The current landscape in antibiotic access and supply issues: a qualitative study with key experts and opinion leaders

Abstract

Introduction

There is an increasing lack of access to safe and effective antibiotics for human consumption. We investigated the main drivers for current antibiotic shortages and existing mitigation strategies undertaken in different regions.

Methods

Purposive sampling was used to identify stakeholders with expertise in antibiotic access and supply chains. Consented participants were interviewed using a piloted semi-structured interview guide that was developed using the PESTELI (political, economic, sociological, ecological, technological, legal, industry) framework. Analysis and data collection are iterative and recursive, using constant comparison. Theoretical sampling is being applied to develop categories until saturation is reached.

Results

Between August 2023 and March 2024, 14 key stakeholders with local, national, and global roles in supply chain management (South Africa-7, UK-2, Sweden- 2, Netherlands-1, Belgium-1, USA-1) were interviewed. Political engagement on antibiotic shortages is reported to facilitate effective mitigation strategies, especially in areas where there is strong evidence of government investment. Political support manifests as legal measures for example in the EU and UK in supporting the response to shortages, giving rights to pharmacists to intervene through protocolized measures to use alternative agents, and negotiating with pharmaceutical companies for greater transparency on the challenges in manufacturing. Economic incentives are required at all levels and are currently missing. There is increasing monopolization of active pharmaceutical ingredients and raw materials in the pharmaceutical industry with a lack of information, partly due to technological insufficiency to gather appropriate data at scale across sectors for example on procurement in the community, for key antibiotics at high risk of being impacted by shortages. Sociological impacts and drivers of shortages include adopting appropriate communication to not cause panic buying and hoarding by organisations when there is an impending shortage and recognising the important role of a multidisciplinary response. The key stakeholders identified for developing mitigation strategies included pharmaceutical manufacturers, policymakers and regulators, and global organisations such as WHO. Mitigation strategies included moving stock between pharmacies, pharmacists being assigned to monitor antibiotic supply and shortages at the hospital level, and implementation of serious shortage protocols in the UK which enable pharmacists to dispense alternate antibiotics in case of shortages.

Discussion

There is a need for improved communications regarding shortages from the suppliers and transparency about potential problems in the supply chain. We were not able to interview actors from the pharmaceutical industry due to their restrictions which was a limitation since they play a key role in effective and sustainable antibiotic supply chains.

Conclusion

Having an understanding of the various factors contributing to antibiotic shortages will support developing mitigation strategies, and tools for forecasting shortages and their optimised management thereby assuring equitable access to antibiotics and mitigating the emergence and spread of antibiotic resistance globally.