Is Latvia ready for various X Hours and would it be able to provide medicines to the public during supply chain interruptions and in the trenches? Pharmacy has a vital role not only in the everyday healthcare, but also in national security, even though pharmaceutical companies would not able to single-handedly provide everything required at X Hour.

“When a terrorist stabbed several police officers in front of London’s Houses of Parliament 10 years ago, none of the people in the vicinity – and there were a lot of them, because there are always a lot of tourists and parliament employees there – knew how to provide first aid. The only exception was a minister, a former British army officer who happened to be nearby. Although we all learn first aid when we learn how to drive, unfortunately these skills lack continuity. Examples like this clearly show that as a society we are not prepared for crisis situations. This was also confirmed by the Covid-19 pandemic, when not only individual people, but entire industries and even governments descended into panic. This lack of readiness for a crisis highlights another problem – people do not cooperate with one another. Each of us lives in our own “work-home” bubble, but this cannot prepare us for medical and other emergencies. This requires extensive public training along with close cooperation between the private and public sectors,” stressed American Enterprise Institute (AEI) senior fellow, Foreign Policy and POLITICO Europe journalist Elisabeth Braw at the AS Olainfarm conference “Health. Security. Pharmacy”.

It is not just businesses that require a detailed crisis plan, so does the state

The importance of cooperation at different levels was also stressed during the discussion “Readiness at X Hour”, in which the participants were the Parliamentary Secretary of the Ministry of Defence Jānis Eglīts, National Health Service Director Āris Kasparāns, Baltic Institute of Corporate Governance CEO Andris Grafs, Latvian Chamber of Commerce and Industry President Aigars Rostovskis and AS Repharm Board Member Jānis Vanags.

For over a year now, the example of Ukraine has provided a harsh example of what happens when society actually experiences X Hour. It is not just soldiers on the front lines or civilians who die during rocket fire, but also people with acute and chronic health problems – simply because neither medicines nor timely health care are available because of the war. However, X Hour is not only war – it can also take the form of natural disasters, widespread epidemics or even pandemics as we experienced with Covid-19, a three-day internet outage that brings a halt to mutual coordination and logistics, and any other circumstances in which supply chains are interrupted, and a business, industry or country is confronted by existential changes that threaten its existence. Moreover, X Hour affects everything – in the medical sector, this is not just stocks of medicines, but also the availability of specialists and infrastructure, transport, deliveries and logistics, etc.

As Repharm Board Member Jānis Vanags underlines: X Hour is what everybody defines for themselves at least a couple of years before it occurs, realizing the implications of this existentially critical situation for his institution or business, and outlining a detailed action plan in such a situation. At present, this country does not yet have such a scenario in place in relation to healthcare and the formation of stocks of medicines. Although there are civil defines plans, there are no clear guidelines on how to act and who would be responsible for stocks of medicines if X Hour actually arrives.

According to Ministry of Defence Parliamentary Secretary Jānis Eglīts, we have a painful, but valuable opportunity to learn from the experiences of Ukraine, and not just in theory, but also in practice, by going to Ukraine and listening to local doctors as they share their experiences. “It is important to realize that when a shrapnel mine explodes, it does not discriminate who it hits, and so, alongside wounded soldiers, a hospital in wartime could find itself treating a little boy who was struck by shrapnel. At X hour, there are no such distinctions as “state” or “private”, “civilian doctor” or “military doctor”. While not every sector would necessarily currently agree, at X Hour we are all in this together, and therefore we should also prepare for this together,” stresses Jānis Eglīts.

Supply chains must be robust enough so that there are no shortages of stocks

The Covid-19 crisis was a good lesson. As the experts acknowledge, in various realms Latvia is currently much better prepared for unforeseen circumstances than it was at the start of the pandemic. A case in point is the infrastructure in which substantial additional funds were invested, or cooperation between public administration and the private sector, which has undeniably improved. However, improvements are not yet in sight in the most vital areas, which are industry’s human resources and supply chain robustness.

Although Latvia is already able to provide a full medicinal product development and supply chain, encompassing high-level education, research and innovation, industrial production and exports, local and regional supply, pharmaceutical care, as well as development of original medicines, local manufacturers’ market share amounts to only about 4% of the range of all medicines available in Latvia. In this regard, we are significantly losing out to Western Europe, where local production makes up 40-60% of the product range, and thus, we are ten times more vulnerable than Western European countries.

As Jānis Vanags underlines, the whole industry is defined by supply chains, “We recall only too well that when the pandemic started, deliveries to Latvia could not take place through Poland for a week. But one does necessarily need to close borders for a risky situation to arise. A shipment of medicines is worth several million euros. It is sufficient to arrange even small hybrid threats along an important delivery route, and while we may forget about them quite quickly, but the insurers will not. By declining to provide coverage for an area deemed to be at risk, no further deliveries will be made. Therefore, it is vital that we are aware of what our material reserves are, how long they will last, and how strong local manufacturers are, in order to be able to provide the requisite quantity and range of medicines in such a situation. Latvia is strong in the realm of food production, where we have a good proportion of local products, but unfortunately this is not true as far as pharmaceuticals are concerned.”

Experts assert that, in order to strengthen the local pharmaceutical industry, it is not only vital to support domestic manufacturers, but to view the situation holistically in the awareness that the energy and raw materials consumed by local pharmaceutical companies to produce their products also come from foreign markets. Accordingly, it is extremely important to build up sufficient stocks and prepare a detailed action plan. However, this requires strong cooperation with public administration.

The state is responsible for decentralization, whereas individuals are responsible for a change in thinking

One of the key security principles at X Hour is decentralization, or “don’t put all your eggs in one basket”. According to National Health Service Director, Āris Kasparāns, at present, stocks of medicines are partly sufficient, because funding was allocated during the Covid-19 crisis for the procurement of three months’ of stocks of the most frequently used medicines, and such stocks have also been built up in a number of hospitals. However, at the same time, Ukraine’s experience demonstrates that at X Hour the biggest blows are often directly inflicted on healthcare infrastructure, and therefore it is crucial to make provision for the storage of reserve stocks outside hospitals, and here, once again, cooperation with the private sector is essential.

“The biggest problem is not stocks of medicines, which, even if they are currently inadequate, can be prepared. Failure to make decisions is much worse. This means not using the time before the crisis to prepare and accumulate strength” acknowledged Jānis Vanags. “But in order to prepare, a decision has to made that these are the reserves that we will require, and which the state will provide for its citizens, and then by means of a tender we’ve got to find a partner within the private sector, who can supply the relevant amount.”

At the same time, the experts also point out that, at present, the primary problem is not the provision of infrastructure, but the way we think. Although it is important to agree on who should be responsible for coordinating the supply of medicines at X Hour, how they should procured and stored, and how to make sure that their shelf life does not expire, and so on; no less important is the extent to which each individual has prepared for X Hour, whether he has helped his family to prepare, and how capable he is helping his fellow citizens in any other situation, for example, by providing first aid.