The Global Centre for Risk and Innovation (GCRI)
Medicines, vaccines, diagnostics, oxygen and medical devices reach patients through long chains of manufacturers, regulators, procurers, warehouses and carriers, many of which cross borders and depend on few producers. A failure anywhere along the chain becomes a stock-out at the facility. This page sets out how supply risk develops and propagates, how it is measured, and what the evidence serves for the institutions that procure, store and regulate health products.
GCRI · Established · service level R0
Medicine shortages are periods when a medicine, vaccine, diagnostic or device is not available in the quantity needed. They arise along long chains of manufacturers, regulators, procurers, warehouses and carriers that often depend on few producers. Stock data, shortage registers and product alerts track them.
How far each division sits from a large city, with the roads and airports that carry patients and supplies, shown for Colombia as an example geography for this subject.
The working screen behind this subject: its structure, terms and states. Names are placeholders and values illustrative.
Health supply chains · Province B · Month 1
| Oral rehydration salts | 3.1 | 1 | 6 | Adequate |
| First-line antibiotic | 1.6 | 6 | 8 | Low |
| Insulin | 2 | 4 | 9 | Adequate |
| Rapid diagnostic tests | 0.2 | 10 | 8 | Critical |
Medicines, cold chain and health logistics. The dossier below sets out how the risk develops, what is measured, where the data come from, how it is modelled and who decides.
Active pharmaceutical ingredients, key starting materials, vaccine inputs and some devices come from a small number of manufacturers and countries. A plant shutdown, a quality failure or an export restriction can affect supply in many markets at once.
Vaccines and many biologics must stay within set temperature ranges from manufacture to administration. Power outages, failed refrigerators and heat in transport can degrade potency, often without any visible change to the product.
When facilities report stock late or not at all, shortages are discovered when patients are turned away. Weak demand data drive both stock-outs and expiry, and panic ordering in a crisis amplifies both.
Substandard and falsified products enter where regulatory capacity is thin and genuine supply is short, and shortages create the demand for them. The harm includes treatment failure and, for antimicrobials, the selection of resistance.
Each term as this page uses it. Where a standard-setting body defines the term, the wording follows that body.
| Term | Definition |
|---|---|
| Stock-out | A period when a facility has none of a product on hand. |
| Substandard medical product | An authorised product that fails to meet its quality standards or specifications, in WHO terminology. |
| Falsified medical product | A product that deliberately misrepresents its identity, composition or source. |
| WHO prequalification | WHO's assessment of medicines, vaccines and diagnostics against quality, safety and efficacy standards, used by procurers. |
Each indicator carries its unit, its cadence, the kind of source behind it and the evidence label a value would carry. No values are shown: a programme supplies them under its own authority.
| Indicator | Unit | Cadence | Source type | Label |
|---|---|---|---|---|
| Tracer medicine availability | percent of facilities with the item in stock | monthly | Logistics systems and facility surveys | OBSERVED |
| Stock-out duration | days per stock-out event | monthly | Logistics management information systems | REPORTED |
| Months of stock on hand | months of average consumption | monthly | Central and regional warehouse records | OFFICIAL |
| Cold chain equipment functionality | percent of equipment functional | quarterly | Cold chain equipment inventories | REPORTED |
| Temperature excursions | excursions per monitored unit | continuous | Remote temperature monitoring devices | OBSERVED |
| Supplier concentration | count of qualified suppliers per product | per review | Prequalification and registration records | OFFICIAL |
| Active shortage notices | notices | weekly | Regulatory shortage registers | OFFICIAL |
| Substandard and falsified product reports | reports | monthly | National regulators and the WHO global surveillance system | REPORTED |
The topic as a computational graph: named sources feed the methods, an evidence review gates the outputs, and the decisions stay with the authorities that hold them.
Fig. 02Nodes carry their type, two metric rows and a state; connectors show what feeds what; dashed frames name the owners; the timeline is the cadence. Design of the pipeline, not a record of a run.
Named public datasets and institutional records, each with its licence class. Sources by agreement are used only under their terms and never republished.
| Source | What it gives | Licence class |
|---|---|---|
| WHO Prequalification lists | Prequalified medicines, vaccines, diagnostics and immunisation devices with their manufacturers | Public records, WHO terms of use |
| Global Fund Price and Quality Reporting | Transaction-level procurement of health products by grant recipients | Public, Global Fund terms of use |
| UN Comtrade | International trade flows in pharmaceutical products and medical devices by commodity code | Free access with registration, terms of use |
| National medicines regulators' shortage registers | Active and resolved shortage notices by product | Public records, terms per regulator |
| WHO medical product alerts | Public alerts on substandard and falsified medical products | Public records, WHO terms of use |
| National logistics management information systems | Stock, consumption and orders by facility, for example in DHIS2 or OpenLMIS | By agreement with each ministry of health |
| UNICEF Supply Division market notes | Supply and demand outlooks for vaccines and essential supplies | Public reports, UNICEF terms of use |
Health Nexus prepares evidence. The decisions below are taken by the authorities named, under their own rules, and never by the platform.
| Who decides | The question | Evidence this page serves |
|---|---|---|
| Central medical stores and procurement agencies | How much buffer stock to hold, where, and from how many suppliers | Supplier concentration; lead-time distributions; stock-out and expiry evidence |
| National medicines regulatory authorities | Which shortages need regulatory flexibility, alternative sources or import authorisation | Shortage registers against demand and qualified supplier lists |
| National immunisation programmes | Where cold chain equipment must be replaced or protected against outages | Equipment functionality, temperature excursion records and power reliability |
| Regional bodies and pooled procurers | Whether to invest in regional manufacturing or shared stockpiles | Concentration and trade dependency evidence; surge scenarios with lead times |
Supply-chain questions trace a product back to its points of failure.
Generic medicines are often produced at low margins by few manufacturers, and production of key starting materials can be concentrated geographically. A quality failure, factory shutdown or trade restriction at one point can therefore affect many countries. Lean inventory practices reduce cost but also reduce the buffer available when demand rises.
Demand shocks and supply shocks frequently coincide in a crisis. Panic buying and stockpiling by some purchasers can create shortages elsewhere. Last-mile distribution depends on transport, power for refrigeration and trained staff, so a working national supply can still fail to reach a clinic.
| Method or data | What it shows | Limits |
|---|---|---|
| Supply-chain mapping | Where products and components come from | Upstream supplier data is often confidential or incomplete |
| Shortage reports and registries | Which products are short and for how long | Reporting rules differ between jurisdictions |
| Inventory and logistics modelling | How stocks behave under surge and disruption | Depends on demand assumptions that change in crises |
| Cold-chain temperature monitoring data | Where temperature excursions occur | Coverage of the last mile is often weak |
The current service level is R0: information and enquiries. An enquiry receives a reference and names the next step; applications, payments, compute allocations and registrations open only when their team, terms and review capacity exist.