Table 5 Examples of approaches using medical products and technologies

From: Health systems resilience in managing the COVID-19 pandemic: lessons from 28 countries

Subdomain Snapshot of health systems resilience measures in reviewed countries
Countries with the least deaths per 100,0000, with a population of over 20 million Countries with the most deaths per 100,0000, with a population of over 20 million Countries in the middle category in terms of deaths per 100,000 population
Preexisting national stockpiles China: the central and local government’s emergency stockpile of commodities, necessities and medical supplies was activated to meet the immediate demand during the earlier stages of the pandemic. Thailand: the government rapidly built up a national stockpile over the first few months of the pandemic while also sourcing external alternatives and domestic production alternatives. United States: the Department of Health and Human Services mobilized the Strategic National Stockpile to provide medical essentials to combat the pandemic. United Kingdom: the Department of Health and Social Care activated the nation’s emergency stockpile to augment existing supplies at NHS facilities. Singapore: drew on lessons from previous the SARS outbreak, and the government ensured adequate national stockpiles of PPE and essential medicines for up to 6 months. South Korea: Seoul had maintained the largest amount of PPE stockpiles (around 16,000 Level D coveralls, 5,200 Level C coveralls and 2,000 powered air-purifying respirator hoods).
Measures to increase in domestic production volume Thailand: Board of Investment (BOI) approved 12 ventures in March 2020 to produce face masks, adding to the already 13 BOI-approved garment and textile companies that are producing medical masks and gowns. Vietnam: promoted inter-industry transfers of technology to produce more innovative and portable ventilators at a faster rate to bolster overall production volume in the country. United Kingdom: several brewers contributed to the production of hand sanitizers by taking the alcohol from their production lines to bolster the local and regional supply of hand sanitizers. United States: The Defense Production Act allowed the president to direct private companies to prioritize orders from the federal government during national emergencies. An example was the federal government requesting automakers to manufacturer ventilators to increase overall domestic production volume. Singapore: a government-affiliated engineering company was tasked to start a production line for face masks by securing equipment, training manpower and protecting supplies of raw materials for the manufacturing processes. Japan: Ministry of Trade Economy and Industry, through the Subsidy Project for Supporting Businesses in Introducing Facilities for Producing Face Masks, had encouraged manufacturers to supply 100 million face masks per week by introducing new and enhanced equipment in manufacturing lines for face masks.
Measures to facilitate the import of medical products China: temporary decrease in import tariffs for medical devices to stabilize domestic supplies especially during the start of the pandemic. Sri Lanka: elimination of import duties and taxes on masks and disinfectants to facilitate movement of these products into the country. Peru: temporary implementation of export authorization requirements on face masks, gloves and other PPE to regulate outwards movement of essential medical resources. Argentina: the government established a zero-percent rate to import taxes, applied to alcohol, laboratory and pharmacy equipment, gloves, disinfectants and sanitary supplies. Fiji: elimination of import duties and VAT on medical supplies to promote movement of medical products necessary to combat the pandemic. Nigeria: federal government approved a waiver for import duties and VAT on all medical equipment and supplies into the country from May 2020 onwards.
Measures to restrict the export of medical products Vietnam: Drug Administration of Vietnam initially prevented the export of 37 drugs to be reserved for domestic healthcare facilities. China: initial prohibition on exporting test kits and medical supplies manufactured by uncertified companies was downgraded to export restriction upon authorization. United Kingdom: banned the export of essential medicines such as insulin and hydroxychloroquine over fears of domestic shortages. Argentina: released a decree that prohibits the export of critical medical merchandise such as oxygen therapy devices, their parts and accessories. Pakistan: authorities imposed restrictions that prohibit the exports of antimalarial drugs and other essential medicines. Russia: executive order signed in March 2020 imposed a temporary ban on exports of some medical goods and equipment, including antiviral drugs, with the exception of goods for humanitarian relief to foreign states.
Receiving donations of medical products Uganda: the WHO, with funding from the Irish Government, delivered USD 250,000 worth of equipment to the Ugandan Ministry of Health, which included 60 handheld pulse oximeters, 49 oxygen concentrators and 31 high-flow nasal cannulas. Thailand: medical supplies including face masks, face shields and protective suits for frontline workers were donated by the Jack Ma Foundation and Alibaba Foundation to Thailand’s Ministry of Public Health. Peru: Germany gave over USD 1 million worth of oxygen concentrators, digital thermometers, oximeters and more than 32,000 coronavirus tests for health professionals with the aim to help 90,000 people from underserved communities in the indigenous and rural areas of Peru’s Amazon. Fiji: Japan together with the Asian Development Bank and UNICEF provided USD 11 million worth of medical equipment to Fiji. Pakistan: China donated 1,000 ventilators to Pakistan in August 2020. Other donations included PPE, test kits and face masks. Nigeria: the United States donated 200 ventilators to Nigeria, which contributed to its membership in the Every Breath Counts Coalition, which aims to combat pneumonia, hypoxemia and COVID-19.
Securing grants or loans for procuring medical products Sri Lanka: China provided a USD 90 million grant to Sri Lanka in October 2020 for an array of uses including medical care. Uganda: the UK government released GBP 1.322 million/USD 1.84 million to support various aspects of Uganda’s fight against COVID-19. Activities funded by the UK grant are being implemented by the WHO and the International Organization for Migration. Argentina: The World Bank provided emergency cash transfers and loans under its COVID-19 Fast Track Facility to Argentina. Mexico: the United States donated more than USD 1.8 million in Migration and Refugee Assistance funds to Mexico to assist the country’s most vulnerable populations. Liberia: The World Bank approved a USD 3.75 million grant and USD 3.75 million concessional International Development Association credit for Liberia to strengthen immediate healthcare capacity and longer-term outbreak response. Pakistan: the COVID-19 Active Response and Expenditure Support program secured USD 500 million from the Asian Development Bank to import equipment and medical supplies.
Guidance principles released for the rational use of medical products Uganda: rational-use guidance documents released by heath authorities accompanied by videos on how to properly don PPE. Mozambique: released rational-use guidance integrated into its Environmental and Social Management Framework for COVID-19 Response to maximize existing supplies of PPE and ensure safe and effective usage. United States: CDC and Occupational Safety and Health Administration released guidelines on the proper use of PPE for frontline workers, which includes donning, repairing, washing, storing and disposing of PPE. Brazil: guidelines used as recommendations so that the unnecessary use of equipment is reduced and contingency is established in case of shortages. Hand and respiratory hygiene are emphasized strongly in the guidelines. South Korea: during the earlier stages of the pandemic in South Korea, when PPE supplies were insufficient, hospitals changed Level D coveralls to disposable plastic gowns and N95 respirators to KF94 masks. Although KF94 masks cannot ensure airtight seals due to the ear-loop structure, their filtration capacity is similar to the N95, and the KCDC recommended the KF94 or KF99 for health workers. India: in the initial months of the pandemic, PPE and masks were procured centrally due to import challenges. Once domestic manufacturers were developed and standards defined, vendors were onboarded to the Central Government e-Marketplace and states encouraged to buy standard and fair price essential commodities from this platform.
Advance-purchase agreements with pharmaceutical companies Vietnam: the government had engagements with Russia to buy 150 million doses of Russian vaccine (Sputnik V) and 30 million doses from AstraZeneca. Thailand: purchase arrangements secured to obtain 2 million doses of Sinovac vaccine and 61 million doses from AstraZeneca to be manufactured in collaboration with Siam Bioscience. Spain: secured multiple agreements through the European Commission’s Advance-Purchase Agreements with vaccine producers including Pfizer- BioNTechArn, AstraZeneca, ModernaARNm, Johnson & Johnson, Sanofi and GSK and CureVac to ensure sufficient access to approved vaccines. Mexico: signed an advance-purchase agreement for 35 million doses of Chinese firm CanSino Biologics’ COVID-19 vaccine while solidifying arrangements in January 2021 to procure 24 million doses of Russia’s Sputnik COVID-19 vaccine. Japan: made multiple investments in many potential vaccine candidates. In August 2020, the health ministry started negotiations with Moderna to secure enough vaccines from the drug firm to cover 20 million people within the first half of 2021, with Pfizer to cover 60 million people and with AstraZeneca for 120 million doses. India: as the largest buyer of vaccines, India has already purchased 196 million doses of domestically manufactured vaccines from Serum Institute and Bharat Biotech of India. It has also supported R&D efforts of local manufacturers. It is in talks to secure 1.6 billion doses of other vaccines once Indian trials conclude (Sputnik V and Novavax).
Participation in the COVAX facility Mozambique: part of the COVAX Advance Market Commitment and will receive vaccines to cover an average of 20% of the population. Thailand: did not pledge to the COVAX facility opting to acquire directly from manufacturers. United Kingdom: helped raise USD 1 billion for COVAX AMC through match-funding other donors, which was added on to the initial amount the United Kingdom had pledged. Peru: to receive approved COVID-19 vaccine from the COVAX AMC in early 2021. Sweden: pledged SEK 100 million/USD 119 million to the COVAX facility and will receive a predetermined number of vaccine doses. Singapore: co-chaired the Friends of the COVAX Facility initiative with Switzerland to promote vaccine multilateralism and contributed USD 5 million to the facility in return for a predetermined number of vaccine doses.
Platforms to monitor supply chains China: the Ministry of Industry and Information Technology established a platform for mobilizing resources nationwide. This platform aims to ensure the production and allocation of sufficient medical supplies to regions in need. Uganda: The Emergency Logistics Management System (Eelmis) provided real-time feedback on medical resource availability at national and subnational levels. The digital system rapidly collects, shares and analyzes information on supplies to guide a coordinated response to allocate medical resources. Brazil: regarding price monitoring, the Health Price Bank (BPS) system and the Material Catalog (CATMAT) for public health managers and control bodies helps the government procure reasonably priced drugs and other medical supplies from credible suppliers after price comparisons. United Kingdom: a parallel supply chain distribution mechanism set up to augment the NHS supply chain system for the rapid and organized distribution of medical essentials guided by the principles of plan, source, make, order and deliver. India: in the state of Odisha, the supply chain is normally managed using the Government e-Marketplace. During the pandemic, special interdepartmental committees were set up to rapidly finalize purchase indents, audit documents and track movements of medical products. Japan: medical facilities reported information on their operating status, bed occupancy rates in general wards, infectious disease wards, ICUs and utilization rates of ventilators and ECMO support, to the Gathering Medical Information System. This platform helps allocate and coordinate the movement of medical resources nationwide.
  1. Countries were selected according to the recorded number of deaths attributed to COVID-19 per 100,000 inhabitants on 6 November 2020. ECMO, extracorporeal membrane oxygenation.