Coronavirus lessons on medical supply chain resiliency

5 min read

We face a key problem in responding to the coronavirus epidemic: a lack of resources needed to carry out testing.

One of the main problems with existing manufacturing systems is that the infrastructure is inflexible. Medicines, supplies, and scientific equipment needed to respond to an outbreak like that of the coronavirus cannot be made in response to sudden increases in need. Part of this problem is the scale of production ― plants are designed and optimized to produce at a certain scale, and it is a very slow and costly procedure to add capacity or change to making a different product, even if it’s a closely related one. This is leaving aside the problems associated with the lack of incentives for corporate medicine to even try to respond to such a crisis effectively, and the anti-competitive barriers such as patents that seriously hinder or prevent new entrants starting to produce in response to increased demand.

Open Insulin is developing affordable equipment to localize the production and purification of proteins, which can be a key element of responding to such events. Repurposing of small scale protein production capacity is much easier than trying to repurpose a factory that costs billions of dollars and produces for the entire world ― systems are made of modular parts which can be much more easily modified and reconfigured by small teams of people, and so a small scale plant needs much less redesigning and work to repurpose to produce a different product. This is already how drugs are produced for clinical trials. Small scale contract manufacturers use modular equipment to produce, purify, and ensure the safety of many different drugs for many different clients. Events like the coronavirus outbreak show that this kind of flexible, small-scale infrastructure should have a much larger role in our economy.

The public health strategy for managing the coronavirus outbreak is mainly based on detecting people infected by the virus and taking individual and collective measures to reduce the propagation from infected individuals and populations to a rate that healthcare infrastructure can manage. At the local level, hospitals use testing to triage their patients and identify health workers who have been contaminated. Meanwhile, governments use information about infection rates yielded by testing, in conjunction with models from epidemiology, to determine when public isolation measures will be needed and how severe these measures must be to control the spread.

Thus, for both hospitals and governments, it’s crucial to know who is infected. A comprehensive testing strategy has been applied in South Korea with very effective results leading to a reasonably swift outcome of keeping the epidemic under control.

The second phase of controlling the pandemic concerns releasing patients who have recovered. This is complicated by the long period of contagion after symptoms have passed, typically several weeks. The most effective way to know if a recovered patient is still contagious is to measure viral shedding. This test is essentially the same as the one used to detect the virus in the first place. Lifting lockdowns and social distancing measures will need to be based on knowledge of how many people are still contagious. Lifting these measures too early, when a large part of the population is still contagious, (even if they are asymptomatic,) could provoke a new rise in cases, perhaps even bigger than the initial one (see Imperial London College report 9).

Different tests have been developed in different countries but the majority of them are based on detecting the RNA of the virus in the patient. For that, the RNA is identified and amplified with RT-PCR. This technique uses two main protein components: the reverse transcriptase enzyme and TAQ polymerase. The Open Insulin project is working on affordable open-source equipment for the production and purification of insulin, but the equipment will apply broadly to all proteins. This equipment could serve to produce the proteins used in virus testing as well. This would make it possible for community-scale labs to produce proteins to be used by testing labs despite the shortages in centralized supply.

In addition, the vaccine and the cure could also be based on proteins, or have major components that are proteins, such as antibodies and enzymes. Most cures for viral infections are a mix of different substances. In this case, even if the safety would have to be higher than testing supplies because the medicine will be injected into the patient, the equipment developed for the testing could also be used to produce the cure.

This is far from unprecedented in history. During WWII, due to restrictions on petroleum fuel use for transporting food and other goods because of wartime needs, the US government asked all citizens to start their own vegetable gardens, in their backyards, community spaces, and public land. In a few months, 80% of vegetables consumed in the US came from these “victory gardens”. We can imagine a similar system to produce the proteins needed for virus testing since the equipment can be made inexpensive and accessible. Meanwhile, on the other side of the world, type 1 diabetic Eva Saxl and her husband set up small scale insulin production under wartime blockade conditions, saving her life and those of all the other diabetics trapped with them in Shanghai.

With the will to do what’s possible to save lives, we can create the means for people to organize to respond to crises in our communities and keep strong in the face of crises like the one we face now.