Q&A: Lori Warrens Discusses Managing Medical Supply Donations

At the start of the pandemic, hospitals, frontline responders, and essential businesses faced grave shortages of personal protective equipment (PPE), resulting in mass emergency shipments from medical surplus recovery organizations and manufacturers. In the world’s wealthiest countries, including the U.S. and much of the European Union, COVID-19 vaccines are helping to reduce outbreaks and alleviate the need for PPE. However, globally the fight is not over, with many countries struggling to vaccinate their populations. 

Countries like Brazil and India are facing their worst outbreaks yet and their health facilities are stretched thin.

Lori Warrens, Director of MSA

So how is excess PPE being reallocated to places where COVID-related hospitalizations are spiking?

To find out, we talk with Lori Warrens, Director of The Task Force’s MedSurplus Alliance (MSA) MSA is the only accrediting body in the world that ensures the donations of quality, usable medical supplies and equipment like PPE.

Why was MSA established?

In low-income settings, up to 80% of the medical supplies, devices, and equipment that health facilities use, including pharmaceuticals, are donated. Research 

from the early 2000s found that 30 – 70% of donations were not being used because they were either unusable at the time of donation or were not able to be maintained. This research led to the realization that while donations are made in good faith, the products that are donated are not always appropriate for the setting, not always needed or requested, and don’t always benefit the patient or the care providers.

MSA was created in 2012 to address that problem. We work to improve the quality of donations and the partnerships between donors and recipients, and to build capacity within countries to manage and maintain their donations. To do this, we created a Code of Conduct with standards for medical product donations, aligned with WHO donation guidelines, and an accreditation program to help donors, recipients, and intermediaries adhere to those standards. Currently, there are nine accredited medical surplus recovery organizations (MSROs) in the world that support health facilities and emergency response. These are all based in the U.S., but we have recently received funding to start accrediting MSROs in other countries.

What does it take to get donated medical supplies to where they’re needed?

Step 1: Donors, predominantly hospitals or manufacturers, will offer their products to MSA-accredited MSROs. 

Step 2: The MSRO determines whether or not to accept the donation based on quality MSA standards and the Code of Conduct.

Step 3: When they receive the product, the MSRO will enter it into their online inventory if the product is sealed in its original packaging. If products are not in original packaging, the MSRO will sort and package them with like items. The online inventory is available to recipient partners who are part of the MSRO’s donation program. Staff from recipient organizations build their donation shipment from what is available on the online inventory. Shipments range from a small kit to a full 40-foot shipping container. The MSRO will consult with the recipient to make sure that the products selected are appropriate for the infrastructure, environment, and patients being served so that the shipment meets the recipient organization’s request.

Step 4: Then the shipment process starts, working with port authorities and a designated consignee in the recipient country who will guide the donation through customs, making sure that it arrives safely to the recipient organization. Throughout the journey, the MSRO stays in contact with the recipient, providing technical assistance as needed, for example, providing help from a biomedical engineer for any equipment that needs installation.

What role have donated medical products played in the pandemic response?

Ever since MSROs responded to the 2014 Ebola epidemic in West Africa, they have kept a stockpile of personal protective equipment (PPE) for health crises. When COVID-19 hit, they immediately started to donate that stockpile to China. As COVID-19 spread around the globe, MSRO response followed. When the pandemic spiked in the U.S., MSROs focused on supporting underserved communities like the Navajo Nation and rural communities. Now, MSROs are returning to their original focus of international assistance.. In areas where COVID-related hospitalizations have slowed, vaccination rates have increased, and mask mandates are ending, hospitals and businesses are giving MSROs their excess PPE to redistribute to COVID hotspots like India and to support  regular health service requests in low-income countries.

With the pandemic, we’ve heard a lot about clinical trials. What role do they play in donation programs?

Clinical research sites, which are the sites that manage clinical trials predominantly for pharmaceutical companies, procure many medical products such as needles, gloves, and even MRI machines in cases of neurological studies, but they often don’t

completely used or they must be removed from the site by the end of the trial and sent elsewhere. We are piloting a project called Kits4Life, through which we train and provide operational tools to clinical research sites so that they can identify quality excess medical products that can be donated.

How do you ensure equitable and ethical access to donated medical products and address the imbalance in power between donor and recipient?

The foundation for MSA was and still is that donations need to primarily benefit the recipient; they need to be ethical in terms of what is being donated, why it is being donated, and who it actually benefits. This is the lens that we are striving to look through as we continue to improve the standards and build equitable partnerships and access to donated medical products.

Header photo: Training course for health workers about COVID-19 Case Management and Donning and Doffing of PPE during the first wave of COVID-19 pandemic at the Isolation Center of COVID-19, Al-Jomhori Hospital, Al-Mahweet, Yemen. Photo courtesy of Yemen FETP.

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