Shital Parikh Mars, CEO at Progressive Media and speaker at FlyPharma US earlier this year, reveals how a fragmented, highly competitive industry like pharma can – and should – work together to prepare for a disaster response. Identifying pharma and logistics priorities, finding realistic solutions, and consulting every supply chain player is critical, as Shital explains.
On 16 September 2017, Hurricane Maria was only a tropical storm just east of the Lesser Antilles. In less than two days, it was a Category 5 storm striking Dominica and 36 hours later it was a high Category 4 storm hitting already hurricane-battered Puerto Rico. Hurricane Michael, in October 2018, intensified rapidly, providing residents of the US Gulf Coast a scant four days to prepare for the third strongest storm to make landfall in the US. Residents in California earlier this year were given mere hours’ notice to evacuate their homes and escape the destructive power of wildfires charring hundreds of thousands of acres. Recent earthquakes in Haiti and Mexico, and floods in India, Sierra Leone, and China, are some of the deadliest on record and provide families and disaster relief workers no notice to prepare.
Society often waits until the last minute to prepare for misfortune. As everyday citizens, we fill our gas tanks, buy water and batteries, and leave for safer shelter just before an anticipated natural disaster. But what if there is no notice? What if the storm is too large to escape? This is the reality of a natural disaster in the modern world. To prepare, healthcare institutions, including the pharmaceutical industry, must be held to a higher standard. When communities are imperiled, the first area of need is medicine and healthcare.
So how does a fragmented, highly competitive industry prepare for disaster response? Identify weaknesses and priorities, evaluate solutions, and make sure when disaster planning is undertaken by relief agencies, logistics leaders, pharmacies, and pharmaceutical manufacturers have seats at the table.
In most cases where there is a breakdown in disaster response, it is because planning and preparedness are inadequate for the realities of life on the ground in the aftermath. In the case of Puerto Rico, the Puerto Rican government had failed to update disaster preparedness plans for years and the relief agencies had not considered the logistical hurdles of delivering aid to a territory with infrastructure so devastated that planes could not land, roads were impassible, and an entire island was left without power or communications capability. Such a scenario was predictable, yet at every turn, it was not prepared for.
Pharmaceutical companies must anticipate not only delivery of necessary medications to the surrounding area of a disaster zone for eventual deployment, but how those medications will get into the hands of patients in need. In many cases standard power, communication, and delivery mechanisms are unavailable. Below are major areas of concern for medication disbursement:
> Power grid. Designated staging and storage areas for relief medication must have adequate backup power capabilities.
> Structural integrity. Medications are often prepositioned just outside of anticipated disaster areas. However, during disasters and immediately after, medications must be available within vulnerable communities for use. The structural integrity of medication dispensing facilities within the community should be evaluated for risk of loss and effective use during a real disaster.
> Transportation. There are many communities around the world vulnerable to disasters that lack adequate infrastructure. Roads, airports, fueling stations and shipping routes can all be rendered inoperable.
> Communication lines are often down after a disaster. This includes mobile telephonic communications as well as landlines and internet capabilities. Our dependence on digital communications makes it that much more difficult to plan for the realities of analog communications.
> During disasters, people are displaced. Qualified medical professionals, pharmacists and technicians evacuate for their own safety, and struggle to return to work to provide care and support.
Prioritizing need is a necessary evil when planning for the worst. The pharmaceutical and logistics industries must identify which medications are the most needed, what are the proper storage and delivery requirements for each, and how best to deploy those medications so that they actually end up in the hands of patients.
Pharmaceutical manufacturers, distributors and pharmacies should work together to identify priorities within a patient population. For many patients, access to proper medications can mean the difference between needing a few hundred dollars in health aid as opposed to thousands of dollars, but even further than that could be the difference between life and death itself. Life-saving drugs come in all forms: pills, capsules, drops, injections, etc. Some medications need to be taken immediately upon diagnosis (e.g. antibiotics, beta-blockers, ACE inhibitors, anti-retroviral); some need to be taken consistently (diabetes medications and insulin, diuretics, statins, antipsychotics); some need to be kept cold (insulin, vaccines, biologics) in order for the patient to achieve results.
The pharmaceutical industry can prioritize certain classes of medications that will be most needed in the 72 hours following a disaster: antibiotics, analgesics, insulin, beta-blockers, antihistamines, corticosteroids, oxygen, antiseptics and any other drug class needed for immediate and acute trauma care. These medications are often in high demand by healthcare professionals and the population, in general, to stave off escalation to more critical health conditions.
Pharmacies may be well stocked with these life-saving drugs, but access to these drugs is often uncertain. Pharmacies are often so badly damaged and/or isolated by destroyed transportation routes that using these facilities as hubs of distribution can be problematic. Pharmacies that are able to function struggle with staffing to resume normal operations. Rather, the industry should prioritize operational hubs for effective distribution of medications.
Logistics companies play a vital role in pharmaceutical distribution. FedEx and UPS handle nearly 20 million packages a day. Large-scale manufacturer transport by air of pharmaceutical products accounts for less than 20% of all pharmaceutical transport. But after a disaster, high-speed air and ground transport are essential to last mile delivery mechanisms. Logistics companies know community roadmaps and infrastructure integrity better than nearly anyone. They know the areas that need logistical improvement and the best and most efficient routes to navigate a community. So it stands to reason that logistics would be prioritized during a disaster. These institutions must prioritize the functionality of their facilities post-disaster including hangers, planes, runways, trucks, fuel, and staffing to ensure that they clear on-site debris and mobilize quickly. This is a tall ask of an industry, given that these facilities are just as vulnerable to destructive force as any other in a disaster zone. But that said, they are still in the best position to help guide and structure delivery of relief efforts.
There are a number of ideas that can be researched and examined that can improve disaster preparedness plans. Cost-effectiveness is the main concern in all areas; however, this issue must be balanced by the health needs of a population. Here are some proposals to consider for future implementation:
> National usage databases and data collaboration in the healthcare industry. During a crisis, on-site data becomes vulnerable to loss or corruption. In times of need, national databases of population health usage can be used to effectively plan for demand and distribute pharmaceuticals in a disaster area. This would require competitors and fragmented segments of the pharmaceutical industry to collaborate and provide data on drug usage by class: this can potentially provide vital information for inventory and storage planning for areas that may be without power for days, weeks, or even months.
> Independently insulated packaging for temperature integrity and control. It is estimated that the pharmaceutical industry loses $35 billion annually to temperature excursions. Much of this burden is borne by logistics providers whose services are provided to a broad range of industries. Pharmaceutical manufacturers can evaluate packaging and shipping container options that can independently stabilize or control the temperature so that it is not so reliant on factors outside of its control like cargo congestion, transition timing and delays, ambient temperature and electrical and computer failures by third parties. This would also solve the last mile issue of temperature integrity during a disaster because the packaging or storage construct could adequately maintain reasonable parameters for a period of time without an outside power source or access to cold packaging products.
> Designated pharmaceutical storage and staging shelters. These hubs should be evaluated for structural integrity, but if suitable locations can be identified, these hubs can provide efficient distribution of emergency medications that will be necessary after a major disaster.
> Route optimization and logistics prioritization. It’s common for relief agencies to clear debris from first responder facilities, highways, and major roads. However, this process is slow and ultimately communities of people can be isolated in their neighborhoods because there is not a clear path to aid facility. Logistics operators can provide governmental agencies and relief organizations with valuable data on how best to reach populations in need. They can also prioritize shipping and transportation venues for debris clean-up and mobilization for acute and mass evacuations via air or ship.
> Patient care plans and diagnostic codes that can be accessed by the patient offline. More needs to be done for patients to have a true understanding of their conditions and the medications used to treat them. Pharmacies and healthcare institutions must develop ways for patients to access their health data in a uniform consistent way and house that data on their phones, tablets, and laptops securely and conveniently for use during disasters. For instance, if a patient has a heart attack during a disaster, it may be impossible for that patient to provide history to the attending physician in the danger zone or where the patient may have evacuated. If that patient had their medical data on their phone, they could provide that to emergency personnel and get better, more effective care.
Having Seats at the Table
The truth about disaster planning and relief is that a lot of individuals can do the right thing, but if they cannot work together from start to finish, it won’t matter. There are many agencies, governments, industries and people on the ground that must coordinate their efforts together to ensure that the right aid is reaching the right people. It won’t matter if the right medications are ready to be deployed in an off-site location if the town is flooded out and nothing can get in. It won’t matter if the temperature is controlled until it reaches the patient if there is no power and no means for the patient to maintain the medicinal integrity of the product. So everyone must work together to get it right.
The only way to accomplish true coordination is if all the players in healthcare delivery are consulted and valued during the planning, preparation and executions process. Relief organizations and governments can discuss needs and pain points, and pharmaceutical and logistics industries can work together to solve problems. By understanding reality, planning for the future, and working together, we will save lives imperiled by modern-day disasters.
Find out more about how the pharmaceutical industry can lead in pre-and post-disaster relief, plus many other topics, at our upcoming FlyPharma conferences: FlyPharma Asia on 27-28 March 2019 in Hong Kong, and FlyPharma Europe on 22-23 October 2019 in Copenhagen. FlyPharma US will return in 2020. If you are interested in attending any of our events, please contact us here.