Developing and Strengthening the Global Supply Chain for Second-Line Drugs for Multidrug-Resistant Tuberculosis Workshop Summary (2013) / Chapter Skim
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4 Innovative Suggestions and Potential Solutions
4 Innovative Suggestions and Potential Solutions
Pages 93-110
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From page 93... ...
MECHANISMS OF PURCHASE AND SUPPLY1 Structural Reorganization and Accountability: Who Will Get It Done? Analogizing to Other Supply Chains A recurring topic throughout the workshop was the question of what structural and governance systems should be in place at the global level 1 This section is based on reflections offered by Peter Cegielski, Team Leader for DrugResistant TB, International Research and Programs Branch, Division of Tuberculosis Elimination, CDC, and comments offered by individual workshop participants during an open discussion session moderated by Cegielski and Barry Bloom, Harvard University Distinguished Service Professor and Joan L
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From page 94... ...
Olusoji Adeyi, World Bank, and several others expressed skepticism that the MDR TB market is in fact unique, arguing instead that more precise definition of the specific problems in the market could aid development of effective solutions. Other participants offered thoughts on ways that the MDR TB SLD supply chain could be viewed as unique.
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From page 95... ...
Some participants cited the importance of GDF or another centralized purchasing mechanism. For example, Andre Zagorski, Principal Technical Advisor for TB, Center for Pharmaceutical Management, MSH, suggested that the 20 percent of countries whose drug procurement is donor-funded and facilitated by GDF would not be able to acquire enough funding to develop sufficient procurement capacities to procure drugs autonomously (and not through a centralized purchasing mechanism)
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From page 96... ...
Gail Cassell, Harvard Medical School, suggested that the donor-funded segment requires more urgent focus in the short term due to probable underestimates of actual burden and vast numbers of unserved populations in those countries. Capacity Building and Accountability In considering allocation of responsibilities, participants discussed the importance of clearly defining and assigning supply chain roles to appropriate entities and supply chain participants.
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From page 97... ...
and Julius H Jacobson Professor of Public Health, Department of Immunology and Infectious Diseases, Harvard School of Public Health, suggested that one way manufacturers could help drive progress is by sharing their supply chains to "piggyback" SLDs on chains that currently exist or by sharing their knowledge of SCM in specific countries.
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From page 98... ...
Matiru stated that GDF's success with pooled procurement for FLDs was backed by consolidated, controlled financing and facilitated by an approval and review mechanism designed to survey and address the quantities of treatment required, which enabled demand aggregation. By contrast, MDR TB financing in the donor-funded market is channeled through GDF in a non-pooled, uncoordinated way, without the benefit of centralized fund management.
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From page 99... ...
LOGISTICS, SUPPLY, AND DEMAND Incentivizing and Regulating QA3 A number of participants emphasized the importance of QA for MDR TB drugs, particularly in light of the number of therapeutic regimens 3 This subsection is based on reflections offered by Amy Bloom, Acting Chief, Infectious Diseases Division, USAID, and comments offered by workshop participants during an open discussion session moderated by A Bloom and Barry Bloom, Harvard University Distinguished Service Professor and Joan L
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Incentivizing Production of QA SLDs Some workshop participants discussed approaches to implement incentives for manufacturers to produce SLDs according to specified quality standards (and removal of incentives to produce low-quality products)
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. 5 This subsection is based on reflections offered by Owen Robinson, Program Manager, Partners In Health, and comments offered by workshop participants during an open discussion session moderated by Robinson and Barry Bloom, Harvard University Distinguished Service Professor and Joan L
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Yadav commented, however, that although the technology for standardizing bar codes is simple, the standardization process itself would be complicated and lengthy, which could pose a serious barrier to the quick 6 This subsection is based on reflections offered by Owen Robinson, Program Manager, Partners In Health, and comments offered by workshop participants during an open discussion session moderated by Robinson and Barry Bloom, Harvard University Distinguished Service Professor and Joan L and Julius H
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From page 103... ...
7 Thissection is based on reflections offered by Prashant Yadav, Director, Healthcare Research Initiative, William Davidson Institute, University of Michigan, and comments offered by workshop participants during an open discussion session moderated by Yadav and Barry Bloom, Harvard University Distinguished Service Professor and Joan L and Julius H
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From page 104... ...
Atun commented that market signaling is as important as funding because potential suppliers prepared to undertake a 10- to 15-year commitment to invest in R&D and manufacture drugs need assurance that they will be able to recoup their investment. He suggested the following long-term pull strategies for the MDR TB market: • long-term instruments such as a TB bond to provide 10- to 15-year funding; • at the domestic level, expanded health insurance or catastrophic risk insurance to cover MDR TB; • venture capital impact funds for development of new SLDs; • value-based pricing; and • outcome-based financing to reward successful novel approaches.
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From page 105... ...
• Working Capital Fund: According to Gordon Comstock, Partner ship for Supply Chain Management, a working capital fund like SCMS's could facilitate better up-front planning, less restrictive funding policies, and pooled procurement plans for liaising with manufacturers. • PRIs: Kimerling suggested that PRIs could be used as a variety of SLD market interventions to address problems of limited drug availability and high prices.
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From page 106... ...
Trish Stroman, Principal, The Boston Consulting Group, suggested that a powerful strategy moving forward would be to quantify the impact of no
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From page 107... ...
Jose Gomez-Marquez, Director, MIT Little Devices Lab, suggested that decentralizing the ways that patient-needs data are collected and shared to make information more freely available would improve transparency about the actual MDR TB burden and thus facilitate better demand signaling. Engagement with Private Sector, Patients, and HCPs Keshavjee proposed that engaging and penetrating the private market should be a primary approach for effecting change because it is in that market that the bulk of TB care is being provided and TB drugs are being sold.
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From page 108... ...
. Herbert suggested a move toward structural integration that could involve taking "everything of high value from the GDF and all the wonderful work they have done and moving it out of WHO into a better, more functional Global Fund," maintaining that the Global Fund is no longer functioning as the innovative financing mechanism that it was set up to be.
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From page 109... ...
• undle SLDs with other well-established drug supply chains to B lower costs and expedite delivery. • mprove flexibility and predictability of funding; facilitate reallocation I of unused funds to avoid loss to use.
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