1Health Human Resources Research Center, School of Health Management and Medical Informatics, Shiraz University of Medical Sciences, Shiraz, Iran
2Vice-Chancellery for Food and Drug, Shiraz University of Medical Sciences, Shiraz, Iran
3Department of Public Health, School of Health, Shiraz University of Medical Sciences, Shiraz, Iran
4Department of Pharmaceutical Biotechnology, School of Pharmacy, Shiraz University of Medical Sciences, Shiraz, Iran
5Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran
6Department of Pharmacoeconomics and Pharmaceutical Administration, School of Pharmacy, Shahid Beheshti University of Medical Sciences, Tehran, Iran
چکیده
Background: Politico-economic sanctions over the recent years have led to significant challenges in the pharmaceutical supply chain (PSC) in Iran. Given the importance of the chain’s resilience for the health system and its impact on accessibility, equity, and public health, this study was conducted to determine the major challenges facing pharmaceutical procurement in Iran after the imposition of these sanctions. Methods: This study was a qualitative research with a content analysis approach conducted in 2019. Eighteen policymakers and administrative managers in food and drug administration of two Iranian Medical Universities and Iran’s Ministry of Health were included in the present study via snowball sampling and semi-structured interview. The data were analyzed using the framework analysis of MAX QDA10. Results: Five main themes and 15 sub-themes were identified, which addressed pharmaceutical supply chain challenges under politico-economic sanctions. These included the challenges in financing, purchasing, importing, and manufacturing domestic products in addition to storing and distributing medicines, along with challenges facing the general public, particularly patients. Conclusion: The results revealed that pharmaceuticals are not immune to politico-economic sanctions, although they are not directly subjected to them. Sanctions, similar to any economic crisis, can affect public health and limit their access to healthcare. Identifying supply chain challenges and planning to address them could help policymakers find solutions to enhance PSC resilience in the future.
Kheirandish M, Rashidian A, Bigdeli M. A news media analysis of economic sanction effects on access to medicine in Iran. J Res Pharm Pract. 2015;4:199-205. doi: 10.4103/2279-042X.167042. PubMed PMID: 26645026; PubMed Central PMCID: PMCPMC4645132.
Abdollahias A, Nikfar S, Abdollahi M. Pharmaceutical market and health system in the Middle Eastern and Central Asian countries: Time for innovations and changes in policies and actions. Arch Med Sci. 2011;7:365-7. doi: 10.5114/aoms.2011.23397. PubMed PMID: 22295018; PubMed Central PMCID: PMCPMC3258741.
Jaberidoost M, Nikfar S, Abdollahiasl A, Dinarvand R. Pharmaceutical supply chain risks: a systematic review. Daru. 2013;21:69. doi: 10.1186/2008-2231-21-69. PubMed PMID: 24355166; PubMed Central PMCID: PMCPMC3913399.
Rajabzadeh Ghatari A, Mehralian G, Zarenezhad F, Rasekh HR. Developing a model for agile supply: an empirical study from Iranian pharmaceutical supply chain. Iran J Pharm Res. 2013;12:193-205. PubMed PMID: 24250689; PubMed Central PMCID: PMCPMC3813359.
Jaberidoost M, Olfat L, Hosseini A, Kebriaeezadeh A, Abdollahi M, Alaeddini M, et al. Pharmaceutical supply chain risk assessment in Iran using analytic hierarchy process (AHP) and simple additive weighting (SAW) methods. J Pharm Policy Pract. 2015;8:9. doi: 10.1186/s40545-015-0029-3. PubMed PMID: 25838919; PubMed Central PMCID: PMCPMC4354976.
Schneider JL, Wilson A, Rosenbeck JM. Pharmaceutical companies and sustainability: an analysis of corporate reporting. Benchmarking: An International Journal. 2010;17:421-34. doi: 10.1108/14635771080001425.
Aigbogun O, Ghazali Z, Razali R. A framework to enhance supply chain resilience the case of Malaysian pharmaceutical industry. Global Business and Management Research. 2014;6:219.
Pettit TJ. Supply chain resilience: development of a conceptual framework, an assessment tool and an implementation process. Ohio State Univ Columbus. 2008.
Pettit TJ, Fiksel J, Croxton KL. Can you measure your supply chain resilience. Supply Chain and Logistics Journal. 2008;10:21-2.
Carvalho H, Cruz-Machado V. Integrating lean, agile, resilience and green paradigms in supply chain management (LARG_SCM). Supply chain management. 2011:27-48. doi: 10.5772/14592.
Nouhi M, Olyaeemanesh A, Teymourzadeh E, Bahadori M, Hakimzadeh SM, Babaei M. Rouhani-care and the joint comprehensive plan of action: a nightmare scenario. Health Policy and Technology. 2019;8:5-6. doi: 10.1016/j.hlpt.2019.02.006.
Cheraghali AM. Impacts of international sanctions on Iranian pharmaceutical market. Daru. 2013;21:64. doi: 10.1186/2008-2231-21-64. PubMed PMID: 23902642; PubMed Central PMCID: PMCPMC3734229.
Mohammadi D. US-led economic sanctions strangle Iran’s drug supply. Lancet. 2013;381:279. doi: 10.1016/s0140-6736(13)60116-6. PubMed PMID: 23359890.
Hassani M. Impact of Sanctions on Cancer Care in Iran. Arch Bone Jt Surg. 2018;6:248-9. PubMed PMID: 30175170; PubMed Central PMCID: PMCPMC6110432.
Setayesh S, Mackey TK. Addressing the impact of economic sanctions on Iranian drug shortages in the joint comprehensive plan of action: promoting access to medicines and health diplomacy. Global Health. 2016;12:31. doi: 10.1186/s12992-016-0168-6. PubMed PMID: 27267898; PubMed Central PMCID: PMCPMC4897941.
Shahabi S, Fazlalizadeh H, Stedman J, Chuang L, Shariftabrizi A, Ram R. The impact of international economic sanctions on Iranian cancer healthcare. Health Policy. 2015;119:1309-18. doi: 10.1016/j.healthpol.2015.08.012. PubMed PMID: 26344426.
Barzegartahamtan M, Mahdavi SR, Haddad P. US Sanctions against Iran; an Irreversible Disaster for Cancer Patients. Arch Iran Med. 2020;23:572. doi: 10.34172/aim.2020.64. PubMed PMID: 32894973.
Yazdi-Feyzabadi V, Amini-Rarani M, Delavari S. The Health Consequences of Economic Sanctions: Call for Health Diplomacy and International Collaboration. Arch Iran Med. 2020;23:S51-S3. doi: 10.34172/aim.2020.s11. PubMed PMID: 32349510.
Guba EG, Lincoln YS. Competing paradigms in qualitative research. Handbook of qualitative research. 1994;2:105.
Gale NK, Heath G, Cameron E, Rashid S, Redwood S. Using the framework method for the analysis of qualitative data in multi-disciplinary health research. BMC Med Res Methodol. 2013;13:117. doi: 10.1186/1471-2288-13-117. PubMed PMID: 24047204; PubMed Central PMCID: PMCPMC3848812.
Ghasemzadeh P, Nazari JA, Farzaneh M, Mehralian G. Moderating role of innovation culture in the relationship between organizational learning and innovation performance. The Learning Organization. 2019;26:289-303. doi: 10.1108/TLO-08-2018-0139.
Mehralian G, Akhavan P, Rasekh HR, Ghatari AR. A framework for human capital indicators in knowledge-based industries: evidence from pharmaceutical industry. Measuring Business Excellence. 2013;17:88-101. doi: 10.1108/MBE-10-2012-0053.
Kokabisaghi F. Assessment of the Effects of Economic Sanctions on Iranians’ Right to Health by Using Human Rights Impact Assessment Tool: A Systematic Review. Int J Health Policy Manag. 2018;7:374-93. doi: 10.15171/ijhpm.2017.147. PubMed PMID: 29764102; PubMed Central PMCID: PMCPMC5953521.
Moret ES. Humanitarian impacts of economic sanctions on Iran and Syria. European Security. 2015;24:120-40. doi: 10.1080/09662839.2014.893427.
Ghiasi G, Rashidian A, Kebriaeezadeh A, Salamzadeh J. The Impact of the Sanctions Made Against Iran on Availability to Asthma Medicines in Tehran. Iran J Pharm Res. 2016;15:567-71. PubMed PMID: 27980593; PubMed Central PMCID: PMCPMC5149045.
Kheirandish M, Varahrami V, Kebriaeezade A, Cheraghali AM. Impact of economic sanctions on access to noncommunicable diseases medicines in the Islamic Republic of Iran. East Mediterr Health J. 2018;24:42-51. PubMed PMID: 29658620.
Azim MI, Azam S. Corporate sustainability reporting by pharmaceutical companies: is it what it seems to be? Corporate Ownership and Control. 2013;11:767-78. doi: 10.22495/cocv11i1c8art6.
Petrescu IM. The Humanitarian impact of economic sanctions. Job Market Paper. 2007:1-25.
Yoon HJ, Woo SH, Kim D, Um JH, Park SH, Seo AR. Changes in medical research trends of North Korea after economic sanctions: A PRISMA-compliant systematic literature review of North Korean medical journals. Medicine (Baltimore). 2019;98:e16500. doi: 10.1097/MD.0000000000016500. PubMed PMID: 31335718; PubMed Central PMCID: PMCPMC6709283.
Simhan I. USA and shortage of food and medicine in Cuba. Lancet. 1997;349:363. doi: 10.1016/S0140-6736(05)62873-5. PubMed PMID: 9024413.