The Case for a More Secure Healthcare Supply Chain to Safeguard the Distribution of COVID-19 Vaccines

By Tom Knight, Chairman of

As our anticipation for the coronavirus vaccine grows, so do our questions. When will a vaccine be available in sufficient quantities? How will it be allocated?

But the one question that healthcare leaders should also be asking—but probably aren’t— is this: How will we prevent the coronavirus vaccine from being stolen?

Recent news reports suggest that supply chains may struggle to handle manufacturing and production demands for a COVID-19 vaccine. Producing huge quantities of stoppers, needles, and refrigeration units alone will present widespread challenges as the nation rushes into the biggest mass inoculation effort since polio in the 1950s.

As we’ve seen with HIV medications, when there are life-saving drugs available in limited quantities, the black-market demand surges. While most healthcare drug diversion incidents involve opioid analgesics, we’re starting to see more COVID-19 related cases — notably in Indiana, California, Washington, South Carolina, and Texas — involving theft of supplies like N95 masks and therapeutics like the drug hydroxychloroquine and Remdesivir.

Considering that only 36% of healthcare workers are confident in their organization’s drug diversion program, according to a 2020 study conducted by Porter Research and Invistics, the time to act is now.

A Perfect Storm is Brewing
The possibility of a short vaccine supply is just one of several indicators that diversion of all drugs, whether opiates or short-supply vaccines, could escalate.

Since COVID-19’s arrival in early 2020, drug overdoses have surged in at least 40 states. What’s even more pervasive and concerning is the depression, joblessness, isolation, and anxiety that are byproducts of the pandemic, which have contributed to a marked decline in our mental health.

A July survey by Kaiser Family Foundation (KFF) revealed that more than half of all U.S. adults 18 and older (53%) said that worry and stress related to COVID-19 had impacted their mental health. In May, fewer adults reported coronavirus worry and stress (39%), KFF noted in a news release.

Healthcare organizations are experiencing changes, as well. Hospitals and health facilities have shifted their focus to managing COVID-19. This shift is necessary, but potential perpetrators may see a window of opportunity to divert medications as clinical leaders focus their energy on treating suspected COVID-19 cases and adapting to other in-house changes.

Bolstering Our Defenses
Healthcare organizations may not have time to overhaul departments or revamp their drug diversion prevention strategies. However, by strengthening three key areas — operations, education, and technology — they’ll be in a better position to tackle diversion in the near future.

  1. Operations
    The first defense against drug diversion is real-time visibility into the supply chain. Healthcare organizations need an airtight system for tracking all drugs and supplies from the moment they are purchased to when they are administered to their patient.Supply chain managers run into problems when they don’t know where the weak links are: Is there an adequate analysis of purchasing and shipments? Are there track-and-trace systems that can detect when a batch of medication is missing? Are surveillance protocols (procedures for locking doors, monitoring cameras) aligned with industry best practices?As we move closer to distribution, analyzing existing supply chain practices will be as essential as conducting criminal background checks on security guards and other personnel who handle not only controlled substances but also COVID-19 therapeutics and its vaccine.
  2. Education and Training
    Most healthcare workers have received some basic education about drug diversion — signs of drug abuse, for example. But they may not be aware of the extent of drug diversion or how often drugs are stolen for resale on the black market. Clinical supervisors should ensure all staff understands these issues along with the consequences of drug diversion (e.g., loss of employment, arrest, a criminal record).It’s also important to keep in mind that most healthcare facilities have had to adapt to life in a pandemic, with the constant use of personal protective equipment (PPE) and new safeguards to protect against the transmission of the coronavirus. If a health facility’s layout has changed in response to COVID-19, clinical staff may need to learn new approaches to medication management to comply with new regulations.
  3. Technology
    Most hospitals have already invested in communications technology that makes clinical care easier, from Electronic Medical Records (EMRs) and clinical decision support tools to patient portals. Yet, there is still limited investment in solutions that go behind the scenes and aggregate data from multiple sources to isolate patterns aligned with drug diversion. Smart, machine learning software can supplement diversion-mitigation efforts by analyzing data from multiple sources and alerting clinical managers to red flags (e.g., missing vials from automated dispensing cabinets or vaccine doses that were not administered to the patient).

We’ll all need to increase our efforts to prevent diversion as we prepare to distribute of COVID-19 vaccines. By taking decisive steps toward strengthening existing drug diversion efforts now, we can help organizations in 2021 and beyond.