Shortages Without Frontiers: Antimicrobial Drug and Vaccine Shortages Impact Far Beyond the Individual!

Reasons for supply side driven drug shortages - A mixed-methods study on first-level, higher-level, and root causes from the perspective of marketing authorization holders

BACKGROUND

Drug shortages impact multiple stakeholders and are detrimental to patient safety. Additionally, drug shortages are an extensive financial burden. In Germany, drug shortages, according to data from the federal ministry for drug and medical products (BfArM), have been increasing by 18% between 2018 and 2021. Studies show that shortages are most frequently supply side driven and that often reasons remain unknown.

OBJECTIVE

The aim is to develop a holistic understanding of supply side causes for drug shortages in Germany from marketing authorization holders' perspectives and to derive implications for shortage mitigation.

METHODS

A mixed-methods research design, with a grounded theory approach based on a structured literature review, BfArM data analysis, and semi-structured interviews, was used.

RESULTS

Input factor supply issues, manufacturing issues, logistics issues, product recalls, and product discontinuations were identified as first-level causes. Furthermore, a theory on their connection to higher-level causes related to business decision-making, as well as root causes linked to regulations, company values, internal processes, market dynamics, external shocks, and macroeconomic factors, was developed.

CONCLUSION

Actions to mitigate drug shortages in Germany (e.g., improving business processes, diversifying tender criteria) were derived. These may thus increase patient safety and decrease the financial burden on the healthcare system.

Knowledge, attitudes and practices regarding antimicrobial use and resistance among healthcare seekers in two tertiary hospitals in Ghana: a quasi-experimental study

OBJECTIVE

To evaluate knowledge of antimicrobial resistance (AMR), to study how the judgement of health value (HVJ) and economic value (EVJ) affects antibiotic use, and to understand if access to information on AMR implications may influence perceived AMR mitigation strategies.

DESIGN

A quasi-experimental study with interviews performed before and after an intervention where hospital staff collected data and provided one group of participants with information about the health and economic implications of antibiotic use and resistance compared with a control group not receiving the intervention.

SETTING

Korle-Bu and Komfo Anokye Teaching Hospitals, Ghana.

PARTICIPANTS

Adult patients aged 18 years and older seeking outpatient care.

MAIN OUTCOME MEASURES

We measured three outcomes: (1) level of knowledge of the health and economic implications of AMR; (2) HVJ and EVJ behaviours influencing antibiotic use and (3) differences in perceived AMR mitigation strategy between participants exposed and not exposed to the intervention.

RESULTS

Most participants had a general knowledge of the health and economic implications of antibiotic use and AMR. Nonetheless, a sizeable proportion disagreed or disagreed to some extent that AMR may lead to reduced productivity/indirect costs (71% (95% CI 66% to 76%)), increased provider costs (87% (95% CI 84% to 91%)) and costs for carers of AMR patients/societal costs (59% (95% CI 53% to 64%)). Both HVJ-driven and EVJ-driven behaviours influenced antibiotic use, but the latter was a better predictor (reliability coefficient >0.87). Compared with the unexposed group, participants exposed to the intervention were more likely to recommend restrictive access to antibiotics (p<0.01) and pay slightly more for a health treatment strategy to reduce their risk of AMR (p<0.01).

CONCLUSION

There is a knowledge gap about antibiotic use and the implications of AMR. Access to AMR information at the point of care could be a successful way to mitigate the prevalence and implications of AMR.

Skin-Based Vaccination: A Systematic Mapping Review of the Types of Vaccines and Methods Used and Immunity and Protection Elicited in Pigs

The advantages of skin-based vaccination include induction of strong immunity, dose-sparing, and ease of administration. Several technologies for skin-based immunisation in humans are being developed to maximise these key advantages. This route is more conventionally used in veterinary medicine. Skin-based vaccination of pigs is of high relevance due to their anatomical, physiological, and immunological similarities to humans, as well as being a source of zoonotic diseases and their livestock value. We conducted a systematic mapping review, focusing on vaccine-induced immunity and safety after the skin immunisation of pigs. Veterinary vaccines, specifically anti-viral vaccines, predominated in the literature. The safe and potent skin administration to pigs of adjuvanted vaccines, particularly emulsions, are frequently documented. Multiple methods of skin immunisation exist; however, there is a lack of consistent terminology and accurate descriptions of the route and device. Antibody responses, compared to other immune correlates, are most frequently reported. There is a lack of research on the underlying mechanisms of action and breadth of responses. Nevertheless, encouraging results, both in safety and immunogenicity, were observed after skin vaccination that were often comparable to or superior the intramuscular route. Further research in this area will underlie the development of enhanced skin vaccine strategies for pigs, other animals and humans.

What Motivates People to Receive Continuous COVID-19 Vaccine Booster Shots? An Expectation Confirmation Theory Perspective

(1) Background: Abundant evidence has shown that the COVID-19 vaccine booster is highly effective against the Omicron variant. It is of great practical significance to explore the factors influencing the intention to receive COVID-19 booster shots. (2) Methods: We introduced expectation confirmation theory as the basis to construct a model of the factors of the vaccination intention for COVID-19 vaccine boosters. We obtained two batches of questionnaires through Chinese social platforms, with a valid sample size of 572. To test the model, we used SmartPLS3.0 software for empirical analysis. (3) Results: In terms of the characteristics of the vaccine itself, perceived vaccine efficacy and perceived vaccine safety had significant positive effects on expectation confirmation. Regarding vaccination services, perceived vaccination convenience also had a significant positive effect on expectation confirmation. Expectation confirmation positively affected the vaccination intention for the COVID-19 vaccine boosters. Furthermore, the results showed two moderating effects: first, health consciousness negatively moderated the positive effect of perceived vaccine safety on expectation confirmation; second, the time interval since the last dose negatively moderated the positive effect of perceived vaccine efficacy on expectation confirmation. (4) Conclusions: Our research demonstrated that there is an expectation confirmation process for previous COVID-19 vaccines before people consider whether to obtain a booster shot. Perceived vaccine efficacy and perceived vaccine safety remained important factors in receiving COVID-19 booster shots, and our conclusions were consistent with previous literature. In this study, multiple dimensions such as distance and cost were used to measure perceived vaccination convenience. This new variable improve the explanatory power of the convenience of the vaccination service and enrich the variables of the factor model of vaccination intention. In addition, the moderating effects of health consciousness and time interval were found. The findings can provide a theoretical reference for public health institutions to help them understand the formation process of people's intention to receive the COVID-19 vaccine booster.

Chemical Profile of the Volatile Constituents and Antimicrobial Activity of the Essential Oils from Croton adipatus, Croton thurifer, and Croton collinus

The aim of this study was to determine the volatile phytochemical constituents and evaluate the antimicrobial activity of the essential oils of the leaves from Croton adipatus, Croton thurifer, and Croton collinus. Essential oils were extracted by hydro-distillation using the Clevenger extractor and the phytochemical analysis was determined by Gas chromatography-Mass Spectrometry (GC-MS). The antimicrobial activity was assessed using the agar diffusion and colorimetric broth microdilution methods against Staphylococcus aureus ATCC 25923, Bacillus subtilis ATCC 6633, Escherichia coli ATCC 25922, Pseudomonas aeruginosa ATCC 9027, and Candida albicans ATCC The essential oils from C. adipatus, C. thurifer, and C collinus had 46, 38, and 35 volatile constituents respectively. The main compounds determined in C. adipatus were β-myrcene (18.34%), while in C. collinus was β-caryophyllene (44.7%), and in C. thurifer was an unknown component (C₁₀H₁₆: 22.38%). Essential oil of C. adipatus showed a MIC against B. subtilis (286.4 µg/mL) and C. albicans (572.8 ± 0 µg/mL); C. thurifer against S. aureus (296.1 ± 0 µg/mL) and B. subtilis (148 ± 0 µg/mL); and C. collinus against B. subtilis (72 ± 0 µg/mL) and C. albicans (576.2 ± 0 µg/mL). The three essential oils of Croton species demonstrated in vitro antimicrobial activity against a strain of bacteria or fungi.

Shortage of essential antimicrobials: a major challenge to global health security

The lack of access to safe and effective antimicrobials for human populations is a threat to global health security and a contributor to the emergence and spread of antimicrobial resistance (AMR). The increasingly common shortages of antimicrobials are an additional threat to the emergence of AMR. While the threat of such drug shortages is most acutely experienced in low-income and middle-income settings, their consequences impact the quality and effectiveness of antimicrobials worldwide. Furthermore, there is a need for robustly conducted studies examining the impact of these increasingly prevalent shortages on patient outcomes and on the emergence and spread of AMR. In this review, we have mapped common drivers for antimicrobial shortages and propose strategies for rethinking the regulation, supply and pricing of antimicrobials to secure their sustainable access across diverse healthcare systems and to help minimise the unintended consequences of weak and ineffective supply chains. Greater government involvement in antimicrobial manufacture and supply is essential to ensure no one is left behind. Dedicated demand systems need to be developed for antimicrobials which take into consideration evolving AMR patterns, burden of diseases, pandemic events and supply and demand issues and facilitate implementation of strategies to address them. Interventions, ranging from advocacy and forecasting to public–private collaborations, new economic models and international consortia working across countries and supply chains, will help assure access to safe and effective antimicrobials to all populations around the globe and ensure that shortages no longer contribute to AMR.

Exploring and Monitoring the Reasons for Hesitation with COVID-19 Vaccine Based on Social-Platform Text and Classification Algorithms

(1) Background: The COVID-19 pandemic is globally rampant, and it is the common goal of all countries to eliminate hesitation in taking the COVID-19 vaccine and achieve herd immunity as soon as possible. However, people are generally more hesitant about the COVID-19 vaccine than about other conventional vaccines, and exploring the specific reasons for hesitation with the COVID-19 vaccine is crucial. (2) Methods: this paper selected text data from a social platform to conduct qualitative analysis of the text to structure COVID-19 vaccine hesitancy reasons, and then conducted semiautomatic quantitative content analysis of the text through a supervised machine-learning method to classify them. (3) Results: on the basis of a large number of studies and news reports on vaccine hesitancy, we structured 12 types of the COVID-19 vaccine hesitancy reasons. Then, in the experiment, we conducted comparative analysis of three classifiers: support vector machine (SVM), logistic regression (LR), and naive Bayes classifier (NBC). Results show that the SVM classification model with TF-IDF and SMOTE had the best performance. (4) Conclusions: our study structured 12 types of COVID-19 vaccine hesitancy reasons through qualitative analysis, filling in the gaps of previous studies. At the same time, this work provides public health institutions with a monitoring tool to support efforts to mitigate and eliminate COVID-19 vaccine hesitancy.