*2.1.5 Recommendations*

Key levers for de-risking the supply chain include the need to balance global sourcing with near shore and local sourcing, the adoption of multiple sources and a greater utilization of information technology to drive more complete and immediate information availability. Talent management in supply chain management needs to promote a focus not just on costs, but also on resilience as well as on learning from current events to improve decision-making [10, 30]. Findings from the reviewed literature reported the following recommendations:


we recommend firms adopt a forward looking approach. These forward-looking strategies must comprise of multiple facets of the supply chain including people, processes, and technology.

Devoting resources for supply network mapping as a risk-mitigation strategy. A firm can design its supply network in such a way that it can balance risk and operational flexibility, manage supply chain disruptions, and keep supply chain agile. Brian Higgins, a principal Supply Chain & Operations Leader of KPMG, US has recommended some very pertinent action points for the long term:


A study proposed a framework for operations and supply chain management at the times of COVID-19 pandemic spanning six perspectives, i.e., adaptation, digitalization, preparedness, recovery, ripple effect, and sustainability. Assessment of COVID-19-related procurement and supply chain risks and life-cycle sustainability assessment of pharmaceutical product systems and development of drug allocation strategies under resource or supply constraints were recommended [6, 17, 41].


possible. Infectious disease outbreak preparedness strategies should incorporate primary healthcare services and other health system modalities to cater for non– pandemic-related conditions [18, 22].

Suppliers should manage the perception of their readiness to adapt to changing situations. Those that demonstrate competence will be rewarded as their customers look back in the coming years. Rather than ignore or complain about uncertainty, suppliers will be well-served if they can demonstrate plans that show customers they can reliably manufacture regardless of societal disruptions. Suppliers also need to be dynamic by focusing on multiple best practices explored by other suppliers, competitors and ecosystem in order to optimize cost and delivery, improve visibility across the network, and accelerate reaction times to issues in production and delivery [6, 14, 15].

#### **2.2 Discussion and conclusions**

The COVID-19 pandemic has impacted global health product supply chains, affecting key materials and ingredients, finished health products, logistics, and shipping medical devices, essential medicines and pharmaceutical products as a result of border closures, international trade restrictions and transportation problems [42]. The COVID-19 pandemic clearly shows the lack of resilience in supply chains and the impact that disruptions may have on a global network scale as individual supply chain connections and nodes fail [41].

As did HIV, the COVID-19 is likely to have profound and long-term consequences on global health care supply chains. The HIV pandemic transformed health care supply chains globally and in particular in lower and middle-income countries, (LMICs) leading to the mobilization of new financial resources for health care products, service delivery, and the creation of international bodies (including The Global Fund and PEPFAR) [43].

The short-term effects of COVID-19 on global health care supply chains have been severe; factory and border closures, transportation disruption, shifting demand, and price increases but it is more important to reflect on what the longterm consequences will be and how global changes will affect the LMICs. This is because LMICs are in their early stages of pharmaceutical development; thus they rely on importation of drugs, raw materials and equipment from countries outside the region, notably India and China.18 Researchers wonder whether the changes will be positive overall or if countries will revert to the same systems that left us unprepared for an international pandemic. This review was unable to find answer to these questions. However, crises like pandemics tend to have lasting impacts, and it is likely that the short-term disruption of health care supply chains we are seeing will result in longer-term structural changes. This highlights the need for policymakers to address challenges to large-scale and sustainable drug manufacturing, using the COVID-19 situation as a learning opportunity. It is interesting that some companies are offering strong technological solutions, which may help them survive and even prosper. While the hope is that COVID-19 will increase recognition of the importance of strong health care supply chains with commensurate investment, there will also be pressure on funders to rebuild their own shattered economies. There will be pressure to turn inward, certainly over the short term. There may also be opportunities for alternative financing mechanisms including venture capital [43]. The review has noted the fact that disruption does not necessarily mean negative outcomes and that it is incumbent on all health supply chains organizations to turn this disruptive event into positive change.

The COVID-19 pandemic is a disruption of an unprecedented magnitude, which is testing the resilience of global supply chains. The ability for a supply chain's operators

#### *Global Impact of COVID-19 Pandemic on Public Health Supply Chains DOI: http://dx.doi.org/10.5772/intechopen.97454*

to effectively plan, enabling a means for the supply chain to absorb, recover from, and adapt to disruptions of various lengths, impacts, and probabilities, is essential to ensuring the supply chain's function and success. For a supply chain, resilience measures the ability to prepare for and provide essential functions during a disruption, and then to recover from and adapt post-disruption into a form that is better suited to the new "present." Although sustainability, robustness, risk mitigation, leanness, and other supply chain management practices are important for business success, supply chain resilience is unique in its focus on recovery following a disruptive event [44].

Maintaining the supply chain of pharmaceutical products is not only paramount to cover the immediate medical response but will be fundamental to reducing disruption of the healthcare delivery system, which requires constant medicines, diagnostic tools and vaccines for smooth functioning.

In Nigeria, for example, over 70% of the prescribed medications are produced from active pharmaceutical ingredients (API) primarily sourced from firms in China and India. Uninterrupted access to medicine is an integral part of healthcare systems much needed and essential for the well-being of the population, but the COVID-19 pandemic has threatened this [31].

There is need to consider the new digital technologies that have potential to improve the ripple effect control in cases of epidemic outbreaks. Making innovations and data work for the supply chain resilience in crisis times, understanding and progressing the research of how these technologies can be used boost supply chains resilience, are important future research areas with a particular focus on data analytics, artificial intelligence, and machine learning [45].

There is minimal risk of bias in this study as articles were merely reviewed as presented and reviewers were not privy to the original data of the individual studies. Reviewers were also not interested in the outcome of the review but aimed at providing recommendations to country supply chains for the benefit of public health. None of the reviewers is a publisher of any of the articles reviewed. The review is limited to the competences of the reviewers in interpreting the results and to the fact that the coverage of included articles was flexible and neither restricted the review to articles conducted in homogenous settings nor compared their findings.

This study buttresses the need to devise and institute clear strategies on supply chain management in country and regional emergency responses, promotion of local manufacturing of medicines and other health products to reduce the extensive dependency on importation from international markets and increase the talent pool of supply chain management especially in Africa.

The review concluded that many manufacturers and service providers in some countries are already experiencing severe shortage of essential and non-essential raw materials including medical and pharmaceutical products, in addition to intermediate inputs, due to the COVID-19 pandemic and it's consequent border closures, trade restrictions among nations, and transportation problems. The COVID-19 pandemic however exposed some hidden potentials in many countries especially in Sub Saharan African. There is need for health supply chain resilience through development of a reliable supply chain strategy for pandemics and other such emergencies.
