious origin to retailers, which could introduce smuggled or unregistered drugs.

“The recent license revocation of four wholesalers supplying unregistered drugs to St. Paul Millennium Medical College’s Hospital exemplifies the EFDA’s commitment to addressing such practices,” he highlights.

Forex shortage, soaring prices

However, Gezahegn attributes a significant factor in such health risks to the scarcity of foreign currency in the country.

“This limitation restricts the ability of importers to acquire essential medications in sufficient quantities, potentially leading to drug shortages,” he explains.

Ethiopia meets the yearly requirement for medications and medical equipment primarily through imports, as domestic production satisfies only 15% of the national demand.

The Ethiopian Pharmaceuticals Supply Service (EPSS) oversees the acquisition of drugs and medical equipment, whether sourced locally or imported.

The scarcity of foreign currency in the country restricts the ability of importers to acquire essential medications in sufficient quantities, potentially leading to drug shortages.”

Gezahegn Endale, the head of the EFDA’s South East Addis Abeba Branch Office

Annually, EPSS supplies over 1,000 medicines and medical equipment to more than 5,000 public health institutions. In the previous year, it allocated over 40 billion birr for the procurement of drugs and medical equipment, with drug procurement alone amounting to over 15 billion birr.

Dr. Solomon further contends that the limited availability of foreign currency is hampering the capacity of local pharmaceutical manufacturers to import essential raw materials necessary for drug production.

Leaders of the Ethiopian Pharmaceutical Manufacturers Association also attribute their underperformance to the unavailability of foreign currency. They highlighted that 85% of the challenges they face are related to foreign currency shortages.

Mukamil Abdella, vice president of the association, recently stated in a state media interview that foreign currency is not accessible in the required quantity and timeframe for procuring raw materials essential for medicine production, adversely affecting their operations.

Another senior manager from a local pharmaceutical company disclosed that his firm requested $21 million for the acquisition of raw materials and other essentials. However, after an 11-month waiting period, the company was only allocated $5 million, which proved insufficient.

The persistent scarcity of foreign currency in Ethiopia continues to render the nation vulnerable to the influx of smuggled drugs, exacerbated by disruptions in the global supply chain that have led to inflated prices for pharmaceutical products.

Studies indicate that disruptions caused by the COVID-19 pandemic, further compounded by the Russia-Ukraine conflict, have resulted in a more than 200% increase in drug costs.

During his appearance before parliament to present the central bank’s quarterly report in November 2023, Mamo Mihretu, the governor of the National Bank of Ethiopia (NBE), acknowledged the escalating pharmaceutical costs, which are depleting the country’s foreign currency reserves.

According to Mamo, the costs of three key import items for Ethiopia—pharmaceuticals, petroleum, and fertilizers—have more than doubled in the past three years.

Although acknowledging that Ethiopia encounters obstacles in ensuring a consistent provision of legally imported medications due to factors such as limited foreign currency reserves, public health experts contend that these challenges should not serve as justification for the increase in illegal drug trafficking and the availability of substandard drugs in pharmacies.

Officials, however, assert that they are actively addressing the issue of smuggled medications despite the persistent challenge of detecting and eliminating any illicit drugs that may already be present within the country.

“The Authority is intensifying surveillance at entry points to deter smuggling,” stated Gezahegn. AS

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COVID-19 and seasonal flu spikes), which highlight the universal risk and the urgent need for robust, coordinated international preparedness.

Title:

Content: 7 essentials to create a resilient global healthcare supply chain

  • SARS, Ebola and COVID-19 have tested the world’s ability to deal with outbreaks and pandemics.
  • A global pandemic preparedness system needs sustained political will and investment to ensure the global healthcare supply chain can effectively respond to a crisis.
  • If we don’t get serious about pandemic preparedness now, millions more lives will be at stake.

It was 20 years ago, when the SARS outbreak exposed key fragilities in the global healthcare supply chain, that people internationally began to talk seriously about pandemic preparedness.

Eight years ago, when the Ebola outbreak proved the world no better prepared to address outbreaks, there was more talk and some action. This included the founding of the Pandemic Supply Chain Network (PSCN), by the World Health Organization, World Economic Forum, World Bank, World Food Programme, US Centers for Disease Control and Prevention, Henry Schein and more than 60 companies. The PSCN was established to make it easier to anticipate and respond to global healthcare supply chain disruptions.

Yet today, nearly three years into the COVID-19 pandemic – the worst global health crisis in a century – many of the same supply-chain fragilities remain. Although partnerships, such as the PSCN, and national efforts somewhat blunted the severity of supply chain disruptions during the pandemic, the effort to develop a global pandemic preparedness system has yet to garner the sustained political will and investment needed to ensure that the global healthcare supply chain can effectively respond to a crisis.

3. Improved stockpiles and inventory management

In addition to enhancing stockpiles of personal protective equipment (PPE) at the local, regional and national levels, we must manage inventory more intelligently – from cycling inventory to deal with product expiry to coordinating and harmonising responses across jurisdictions.

4. Platforms for data sharing and enhanced transparency

Through the globally-focused PSCN and various national efforts, including the US Supply Chain Control Tower, Henry Schein has been working across sectors to support the creation of market intelligence platforms that enable the appropriate sharing of real-time supply chain data. While progress has been made, encouraging responsible information sharing across public and private partners requires significant additional funding.

5. Fostering the free flow of goods

Over the past three years, government restrictions on exports played a significant role in exacerbating product distribution shortages. While the desire of governments to protect their populations in times of crisis is understandable, international cooperation to allow the free flow of key products lessens the risk of panic buying, hoarding and, ultimately, viral spread.

6. Coordinated early-warning system for outbreaks

Detecting the next outbreak early is essential to mitigating its impact, protecting global healthcare supply chains and saving lives. Strengthening our global surveillance capacity requires significant investment and better coordination across governments, international organizations and the private sector.

7. Strengthened health systems and better primary care

As Dr. Tedros Adhanom Ghebreyesus, Director-General of the World Health Organization, famously said: “Universal health coverage and health emergencies are cousins — two sides of the same coin.” Major and sustained investment is needed if we are to reap the benefits of expanded access to care.

Let’s conclude with another number: one. This is the number of viruses it could take to shut down our world again. If ever there was an issue to unite us – one for which we all share the same risk – pandemic preparedness is it. If we don’t get serious now, millions more lives are surely at stake.

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- **Medication Shortages—Case Examples**:
    - **Ireland (2022/23)**: Suffered paracetamol shortages as COVID-19 and flu cases spiked; calls for official government response and transparency.

Title:

Content: Ireland has been suffering a paracetamol shortage as cases of Covid-19 and the winter flu in the country soared over the festive and new year period.

The revelation was made by Health Minister Stephen Donnelly after his department received notification of a supply issue from the Health Products Regulatory Authority.

It is understood the shortage impacted some prescription paracetamol products.

Read More:Irish people complain of ‘worst ever’ winter bug sweeping country that feels like Covid but isn’t

Two suppliers affected have stated that resupply will be sometime in January 2023.

However, there are other prescription paracetamol suppliers with some stock available on the shelves.

Paracetamol is one of the medicines used most often in Ireland and especially for the flu, aches and pain.

But Mr Donnelly pointed out that there are multiple forms of the drug with different strengths and brands available from various sources.

He said: "In the event that there are some supply issues for individual medicines, alternative options such as alternative strengths and brands, generic medicines will usually be available to ensure continuity of treatment.

"In some cases where the medicine initially prescribed for the patient is unavailable, patients may be switched to a suitable therapeutic alternative following appropriate consultation with a healthcare professional."

The Health Minister said medicine shortages have been increasingly prevalent worldwide over the past decade. The causes of such shortages are multifactorial including shortage of raw materials, manufacturing difficulties and industry consolidations.

He stated: "Medicine shortages can originate at any point in the supply chain. They can involve and impact many stakeholders in different ways as the supply models and clinical use of therapies can vary across national health systems.

"Management of medicines shortages necessitates a multi-faceted, multi stakeholder response to ensure patient safety , continuity of care and protection of public health.

"Patients or their carers who have any concerns in relation to temporary alternative products provided because of medical shortages are advised to speak with their pharmacist or other healthcare [professionals] involved in their care."

Mr Donnelly was responding to a number of written Dail questions on the shortage of medicines.

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- **United States (2023)**: Ongoing shortages of critical cancer drugs such as carboplatin and cisplatin caused hospitals to ration care, with providers forced to tell patients potentially lifesaving treatment was unavailable.

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Content: Advertisement

U.S. cancer centers report ongoing shortage of chemotherapy drugs

By Cara Murez, HealthDay News
In all, 72% of cancer centers surveyed reported a continued shortage of carboplatin. And 59% were still seeing a shortage of cisplatin. Photo by klbz/Pixabay

U.S. cancer centers continue to have shortages of commonly used chemotherapy drugs, a new survey shows, though the medications are not as scarce as they were last June.

The National Comprehensive Cancer Network (NCCN), a nonprofit alliance of leading cancer centers, surveyed its network in September.

In all, 72% of cancer centers surveyed reported a continued shortage of carboplatin. And 59% were still seeing a shortage of cisplatin.

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These two platinum-based generic chemotherapy medications are recommended for treating many different cancers. Overall, 86% of centers surveyed said they were short on at least one type of anti-cancer drug. A survey in June showed that 93% of cancer centers had a shortage of carboplatin, and 70% of cisplatin.

"Everyone with cancer should have access to the best possible treatment according to the latest evidence and expert consensus guidelines," said Dr. Robert Carlson, chief executive officer for NCCN.

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"Drug shortages aren't new, but the widespread impact makes this one particularly alarming. It is extremely concerning that this situation continues despite significant attention and effort over the past few months. We need enduring solutions in order to safeguard people with cancer and address any disparities in care," Carlson said in a NCCN news release. Twenty-nine of the NCCN's member institutions responded to the September survey. They include leading academic centers across the United States. The findings may not reflect additional challenges that smaller community practices serving rural and marginalized patients are experiencing. The centers surveyed were using strict waste management strategies, so nearly all were still able to provide the medications to all patients who needed them. Other medications in short supply included methotrexate, with 66% of centers reporting a shortage; 5-fluorouracil, with 55% falling short; fludarabine at 45%; and hydrocortisone at 41%.

"These drug shortages are the result of decades of systemic challenges," said Alyssa Schatz, NCCN's senior director of policy and advocacy. "We recognize that comprehensive solutions take time."

Schatz said the network appreciates those who have put forth proposals to improve investment in generics.

"At the same time, we have to acknowledge that the cancer drug shortage has been ongoing for months, which is unacceptable for anyone impacted by cancer today," Schatz said. "These new survey results remind us that we are still in an ongoing crisis and must respond with appropriate urgency."

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The organization is continuing to advocate for more supplies.

CNN recently reported that two other drugs used for cancer, vinblastine and dacarbazine, went into shortage in September.

"These drugs are particularly used to treat patients with Hodgkin's lymphoma. Hodgkin's lymphoma is probably one of the most curable types of cancers out there," Dr. Doug Hawkins of the Children's Oncology Group, a research organization, told CNN.

"The problem is never-ending. It is horrible," he added. "I mean, to say to a patient, 'we know how to treat your child, but we can't get the drugs,' and this is America, and it's 2023 -- it's crazy."

More information

The White House has more on strengthening the supply chain for cancer drugs.

Copyright © 2023 HealthDay. All rights reserved.

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Federal action was prompted, with the White House exploring strategies to strengthen the drug supply chain.

- **Botswana**: COVID-19 disruptions led to shortages not just in essential medicines but also basic supplies like condoms, indicating broader disruption across sexual/reproductive health commodities.

Title:

Content: BONELA calls for axing of incompetent medical supply officers

  • Says shortage of medicines is a matter of life and death
  • MoH blames it on COVID-19

GAZETTE REPORTER

The Botswana Network on Ethics, Law and HIV/AIDS (BONELA) has called on President Mokgweetsi Masisi to fire incompetent officers for their failure to procure medicines and drugs for public health facilities.

The Assistant Minister of Health and Wellness (MoH), Sethomo Lelatisitswe, recently told Parliament that public health facilities were running short of medicines and condoms, saying the situation was being addressed.

According to BONELA, the situation got worse after the outbreak of COVID-19.

In an interview with The Botswana Gazette this week, the Executive Director of BONELA, Cindy Kelemi, said those responsible for the dearth of drugs and medicines should be fired.

“There is a serious shortage of medicines,” Kelemi said. “Whether you are talking about hypertension medication or anti-retroviral drugs, there are shortages. This is a concern for us because BONELA exists to ensure that the right to health is made a reality in Botswana.”

“The question we often ask is what the ministry is doing to address this, especially for people in hard-to-reach areas? We have always maintained that we have not explored fully our procurement potential, including looking at the private sector.”

She added that in addition to medicines and drugs, condoms are also in short supply at public health facilities. “We have had condom shortages since last year and we were informed that logistical problems were preventing distribution of a donation through the US embassy,” she said. “Central Medical Stores must understand that this is a life and death situation.”

Kelemi expressed hope that the budgetary vote for MoH being the largest, medical supplies to public health facilities will be replenished.

“But we had this problem even before COVID-19,” she noted. “This goes to show that we can throw money at a problem when there are underlying problems.”

The Chief Public Relations Officer at MoH, Dr Christopher Nyanga , has acknowledged the shortage of medicines and drugs at public health facilities but blames it on COVID-19 slowing down production and delivery timelines.

“Health facilities in Botswana and across the world have been experiencing shortages and delayed delivery of certain drugs and medical supplies,” Nyanga said.

He added that the problem has become more pronounced since the last quarter of the 2020/2021 financial year.

- **Some African countries**: Importers' inability to source foreign currency led directly to critical drug shortages, compounding problems with substandard and ineffective medications.

- **Underlying Causes**:
    - **Supply chain disruptions**: Resulted from pandemic-driven logistics blockages, export restrictions, and spike in global demand outpacing production—impacting shipment and delivery of both raw materials and finished drugs.

- **Manufacturing delays**: Increased demand for specific drugs (e.g., paracetamol, carboplatin, and cisplatin), plus limited manufacturing capacity, led to backlog and delayed supply.

- **Foreign currency shortages**: In resource-constrained countries, restricted access to foreign currency prevented timely import of required pharmaceuticals, creating consistent shortages.

- **COVID-19 Impact**: Health programs for diseases such as HIV/AIDS experienced service interruptions and a slower rate of improvement in infection control, particularly affecting key and vulnerable populations.

Title:

Content: There were 1,249 press releases posted in the last 24 hours and 345,480 in the last 365 days.

Health: Assuring health security for all

Finishing the job on HIV/AIDS

John N. Nkengasong

U.S. Global AIDS Coordinator and Special Representative for Health Diplomacy, U.S. Department of State

What it will take to end the HIV/AIDS pandemic as a global health threat by 2030

In the wake of the COVID-19 pandemic, there is a renewed need for domestic and donor support to end the HIV/AIDS pandemic as a global health threat. This requires a strong emphasis on galvanizing political and programmatic leadership to sustain the response, centering programs around health equity, sustainably strengthening public health systems, and health security.

In 2001, the Heads of State of Africa met in a special summit in Abuja devoted specifically to addressing the exceptional challenges of HIV/AIDS. The HIV/AIDS pandemic had been raging worldwide with an acute impact on most countries in Africa. The spread of the disease was impacting every dimension of society–in African countries most affected, AIDS had lowered life expectancy of adults on average by 20 years. This session, which came soon after the unprecedented U.N. Security Council Resolution in 2000 declaring HIV/AIDS a security threat, acknowledged the tremendous impact that the spread of HIV was having on the continent as not only a health crisis, but also an economic and security crisis, which would lead to massive instability in the continent if left unchecked.

The Abuja summit concluded with heads of state committing to take personal responsibility and provide political leadership at the highest level to commit all necessary resources and measures to attack the epidemic–from pledging 15 percent of budgets to the health sector, providing access to affordable treatment, scaling-up educational efforts, to reforming national policies. These commitments helped spark a regional movement to attack the HIV/AIDS pandemic on the continent by governments, donors, advocates, non-profits, private companies, and more.

Twenty years later, the annual number of new infections has dropped by 75 percent (from 3.4M to 870,000), and deaths have dropped 80 percent (from 2.3 million to 460,000) in Africa.1 Several high-burden African countries have reached the UNAIDS 90- 90-90 targets.2 It is no coincidence that this period has resulted in the fastest economic growth in Africa’s history and has seen tremendous gains in other development indicators such as poverty alleviation, educational attainment, gender equity, and maternal and child health. Analysis comparing U.S. President’s Emergency Plan for AIDS Relief (PEPFAR) recipient countries with similar non-PEPFAR supported low-and middle- income countries found that PEPFAR countries experienced 35 percent greater reductions in child mortality, 25 percent reductions in maternal mortality, and significant improvements in childhood immunizations. GDP per capita growth rates were 2.1 percentage points higher for PEPFAR countries compared to non-PEPFAR supported countries, and the share of girls and boys out of school declined by 9 and 8 percent respectively. The effects were strongest where PEPFAR engaged in more intensive planning and funding.3

Despite this progress, we are at a new inflection point in the HIV/AIDS pandemic in part because of the COVID-19 pandemic. The pandemic particularly impacted access to HIV prevention services, and the rate of decline of new infections has slowed. If the current pace continues, we will be off-track to reach the UNAIDS global target of 370,000 infections by 2025.

What is worse is that the most vulnerable populations continue to be at the highest risk. Approximately 52 percent of children living with HIV receive the lifesaving treatment they need, compared to 76 percent of adults.4 Adolescent girls and young women continue to be more than twice as likely to be infected relative to their male counterparts. And Key Populations (KP)–men who have sex with men, transgender persons, people who inject drugs, sex workers, incarcerated people)–make up an increasingly large share of new infections.

PEPFAR’s five-year strategy

To meet the moment in the trajectory of the HIV/AIDS response, we launched PEPFAR’s new 5-year strategy on December 1, 2022. The strategy outlines several areas that PEPFAR will be pursuing to help achieve the global goal of ending HIV/AIDS as a global health threat. There are three key areas where African policymakers have a unique role to play in the response.

1. Elevating HIV/AIDS to the highest levels of political leadership to sustain the response

The 2001 Abuja summit was a powerful example of African political leadership. African heads of state outlined concrete goals and commitments and helped to galvanize the global community to aid in the response. In the decade that followed, thanks in large part to continued African leadership and partnerships, 27 countries increased the proportion of their expenditures on health. However, the situation has deteriorated; in 2016, 19 African countries were spending less on health as a percentage of their public spending than the early 2000s, and only three countries exceeded the 15 percent threshold.5

New political leadership is needed to sustain progress. Over the next decade, HIV/AIDS programs should primarily become the responsibility of African countries as support from outside donors inevitably declines, even as PEPFAR continues its commitment to our partner countries. This should start with clear political commitments from Heads of States to lead and manage their own HIV response–by articulating and acting on their own vision and holding their ministries accountable for results. This will help to unlock greater programmatic leadership for the oversight and management of HIV prevention and care efforts, and the broader strengthening of health systems (workforce, labs, data and surveillance, supply chains, etc.) that underpin HIV/ AIDS programs.

In many countries, donors are currently performing many of the core functions around performance management and service delivery. Until countries take over programmatic accountability, the HIV/AIDS response will continue to be viewed as a donor-led activity. Over time, more robust political and programmatic leadership should help to unlock financial leadership as well by encouraging ministries of finance, and development to recognize that investing in HIV/AIDS and health systems programs domestically will yield high returns.

PEPFAR will help to enable these three components of sustaining the response by working with countries in partnership with the African Union (AU) and other regional and global entities to jointly develop a sustainability roadmap, articulating a shared pathway for countries to take increasing responsibility for their own epidemics and hold all parties accountable for results.

2. Improving health equity for priority populations

The HIV/AIDS pandemic does not affect people uniformly. We know that persistent inequities for the most marginalized populations persist—countries should address these inequities head-on to close these gaps. This starts with adolescent girls and young women, who remain disproportionately impacted by the HIV/AIDS pandemic in Africa. Governments need to recommit to providing holistic, multi-layered support and enabling policy environments that for meet the needs of girls and women given the intersecting challenges they face that increases their risk for contracting HIV. This includes ensuring they can stay in school, access economic opportunities to earn livable incomes, receive comprehensive destigmatized sexual and reproductive health services like PrEP, and thrive in their daily lives free from violence.

Children remain less likely than their adult counterparts to receive treatment, despite the existence of highly effective pediatric treatments in the form of dolutegravir. This gap is unacceptable, and the seven countries that make up the roughly 80 percent of these missing children (Democratic Republic of Congo, Mozambique, Nigeria, South Africa, Tanzania, Uganda, and Zambia) should especially double down on the funding and management of preventing mother to child transmission (PMTCT) and care linkage programming.

Lastly, Key Populations (KPs)—continue to bear the highest per capita risk of contracting an HIV infection. Governments and donors need to bring KPs and community organizations in the lead to inform the design and expansion of equitable and nondiscriminatory prevention, testing, and treatment services. Governments also need to look critically at the restrictive laws and policies that criminalize or stigmatize these populations and prevent them from accessing the services they need–and learn from peer countries in the region who have successfully pursued reforms.

3. Leveraging the PEPFAR platform to strengthen public health systems and health security

During the COVID-19 pandemic, the recent Ebola outbreak in Uganda, and other disease outbreaks, the public health infrastructure, relationships, and practices that PEPFAR has helped to establish and strengthen for HIV proved essential to responding to new and unexpected health threats. While maintaining focus on HIV as our core mission, moving forward, PEPFAR will continue to apply lessons learned from HIV and intentionally strengthen overall public health systems to respond to health security threats. Such investments will aim to protect HIV/AIDS gains and ensure increased sustainability for countries’ HIV/AIDS response.

Regionalized and modernized supply chains for health commodities

The COVID-19 pandemic has clearly demonstrated the need for a robust regionally diversified, sustainable pharmaceutical manufacturing and supply chain ecosystems to protect against health security threats, including in Africa. A strong, diversified, and sustainable manufacturing base would also decrease procurement costs, prevent stockouts, introduce new products faster, and create substantial economic benefits. However, between 70-90 percent of drugs consumed on the African continent are imported; (China and India have comparable populations and import 5 percent and 20 percent, respectively). For vaccines, only 1 percent of vaccines consumed are manufactured in Africa.6 For Africa to address this challenge, it needs a holistic approach and an enabling environment for sustainable regional manufacturing that allow manufacturers to supply multi-country geographies, promote healthy competition, and enables sizeable, sustainable manufacturers to emerge. PEPFAR will lead by setting explicit, ambitious targets for African procurement of HIV commodities for the next decade and will adjust our procurement policies to help jumpstart demand–and drive other donors to follow.

To create this enabling environment, we will need to work with African policymakers and multilateral organizations to develop tariff and trade policies, environmental policies, and regulatory policies to support sustainable local manufacturing capacities. It will also be critical for African policymakers to certify and fund the African Medicines Agency (AMA) to lead in certification of products and implement the African Free Trade agreement to enable cross-border trade. Leaders of global and African development finance institutions should take this opportunity to provide financing and other support to pharmaceutical manufacturers standing up or expanding operations and enhancements to health supply chains across the region.

But manufacturing is not enough to get the products to the people who need them quickly and efficiently. We continue to see high rates of stockouts across PEPFAR-supported countries, and our supply chains are simply not people-centered.

African policymakers need to promote a long-term vision for a modern and sustainable supply chain, which includes movement away from the emergency nature of Central Medical Stores and integration of private sector providers across the value chain; strengthening government capacity in supply chain leadership, oversight, comprehensive planning and risk management; and diversifying channels of last-mile delivery of products beyond the public clinics. Policymakers need to also recognize that supply chains go beyond ministries of health and engage the ministries of finance, development, and trade to remove bottlenecks that create artificial supply shortages at the port or the border. PEPFAR will coordinate with African partners and other donors to help to strengthen country capacity to lead in the development and implementation of this long-term approach to supply chain modernization.

Despite the lessons from Ebola, COVID-19 and other outbreaks, the health workforce remains one of the most under-invested areas of the public health system. Africa needs 6,000 field and 25,000 frontline epidemiologists but has only trained 2,000 and 5,000 respectively. In 2017, the AU launched a two million community healthcare worker initiative, but to date only a few hundred thousand professionalized workers have been deployed, and many remain un-salaried, and poorly trained, equipped, and supervised. Nurses continue to be under-equipped and poorly prepared for new outbreaks, leading to high rates of mortality among their cohort.

Country leaders need to bring together ministries of health, education, and finance to develop an integrated plan to train, finance, and support the next cohort of nurses, community health workers, epidemiologists, and health data scientists. PEPFAR and other disease-specific donors need to align their future health workforce investments to better support those integrated country plans and, workforce leadership programs going forward.

Empowered national public health institutes

National Public Health Institutes (NPHIs) serve as the backbone of an effective public health response; during COVID-19, countries with strong NPHIs were more effective in coordinating the outbreak response. More than 30 African countries have already created NPHIs, and for those countries it is incumbent on political leaders to financially support their core capabilities (surveillance, lab networks, emergency operations centers, research). PEPFAR will work to strengthen NPHIs by partnering with the Africa CDC to enlist NPHIs to lead on core HIV-control functions such as conducting household surveys to measure the epidemiological change in the disease and leveraging their EOCs to tackle pockets of new infections.

PEPFAR has a critical role to play in the future of the HIV/AIDS response. But without leadership from policymakers, all our collective efforts will be unsustainable. African leaders need to recognize that strong public health systems are a fundamental element of strong national security and economic growth, and prioritize it accordingly in domestic budgets, laws, and policies. Country leaders also should endorse, fund, and strengthen regional institutions such as the Africa CDC and AMA who are taking a lead in coordinating the health response. Disease-specific donors including PEPFAR need to come together to harmonize and prioritize public health systems and security investments, and support country leadership in developing and implementing integrated national plans. We have come so far, and together we can end HIV/AIDS as a public health threat on the continent and globally.

Leveraging lessons from COVID-19 to build stronger health systems

Edwine Barasa

Director of the Nairobi Programme, KEMRI-Wellcome Trust
Visiting Professor of Health Economics, University of Oxford

Sir Winston Churchill averred, in the aftermath of World War II, that one should never let a “good” crisis go to waste. The COVID-19 pandemic offered several lessons for Africa’s health systems that should form the basis for a stronger, more inclusive recovery. One such lesson is that African governments ought to prioritize investments in the health sector as a means, not only to improve population health, but also to safeguard the economy. African health systems are chronically underfunded; it is estimated that on average African countries’ government expenditure on health, as a share of gross domestic product (GDP), is 2 percent—far less than the 5 percent recommended threshold for low- and middle-income countries to register meaningful improvements in population health outcomes.7 Under-investment in the health sector meant that African health systems were ill-prepared for the pandemic, and thus, suffered great economic loss.

One way to unlock additional financing and resources for the health sector is to exploit efficiency gains by reducing wastage. Two strategies are worth considering. African countries could achieve better outcomes from existing resources by introducing and institutionalizing the use of economic evidence to guide and inform healthcare resource allocation decisions in ways that promote value-for-money. One such approach is health technology assessment (HTA). HTA is a multidisciplinary process that uses explicit methods to determine the value of health interventions and services in ways that promote efficiency and other health system goals. Good examples of countries that have implemented HTA to improve the efficiency of their health system include Thailand’s universal coverage scheme, and the UK’s National Health Service (NHS). Likewise, there is also a need for African governments to tackle corruption head-on by implementing effective anti-corruption strategies. Some estimates put the loss of healthcare resources owing to weak governance and accountability environments that in turn facilitate health sector corruption to as much as 10 percent annually.8

The second lesson is that African countries ought to foster self-reliance by investing in the manufacture of essential health commodities. The vaccine nationalism and apartheid witnessed during the COVID-19 pandemic, coupled with international supply chain disruptions, exposed the vulnerability of African health systems to over-reliance on imports. Some estimates indicate that Africa imports more than 80 percent of its pharmaceutical and medical consumables, and 99 percent of its human vaccines.9 It is encouraging that several African countries have since initiated plans to establish local vaccine manufacturing. African governments must also understand that the sustainable development of vaccines and pharmaceutical manufacturing is underpinned by a vibrant research and development (R&D) ecosystem. While African countries have committed to spending 1 percent of their GDP on R&D, the continent’s funding of R&D stood at only 0.42 percent, compared to the global average of 1.7 percent.10

The third lesson is that African governments must re-prioritize universal health coverage (UHC). COVID-19 revealed that countries with advanced UHC systems are far better at responding to a pandemic or health shock.11 A system where individuals face financial barriers to access healthcare, compromises vital public health strategies during a disease outbreak (i.e., detect, isolate, and treat) such that infected individuals go undetected and cannot access isolation or treatment services, and thus continue to spread disease. While many African countries have made political commitments to UHC, this commitment has hardly translated to investment and implementation. Out-of-pocket spending, as a share of total health spending, in Africa is also among the highest in the world at 38 percent—with countries like Nigeria having levels as high as 77 percent.12 During the pandemic, this manifested in the form of individuals not accessing testing, isolation, and treatment because they could not afford to pay for these services, and in some cases, individuals are being forcefully detained in health facilities for not being able to pay the costs of isolation or care.

In addition to increasing health sector funding, several shifts will be required to course correct the continent’s UHC aspiration. The first shift is the need for African countries to re-orient their UHC plans and ground them on tax-funded approaches as opposed to contributory health insurance. Many African countries are planning or already implementing public health insurance systems that rely on individual/household premium contributions as a means to achieve UHC. There is overwhelming evidence that it is problematic to achieve scale and equity in coverage, with health insurance systems that rely on individual/household premium contributions—especially in Africa where large shares (up to 80 percent) of the population are in the informal sector with unpredictable and irregular incomes. A recent analysis found that only four out of 36 African countries (Rwanda, Ghana, Gabon, and Burundi) have achieved health insurance coverage levels greater than 20 percent, and that coverage for all four countries, was characterised by substantial funding from tax revenues.13

Contributory health insurance systems were also found to be highly inequitable on the continent. A third shift is the prioritization and financing of common goods for health (CGH). CGH are core, population-based functions that are essential to the health and wellbeing of entire societies, as opposed to individual-based services. Examples of CGH include disease surveillance systems, research and development, regulatory systems, and public health policies. CGH not only support the health and wellbeing of populations generally, but also bolster health security.

Lastly, several regional opportunities abound for African governments to leverage and strengthen their health systems. I will highlight two here. First, African leaders should take advantage of regional integration to strengthen healthcare markets and systems. The Africa Continental Free Trade Area (AfCFTA), is the world’s largest free trade area in terms of population (1.3 billion) and number of countries (54), and has the potential to spur the growth of Africa’s health markets by opening up markets for labour (health workers) and health commodities, and by attracting investments into the continent’s health sector. In addition, it has the potential to support the continent’s initiative to develop vaccines and pharmaceutical manufacturing.

Another regional opportunity that African health systems should take advantage of is, the continent’s strong regional organizations that include the African Union (AU), the Africa Centres for Disease Control and Prevention (Africa CDC), and the African Development Bank (AFDB). These organizations not only have immense convening power, technical capacity, and capacity for advocacy, but they have also put in place initiatives whose implementation will leapfrog Africa’s health system. For instance, the AU and Africa CDC have outlined a blueprint to strengthen health security in Africa labelled the “New Public Health Order.” The AU has articulated a plan to spur pharmaceutical manufacturing—Pharmaceutical Manufacturing Plan for Africa (PMPA), while the Africa CDC has also laid out a framework for the development of local vaccine manufacturing (the partnership for Africa Vaccine manufacturing). Further, the AFDB has established the African Pharmaceutical Technology Foundation, that plans to spend $3 billion over the next decade to support the continent’s pharmaceutical and vaccine manufacturing plans. However, these efforts will only be successful if African governments support and facilitate the leadership role of these regional agencies.

As we look forward to 2023 and beyond, here is hoping that African governments learn from the COVID-19 pandemic and invest in nurturing the resilience of the continent’s health system to safeguard

- **Healthcare System Responses**:
    - **Emergency Adaptations**: Health programs developed new models to continue care during disruptions (e.g., remote delivery of HIV services, new distribution methods).

Title:

Content:
World

Consultation calls for the global AIDS response to build on emergency adaptations to COVID-19, tackle structural barriers and ensure that country programmes fully recover from COVID-19 disruptions and end AIDS

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News and Press Release
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03 FEBRUARY 2022

As the Omicron variant surges through communities and health systems already stretched to the breaking point by two years of COVID-19, HIV programme managers and community representatives gathered virtually to review efforts to keep the AIDS response on track and propose ways to better overcome the challenges caused by two clashing pandemics.

“The COVID-19 pandemic has disrupted health services worldwide, at different times and in different ways, and it continues to do so,” UNAIDS Deputy Executive Director, Programme, a.i., Eamonn Murphy said at the opening of the consultation. “But at the same time we’re hearing great successes. Stories and data of impressive resilience and programmatic rebound are increasingly being documented and researched.”

The participants identified the most effective innovations that have allowed HIV services to continue to reach those who need them the most and proposed follow-up research and actions that can help guard against future waves of COVID-19 infections.

“We have learned so much over the past two years of the COVID-19 pandemic. Anticipating the worst, countries and communities rallied effectively to adapt and maintain most HIV services. These global efforts have meant that although there have been gaps and disruptions to services, and some catch-up will be needed, most people living with HIV continued successfully on treatment,” said Meg Doherty, the World Health Organization (WHO) Director of Global HIV, Hepatitis and STI Programmes.

Networks of people living with HIV and key populations at higher risk of HIV infection warned that the often life-saving adaptations made to HIV services have not addressed the stigma, discrimination and structural barriers they face in their day-to-day lives. In addition, COVID-19 has left many even more vulnerable to depression, violence and other harms.

“People are working hard to ensure that treatment is still available and accessible, but people have also lost livelihoods during COVID-19, and they have taken on additional community and family responsibilities,” said Florence Anam, a Programme Manager at the Global Network of People Living with HIV (GNP+). “Strengthening of community systems of health, and the integration of mental health and psychosocial support is more important now than ever. We need to focus on reducing inequities and ensuring that people are economically empowered enough to meet their basic needs as much as possible.”

Country data collected by UNAIDS, WHO, the Global Fund to Fight AIDS, Tuberculosis and Malaria (Global Fund) and the United States President’s Emergency Plan for AIDS Relief (PEPFAR) show that HIV service disruptions were most severe during the first lockdowns that many countries put in place in early to mid-2020. A combination of movement restrictions and health systems overwhelmed by COVID-19 cases cut off many people living with HIV from the daily medicines they need to stay healthy. HIV testing, the enrolment of people newly diagnosed onto treatment and the provision of HIV prevention tools such as condoms and pre-exposure prophylaxis nearly ground to a halt. Voluntary medical male circumcision, health services for transgender people and other elective medical procedures were suspended altogether in many countries.

Prolonged service interruptions could have led to a wave of AIDS-related illnesses and deaths, undermining decades of efforts to contain the HIV virus. Programmes across the world scrambled to find new ways to reach people living with HIV and the key populations who are at highest risk of HIV infection.

These measures included working with affected communities to deliver antiretroviral medicines door to door and to increase the quantity of medicines provided during each visit in order to reduce the frequency of medical appointments. This multimonth dispensing of antiretroviral medicines has been recommended by WHO since 2016, as it is easier for the patient and reduces the workload of the health system.

Most HIV treatment programmes quickly rebounded after adaptations were put in place.

“The data show that most national HIV treatment programmes in low- and middle-income countries responded with extraordinary resilience to protect 20 years of hard-earned gains through rapid adoption of COVID-19 adaptations,” said Siobhan Crowley, Head of HIV at the Global Fund. “The strong HIV services platform and highly engaged HIV civil society are well poised to serve as an important foundation for integrated services to tackle COVID-19 and other public health threats, but increased investment from all stakeholders is needed to sustain and build on these impressive achievements.”

Irum Zaidi, the Deputy Coordinator at the Office of the United States Global AIDS Coordinator, stressed that the strengthening of health information systems and the adoption of people-centred approaches in the years before COVID-19 was critical to the rapid reaction to the challenges created by the new pandemic.

“Over the past four years, PEPFAR and partner country governments collaborated to implement WHO policies and adaptations for providing people-centred clinical HIV services,” Ms Zaidi said. “These adaptations were rapidly scaled during COVID-19, establishing a flexible service delivery environment to keep individuals on lifelong antiretroviral therapy during COVID-19 surges. Granular real-time data along with PEPFAR’s commitment provided a path forward to support governments and beneficiaries during this unprecedented time.”

Efforts to expand access to a relatively new and promising HIV prevention option—antiretroviral medicines pre-emptively taken by people at higher risk of infection, known as pre-exposure prophylaxis, or PrEP—were also rapidly adjusted to overcome COVID-19 challenges. Those adaptations have included the shifting of clinical consultations to telemedicine and outdoor settings, the use of social media for virtual adherence support and home delivery of PrEP pills. Expansion of self-testing for HIV has helped to maintain the expansion of both PrEP and HIV treatment.

“We need to keep building the resilience that HIV services have shown by prioritizing person-centred differentiated service delivery in response to challenges posed by COVID-19,” said Adeeba Kamarulzaman, the President of the International AIDS Society.

The consultation looked ahead to a future where the COVID-19 response transitions from an acute pandemic phase to a more sustained control programme, similar to the responses to HIV, tuberculosis and other infectious diseases.

The participants agreed that, even within a best-case scenario, it will be important to build on emergency adaptations by establishing a more enabling environment for the populations who currently struggle to access services, and to ensure that HIV programmes can fully recover from COVID-19 shocks and reach the global goal of ending the AIDS pandemic by 2030.

“Perhaps one of the silver linings of the COVID-19 pandemic is how it sparked innovation and inspired their rapid adoption by countries and communities. These will have not only a positive and durable effect on the HIV response but offer models for others to adapt in tackling other health challenges,” said Wafaa El-Sadr, the founder and Director of ICAP.

The consultation, held on 1 and 2 February, was co-organized by UNAIDS, WHO, the Global Fund, PEPFAR, the International AIDS Society and ICAP at Columbia University.

- **Institutional Strengthening**: There is a call for investment in public health infrastructure and regional bodies (e.g., Africa CDC, regional pharmaceutical manufacturing) to improve resilience.

- **Policy and Planning Initiatives**: Reports stress the importance of switching to tax-funded universal healthcare approaches, sustainability roadmaps (e.g., via PEPFAR and AU partnership), and international collaboration (e.g., UICC's ATOM Coalition for cancer drug access).

- **Leadership Accountability**: Urging better government oversight, transparency, and competence in supply management; recognizing that investing in systemic, not just emergency, solutions is essential.

- **Advocacy & Partnerships**: Civil society (e.g., BONELA) and international agencies advocate for accountability, support, and coordinated responses rather than piecemeal interventions.

- **Key Takeaway**: Medication shortages—sparked by supply, manufacturing, and financial bottlenecks—directly threaten patient care worldwide.

System resilience depends on diversified supply sources, reformed funding and procurement mechanisms, empowered local manufacturing, and coordinated international efforts to anticipate, prevent, and rapidly respond to health system shocks.

Here are summarized nuggets capturing core information from the extract provided, suitable for illustrating how supply chain disruptions, demand spikes, and manufacturing delays have affected medication access around the world, especially from 2021–2024:

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**Global Nature of Medication Shortages**
- Medication shortages are a growing concern globally, affecting both developed and developing countries.

Title:

Content: The New York Times Original
Continue reading Growing drug shortage in the United States has become a threat to national security
The shortage of medicines in the United States last year increased compared to 2021 by 30%, according to The New York Times.
However, the article notes that the growing shortage of inexpensive but critical drugs poses a national security threat to the United States.
The growing shortage of inexpensive but critical drugs poses a threat to U.S. national security and forces hospitals to make “terrible ” choices, writes The New York Times, citing a report prepared for hearings in the U.S. Senate.
According to this report, the shortage of medicines last year increased by almost 30% compared to 2021, with an average shortage of medicines observed for 18 months, and for some drugs – 15 years.
Among the drugs in short supply are conventional antibiotics and anesthetics, the article said.
Senator Gary Peters, a Democrat from Michigan and chairman of the Senate Committee on Homeland Security and Government Affairs, said that these problems are related to economic factors, an opaque supply chain and the fact that 80% to 90% of some products are made abroad.
“Taken together, these underlying causes not only raise serious concerns about ensuring proper patient care, but also pose a serious threat to national security, ” Peters said.
Dr. Andrew Schumann, an oncology surgeon from Michigan, told senators at the hearing that the shortage of drugs in his field is "a tragedy occurring in slow motion."
As Schumann noted, recently due to the shortage of one cheap, but well-proven cancer drug, he had to choose which patients will receive this drug.
The article notes that many of the cheapest drugs tend to be made in countries such as India and China, where they are inexpensive to manufacture.
However, this concentration of production capacity creates an additional level of vulnerability to problems such as natural disasters and political unrest, emphasizes The New York Times.
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Small and poorer nations face particular vulnerability, with less publicly available data on their situations.

Title:

Content: Experts have recorded a shortage of antibiotics in the world due to the increase in the number of infectious diseases.
On December 21, writes the Financial Times with reference to the head of the group of the World Health Organization (WHO) for the supply of medicines and ensuring access to them Lisa Hedman, reports Day.Az.
Twenty-eight of the 35 countries for which WHO collects data are deficient in penicillin-type drugs.
In the United States and Canada complained about the lack of amoxicillin.
Less is known about the situation in poor or small countries, according to Hedman.
It is noted that in addition to the difficulties experienced by pharmaceutical manufacturers in the pandemic, the current situation is complicated by high energy prices, and this leads to a decrease in profits of companies.
In addition, countries, according to Hedman, did not expect that in the first year without masks, respiratory infections would hit the population so hard.
In addition to antibiotics, pharmacists also complain about the lack of painkillers, drugs for tuberculosis and drugs for skin infections.

**Demand Spikes Overwhelm Supply Chains**
- When demand for certain drugs surges sharply (e.g., due to pandemics like COVID-19), existing distribution chain stocks are insufficient to cover the sudden increase (“hype”), leaving patients unable to access needed medications at critical moments.

Title:

Content: What is needed for the localization of substances in Russia
The detailed content of the Pharma-2030 strategy remains intriguing.
But it is unlikely that it will come out without a large section dedicated to the localization of active pharmaceutical substances.
After the Chinese lockdown showed the extreme dependence of the domestic pharmaceutical industry on external supplies, there can be no other way.
Many countries want to get off the hook of imports.
What are Russia ’ s options?
Stress test for pharmaceutical industry
Throughout 2021, the world analyzed the consequences of the shock that it endured due to the stoppage of supplies of raw materials from China.
The system, which worked well for several decades, failed partly due to the overlapping of borders at the peak of the first wave of the epidemic - then importers of most goods from the PRC suffered - partly due to the fact that the chemical production of China was closed one after another due to the hard lockdown imposed by the Chinese authorities.
It became obvious to everyone: the global pharmaceutical industry is totally dependent on supplies from China.
First of all, this applies to active pharmaceutical substances (APS) - raw materials for the synthesis of finished dosage forms.
A study of the American market conducted by the Center for Analytics and Business Analytics (CABI) of the Olin Business School of the University of Washington found that more than 80% of APS in key therapeutic areas in the United States is not produced.
The country, like most others, relies on the "world factories of pharmaceutical substances" - India and China.
The COVID-19 outbreak and the subsequent unprecedented demand for drugs in the United States revealed a low level of drug safety in the country.
"During the pandemic, a number of drugs were lacking," CABI senior researcher Anthony Sardella told Pharmaceutical Technology. - There were drugs for patients on ventilators, there were some drugs that were considered as potential remedies for COVID and were in the study stage - they were in short supply. "
The dramatic increase in the number of sites for the production of AFS in the United States is not an easy task that requires large-scale investment, but there are other ways to fix the situation, Sardella said.
“It is possible to use advanced technologies, one of which is continuous production.
Such technologies are more maneuverable, since they do not require significant capital investments, allow less investment at the initial stage and faster to enter the market, ” he said.
While traditional serial production may take seven to eight years, the introduction of new technologies can ensure the production of AFS within two to three years.
At the same time, it is important first of all to establish the release of ingredients for vital medicines.
To form such industries, the American authorities should first of all provide regulatory support to developers, experts say.
In addition, the United States should build partnerships with different sites in other countries to diversify supplies.
In 2021, the Government of India announced the launch of a large program to develop the production of APS in the country.
The program includes subsidies and preferences for developers, the introduction of duties on imported components from abroad, the creation of research centers for the development of ingredients, environmental concessions for production sites and much more.
How to replace China?
In the midst of the pandemic, French pharmaceutical giant Sanofi announced plans to create a European company for the production of active pharmaceutical ingredients.
The new manufacturer should cover a significant share of the needs in the API, primarily in the European pharmaceutical industry.
Russia experienced the same shocks in 2020 as most countries.
Domestic industry buys abroad 75% of the pharmaceutical substances it needs, mainly of Chinese production.
The matter was complicated by the fact that the substance for the synthesis of drugs involved in the first protocols for the treatment of coronavirus infection, the demand increased five to ten times.
The system of AFS turnover, developed in the last three decades and more or less satisfied with the majority of market participants, for the first time in this time demonstrated its unreliability.
Touched stock
Russian companies went through the “narrow neck ” of supplies due to the available reserves of raw materials.
The fact is that all suppliers of substances must be included in the registration dossier of the drug, and the change of any of them means for the Russian pharmaceutical company the beginning of a multi-month regulatory process.
Therefore, factories strive to keep a stock of APS, which will ensure their smooth operation in the event of changes in the supply chain.
And buyers of Chinese products, in addition, are trying to make additional purchases before the Eastern New Year, which begin to be celebrated at the end of January and celebrate more than two weeks - at this time, economic life in China freezes.
These stocks helped Russian producers survive the crisis spring of 2020.
The coronavirus crisis focused on what Russian officials and manufacturers have been saying for years: only a large-scale domestic production of the API can avoid such problems and ensure the country ’ s drug safety.
Russia should return to the full cycle of drug production, which was formed during the late Soviet Union, and then lost.
Countless tasks
The task of establishing the production of pharmaceutical substances, set in "Farm-2030", is difficult primarily because it includes many sub-problems.
Substances are of several types: chemical, biotechnological, from plant raw materials, etc. - and each has its own suppliers, technologies and industry connections.
The pharmaceutical industry needs a lot of substances.
However, from the point of view of the chemical industry, these volumes are small, and it is unprofitable for the chemical industry to produce this or that nomenclature in small quantities.
To smooth out this contradiction, officials from the Department of Chemical Industry Development of the Ministry of Industry and Trade of the Russian Federation were involved in the Farm-2030 meetings.
Biological APS is another problem.
The Soviet Union was among the world's largest producers of antibiotics, but in the 1990s this direction ceased to exist, specialists went into other industries.
There are more and more new antibiotics in the world, the production technologies of which we do not own.
And for the release of substances from plant raw materials (heparins, glucose, starches, etc.), the industry must work in close cooperation with agriculture, because suppliers need to know what quality the source material for substances should be.
These connections are also largely lost.
The industry is faced with an infinite number of tasks that must be taken into account at the same time.
Asian bait
Even to the indicator of 25% of substances produced in Russia, you need to approach carefully.
Many companies that claim to produce their own pharmaceutical substances are cunning.
In the synthesis of substances there is such a thing as the “minus one ” stage – the preliminary processing of chemical or biological material.
We have a "minus one" stage - additional cleaning.
Some companies talking about their own production of pharmaceutical substances, since the early 2000s, limited themselves to importing APS from China, recrystallizing or refining them, calling it synthesis.
Sometimes it ’ s just a matter of labeling.
“Now a large share of raw materials for the entire pharmaceutical industry comes from Asia, from it in Russia (and in many countries of the world) produce finished medicines, ” said in an interview with“ Vedomosti ” the owner of a large Russian production of substances of the group of companies “Promomed ” Peter White.
The trend was set 30 – 35 years ago by European and American pharmaceutical companies, starting for economic reasons to take the production of substances to China.
In a short period of time, a system was formed in which the trade in substances with China began to be controlled by international distribution companies, which guaranteed orders to manufacturers of the Celestial Empire, and prices to buyers in the West seemed comfortable.
At the same time, distributors earned up to 30% on each delivery.
In the 2000s, Western and European pharmacists began to gradually exclude intermediaries from the supply chain, entering the Chinese market directly as buyers, and the Americans began to build their own factories in Southeast Asia.
The production of substances in “big chemistry ” is cheap, the requirements for ecology and safety in China at that time were formal.
Huge factories plus low environmental requirements and cheap labor - this is the recipe by which China and to a lesser extent India have managed to monopolize the world market of pharmaceutical substances.
“The Chinese just ruined the market.
They dumped, hooked everyone on themselves and only then began to slowly raise the price, ” says one of the market experts.
Getting off the needle is difficult.
Manufacturers of pharmaceutical preparations make each substance with which they work in the registration certificate and refine the technology for the release of the finished form for it.
To change the supplier, you need to reconfigure the production process and re-go through all the circles of bureaucratic hell.
Nevertheless, the issue of phasing out Asian supplies has been brewing for many years.
The year 2000 is long gone, China has formed a steady trend to raise environmental standards.
Unenvironmentally friendly, unsafe chemical production, created 20-30 years ago, are closed in China by dozens, and among them those that are focused on the production of pharmaceutical substances.
Instead of closed production, new, multifunctional and even more large-scale than before are opened.
New enterprises are built in accordance with GMP and other modern standards, hire highly qualified specialists - and their products are becoming more expensive.
The market has long become a familiar situation when one or another nomenclature temporarily disappears, and then appears at a higher price.
This is due to the opening of new plants that produce substances.
One way or another, the constant rise in price of substances of Chinese production is a trend that is not destined to be interrupted in the foreseeable future.
Necessary and possible
It may take five years for a pharmaceutical manufacturer to create a full-fledged production of substances for their drugs and include them in the regulatory documentation of a drug.
For biotechnological drugs, this period will be about seven years.
At the same time, the volume of investments in the construction of a chemical plant for the production of APS is estimated at at least 2.5 billion rubles, optimally at 4.5 – 5.5 billion rubles with a payback period of the project from ten years.
Modern molecules with a large market and good margins involve eight-twelve-step synthesis with complex technology, the development of which, in turn, takes from eight months to one and a half years per product, while companies can create 5-8 products at a time.
In addition to developing synthesis technologies and scaling them for industrial production, for each product, the manufacturer needs to create a set of analytical methods that will make it possible to form a product dossier and prove to regulators and partners that the quality of the substance meets the requirements of the pharmacopoeia.
Technically, nothing is impossible.
Ten years ago, we did not have the technology and the specialists to produce many ready-made molds.
Since then, dozens of pharmacies have opened in the country.
“There is nothing supercritical in the organization of the production of substances, ” says the chairman of the board of the non-profit partnership Medico-Pharmaceutical Projects.
This is not R & D, you know exactly the molecule that you produce, you know the parameters, they are all described in the pharmacopoeia, there is a clear scheme for the selection of equipment; it is a technologically complex, but solvable process.
We have up to ten companies that can organize it. ”
But it will take decades to do such work on an industry-wide scale.
Large enterprises have 250-350 items of finished medicines in their portfolio.
Substances are purchased for each of them.
And that's just the tip of the iceberg.
There are also auxiliary chemicals, there are packaging materials - cardboard, foil, PVC film, vials and prefilled syringes.
Creating a domestic production base for such a range of products is such a difficult task that at a certain stage there was an idea to attract veterans of the Soviet Gosplan to work on it.
On the one hand, tasks of frightening scale.
On the other hand, China already supplies 90% of all necessary substances to the world market.
So what is the point for manufacturers to take risks and change something in the current practice?
The process is already underway
Reducing the dependence of the local market on imported products is not a plan for the future, but a reality that we have been observing for several years, stated in the first versions of the program "Pharma 2030".
Its authors cite data from the marketing agency DSM Group: already in 2017, in the Russian market, the increase in sales of domestic drugs amounted to 7.4% in monetary terms and 4.3% in kind and surpassed the same indicator for imported drugs - 6.1% in money and 2.3% in physical terms.
From 2006 to 2017, the share of imported drugs in the programs of preferential provision of medicines fell from 91 to 70%, in hospital purchases - from 78 to 63%, and in the commercial segment - from 76 to 71.5%.
The first version of Pharma 2030 was presented in 2018, so the statistics in the program are tied to 2017.
Subsidies and guarantees
The release of substances is not only a complex, but also an expensive process, and any production should be economically profitable, says Lilia Titova, Executive Director of the Union of Professional Pharmaceutical Organizations.
In her opinion, one of the options is to agree on a joint program for the issuance of the AFS with the countries of the Eurasian Economic Union.
“There is no point in producing all substances in one country, ” she says.
In addition, notes Titova, where real production, there can not do without measures of state support.
Creating incentives for producers is the task of the state.
Drug security is considered to be part of the national: the state has undertaken to provide free medical care to citizens in a certain amount.
In order for the state to fulfill its obligations to its citizens, a country must have sources of raw materials for the production of medicines, regardless of crises that may be caused by factors beyond its control: problems with foreign manufacturers, external sanctions or, as happened last year, the closure of supplies due to the epidemic.
“The disappearance of products or groups of drugs from the market just because China or India stopped production, severely affects the national security of any country, including ours, ” Alexander Semenov, president of the pharmaceutical company Active Component, told GxP News in an interview.
When the state undertakes to solve a problem, it must assume that the decisions made will be beneficial to market participants - at the expense of subsidies, long-term contracts, preferential taxation or other similar incentives.
“Let ’ s remember the Soviet times: our country was one of the world leaders in the production of substances, – says Semenov. – We had these chains: the production of intermediates, chemical components of APS, reagents and pharmaceutical substances themselves. ”
To release all pharmaceutical substances is a utopia, but to single out the strategic pool of the AFS and adjust these chains to them is more than a reasonable idea, and state strategic support is important in this matter, he believes.
We do not need our own production of all the APS imported today, agrees the scientific director of the RCTU named after D. I. Mendeleev Alexander Mazhuga.
It is wise to focus on antiviral drugs and antibiotics.
Two sets of measures could be effective.
The first is infrastructure subsidies.
This support option was valid until 2019: the state Industrial Development Fund (FRP) could compensate up to half of the costs for the arrangement of a new workshop, the purchase of technological equipment, if the manufacturer proved that the equipment was used to produce the substance.
This was one of the most effective ways to show the interest of the state: the manufacturer spent money - part of it is compensated.
The second key measure is sales guarantees.
Representatives of regulators have repeatedly mentioned such a form of support for the sale of local substances as the expansion of preferences in public procurement for manufacturers of drugs, all stages of production of which, including the synthesis of APS, are carried out in Russia and other states of the Eurasian Economic Union.
But such guarantees can also be introduced in other forms.
For example, in the form of flexible customs duties on imported products or even the participation of the state in the procurement of substances from domestic manufacturers - perhaps not directly, but in the format of compensations to manufacturers of ready-made forms of costs for the purchase of local AFS.
In fact, this is the same subsidization, but not the development of production, but the sale of its products.
Attempts to impose customs duties on imported products will inevitably face resistance from different interest groups.
For example, in our country for a long time there was a duty-free regime for the import of medical equipment, despite the fact that there is a duty on the import of components.
For the development of local production, this situation is counterproductive, but it was lobbied by foreign manufacturers of medical equipment at a time when their Russian colleagues did not have sufficient resources to defend their interests.
In the case of pharmaceutical substances, an obvious mechanism of customs regulation arises.
If two or more manufacturers of a certain range appear on the Russian market, this may become the basis for the government to introduce increased import tariffs on it.
However, this will inevitably be hampered by both the lobby of distributors and representative offices of foreign companies, and the political factor - the fear of increasing the cost of drugs.
Medicines, as well as food, are rightly considered socially oriented products, so restraining the growth of prices for them is a priority for the government.
It is worth taking any actions that somehow relate to customs duties or some other barriers, as there are voices that this will lead to a rise in the price of medicines in pharmacies.
Nevertheless, the question is overdue and it will not be possible to bypass it.
No one can guarantee that in the future there will not be a repeat of the import crisis comparable to what we saw in early 2020.
Russia is painfully experiencing failures in the global distribution system of APS, but our advanced chemical science, rich natural resources and a powerful chemical industry allow us to solve this problem, says Alexander Mazhuga.
“Own production of substances will help the Russian pharmaceutical industry to become more independent and ensure national drug safety, as well as open up prospects for the export of API and finished products.
The situation for this is favorable: many countries, feeling the threat of shortages and dependence on China, will seek to diversify imports of pharmaceutical substances at the expense of alternative sources, ” he says.
After we have launched our own coronavirus vaccine on the market as soon as possible, we can expect a positive response to our pharmaceutical products abroad.
So at stake is not only the domestic market, but also the external, European and Eurasian.
Goal for the decade
The development of the domestic pharmaceutical industry with an emphasis on full-cycle production, including local production of substances, is one of the focuses of Pharma 2030.
This program was first officially presented by the Ministry of Industry and Trade in July 2019, and the first version of it was published in 2018.
It should replace the strategy “Pharma 2020 ”, the main goal of which was to ensure the transparency of the movement of medicines from the manufacturer to the consumer, the disappearance of fakes and“ gray ” supplies from the market.
The goals of Pharma 2020 are generally considered fulfilled, and the new program sets much more ambitious goals for the industry, but its approval has already been postponed several times.
The first versions of the program were criticized by experts and the press for being unstructured and too vague.
In June 2020, one of the top officials of the Ministry of Industry and Trade of the Russian Federation reported that the Pharma 2030 project was sent to the Government of the Russian Federation, however, despite this, it is still being “actively refined ” in accordance with the wishes of market participants and interested departments.
Finally, in June 2021, at the St. Petersburg International Economic Forum, First Deputy Minister of Industry and Trade Vasily Osmakov said that the strategy will be approved and put into effect at the end of the year.
In fact, all the provisions of Pharma 2030 are somehow focused on the need to improve the domestic pharmaceutical industry.
The program proposes to change the balance in the industry in favor of manufacturers, reduce the dependence of the local market on imported products, create conditions for Russian players to invest in the development of new drugs, accelerate technological development in the industry.
The ultimate goal is to increase the export of domestic pharmaceutical products.
gxpnews

**Specific Drugs Affected**
- In the United States, shortages have affected conventional antibiotics and anesthetics, raising concerns about national security and patient care continuity.

- Broader trends show new antibiotics and many advanced drugs are often in short supply, due in part to limited domestic production capabilities.

**Manufacturing and Import Challenges**
- Many countries, including Russia and India, identified over-reliance on imported Active Pharmaceutical Substances (APS) as a core weakness.

- India launched large-scale programs to build domestic APS production (2021).

- Russia, after initial resilience during the COVID-19 crisis, began focusing on reestablishing full-cycle drug production lost since Soviet times.

- Losing access to imports, including raw materials and finished medications, severely strains local pharmaceutical industries.

**Industry Barriers and Delays**
- Advanced pharmaceutical manufacturing requires multi-level expertise: from synthesis to quality analytics, to regulatory approval—hindering rapid scaling.

- Even with government incentives, creating domestic capacity and reducing import dependence is a long-term (decades-long) task.

**Governmental and Health System Responses**
- Many governments have moved to subsidize domestic production, implement or consider bans on medical sanctions, or reduce customs duties to stabilize supply.

- Strategic national programs, such as Russia’s “Pharma 2030”, focus on ensuring domestic “drug security” for essential medicines, particularly antibiotics and antivirals.

- Authorities in Russia, for example, pointed to forming strategic reserves of pharmaceuticals and rapid crisis interventions as key COVID-19 lessons.

Title:

Content: NEWS
10 / 14 / 2021 06: 36 AM
Rubric: Economy
Lessons of the Pandemic
COVID-19 tested the world for sustainability
Text: Elena Aksenova (Director of the Research Institute of Healthcare Organization and Medical Management of the Department of Health Care of Moscow, Doctor of Economics)
The COVID-19 pandemic has become a serious challenge for the world community.
There are more than 100 million confirmed cases and more than 2 million deaths worldwide.
In any properly built system, the main task is to resist the rampant elements.
Photo by RIA Novosti
In our country, there are about 4 million cases of infection, of which 2 percent resulted in death.
The fight against the aggressive spread of the pandemic has launched processes of large-scale transformation of health systems, exposing all the weaknesses and pain points.
During this period, the London School of Economics, the World Economic Forum, with the support of AstraZeneca, initiated the largest cross-country scientific study dedicated to assessing the resilience of national health systems and their resilience to crises.
The project involves the Russian Federation, France, Germany, Italy, Poland, Spain, the United Kingdom and Vietnam.
From Russia the work was carried out by our institute.
The main goal of the project is to make a significant and long-term contribution to the development of global health in several areas:
1.
Sustainability of health systems (the ability to maintain, generate resources and deliver services, as well as learn and improve in this direction).
2.
Resistance of health systems to crises (ability to prevent, mitigate and overcome crises, natural disasters and environmental disasters).
The key sustainability criteria are divided into:
- Management of health systems;
their financing;
- medical personnel;
- medicines and technologies;
- organization and provision of medical care.
New technologies need to be introduced to improve health system sustainability
The sustainability of national systems depends more on well-chosen measures to achieve leadership and concretization of national health systems, ensuring continuity between levels of government.
The study found that most health systems were not prepared to function sustainably in times of crisis.
Many of them were not properly funded, given the persistent impact of the 2009 banking crisis on public sector finance.
But other disturbing aspects have also been identified.
It is shown that in many cases management systems lack guidance and clear strategies.
In many countries, the vertical of governance in health care is far from clear, and there is a tense relationship between national and local authorities that discourages rapid response.
It is expected that there is a shortage of labor, and the methods of planning the staffing of medical specialists are outdated and do not allow to assess the real situation in health care.
In most countries, well-being in the workplace is regarded by the authorities as a secondary characteristic.
In some of the countries studied, investment in different parts of the health system is limited, such as innovation.
Finally, even in health systems described as integrated (for example, the UK National Health Service), there is a lack of coordination at different levels and on different aspects of service delivery.
As part of cross-country comparisons, it was noted that Russia coped quite well with the crises caused by the spread of COVID-19.
For example, state financial support in the event of local and global emergencies, which turned out to be the spread of a new virus, was provided by changing the budget list (redistribution of funds in the directions) or at the expense of the reserve funds of the President and the Government of the Russian Federation.
And this was done very quickly.
The pandemic has also shown that capacity can be urgently increased and personnel can be redistributed.
The issue of education can not be solved so quickly: the demonstrated lack of doctors' ability to sort patients, work in personal protective equipment, reasonable alertness indicates the need to supplement or revise educational programs and advanced training courses on infectious diseases.
In Russia, during the pandemic, centralized training of medical specialists in infectious safety programs was organized, standard algorithms for the diagnosis and treatment of a new coronavirus infection were promptly developed and distributed.
Also identified parameters that require correction in the context of the transformation of health care.
For example, it makes sense to consider the introduction of estimated funding for medical organizations in crisis situations, as well as the legislative consolidation of temporary measures to limit mediation for certain groups of goods necessary for the treatment and prevention of the spread of COVID-19.
Special attention should be paid to the policy of the Russian Federation regarding the provision of medicines to citizens.
After passing complex studies at a meeting of the commission on the formation of lists, a decision is made on the inclusion (exclusion, refusal to include) of a drug in the lists: VED (formed annually); expensive drugs; a minimum range of pharmacies (formed at least once every 3 years).
Decisions are dictated by the principles of expediency, acceptability and "cost-effectiveness" (that is, that additional costs are justified by obtaining additional efficiency).
Accordingly, the group of end users of medicines and the source of financing depend on this decision.
In accordance with the current legislation, the Ministry of Health of Russia is responsible for the registration and evaluation of medicines in Russia.
The duration of registration of medicines under the legislation of the EAEU in general is 210 days.
During the pandemic, government resolution No. 441 introduced a simplified and accelerated procedure for the registration of new medicines (20 days) and allowed, if necessary, to purchase them from a single supplier.
This procedure will be valid until January 1, 2022.
Another important element in the formation of the sustainability of the national health system is the rapid introduction of new medical technologies.
It is advisable to ensure unification and legislate the indicators of thresholds of economic efficiency, for example, the cost of acquired years of quality life or the price of one year of saved life, adjusted for functional impairment.
This is fully combined with the approach of value-oriented medicine and taking into account the costs incurred in assessing the quality of life of the population.
On the one hand, it increases the consistency and transparency of the management decision-making process.
On the other hand, the need to make decisions based on a single factor often deprives the managerial apparatus of flexibility and does not allow to take into account other factors than economic ones.
In addition, for different diseases and periods in the development of the state, the indicators of the threshold values of economic efficiency can vary greatly.
It seems expedient to introduce a flexible system of thresholds of economic efficiency, subject to periodic review to objectively reflect the economic situation in the country.
To increase the sustainability of the health system, it is important to focus not only on funding the development of new medical technologies, but also on creating the conditions for their implementation in clinical practice.
Therefore, it is important to draw the attention of decision-makers to the maximum assistance to the process of digitalization of healthcare, since it represents an uncontested stage in the evolution of development.
This assistance includes many tasks: removing legal barriers to the development of technology, improving the legislative framework in terms of telemedicine services and cybersecurity, completing the process of creating a single digital circuit, which consists in the complete mutual integration of all electronic medical systems and eliminating the lack of open data, improving the information culture of the population.
Cross-country recommendations have also been developed to improve the sustainability of national health systems.
Among them, Russia proposed the following.
With regard to the management of health systems: expanding the participation of citizens and civil associations in the legislative process through the adoption of a single normative legal act regulating public legislative initiative.
In terms of financing health systems: development of PPP and assessment of the possibility of providing certain types of medical care on the basis of private medical organizations; introduction of mandatory mechanisms to stimulate the quality of medical services.
In matters of new drug policy and the introduction of innovative technologies: the need for full mutual integration of all electronic medical systems, eliminating the lack of open data, as well as the creation of a high-quality unbiased source of professional knowledge; improving the regulatory framework for the provision of telemedicine services; introducing at the federal level a program to improve the information culture of the population; creating a separate National Health Fund (NHF) according to the RFBR model.
In the organization and provision of medical care: the introduction of rehabilitation on a strong base of hospitals, as well as the development of institutions of treatment and care at home; overcoming the crisis of social consciousness and further promotion of health-saving practices.
The implemented project has a huge potential.
The World Economic Forum has already begun to build a digital platform and partnership for the sustainability of national health systems.
In the next stage, it is important not only to provide unhindered access to analytical tools, assessment of best practices to improve the sustainability of national health systems, but also to develop a global rating of their sustainability.
It will make it possible to respond quickly to changes, adjust national policies and reallocate resources.
And experts will have access to important process planning tools to improve the sustainability of health systems.
Point of view
George Warton, Senior Lecturer, Department of Health Policy, London School of Economics:
As a result of COVID-19, global health systems have experienced a burden many times greater than their capacity.
With an elderly population and a country made up of densely populated cities and isolated rural communities, Russia faces a particular challenge in responding to COVID-19.
The Health System Sustainability and Viability Partnership project was initiated to collaborate with leading health researchers around the world to produce fast and reliable health system reviews.
In Russia, the problem of the digital divide has been exposed, and there are clear actions that need to be taken to improve the integration of digital health data and increase digital literacy.
We are now starting the second phase of the partnership and hope that other countries can learn from Russia ’ s experience and that Russia can implement our recommendations to ensure the long-term sustainability of the healthcare system to build a sustainable future.
Eric Roche, Senior Vice President, Head of Teva Russia, Eurasia, Turkey, CEO of Teva Russia:
As a result of the pandemic, the topic of health has become top of the agenda.
During this time, the Russian state introduced a number of significant changes for the pharmaceutical industry and patients.
For example, the procedure for the import of unregistered drugs used in COVID-19 has been established, a procedure for accelerated registration for a number of drugs has been introduced, pricing mechanisms have been improved, distance sales have been liberalized, etc.
Nevertheless, to achieve the goal of the Russian state to increase the average life expectancy of the population in Russia to a level of more than 78 years by 2030, it is necessary to take a number of steps.
We believe that at least three significant steps are necessary: first, to ensure the availability of drugs (physically and at a price); secondly, to expand the range of drugs; thirdly, to switch to the model of universal drug insurance.
Economy Industries Pharmaceutical industry Coronavirus pandemic COVID-19

- International initiatives (World Economic Forum) encourage digital platforms and partnerships to monitor and sustain health system supply chains.

**Concerns and Unintended Consequences**
- Policy measures (trade barriers, customs changes) risk unintended effects, such as price increases at pharmacy counters, impacting patient affordability.

- The overall market, including exports, is influenced by these domestic policy choices.

**Recent Country Examples**
- Estonia and other nations have reported worsening drug supply problems, indicating the broad pervasiveness of such disruptions beyond just large economies.

Title:

Content: Drug supply problems have worsened in Estonia
This year, pharmacies in Estonia faced a much larger shortage of drugs than a year earlier.
Problems with supplies are caused by both increased demand and shortage of raw materials, reports rus.err with reference to "Actual chamber".
This spring, parents faced a shortage of antibiotics and antipyretic drugs suitable for children, and in the fall, the Sorbister drug for renal patients had to be issued from the state reserve stock, since it was not enough due to supply problems in pharmacies.
Hospitals are also facing a severe shortage of medicines this year.
“For example, hospitals use very important drugs to treat the consequences of heart attacks and strokes, the supply problems of which have been observed for a year, but thanks to good cooperation, we were able to ensure that no one was left without treatment, ” said Marco Tiisler, head of the Import and Export Supervision Department of the Drug Department.
In 2021, there was a shortage of 183 drugs in pharmacies, last year - 359, as of the end of this year - 450 drugs, and in the case of 130 drugs, the cause of the deficiency is unknown.
The second significant reason was a sudden surge in demand, for example, for the drug Ozempic, which is popular among those who lose weight, but drugs can be in short supply due to problems with production.
- Producers lack the active ingredient.
The active substances come from third countries, they are not always available, this was stated by one of the largest European manufacturers of antibiotics, - said Tiisler.
Drug supply problems put not only patients in a difficult position, but also doctors who have to quickly find replacements, sometimes in conditions of scarce information about alternatives.
If earlier, in the case of a shortage of drugs, the patient had to pay the full cost of the drug prescribed as a substitute, recently the Health Insurance Fund, as an exception, decided to extend the discount to some alternatives.
According to Lee Rootslane, head of the Union of Pharmacies, problems with the supply of medicines are a growing problem throughout Europe.
- This year, in cooperation with the Drug Department and family doctors, we made recommendations so that if a problem arises, we do not solve it after the fact, but try to provide some solutions and avoid panic.
In the case of children ’ s syrups, people read about the shortage of syrup, went to the pharmacy and took two syrups instead of the usual one, ” Rootslane said.
The drug department recommends having a weekly supply of non-prescription drugs and a monthly supply of prescription drugs at home.
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**Broader Health System Evolution**
- The pandemic elevated health system resilience and technology adoption to top government agendas, prompting reform efforts—like better electronic health records, telemedicine expansion, and centralized health funds.

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These points present a broad picture of the dynamics underlying recent global medication and supply shortages, the specific impacts seen at the patient level (unavailability of key drugs), and the types of policy responses (industrial, regulatory, and strategic) by national health authorities.

**Summary of Key Points on Medication and Medical Supply Shortages (2021–2024):**

- **Global Health System Vulnerabilities:**
  The reports highlight a persistent deficit in global healthcare systems' ability to withstand crises, with "resilience of health systems and pandemic preparedness" cited as critical areas needing urgent investment.

Title:

Content: This came in a panel discussion held during the Forum – which was broadcast on its official website a little while ago – and highlighted that the global pandemic preparedness system needs sustained political will and investments to ensure that the global healthcare supply chain responds effectively to any crisis.
If we don ’ t take pandemic preparedness seriously now, the lives of millions more will be at stake.
The SARS, Ebola and COVID-19 crises have tested the world ’ s ability to deal with outbreaks of epidemics and infectious diseases, and the global pandemic preparedness system needs sustained political will and investments to ensure that the global healthcare supply chain responds effectively to the crisis.
“Eight years ago, when the Ebola outbreak proved that the world was no better prepared for outbreaks, there was more talk and some action, ” participants said.
This included the establishment of the Epidemiological Supply Chain Network (PSCN), by the World Health Organization, the World Economic Forum, the World Bank, the World Food Programme, the US Centers for Disease Control and Prevention and more than 60 companies.
However, nearly three years after the COVID-19 pandemic – the worst global health crisis in a century – many of the same supply chain vulnerabilities remain, and although partnerships, such as PSCN and national efforts have somewhat reduced the severity of supply chain disruptions during the epidemic, efforts to develop a global pandemic preparedness system have not yet mobilized the will. “The sustainable policy and investment needed to ensure that global health care is delivered in a way that can respond effectively to any crisis. ”
The Forum recommended seven key actions to address this issue:
- Providing political will and sustainable financing.
Although crises often lead to an influx of short-term spending, money quickly dries up as memories fade and priorities change.
Genuine global health security requires global financing mechanisms that enable sustainable investment and ultimately break panic and fear.
- Geographical diversification in manufacturing; achieving greater geographical diversity requires more than just investing in new factories.
Long-term contracts and financial guarantees are needed to maintain the manufacturing of important health-care materials in diverse locations.
- Improved inventory management.
In addition to strengthening stocks of personal protective equipment (PPE) at local, regional and national levels, we must manage medical stocks more intelligently.
- Establish platforms for data exchange and enhanced transparency.
Through globally focused PSCN and various national efforts, while progress has been made, encouraging responsible information sharing between public and private partners requires substantial additional funding.
Promote the free flow of goods.
Over the past three years, government restrictions on exports have played an important role in exacerbating the lack of product distribution.
While governments ’ desire to protect their people in times of crisis is understandable, international cooperation to allow the free flow of key products reduces the risk of viral spread.
- Strengthen coordinated early warning systems for epidemics.
Strengthening health systems and improving primary care.
Dr Tedros Adhanom Ghebreyesus, Director-General of WHO, said: “Universal health coverage and health emergencies are cousins – two sides of the same coin.
Significant and sustained investments are needed if we are to reap the benefits of expanded access to care. ”

The COVID-19 pandemic notably strained both supply chains and healthcare infrastructure worldwide.

Title:

Content: World News
Senate to discuss government policy to reduce impact of economic crises on health services
Thank you for reading the news about the Senate discussing tomorrow the government's policy to reduce the impact of economic crises on health services.
CAIRO - Samia Sayed - The Senate will discuss during its plenary session on Wednesday under the chairmanship of Chancellor Abdel Wahab Abdel Razeq on the measures and measures, addressed to the Minister of Health and Population, to clarify the government's policy to reduce the effects of the economic, health and political crises witnessed by the world on the care sector, health services and medicine prices.
The MP pointed out in the request for discussion that the impact of global repercussions on the cost of health services can be diverse and complex, and depends on many factors, including: global economic conditions, where the fluctuations of the global economy affect the availability of funding for health services and the spread of global epidemics and diseases
Another factor is the COVID-19 pandemic, which can lead to increased demand for health care services and, by extension, the costs of responding to such services.
health care system, which leads to an increase in its costs, and the following care system
He pointed out that changes in the structure of the population also affect the cost of health services as population growth can lead to an increase in the demand for health services, which puts additional pressure on the health care system and leads to an increase in the cost of health care and in the price of medicine.
Global political crises can make it difficult to access essential medical supplies, including medicines and medical equipment.
The MP said that all these factors can negatively affect the ability of the concerned parties to provide health care, adding that the provision of decent health care and the provision of medicine is within the framework of community protection, as they agree with the vision of the state to provide a decent life for the Egyptian citizen. Clarify its policy to reduce the impact of the economic, health and political crises that the world is witnessing on the care sector, health services and drug prices.
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- **Causes of Shortages:**
  - **Supply Chain & Manufacturing Issues:** Disruptions and downtime in manufacturing, along with supply chain gaps, were key contributors.

Title:

Content: General Supervision
Elham Aboul Fath
Editor-in-Chief
Thank you for your patience.
General Supervision
Elham Aboul Fath
Editor-in-Chief
Thank you for your patience.
An Unexpected Catastrophe in the World ’ s Largest Country: The Complete Story of U.S. Drug Shortages
The deficit is at a record level.
According to data from the American Society of Health System Pharmacists and the University of Utah Drug Information Service, organizations began tracking drug shortages for the first time in 2001. Steady since 2021 – now reaching a record high of 323 drugs in the first three months of 2024.
Paul Abramowitz, CEO of the American Society of Health System Pharmacists, wrote in a blog post on Thursday: “It ’ s been a long time to end drug shortages, ” and wrote:“ All drug classes are vulnerable to shortages, some of the most worrisome shortages include sterile injectable generic drugs, including cancer chemotherapy drugs and emergency drugs stored in hospital vans and procedural areas. It is dangerous for doctors and patients. ”
In addition to the 32 chemotherapy drugs that are deficient, the five categories of drugs with the greatest deficiency include central nervous system stimulants, antimicrobials, hormonal agents, and intravenous fluids. [1] The Drug Deficiency Database maintained by the American Society of Health System Pharmacists and the University of Utah is based on voluntary reports from practitioners, patients, and others that have been confirmed by manufacturers. The U.S. drug is in short supply, because it captures broader effects on service providers and patients.
The crisis has lasted a year and a half.
More than half of the treatment shortages have lasted for more than two years, according to an analysis by health consultancy IQVIA, and the average shortage affects at least half a million patients, many of them elderly, according to the US Office of Health and Human Services under the Assistant Secretary for Planning and Evaluation, which shared its analysis with Congress in May.
Growing demand can play a role in drug shortages, as with the recent shortage of weight-loss drugs, but often manufacturing and quality problems, such as supply chain gaps and downtime, are the root cause. And varied.
But the American Society of Health System Pharmacists has “serious concerns ” about parts of this proposal, especially financial sanctions imposed on hospitals that lack the resources to comply with the recommendations, Abramowitz wrote:“ We all know that managing shortages is not enough and is not a sustainable solution to the worsening crisis, and there is still a lot of work to be done at the federal level to fix the root causes of drug shortages. ”
Why Shortage Occurs
Shortages can be caused by high demand, as with the recent shortage of weight-loss drugs, but this is not usually the main problem.
The FDA also blames manufacturing and quality problems, supply chain gaps, and downtime, and Dr. Emily Tucker, a drug shortage expert and an assistant professor of industrial engineering at Clemson University, says that when there is an indication of shortages, large health systems often also proactively place large orders, adding to the system ’ s stress.
“I don ’ t blame anyone.
“When I talk to all the stakeholders – whether it ’ s wholesalers, manufacturers, or the government – everyone wants this problem to end, ” she said.
Lack of transparency
Dr. Julie Grallo, chief medical officer and executive vice president of the American Society of Clinical Oncology, told the House Committee earlier that the shortage puts providers in a terrible position: “The drug shortage crisis is forcing providers to make impossible choices, and it is also hindering the development of new drugs. Health drugs are purchased only on a price basis, and manufacturers do not have to disclose the source of their acquisition of the ingredients.
The shortage of this generic chemical drug came due to the closure of one factory in India that manufactures the active ingredient after a surprise FDA inspection found “significant quality issues, ” says Jarallo:“ We didn ’ t know, and there was no transparency regarding the company ’ s supply of the majority of active pharmaceutical ingredients to all manufacturers across the board.
Knowing this in advance, we could have responded much faster, ” Dr. Steven Schundlemeyer, director of the PRIME Institute of the University of Minnesota School of Pharmacy, which focuses on economic and management issues, told the committee that as with defense contractors in the United States, New Zealand requires manufacturers to disclose their suppliers, and that information is required.
Easily accessible in the database.
Related Topics

Pandemic-related transportation interruptions and border closures particularly constrained the movement of medical goods.

- **Demand Surges:** Certain medicine shortages were aggravated by sudden spikes in demand, as seen with popular weight-loss drugs and COVID-19 treatments.

- **Economic Instability:** Economic crises increased pressure on health systems, raising costs and straining already limited resources.

- **Drugs & Supplies Affected:**
  - **Insulin:** Despite being discovered a century ago, insulin access remains limited—"one in two people who need medication does not get it," especially in low- and middle-income countries where diabetes rates are rising.

Title:

Content: Insulin is still out of reach for many diabetics a century after it was discovered.
12 November 2021
The World Health Organization says insulin is still out of reach for many people with diabetes.
This came in a report published on Friday to mark the 100th anniversary of insulin discovery.
The report, “Fulfilling a 100-year-old promise – making insulin accessible globally, ” details the main barriers to access to life-saving drugs: rising prices, low availability of human insulin, market dominance by a few producers, and weak health systems.
Profit over solidarity.
Insulin is a “cornerstone ” for diabetes treatment, and WHO is working with countries and manufacturers to expand access to everyone who needs it.
Dr Tedros Adhanom Ghebreyesus, director-general of the UN health agency, said: “The scientists who discovered insulin 100 years ago refused to take profit for their discovery and sold the patent for just $1.
Unfortunately, this gesture of solidarity has been moved away by a multi-billion dollar business that has created significant gaps in access. ”
Diabetes is a chronic disease that occurs when the pancreas is unable to produce enough insulin, or when the body is unable to effectively use the insulin it produces.
Insulin is a hormone that controls the level of sugar in the blood.
Hyperglycemia, also known as high blood sugar, is a common result of a malfunction in blood sugar control, and over time leads to serious damage to many body systems, especially nerves and blood vessels.
WHO / T. Habjouqa
Raghad, a refugee girl living in a refugee camp in Jordan, has diabetes
Millions cannot reach.
There are two forms of diabetes.
The first type is type 2 diabetes.
This type, previously called non-insulin diabetes or prediabetes in adults, is caused by the body ’ s lack of effective use of insulin.
Most people with diabetes have type 2 diabetes.
This pattern is often caused by excessive body weight and lethargy.
The second type is type 1 diabetes.
Formerly known as insulin-dependent diabetes or diabetes that appears in adolescence or childhood, this type is characterized by a lack of insulin production and requires daily insulin intake.
The causative factors of type 1 diabetes and the means to prevent it are unknown.
Symptoms include hyperuria, thirst, persistent hunger, weight loss, blurred vision and fatigue.
These symptoms may appear suddenly.
The World Health Organization said insulin is essential for more than 60 million people living with type 2 diabetes to reduce the risk of kidney failure, blindness and amputation.
However, one in two people who need medication does not get it.
While diabetes is on the rise in low- and middle-income countries, the insulin consumption of patients in these countries has not kept pace with the increasing burden of the disease.
Although three in four people with type 2 diabetes live outside of North America and Europe, they account for less than 40 percent of insulin sales revenue.
World Health Organization
According to the World Health Organization, nearly one in five deaths from COVID-19 in the African region is related to diabetes.
Closing the Insulin Gap
The report identifies measures to improve access to insulin and related products.
Actions include boosting human insulin production and supply, and diversifying the manufacturing of bio-alternative products to create competition and lower prices.
The World Health Organization says global markets have shifted from human insulin, which can be produced at relatively low cost, to more expensive synthetic insulin, which can be up to three times as expensive.
The UN health agency called for improving affordability by regulating prices and profit through profit margins, increasing price transparency, and strengthening local manufacturing capacity in underserved areas.
Dialogue achieves results
At the same time, research and development should be focused on the needs of low- and middle-income countries, while increased access to insulin should be accompanied by prompt diagnosis along with access to affordable devices for drug injections and blood sugar monitoring.
WHO has worked with industry in this area to address some of the barriers to the availability of insulin, medicines and related technologies, through dialogues with business associations and manufacturers.
This has resulted in numerous commitments by the industry, ranging from developing a policy outline to improve access to vital insulin alternatives, to participation in the WHO pre-qualification programme for insulin, glucose meters, test strips and diagnostic tools.
WHO / Atul Loke
Over the past four decades, the prevalence of diabetes has risen faster in low- and middle-income countries.
In this photo, a nurse from a hospital in India checks a patient ’ s blood sugar level.
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- **Vaccines:** During the H1N1 pandemic, vaccine development outpaced equitable access—by the time poor countries received doses, the crisis had waned.

Title:

Content: Tuesday, 07 November 2023 01: 24 GMT
WHO: Egypt has developed its national vaccine capacity and reached maturity level 3
Dr Tedros Adhanom Ghebreyesus, Director-General of the World Health Organization (WHO), said in a statement: “The coronavirus pandemic has shown the incredible power of vaccines, tests, treatments and other medical technologies to save lives, but it has also revealed the enormous inequalities in our world, in terms of access to those products, and, of course, this is not the first time. ” When HIV emerged more than 40 years ago, life-saving drugs were developed, but it was more than a decade before the world ’ s poor had access to them.
Egypt, for example, has launched a program.
In January this year, which brings together public and private sector manufacturers with different areas of expertise, Egypt has also developed its national capabilities, and has now reached the third maturity level of the World Health Organization (WHO) regarding vaccine regulation, I congratulate the Minister of Health and Population Dr. Khaled Abdel Ghaffar for the remarkable progress achieved.
Tedros said the program now includes a network of 15 recipient countries around the world, including five in Africa, adding that at the World Health Assembly in 2021, member states agreed on a resolution to boost local production of medicines and other health technologies.
In the same year, WHO and its partners established the mRNA Technology Transfer Centre in South Africa, to build sustainable manufacturing capacity in low- and middle-income countries to combat coronavirus and other global health threats including malaria, tuberculosis and cancer.
He noted that Kenya is also setting up a manufacturing facility from scratch.
During the construction of the KEMRI National Research Institute, he will receive mRNA technology on a research scale to promote the search for new vaccines tailored to the needs of the country and the region.
In India, the BiologocalE Technology Receiving Program is one of the program ’ s most advanced partners, and we have recently begun expanding the Indian network to include academic institutions.
We have also established the first global bio-manufacturing training centre in the Republic of Korea, so that the new facilities can be equipped with a skilled workforce, trained in general bio-manufacturing processes in an industrial environment.
Based on the lessons learned from the COVID-19 pandemic, we have also developed a proposal for a temporary mechanism for equitable access to medical countermeasures.
Commitment to local production and equitable access is also a key part of the epidemic agreement that countries are now negotiating, and the Second Global Forum on Local Production again brings together health, industry, trade and other sectors with manufacturers, civil societies, associations and other key actors.
We expect this forum to stimulate coordination, collective action and partnerships within national and regional ecosystems for technology transfer and sustainable local production.
There are many practical things governments can do, with the support of WHO and other partners, to strengthen the ecosystem for local production.
Provide an enabling environment, with policies and regulations to streamline approval processes, provide incentives for local production, and ensure compliance with quality standards.
Second: Provide investment and financing, through grants, tax incentives or low-interest loans to encourage private sector participation in local manufacturing.
Third, facilitate the exchange of knowledge and technology between the public and private sectors, through the promotion of research cooperation, and support the transfer of industrial knowledge.
Fourth: Building the capacity of the workforce, through training programs to increase quality, improve efficiency, and encourage innovation.
Fifth, ensure market access for local manufacturers by improving supply chain management and expanding market access.
When the H1N1 pandemic broke out 14 years ago, vaccines were developed, but by the time the world ’ s poor had access to vaccines, the pandemic was over.
The COVID-19 Accelerating Access to Anti-Coronavirus Tools Program and the Kovacs facility have delivered nearly 2 billion doses of vaccine to 146 countries, in addition to millions of tests, treatment cycles, medical oxygen and personal protective equipment, but narrow nationalism and hoarding by high-income countries meant many low-income countries got too little and too far. Time. Time.
Similarly, the Korona-19 technology access complex, or C-TAP, was created as an innovative platform for vaccine, testing and treatment developers to share their intellectual property and knowledge with manufacturers in low-income countries, but few manufacturers were willing to participate, so one of the most important lessons learned from the epidemic is that the ability to manufacture drugs, diagnostic vaccines and other technologies is a key component of the epidemic. The tools are concentrated in very few countries.
Expanding domestic production, and strengthening domestic regulatory capacity, is essential to reducing health inequalities between and within countries – not only for tomorrow ’ s environments, but also for today ’ s diseases.
“Access to high-quality medicines is a key priority for WHO and our Member States, ” he said, explaining that since 2018, WHO has supported more than 7,000 manufacturers, regulators and other stakeholders from more than 70 countries around the world to build their local manufacturing capacity. Coronavirus outbreak.
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This pattern repeated to some extent during COVID-19.

- **General Medicines and Medical Supplies:** Multiple unnamed medicines and supplies have experienced shortages, with authorities in some regions (e.g., Egypt, as stated by their Health Minister) denying deficits, while working on consumption rationalization.

- **Health System Responses:**
  - **International Aid & Multilateral Cooperation:** Organizations like WHO and countries such as the UAE responded with rapid dispatches of medical supplies to crisis zones (e.g., Sudan), utilizing global logistics hubs to support acute needs.

Title:

Content: Saturday 6 May 2023 Abu Dhabi UAE
Prayer times
News Highlights
Today 's Issue
Today 's Issue
United Arab Emirates
UAE, WHO send urgent medical supplies to Sudan
Emergency medical supplies shipped to Sudan
May 5, 2023 22: 23
The UAE, in cooperation with the World Health Organization (WHO), on Friday sent 30 tons of urgent medical supplies to Sudan, where a plane loaded with medical supplies to treat injuries, emergency surgeries and essential drugs arrived at Port Sudan airport.
The shipment, valued at $444,000, is the first delivered by WHO to Sudan by air since the conflict began.
The organization distributed supplies to health facilities that ran out of medical supplies days after the outbreak of the conflict in view of the large numbers of wounded.
The dispatch of the aircraft is part of the UAE ’ s ongoing relief efforts to support the Sudanese people and reflects the depth of its relations with Sudan, especially in light of the current situation.
This relief is an extension of the UAE ’ s humanitarian vision and a reflection of its relations with other countries based on bonds of human fraternity and commitment to help others during crises and emergencies.
Her Excellency Reem bint Ibrahim Al Hashimi, Minister of State for International Cooperation, said that the UAE continues to work closely with the World Health Organization (WHO) to ensure the success of the important logistical operation to send urgent medical and food supplies to help address the current crisis in Sudan.
In parallel with the calls for all parties to the current conflict to immediately cease hostilities and de-escalate a situation that is causing untold suffering to the Sudanese people, the UAE is steadfast in its commitment to provide aid and assistance to countries in times of need.
“The UAE is particularly focused on providing support to the most vulnerable people affected by the situation in Sudan, namely the sick, children, the elderly and women, who are most at risk from the ongoing and extremely worrying conflict, and these relief flights will address the most urgent gaps in the provision of medical and food services. ”
Al Hashimi stressed that the UAE ’ s steadfast humanitarian values make it imperative to continue communicating with the world with unrelenting sincerity to promote peace, security, security and stability, not only at the regional level but also around the world.
Together with its partners and the international community, the UAE continues to assist the Sudanese people in times of crisis.
Dr Michael Ryan, Executive Director of the WHO Health Emergency Programme, said: “Early this morning, a flight carrying 30 metric tonnes of health supplies worth US $444,000 left the WHO Global Logistics Centre in the UAE en route to Port Sudan in response to the current crisis in Sudan.
Health supplies include enough to treat injuries, cover emergency surgical supplies, and essential medicines to treat 165,000 people most in need of humanitarian assistance after health facilities across the country declared they had run out of basic health supplies and national medical stores were no longer available due to the security situation.
WHO has sent two emergency logistics on board to ensure these supplies are immediately distributed to 13 key health facilities to support healthcare workers and provide care to those in need.
“WHO has another 30 tonnes of supplies to fight malaria and non-communicable diseases such as diabetes and high blood pressure, conditions that can become fatal if left untreated.
These supplies and about 23,000 bags of blood are being processed within the WHO Global Logistics Centre in the International Humanitarian City in Dubai, and WHO is currently exploring all possible ways to deliver these supplies to Sudan as soon as possible in collaboration with the Sudanese Ministry of Health. ”
He pointed out that the WHO Global Logistics Centre in the UAE has become the focus of rapid supply response to acute events globally with the support of more than 140 countries in all six WHO geographical regions.
He explained that the center is a lifeline for Member States suffering from health emergencies caused by outbreaks of diseases, disasters such as floods, earthquakes and the impact of conflicts on health systems, and that the support provided by the UAE enables WHO to be at the forefront of health emergency responses and provide specialized medical assistance to those in need wherever and whenever needed.
“As part of efforts to strengthen the global health emergency preparedness, response and resilience architecture, the UAE and WHO are working together to deliver supplies to reach the world ’ s most vulnerable at a time when they are most needed. ”
Dr. Ahmed Al-Mandhari, WHO Regional Director for the Eastern Mediterranean, said that WHO continues to coordinate with the Sudanese health authorities to deliver essential health supplies through all available routes, explaining that due to the conflict, hospitals, pharmacies and healthcare facilities have run out of essential life-saving medicines.
The arrival of an additional 30 tonnes of surgical and emergency supplies, in addition to essential medicines, will enable WHO to support 13 major health facilities and restore health care services to those in need.
Dr Al Mandhari said: “Our global logistics hub in Dubai plays a vital role in ensuring a continuous supply of health goods.
We are grateful for the support provided by the UAE to facilitate our first casual flight of these much-needed supplies.
Such support underscores our regional vision of health for all and for all. ”
It is worth mentioning that medical assistance provided by the World Health Organization (WHO) through the UAE amounted to about 55% of the total medical supplies provided to Sudan from abroad during 2022, which reflects the UAE ’ s position as a major center for humanitarian response and support globally.
Source: WAM
All rights reserved to Al Ittihad Newspaper 2023 ©

- **Policy and Financial Support:** Initiatives by actors like the European Investment Bank (EIB) pledged financing (e.g., €500M) towards health-related Sustainable Development Goals and system resilience.

Title:

Content: Multilateral cooperation crucial in times of adversity
T + T - normal size
In an age of advanced technology, it is easy to forget that humans – and life itself – depend entirely on fragile planetary conditions.
Now that we face an increasing number of serious – if not existential – threats, this is a fundamental fact from which we would do well to redefine ourselves.
Climate change, severe supply shortages, loss of biodiversity, and devastating pandemics are all crises that expose the vulnerabilities that afflict our societies like never before.
No country can escape these challenges or tackle them alone.
Although multilateral cooperation is difficult even in prosperous days, it is crucial in times of adversity.
In moments of crisis, we must overcome narrow interests, focus on cooperation, pool resources, and improve how we make and implement collective decisions.
Due to the war between Russia and Ukraine, drought, and other factors, millions of people around the world are facing severe food and energy shortages, along with unprecedented heatwaves in Europe, China, South Asia, and other parts of the world.
In the absence of concerted global action, these crises could easily escalate into large-scale humanitarian disasters.
G20 members account for 85% of global GDP, 75% of international trade, and two-thirds of the world ’ s population.
If they can work as a whole, this would enable them to help manage these challenges and set a course for others to follow.
Those who turn their backs on cooperation and the common good must be held accountable.
Just as those who waste time and energy in violence and war must be condemned and deterred.
But states and governments are not the only actors in this global drama.
To manage today ’ s crises, we must also bring the private sector to the stage.
Countries simply do not have the resources and expertise to solve supply shortages, scale up the deployment of clean energy, or develop vaccines and treatments on their own.
Its strength lies in the ability to engage the private sector, mobilize its full potential and creativity.
This will determine whether humanity can rein in global warming, and at what speed, ensure enough food and clean water – for the current and future generations – and survive future pandemics.
International institutions and forums can play a crucial role in such mobilization.
For example, multilateral financial institutions can increase the impact of public funds several times by guaranteeing loans to help finance desired investments, and reduce risks for private investors.
They can also provide invaluable advice in project planning, structuring and implementation, given their expertise and practical experience from their work around the world.
For example, the development arm of the European Investment Bank (EIB) can benefit from more than 60 years of experience in more than 150 countries.
As part of the Europe team, the Bank assists EU institutions and member countries in developing the EU Global Gateway.
The Gateway is an EU initiative to catalyse up to €300 billion (US $305 billion) of investment for climate change mitigation and adaptation, digital technology, sustainable transport, healthcare systems, education, and research in partner countries around the world.
Launched in late 2021, the portal is now part of the Partnership for Global Infrastructure and Investment, unveiled by the G7 last month with the goal of investing $600 billion to achieve the same goals.
The 2019 Coronavirus Pandemic Crisis (COVID-19) has highlighted the threat posed by disease pandemics, which will become more likely to recur as a result of climate change and loss of natural habitats.
International cooperation is urgently needed to boost investment in infrastructure, primary health care, and trained medical personnel to prepare for future disease outbreaks, so that we can prevent them from becoming global pandemics.
To this end, the EIB is helping to develop a financing strategy that can be adapted and applied to other issues globally.
We are working with the World Health Organization, the European Commission and the African Union to mobilize €1 billion of investment to strengthen primary health care services in sub-Saharan Africa, including by expanding access to vaccines.
The EIB will provide at least €500 million to help these countries meet the health-related Sustainable Development Goals.
This investment is expected to leverage additional public sector funding to restore, expand and sustain access to basic health services; increase financial risk protection; improve access to vaccines, medicines, diagnostic tools, devices and other health products; expand innovative primary health care delivery models; and invest in the health workforce.
Such partnerships are critical to creating ecosystems that engage the private sector, especially when it comes to skills development and investment in specialized human capital.
In the face of global challenges that are too big and complex for any single country to address, international cooperation – not only between countries, but also between governments and the private sector – is key to success.
Multilateral financial institutions are designed to facilitate such cooperation.
At a time when global centrifugal forces threaten to divide us, they can and should help build bridges – literally and figuratively – to bring people closer together.
Vice President of the European Investment Bank
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- **National Initiatives:** Some countries have focused on developing local vaccine production (e.g., Egypt) to mitigate dependency on external sources.

- **Broader Implications:**
  - The gap in global perspectives—between developed and developing countries—risks exacerbating inequities in access to health technologies during crises.

Title:

Content: Translations
The World Beyond Ukraine: The Survival of the West and the Demands of the Rest (1-2)
David Miliband * – (Foreign Affairs) 18 / 4 / 2023
Subtitles by: Aladdin Abu Zeina
Advocating for greater solidarity and equity in global risk management is now a key requirement.
Now, great-power competition exacerbates global challenges at the expense of the poorest countries.
The food crisis resulting from the war in Ukraine and the inadequacy of the global response to it are just one example.
This trend makes the efforts of the Center for Global Development to apply a “global public goods ” perspective to international development particularly important.
These include developing programs to reduce epidemic risk, mitigate climate change, address antimicrobial resistance, and combat non-state terrorism and cybercrime.
• * *
In a speech on the first anniversary of the start of the war with Russia, Ukrainian President Volodymyr Zelensky declared: “Ukraine has united the world. ”
If only that were true!
War has certainly united the West, but it has divided the world.
This global rift will only widen if Western countries fail to address its root causes.
The traditional transatlantic alliance of European and North American countries has mobilized in an unprecedented way for a protracted conflict in Ukraine.
This coalition provided extensive humanitarian support to people inside Ukraine and to Ukrainian refugees alike.
He is preparing to undertake what will be a monumental rebuilding of that country after the war.
But defending Ukraine, outside Europe and North America, is not at the forefront of mind.
Few governments support Russia ’ s brutal invasion, yet many remain unconvinced that the West ’ s insistence on fighting for freedom and democracy in Ukraine is its own.
As French President Emmanuel Macron said at the Munich Security Conference in February, “I was struck by how we lost the confidence of the global South. ” And he ’ s right.
The Western conviction of war and its importance are met elsewhere with skepticism at best and outright disdain at worst.
The gap between the West and the rest goes far beyond the correctness or error of war.
Rather, it is the product of deep frustration — indeed anger — at the mismanagement of Western-led globalization since the end of the Cold War.
From this perspective, the coordinated Western response to the Russian invasion of Ukraine sharply highlighted occasions when the West itself violated its own rules, or when it was visibly absent from action to address global problems.
Such arguments may seem far-fetched in light of the daily brutality of Russian forces in Ukraine.
But Western leaders should address them, not reject and ignore them.
The gap in perspectives will pose a risk to a world facing enormous cosmic risks.
It also threatens to renew a rules-based order that reflects a new multipolar balance of power in the world.
The West is separated from the rest.
The Russian invasion of Ukraine produced a remarkable unity and action in the liberal democratic world.
Western countries have coordinated a broad list of economic sanctions targeting Russia.
European countries have increasingly aligned their climate decarbonization policies with national security commitments to end their dependence on Russian oil and gas.
Western governments have rallied to support Ukraine with massive shipments of military aid.
Finland and Sweden are aiming to join the North Atlantic Treaty Organization (NATO) soon.
Europe has adopted a welcoming policy towards 8 million Ukrainian refugees within its borders.
All of these efforts were bolstered by a U.S. administration that was confident in its partnership with European and other allies.
The bickering over Afghanistan and the Oakus partnership (a 2021 deal by Australia, the UK and the US that angered France) seems to be a thing of the distant past.
Many in the West were surprised by this turn of events.
Obviously, this was also the case for the Kremlin, which envisioned that its invasion would not elicit such a strong and assertive Western response.
But the West ’ s unity and commitment to this cause is matched nowhere else.
At the beginning of the war, the United Nations General Assembly voted 141 to 5, with 47 countries absent or abstaining, in favor of condemning the Russian invasion.
But this result was a compliment intended to deceive.
As the International Crisis Group ’ s team of analysts noted, “Most of the non-European countries that voted to condemn Russia ’ s aggression last March did not follow through on the implementation of sanctions.
Doing the right thing at the UN can be an excuse not to do much about war in the real world. ”
In a series of votes held at the United Nations since the war began, some 40 countries representing nearly 50 percent of the world ’ s population regularly abstained or voted against proposals condemning the Russian invasion.
In April 2022, 85 countries abstained from voting to expel Russia from the UN Human Rights Council.
According to the Economist Intelligence Unit, two-thirds of the world ’ s population lives in officially neutral or pro-Russian countries.
These countries are not some sort of axis of authoritarianism, but include several prominent democracies, such as Brazil, India, Indonesia, and South Africa.
Much of this reluctance to decide and sit on the fence is not driven by disagreements over the conflict in Ukraine, but is symptomatic of a broader syndrome of anger at Western double standards and frustration with stalled reform efforts in the international system.
A prominent Indian diplomat, Shivshankar Menon, expressed the idea sharply in Foreign Affairs earlier this year when he wrote: “Many developing countries, feeling alienated and resentful, see the war in Ukraine and the West ’ s rivalry with China as distracting from pressing issues, such as debt, climate change and the effects of the epidemic. ”
hesitation to take a stand.
Realpolitik played its role in determining the positions of some countries on the Ukrainian conflict.
India has traditionally relied on Russia for military supplies.
Wagner ’ s paramilitary forces, the Russian mercenary organization now active in Ukraine, have worked with governments in West and Central Africa to shore up their security and survival.
China, a major source of support for Russia, is the largest trading partner of more than 120 countries around the world and has proven ruthless in responding to diplomatic insults.
But there are also other factors that influence attitudes.
There are some countries that oppose the Western narrative about the causes of war.
For example, although Brazilian President Luiz Inacio Lula da Silva called the invasion a “mistake, ” it gave credence to the argument that Russia had been wronged.
Lula claimed last summer in a statement that highlighted the global ambivalence about the conflict: “Zelensky, like Putin, is responsible for this war. ”
Many observers outside the West also argue that impunity is, in general, something that belongs to all powerful countries, not just Russia.
The United States is in a particularly vulnerable position to defend global norms after the presidency of Donald Trump, which has overseen contempt for global rules and practices in areas as diverse as climate, human rights and nuclear non-proliferation.
Critics point to the US-led wars in Afghanistan and Iraq to claim that hypocrisy, rather than principle, drives Western policies.
U.S. support for the war in Yemen, which has spawned a humanitarian crisis in that country, is presented as evidence of duplicity of rhetoric when it comes to concern for civilians.
It is also said that the West has shown more sympathy for the victims of the war in Ukraine than for the victims of wars elsewhere.
For example, the UN appeal for humanitarian assistance to Ukraine was 80 to 90 percent funded.
Meanwhile, half of the UN ’ s 2022 appeals for aid to people caught up in crises in Ethiopia, Syria and Yemen have not been funded.
Taken by themselves, some of these reasons for standing on the sidelines may seem trivial to Ukrainians fighting on the front lines.
But caution about supporting Ukraine should not mask a bigger problem.
Since the 2008 financial crisis, the West has failed to demonstrate its willingness or ability to advance a more equitable and sustainable global economic deal or to develop the appropriate political institutions to manage a multipolar world.
Now, that failure is brewing back home.
Even before the COVID-19 pandemic, for example, the world was off track to achieve the Sustainable Development Goals (SDGs) announced by the United Nations and set by member states in a big uproar in 2015.
In 2018, four out of five fragile and conflict-ridden countries failed to implement SDG measures.
World Bank figures for 2020 show that people born in those places were 10 times more likely to end up in poverty than those born in stable countries, and the gap is widening.
Since then, as a result of protracted conflicts, the climate crisis, and the epidemic, the protection barriers have collapsed altogether.
More than 100 million people are currently fleeing for their lives from war or disaster zones.
According to the United Nations, 350 million people today are in urgent need of humanitarian assistance, compared to 81 million a decade ago.
More than 600 million Africans lack access to electricity.
According to the United Nations Development Programme (UNDP), 25 developing countries spend more than 20 per cent of government revenues on debt servicing, with 54 countries suffering from severe debt problems.
Inequality in access to vaccines to combat the epidemic — a gap that was particularly stark during the early stages of the roll-out of COVID-19 vaccines in 2021 — has become a living example of empty promises.
Western governments have also failed to live up to their commitments in other areas.
The UN Climate Adaptation Fund, set up in 2001 to protect poor countries from the consequences of carbon emissions from rich countries, has yet to meet its core funding commitment to raise $100 billion a year and is seen as a symbol of Western bad faith: talk in words, no action.
Long delays in raising these funds have increased demand for a new fund to cover “loss and damage ” arising from the climate crisis.
This new fund was opened last year but has yet to be funded.
Any other underfunded global initiative will only deepen mistrust between rich and poor countries.
Hollowed solidarity
If the next two decades are to be the same as the last two marked by the West ’ s confused priorities and failed promises, the multipolarity of the world order will mean more than just greater economic competition.
It will mean reinforcing ideological challenges to Western countries ’ principles and weakening the incentives for non-Western countries to associate with or cooperate with the West.
Instead, liberal democratic states that support a rules-based global order need to think and act on a long-term strategic goal as they engage with the rest of the world.
China has been doing this since 1990.
Solid power based on military partnerships and commercial cooperation will be crucial in determining the West ’ s relations with the rest of the world.
But Western governments also need to address a number of soft power issues, especially in three areas: making commitments to solidarity and fairness in managing global risks; adopting reforms to broaden the voices on the table when it comes to international affairs; and developing a winning narrative in an era of declining democracy.
These actions will not only help maintain the West ’ s global position; they are the right thing to do as well.
Advocating for greater solidarity and equity in global risk management is now a key requirement.
Now, great-power competition exacerbates global challenges at the expense of the poorest countries.
The food crisis resulting from the war in Ukraine and the inadequacy of the global response to it are just one example.
This trend makes the efforts of the Center for Global Development to apply a “global public goods ” perspective to international development particularly important.
These include developing programs to reduce epidemic risk, mitigate climate change, address antimicrobial resistance, and combat non-state terrorism and cybercrime.
But investing in fending off these threats looming over the global horizon suffers from market failure: because all people benefit, not just those who pay, no one pays.
According to the Center for Global Development, about six percent of the State Department ’ s total budget over the past decade has gone to development-related global public goods, and that percentage does not appear to have increased over time.
Epidemics are also a good example.
In 2022, the Independent Panel on Pandemic Preparedness and Response, commissioned by the World Health Assembly and in which I myself worked, published a comprehensive review of global actions needed to prevent and mitigate future pandemics.
The report estimated the financial cost of preventing the epidemic would be $15 billion a year, less than half of what Americans spend on pizza each year.
The most shocking revelation was that 11 teams and high-level committees in 16 reports over the past 20 years have made plausible recommendations on how to prepare for, detect and contain epidemics, but most of these recommendations have not found their way into implementation.
The independent team concluded that this problem can only be overcome by encouraging leaders to mobilize sustained commitment from the entire Government to pandemic preparedness.
We have proposed the creation of a World Health Threat Council separate from the WHO (because epidemics are not just a health issue), whose task would be to ensure that governments are adequately prepared to respond to epidemics, whether through effective surveillance systems or timely warnings about outbreaks.
This proposal should not be allowed to be left to dust the shelves.
Refugee support provides another example of how global costs can be unevenly shared.
Although many Western countries complain about the influx of refugees, it is the poor and lower-middle-income countries that host more than 80 per cent of them.
Bangladesh, Ethiopia, Jordan, Kenya, Lebanon, Pakistan, Turkey and Uganda are receiving large numbers of refugees.
Poland, which currently hosts more than 1.6 million Ukrainians, and Germany, which has 1.5 million Syrians, are unique rich countries in this regard.
Poor and lower-middle-income countries receive limited compensation from rich countries for their responsibilities, and thus have limited incentive to enact policies that promote the integration of refugees into their employment, education and health systems.
(continued)
* David Miliband (15 July 1965), British politician, eldest son of sociologist Ralph Miliband.
Born in London and studied at Oxford University, he joined the Massachusetts Institute of Technology (MIT), one of the most famous scientific institutes in the United States, after receiving a scholarship in 1988.
He was known for his keen interest in information technology and the Internet, and was the first British minister to write blogs on the Internet when he was environment minister.
He began political work by joining the Policy Unit, which worked directly with Tony Blair in 1994, and became a Member of Parliament in 2001.
On 5 May 2005, he assumed his first ministerial position in Tony Blair's government as Minister of State for Communities and Local Government, and on 5 May 2006 he was appointed Minister of the Environment.
On 28 June 2007, he was appointed Foreign and Commonwealth Secretary of the United Kingdom at the age of 41, the youngest to have held the position in the United Kingdom in 30 years, and continued in the position until the resignation of the government on 11 May 2010.
He is currently the president and CEO of the International Rescue Committee.
The World Beyond Ukraine: The Survival of the West and the Demands of the Rest
Fringe:
Q Anon: A conspiracy theory devised by the American extreme right details an alleged secret plan of the so-called “deep state of the United States ” against US President Donald Trump and his supporters.
The theory began circulating in October 2017 with a post on the photo board forums, Forchan, of a writer under the pseudonym “Q, ” presumably an American citizen.
It is possible that the name later included several people.
Q claimed to have access to classified information relating to the Trump administration and its opponents in the United States.
He accused a number of liberal Hollywood actors, Democratic politicians and high-ranking officials of being involved in an international child trafficking ring, and claimed that Trump pretended to collude with the Russians to recruit Detective Robert Mueller to his side to expose the gang and prevent a military coup led by Barack Obama, Hillary Clinton and George Soros.
The “Q ” symbol is a reference to the access authorization, Q, for sensitive information.
In their social media posts, Q'anon believers use the hashtag # WWG1WGA as an acronym for "where we go one, we go all".
(Wikipedia)
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Insulin and vaccines stand as prominent examples.

Title:

Content: Health · Life
How to solve the problem of drug shortage in rural areas?
National Health Commission response
January 07, 2023 17: 26 Source: People 's Daily Online
Beijing, January 7 (Reporter Yan Yan Yan) Today, the joint prevention and control mechanism of the State Council held a press conference to introduce the situation of epidemic prevention and control in rural areas and answer questions from the media.
At the press conference, a reporter asked, recently, many township health centers and village health rooms have a shortage of drugs and other problems, how to properly solve?
Nie Chunlei, director of the grass-roots department of the National Health Commission, said that rural areas are the focus of epidemic prevention and control and are also weak links.
The joint prevention and control mechanism of the State Council has attached great importance to the prevention and control of the epidemic in rural areas and made a lot of arrangements for deployment.
There is a shortage of medicines and other medical supplies in rural areas, for three reasons: First, the production capacity of individual medicines is insufficient, and the supply is in short supply.
Second, the information between the supply and demand sides is not smooth.
Third, logistics reasons, some purchased drugs can not be delivered in time, resulting in a shortage of drugs.
In response to the shortage of drugs, the state has taken a series of measures, Nie Chunlei said. First, the material support group of the joint prevention and control mechanism of the State Council has established a daily dispatch system to coordinate the daily dispatch of drugs and other key medical supplies.
According to the development of the epidemic, priority is given to medical institutions in rural areas, especially in rural areas.
For some drugs that are in short supply, those with insufficient production capacity, actively coordinate and expand production capacity.
Relevant departments have formulated policies to support relevant enterprises to expand production capacity, mobilize the enthusiasm of enterprises, and work overtime to produce relevant drugs.
The second is to strengthen supply and demand docking.
Rural areas have a wide range of points and long supply chains, and if the docking of supply and demand is not smooth, the problems reflected by the grassroots may not be timely feedback.
Local governments are encouraged to focus on procurement.
All localities should strengthen the docking of supply and demand through material support groups to solve the shortage of medicines in a timely manner.
Third, adhere to the combination of Chinese and Western medicine, rational selection of Western medicine, Chinese patent medicine and traditional Chinese medicine decoction.
Local governments, especially in rural areas, should be encouraged to give full play to the characteristics of rural areas, make full use of traditional Chinese medicines, alleviate the problem of insufficient medicines, and reduce the pressure on grass-roots medical care
Nie Chunlei said: "From the current monitoring situation, the shortage of medical supplies is more prominent, but recently with the development of the epidemic and the growth of drug production capacity in various localities, the coordination of material support groups and logistics is smooth, and the local government Strengthen the organization, the problem of drug shortage is gradually improving.
(Editor: Yang Di, Gao Lei)
Related News

Title:

Content: The lack of medicine continues to burn!
The Ministry of Health and Welfare has proposed a short, medium and long-term strategy to deal with the current 5 coping mechanisms.
Journalist Yen Zhenzhen / Taipei Report
According to the Ministry of Health and Welfare, the shortage of drugs is not a single factor, but includes supply problems, manufacturing problems, clinical demand factors, uneven distribution of drugs, drug use habits and drug prices. In addition to dealing with the relatively high clinical demand items, it is properly allocated to all levels of medical institutions and pharmacies to fully meet the needs of clinical end-use drugs.
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In the face of the shortage of drugs, Wang said, the existing health insurance uses five major coping mechanisms, including 1, a single processing window, a dedicated person to help deal with the problem of drug purchase, and contact the Food and Drug Administration to put relevant information on the website of the NHI. (4) Drug price adjustment mechanism that does not meet the cost can be re-checked according to the way of raising the price of special drugs; (5) Alternative drugs can still declare the cost, if they are not irreplaceable, they can be replaced at the same price or lower than the original prescription drug price.
In addition, Wang pointed out that in the face of the international epidemic, the Russian-Ukrainian war, and labor shortage, drug shortage is a problem facing all countries. In order to strengthen the stable supply mechanism of drugs in China, the Ministry of Health and Welfare continues to actively respond to the short-term strategy to solve the problem of drug shortage. The Food and Drug Administration (FDA) and the pharmaceutical industry have made every effort to actively arrange production lines, strive for early import, increase production / import quantity, and properly distribute to all levels of medical institutions and pharmacies to fully meet the demand for clinical end use drugs.
In addition, to properly handle the issue of drug price adjustment, the Central Health Insurance Administration of the Ministry of Health and Welfare intends to implement the "Universal Health Insurance Cost Distribution Target System (DET)" in April this year, which will adjust the number of drug prices and adjust the quota in a suitable manner, taking into account factors such as the epidemic, the Russian-Ukrainian war and inflation.
In terms of medium-term strategy, Wang said that he will establish a permanent drug shortage treatment center and optimize drug supply information transmission.
In order to speed up the handling of drug shortage incidents, we will adopt dedicated personnel and cross-departmental cooperation to develop drug shortage prevention policies to prevent drug shortage in advance, strengthen cross-departmental data integration and proactive monitoring to detect drug shortage incidents at an early stage, and intervene early through cross-departmental cooperation to stabilize drug supply.
At the same time, the Food and Drug Administration (FDA) continues to disseminate drug supply and alternative drug information through various channels. In addition to posting on the “Drug Supply Information Platform ”, the FDA will notify medical institutions and pharmacies through VPN, and weekly letters to relevant medical associations and public associations to inform members. Management system.
In the long-term strategy section, it includes reviewing the current health insurance drug pricing policy and encouraging the production of domestically manufactured generic drugs.
Wang Bi-sheng pointed out that in the review of the current health insurance drug price policy, including the development of the price protection of indicative drugs, drug price review for the lack of drugs; start the review of drug expenditure target (DET), plan the establishment of a risk control mechanism, plan the national unified procurement trial plan; comprehensively review the health insurance drug price policy, give an appropriate price protection mechanism for necessary drugs, and also target the patent period. To encourage the production of domestic manufacturers to ensure that when there is a shortage of original pharmaceutical products, there are domestic famous drugs to respond.
Wang also stressed that the Food and Drug Administration has set up a "Drug Supply Information Platform" (https: / / dsms.fda.gov.tw /), reporting hotline (02) 27878249. If medical institutions and pharmacies have any shortage of drugs, they can go to the platform for enquiry or notification, and the department will deal with it immediately.
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Title:

Content: International / Economic / Political
The United States, Britain, France, Germany, Japan and other 18 economies issued a joint statement: put forward four principles of global supply chain cooperation
The Supply Chain Ministerial Forum 2022, co-chaired by Secretary of State Antony Blinken and Secretary of Commerce Gina Raimondo, concluded on July 20.
The United States, the European Union, the United Kingdom, France, Germany, Japan and South Korea issued a joint statement after the meeting to clarify the principles of supply chain cooperation.
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The two-day forum was attended by representatives from Australia, Brazil, Canada, the Democratic Republic of the Congo, the European Union, France, Germany, India, Indonesia, Italy, Japan, Mexico, the Netherlands, South Korea, Singapore, Spain, Britain and the United States.
According to the United States, the online forum brought together stakeholders from labor, industry, civil society and subnational officials from all sides to address short-term bottlenecks and long-term supply chain challenges.
The State Department said that at the July 20 ministerial plenary meeting, the United States, allies and partners made a political commitment to work together to address recent supply chain disruptions.
Their goal is to collaborate to build long-term supply chain resilience by supporting transparency, diversity, safety and sustainability, adhering to high environmental and labor standards, including the prevention of forced labor, coupled with workforce development that meets future needs.
"Almost all of our people have experienced the pain of supply chain disruptions," Blinken told officials at the meeting.
We have shopkeepers unable to stock shelves, chronic patients, life-saving medicines, factories sending workers home because they can ’ t get the necessary materials and inputs to keep the production line running.
I think we understand more than ever how important supply chains are to meet our everyday needs. ”
Blinken continued: “They are also vital to addressing almost all of the pressing global challenges we face.
To prevent climate catastrophe and adapt to the growing impacts of climate change, we need resilient supply chains to produce clean energy technologies, from wind turbines to batteries.
To end the acute phase of COVID-19 and ensure that we are better prepared to respond to future health emergencies, we need resilient supply chains for vaccines and other critical hygiene products.
So today ’ s gathering is just our latest joint effort to try to address these challenges while minimizing disruption, keeping workers at work and lowering costs for families. ”
“A resilient supply chain is safe and makes us less vulnerable to cyber attacks by governments or other actors; a resilient supply chain is sustainable and complies with labor and environmental standards we have agreed to because it is in line with our shared values, as we have seen governments that ignore these benchmarks are often less reliable partners and because in 2022, any supply chain that is not environmentally sustainable will not last. ”
Raimondo said, “I don ’ t think anyone now understands the importance of a resilient supply chain.
"We also know, and we have become very, very clear that supply chains are global," she said.
That ’ s why we need to work with like-minded partners like everyone in this conference and conference call if we really will be able to find sustainable, lasting, long-term solutions to our shared supply chain challenges. ”
Raimondo said she and Blinken are working very hard to implement the Indo-Pacific Economic Framework (IPEF) “because it ’ s a way for us to work with our allies in the Indo-Pacific region to jointly support our supply chains. ” It will benefit industry, labor, civil society, and ensure that all our efforts are inclusive and that the benefits are widely shared. ”
After the online meeting, the ministers of the 18 countries issued a joint statement on global supply chain cooperation.
"(The parties) intend to work together on crisis response in an effort to mitigate recent transport, logistics and supply chain disruptions and bottlenecks, as well as long-term resilience challenges that have left our supply chains vulnerable and spillover effects on consumers, large and small businesses, workers and households," the statement said.
"I am
"Building collective, long-term and resilient supply chains based on international partnerships is critical to the success of this effort," the statement said. To this end, delegates from 18 economies presented four principles for global supply chains and pledged to follow them.
They include: "Transparency, diversity, security and sustainability."
“We welcome all economies and invite all industries, businesses, women, workers, government officials at all levels, labor and civil society, and other stakeholders to join us in pursuing resilient supply chains guided by these principles. ”
We recognize that the key to solving the next global supply chain crisis is to prevent it in the first place.
It is worth mentioning that US Treasury Secretary Janet Yellen said in a speech during her visit to South Korea on the 19th that she needs to focus on reviving the economy and restoring the supply chain, and implement a "friendly shore outsourcing" strategy between allies and partners to lay a more solid foundation for economic growth.
She stressed that restoring the resilience of the supply chain requires consolidating economic and trade cooperation with major friends, and South Korea is also in this list, and more attention should be paid to the core countries that need to focus on developing relations.
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