Title: Environmental decision criteria for partial nationalization of pharmaceutical supply chain

Abstract

Background: Any disturbance affecting the Pharmaceutical Supply Chain (PSC) can affect the efficiency of the health system and disrupt the supply of medicines. The global pharma supply chain has been facing shortages in the supply of pharmaceuticals. Due to PSC shortages, many countries adopted actions to mitigate the risks of disruptions. Many recommendations have been proposed, such as adopting a plus one diversification approach, increasing safety stock, and nationalizing the medical supply chains. Objective: The objective of this paper is to scope findings, advanced in the academic literature related to criteria to be elected to guide national policy decisions regarding the partial nationalization of the pharmaceutical supply chain under the three main stakeholders’ points of view: Industry; payers (government and health insurance) and patients. Definition: A criterion can be defined as an “individual measurable indicator” of a key value dimension (Department for Communities and Local Government, 2009) or more specifically, a “particular perspective” according to which alternative technologies may be compared (Belton and Stewart, 2002). Results: A total of 10,501 titles were screened 984 entered the abstract screening. Of these, 400 were eligible for the full-text review, 120 were included in the final data extraction phase the articles related to the “Partial Nationalization of Pharmaceutical Supply Chain” were aggregated into three main perspectives: Industry Perspective; Payers’ Perspective and, Patients’ Perspective. After deduplication and clustering, 6 scopes and were identified and after the merging and selection process, a set of 16 general criteria was proposed. Environmental impact is one of the scopes/ points of view to be observed. Under this scope “Environmental risk caused by emissions and Waste generation during Level I upstream process” was chosen as a criterium. Conclusion: Based on the results of the systematic and scoping literature review, a pool of 6 and their respective scopes of concepts were identified in the literature, under which 19 criteria were selected. The findings can serve as a starting point for constructing “Partial Nationalization of Pharmaceutical Supply Chain” frameworks after careful adaptation to the local context.