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The target of this joke is ‘competitive’ imports. These are commodities that an economy could, and indeed does, produce to some extent, and which the 2019 coronavirus (COVID-19) pandemic has raised concerns about in the context of national security and healthcare. A double-whammy of supply disruption and unprecedented demand hit most healthcare systems. Firstly, the lockdown exposed the extent to which the supply of medicines depends on a handful of locations. An example is the global reliance on China for the manufacture of APIs – active pharmaceutical ingredients (Anonymous 2020). Secondly, the rapid escalation of severe and critical cases is a reminder that the resources available to hospitals and labs are limited. An example is the intensification of COVID-19 testing campaigns. Indirectly, this caused abnormal demand for reagents to extract the virus’ nucleic acid from samples – in short: RNA extraction kits (Mehta 2020). Most countries could not meet this demand in the absence of a home-grown manufacturing base (Smyth et al. 2020). The examples above are not about glamorous, ‘high value’ items. Yet they caused national security-level distress. In hindsight, it is easy to draw conclusions. At exceptional times, we wonder why everything is not on hand in our backyard—even the cheapest face mask, lab reagent, and API. At any other time, we wonder why medicines are pricey, and why healthcare spending is not in check. It is tempting to look for definitive answers about the risk of depending on a foreign manufacturing base. But is it reasonable to assume that a 100% homegrown healthcare supply is possible? Is it reasonable to expect ‘always on’ readiness end-to-end – from manufacturing to the patient, in both normal and exceptional operating conditions? At the least, no one has figured it out yet. Instead, I offer a few, inconvenient lessons we might consider learning. Roughly, these can be grouped into three topic areas: (1) Choosing sourcing locations. (2) Establishing supply dependencies through outsourcing and offshoring decisions. (3) Matching supply to a changing, often erratic demand. The reminder is loosely based on previous work on pharmaceutical supply risk carried out within a recently concluded collaborative research project on Reconfiguring Medicines End-to-end Supply—ReMediES (Geyman et al. 2020).

Those who do not move, do not notice their (supply) chains—inconvenient lessons from disruptions related to COVID-19