Global Health Supply Chains: Acknowledging our climate action responsibilities

Health supply chains deliver life-saving medicines and equipment to people in need throughout the world. But what is their effect on the environment and climate change? In a 2019 report, Health Care Without Harm showed that health care causes 4.4% of all global net emissions contributing to climate change; if the health sector was a country, this would make it the fifth largest emitter in the world. The same report noted that 71% of these emissions come from the health care supply chain’s complex flow of products from production to consumption and final disposal.

Health supply chains’ considerable contribution to climate change is a problem. At the same time, it is an opportunity for mitigation and reduction actions. A wide range of actors and organizations working in public health are mobilizing to meet the challenges of climate change while maintaining focus on serving the world’s most underserved people. Donors and funding agencies are showing leadership in this area, as highlighted by USAID’s recently released Climate Strategy. InterAction’s NGO Climate Compact, which JSI joined in April, is an example of how the sector is working to reduce its impacts while adapting program designs and focus accordingly. Reducing emissions from supply chains is key to meeting organizations’ climate targets. To do this we must:

• Identify, measure, and reduce emissions. The first step to setting targets and reducing emissions is for organizations to take an “emissions inventory.” This will be a complex process for public health supply chains. It will entail effective communication and data collection to identify emissions, along with multi-year collaborative strategies to reduce them. As complex as this will be, starting with one piece of the supply chain is a good way to make inroads into others. The Partnership for Supply Chain Management, a JSI affiliate, is using the Global Emissions Logistics Council Framework to measure transport emissions from its 1,000+ shipments a year. This will enable the identification of emissions hotspots and facilitate wider analysis of emissions trade-offs from other areas of the supply chain.
• Incorporate environmental requirements into sourcing and contracting to reduce emissions and waste in the supply chain. Quality, lead-time, and price have often dictated the procurement of pharmaceuticals and medical equipment as health programs have sought to maintain value for money while ensuring the delivery of life-saving products. Now we must incorporate sustainable procurement practices and metrics into our approach. Requiring environmental management systems from suppliers (e.g., through internationally recognized standards such as ISO14000), will be crucial to reduce the consequences of climate change and promote environmental responsibility among suppliers.
• Shift from linear operating models of consumption to circular economy models that seek to reduce waste, extend product life cycles, and regenerate nature through product design and use of finite resources. This will entail wider collaboration to identify waste throughout the supply chain and leverage opportunities for reduction, such as elimination of excess packaging and single-use plastics. Opportunities for reuse, life cycle extension, and repurposing must be identified, which will necessitate cross-sectoral collaboration, potentially beyond the health sector.

Mitigation and reduction efforts will be critical to limit climate change but not enough to cease or reverse the effects that are already being felt across the globe. Shifting disease burdens and the increased severity and frequency of climate-related disasters mean that health systems must urgently adapt and undertake resilience measures to ensure continuity of services. Health systems are crucial to countries’ National Adaptation Plans to meet climate change commitments. Given the central role supply chains play in a health system, supply chain managers can contribute to adaptation and resilience efforts by:

• Leveraging supply chain design, analysis, and optimization methods regularly used in the commercial sector to adapt to the demands of a changing climate. Scenario planning and simulations will enable an active approach to risk management and surveillance of emerging threats, population movements, and new diseases on national and regional scales. At the facility level, adapting to the changing climate will entail reinforcing or even relocating health facilities and logistics infrastructure to less-vulnerable areas. Supply chains will also enable the transition to carbon free energy sources.
• Building on the lessons from humanitarian and health emergencies, including COVID-19, to increase the resiliency of health supply chains. Extreme weather events will continue to disrupt logistics infrastructure and suppliers. Risk mapping and the inclusion of strategic redundancies, such as establishing multiple supply contracts for key commodities, throughout the supply chain will help ensure that a shock to one link in the chain does not disrupt overall operations. This entails looking deep into the supply chain to identify potential vulnerabilities multiple tiers up and down. The cost and effort of doing this are now an operational necessity.

Recent reports on climate change, including the IPCC’s Sixth Assessment Report, make clear that the situation is critical. But it is not completely hopeless. With the right policies and collaborative action, backed by innovation and adequate investments, it may be possible to achieve the 40–70% reduction in greenhouse gas emissions by 2050 necessary to keep warming below 2°C. To do so will require the commitment of every major sector—health included. It is time to accelerate our individual and joint efforts and re-imagine every step of the health supply chain to fulfill our climate action responsibilities.