Building Resilient Health Infrastructure with ASPR

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MICHAEL ELTRINGHAM: You’re listening to “Building Resilient Health Infrastructure with ASPR,” a podcast from the HHS ASPR Critical Infrastructure Protection Division. If you have any questions about this episode, please email us at [email protected].

Hey everyone, thanks for listening. I'm Michael Eltringham, a program analyst within the HHS ASPR Critical Infrastructure Protection, or CIP division. Alongside me is our division director Dr. Laura Wolf. How are you, Dr. Wolf?

LW: Excellent!

ME: We're back for another episode. We're really excited about this podcast, we hope you’re enjoying them. Today's question for the episode: how do supply shortages impact the healthcare and public health community? So to kind of lead us off here: the healthcare supply chain. Why do we care about it?

LW: Why do we care? So much of the provision of health care relies on supplies and relies on a lot of them. So healthcare receives shipments of products throughout the day. Like a major hospital will receive deliveries throughout the day. So if anything impacts those deliveries, transportation issues, they could be put at risk. And if something stalls those deliveries for days that could be a reason a facility has to to shut down or evacuate if they can't provide care.

ME: And I think one of the interesting things about the healthcare supply chain that maybe folks don't think about it as a system in and of itself. But it really is one of the most dynamic types of systems within the healthcare and public health sector right?

LW: Sure. I mean, to get to that just-in-time delivery mechanism you need the production of these products which often relies on deliveries from overseas. Raw materials or API’s come over from Asia. That product may be produced in in Asia, or somewhere overseas, might be produced in the US but that manufacturing occurs. Then there's a large network of healthcare distributors. Some third-party delivery trucks that bring it that last mile to the facility, and then the processes in a facility of coordinating the ordering and distribution within a hospital of a product. Those all have to be working synchronously throughout the day to keep those systems going.

ME: So that lends itself to the concept that this could be or hypothetically be a fragile kind of system don't you think?

LW: It is very fragile and there are a lot of threats to that system as I mentioned natural disasters could get in the way, transportation challenges, international policy changes because we rely so much on foreign sources of materials. It's very fragile.

ME: So we have a lot of partners within the private sector side obviously can you talk about some of the efforts or maybe the ways in which our private sector partners organize to address issues related to the supply chain?

LW: Absolutely, so one of our partners is the American Society of Health System Pharmacists, and these American Health System Pharmacists deal with shortages all the time. This year alone there have been shortages in pain medications, anesthesia, saline. Their job has has often become more focused on logistics of supply chain than on managing a pharmacy in and of itself. And so that society is partnered with several others: the American Hospital Association and the Society for Anesthesiologists to really think about the implications of shortages for national security. And so they do a lot to communicate with their partners at the facility level for some best practices on how to work through shortages. So for saline there were different types of devices that could be used that minimized the amount of saline you actually needed, different procedures that could be workarounds for using again large volumes of saline and shrinking that volume needed. So they do a great job of sharing information with their practitioners about what to do. We also had calls and resources through ASPR TRACIE, the technical resource assistance center and information exchange. Some webinars and great products of how to mitigate those problems. So at this point you know when we learn about shortages basically our response is to talk about how to deal with it. We don't know ahead of time what those problems might be but with the lessons that we learned in our hurricane experience maybe there is more we can do ahead of time. We anticipate where there might be national level shortages because of an event and we're going to try harder in the future to prevent more of those.

ME: I think it really underlines the kind of importance of the partnership because that's an area where there's so many moving parts that you really need that coordinator response from you know obviously the private sector side, the distributor side, the manufacturers, and the government as well so it really shows the importance of that public and private partnership.

ME: Sure and we try to paint a realistic picture when talking with our partners, so often there's not a lot that can be shared from manufacturers and distributors and the question that we often get is: well, when you know do anticipate the recovery? In a few days or weeks? And so we're able to sort of be provide a realistic perspective of helping our partners think through a long term shortage and planning in the long term, that yes this could resolve in a few days or weeks but please think about a long term plan for a supply shortage. So we try to help with that perspective of realism and helping someone think through and justify to their leadership why they need to be more strategic about preserving the supplies that are on hand at that time. So it's a complicated issue.

It's an issue with really a lot of different subtopics you could get into but as an overview I think that's that kind of shows you, our listener at home, the importance of it and again, what a dynamic kind of issue it is with so many moving parts and I'm sure we'll cover that more in the future the different aspects of it.

LW: We could even have an entire episode about cybersecurity impacts on supply chain because all those systems rely on cyber systems.

ME: They're all so interconnected. It's impossible that there's always overlap. And yeah, absolutely I think that'll be great. So that's our episode thank you so much everyone for joining us. If you have any questions about any of the materials you heard about today especially I really recommend everyone check out ASPR TRACIE that Laura referenced. They have a lot of great material on not just supply chain but topic collections on so many different issues related to critical infrastructure protection and other kind of health care and public health issues as well. Check them out. If you have any questions about anything else, please email us at [email protected] and again if you have any feedback on the podcast we'd love to get that as well, recommendations on future topics, we'd love to hear what you want to hear about that. That would be really important for us to hear. So thank you again, thank you Laura.

LW: Thank you, Mike!

ME: And thank you for everyone listening at home, we’ll see you next time!

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