Blessing Takawira and Emmanuel Mutambara, A strategic response to COVID-19 induced supply chain disruption in South Africa’s pharmaceutical industry (2023)

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A study by Blessing Takawira of the University of Johannesburg and Emmanuel Mutambara of the University of KwaZulu-Natal, A strategic response to COVID-19 induced supply chain disruption in South Africa's pharmaceutical industry, published in the International Journal of Research in Business and Social Science, Vol. 12, No. 8, 2023, pages 61–73. The paper uses twenty-five semi-structured interviews with pharmaceutical supply chain experts in South Africa to examine competitive strategies and recovery measures adopted by large and small pharmaceutical businesses during COVID-19 medicine supply interruptions. It discusses methods for managing supply chain disruption, handling low switching costs and improving customer experience, while noting expected enterprise closures and global supply chain consolidation.

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INTERNATIONAL JOURNAL OF RESEARCH IN BUSINESS AND SOCIAL SCIENCE 12(8)(2023) 61-73

Research in Business & Social Science
IJRBS VOL 12 NO 8 (2023) ISSN: 2147-4478
Available online at www.ssbfnet.com
Journal homepage: https://www.ssbfnet.com/ojs/index.php/ijrbs

A strategic response to COVID-19 induced supply chain disruption in
South Africa’s pharmaceutical industry
Blessing Takawira (a)* Emmanuel Mutambara (b)
(a)
Graduate College of Business & Economics, University of Johannesburg, Auckland Park Kingsway Campus, South Africa
(b)
Professor, Senior Lecturer, Graduate School of Business & Leadership, University of KwaZulu-Natal, University Rd, Westville, 3630, South Africa

ARTICLEINFO ABSTRACT

Article history: The COVID-19 pandemic had a significant impact on the pharmaceutical industry, leading to severe
interruptions in global medicine supplies. Both large and small businesses implemented exceptional
Received 02 April 2023 strategic efforts to mitigate the impact of the infection and minimize the resultant financial harm. A
Received in rev. form 15 May 2023 total of twenty-five semi-structured interviews were carried out with pharmaceutical supply chain
Accepted 26 July 2023 experts in South Africa in order to gain insight into the strategic reactions and long-term impacts of
these responses, as perceived by the participants. The occurrence of strategic reactions seems to
resemble those observed in prior instances of disruptions in the pharmaceutical supply chain, but with
Keywords: some degree of variation. These solutions encompass methods for addressing the specific supply chain
disruption, managing the reality of supply chain disruption to efficiently handle low switching costs,
Strategic response, COVID-19, supply
and implementing attempts to recover by increasing the customer experience. These strategic
chain, South Africa, pharmaceutical initiatives were expected to lead to the permanent closure of numerous pharmaceutical enterprises,
industry increased consolidation in the global pharmaceutical supply chain, and long-term changes in
responsiveness and efficiency improvements.
JEL Classification:
O15, E32 © 2023 by the authors. Licensee SSBFNET, Istanbul, Turkey. This article is an open access article
distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license
(http://creativecommons.org/licenses/by/4.0/).

Introduction
In the last forty years, numerous authors have elaborated and improved upon the notion of strategy (Louw & Venter, 2021) in order
to address the requirement for organizations to adjust to changing market conditions in diverse circumstances. Hitt, Ireland, and
Hoskisson (2019) provide a definition of strategy as a flexible and proactive course of action that outlines how businesses should
respond to diverse external and internal environmental elements, considering both the short-term and long-term perspectives.In
contrast, some scholars have defined strategy as the deliberate or existing synchronization of an organization's fundamental objectives
and activities at a specific time and location, consistently aligning the firm with its surroundings (Johnson, Whittington, Regnér,
Angwin, & Scholes, 2020).

The objective of this study is to investigate the strategic reaction to supply chain disruptions caused by COVID-19 in South Africa's
pharmaceutical business. In this study, we used an exploratory qualitative research method to find out how much South Africa's
pharmaceutical sector uses different competitive strategies in response to the PSC disruption, with the goal of making
pharmaceuticals easier to get.
Moreover, it highlights the difficulties that pharmaceutical companies in South Africa encounter because to the COVID-19 pandemic
in the pharmaceutical sector. Consequently, we aim to address these issues by providing answers to the following questions:
i. What obstacles do pharmaceutical companies encounter in the pharmaceutical sector due to the COVID-19 pandemic?
ii. What strategic measures are pharmaceutical companies implementing in response to the commercial climate created by
the COVID-19 pandemic?

* Corresponding author. ORCID ID: 0000-0002-1633-8693
© 2023 by the authors. Hosting by SSBFNET. Peer review under responsibility of Center for Strategic Studies in Business and Finance.
https://doi.org/10.20525/ijrbs.v12i8.2487
Takawira & Mutambara, International Journal of Research in Business & Social Science 12(8) (2023), 61-73

The data were acquired through semi-structured expert interviews. The application of the thematic analysis technique is encompassed
under research data analysis approaches.
The structure of this article is as follows: Section 2 presents a comprehensive analysis of the existing literature. Section 3 provides
an in-depth analysis of the techniques and resources employed. The results are presented in Section 4. Section 5 introduces a novel
pharmacological strategic response method to tackle the primary difficulties encountered in South Africa's PSCs during the COVID-
19 outbreak.

Literature review
Strategic response to Covid-19 pandemic

Over recent years, many companies have fulfilled their objectives of responding to their supply-chains network and those for the
economy (Fattahi, Govindan & Keyvanshokooh, 2017). According to Aruru, Truong and Clark (2021), the Covid-19 response faces
a variety of challenges, including a shortage of appropriate PPE (e.g. masks and hand-sanitisers), monitoring kits, and ventilators,
accessible hospital beds, licensed medication and a particular SARS-CoV-2 vaccine. Therefore, it is vital to incorporate strategic and
operational decisions into the supply-chain design processes in today’s competitive and unpredictable market climate to obtain a
practical supply-chain framework (Fattahi & Govindan, 2020). One of the main tactics of an organisation is a supply-chain strategy.
Supply chains should follow competitive and organisational processes (Ivanov, Tsipoulanidis & Schönberger, 2017). In addition,
strategic considerations linked to long-term connections with suppliers, their output evaluation and the continuous review of spending
trends are required for constant assessment and enhancement of the supplier’s activities. Nasrollahi and Razmi (2019) focused on the
PSC design to increase the system’s reliability and simultaneously reduce the cost of the healthcare supply chain. Franco and Alfonso-
Lizarazo (2017) provided a literature analysis of predictive models of PSCs. They defined three classification groups: strategic,
tactical and operational decisions. Computational-model studies incorporate various types of methods; the study therefore suggested
that the usage of hybrid technology is inadequate so that researchers should realistically estimate the activity of a PSC.

According to Schmalz (2020), strategic responses to the Covid-19 pandemic include creating regional chains, using technology more,
and promoting overall productivity and resiliency. de Carvalho, Ribeiro and Barbosa-Povoa (2019) attempted to develop a vaccine
supply chain that takes into account the three dimensions of the triple bottom line. The developed model helps the supply chain to
make strategic and tactical decisions. There is imperative to recognise principles such as SCM, modelling, risk analysis and
optimisation (Lozano Díez, Marmolejo-Saucedo & Rodriguez-Aguilar, 2020). Flexible and effective prototypes will help us adapt to
contingencies. Paul and Venkateswaran (2020) analysed the inventory-management problem during an unpredictable epidemic. They
also modelled the supply-shortage model and the integrated model. The supply-shortage model is employed to explain the
phenomenon of the drug shortage.

Covid-19 pandemic disruptions
Covid-19 pandemic has undeniably affected populations, the public health system and economies worldwide (Trump & Linkov,
2020). The pandemic has been a disruption of an entirely unprecedented magnitude, and it is testing the resilience of GSCs (Brown,
Kumar, Rajji, Pollock & Mulsant, 2020; Golan, Jernegan & Linkov, 2020). During the Covid- 19 pandemic, many companies failed
to get their products to the market owing to supply chain constraints (Esper, 2021). This issue highlighted the various processes and
people involved in getting goods to the consumers. This, in turn, highlighted the importance of ensuring the safety and welfare of the
supply chain’s workers. Initially, the coronavirus was viewed as a local issue in China. However, even at this stage, its impact on the
GSC was felt widely. According to industry reports, 95% of Fortune-1000 companies have GSC operations in the country. The
primary focus of SCM risk research is operational risks that threaten supply chain efficiency and inventory investments (Govindan,
Fattahi & Keyvanshokooh, 2017). However, it is also necessary to consider the consumer welfare risks associated with GSCs.
Since there has been an overwhelming demand for medical equipment and protective healthcare products, new initiatives, such as
three-dimensional (3D) printing, are being used to help healthcare providers (Larrañeta, Dominguez-Robles & Lamprou, 2020). The
short-term implications of the Covid-19 pandemic for global trade tend to be manageable (Gruszczynski, 2020). Veselovská (2020)
analysed the impact of the Covid-19 pandemic on supply chains in Central Europe. It focused on companies in various countries and
included a detailed analysis of their supply chain characteristics and initial results. The findings indicated that some companies were
able to modify their supply chains in such a way that they were able to increase their revenues. Other companies struggled. Craighead,
Ketchen Jr and Darby (2020) explained to researchers several ideas that they believe are powerful instruments for understanding
what has occurred, how organisations have been responding, and how mechanisms and procedures in the supply chains can be
changed in the event of another pandemic.
Supply-chain disruptions

In 2019, almost 400 natural disasters occurred globally, which affected 95 million people and resulted in over 11,000 deaths. Asia
had the highest number of disasters (Pujawan & Bah, 2021). Disruption is a phenomenon that occurs suddenly and with an enormous
impact on society. It can cause economic losses and environmental damage (Albertzeth, Pujawan, Hilletofth & Tjahjono, 2020).
Similarly, Reddy, Singh and Anbumozhi (2016) discussed the significance of disruption in describing cases of supply chains that
significantly affect end-user activities. Araz, Choi, Olson and Salman (2020) asserted that disruption to a supply chain is considered

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a significant breakdown in production processes. It occurs when the consumption activities of a supply chain are interrupted. The
planet is becoming even more unsure and fragile. The last 10 years saw several unforeseen catastrophes, such as terrorist attacks,
conflicts, earthquakes, economic crises, currency devaluation in Asia, SARS, tsunamis, strikes and computer-virus attacks (Mangan
& Lalwani, 2016).

Geyman, Settanni and Srai (2020) worked in collaboration with other industry partners and explored the nature of supply-chain risk
and how it can affect the efficiency and profitability of the pharmaceutical industry. They studied the factors that affect the stability
of PSCs and their potential to disrupt them. These factors are a joint adaptation of beliefs, how sensitive views are about
trustworthiness, and disruption characteristics. The journals investigated were designed to capture the present status of research on
implications for and strategic response from PSCs during the Covid-19 pandemic. The review revealed that many writers in this field
had written articles on various elements of the Covid-19 pandemic disruption, depending on the author’s interests and study area.
The authors provided some information about the background of the problem.

South Africa’s pharmaceutical industry
The pharmaceutical industry involves drug discovery, development and manufacture by private and public organisations (Dailey,
2020). The modern pharmaceutical industry was founded in the 19th century after numerous threats to the well-being of plants,
minerals and animals prompted research into their medicinal properties (Tannoury & Attieh, 2017). The global pharmaceutical
industry recorded sales of more than $1 trillion in 2014 and was forecast to hit $1.2 trillion by 2020 (Horner, 2022). In 2019 the
pharmaceutical industry invested $186 billion into research and development, an increase of more than $5 billion from the previous
year (Statista, 2020). The GSC is an ecosystem supporting the core of the modern economy and society (Lehmacher, 2017). Global
supply chain growth is an opportunity and strategic tool which can produce economic growth and jobs and solve other pressing
challenges of our time (Caniato, 2020). At the same time, severe disruptions may ripple quickly through GSCs and cause losses in
supply-chain performance that such key performance indicators can measure as revenues, sales, service level, and total profits (Ivanov
et al., 2017). Regardless of a country’s current stage of economic development, the GSC allows for moving production away from
less favourable locations (Lehmacher, 2017). Consequences can include job losses and social tensions. Thus, supply chains play a
crucial role in a country such as South Africa, which incurs 14% of its GDP as logistics costs, a higher figure than the other BRICS
nations (Brazil, Russia, India and China) (Alora & Barua, 2019).
The pharmaceutical industry has been subject to a highly unstable economic climate. Challenges that have significantly impacted the
development of the industry include political unease, competition from new entrants, social reforms, technical development, and
global developments. In today's fast-paced pharmaceutical market, companies face a wide range of obstacles. To be competitive in
today's rapidly evolving pharmaceutical market, organizations must be open to new ideas and methods of doing business. According
to Seidman and Atun (2017), pharmaceutical supply-chain disruptions can hugely hamper drug availability. Considering the size of
PSCs, Scheibe and Blackhurst (2018) cautioned that if the implications of the disruptions are not adequately understood, the
disruption is likely to spread through the system and cause damage to more than one supply-chain network. A few studies have been
conducted amid Covid-19 in the areas of logistics systems and disruptions in food supply chains (Singh & Kumar, 2020). The object
of these studies has been to explore the impact of interruptions to HIV services (Jewell, Smith & Hallett, 2020), respond to disruptions
in the PSC (Sweeney, 2020) and minimise disruption in the pharmaceutical industry (Cundell, Guilfoyle, Kreil & Sawant, 2020).
However, the Covid-19 pandemic posed urgent and even novel challenges to the stability and integrity of medication supply.
Therefore, this suggests a need to rethink and strengthen pharmaceutical management strategies (Kuo, Ou & Wang, 2021). Recent
research has consisted of a comprehensive analysis of previous research on the epidemiology, infectivity and survival of
coronaviruses and their susceptibility to disinfectants (Fitzpatrick, 2022).

The under-performance of supply chains presents a significant hindrance to disease control in South Africa. Stock-outs of essential
medicines lead to treatment interruption, forcing changes in patient drug regimens, driving drug resistance and increasing mortality
(Díaz-Reza, Morales-García, Rodríguez-Medina, Castellanos & García-Alcaraz, 2022). Therefore, empirical work is needed to
explore the strategic response to Covid-19 induced supply chain disruptions in South Africa’s pharmaceutical industry. This study
hopes to contribute to increased knowledge of ways to minimise the impact of disruptive pandemics on PSCs since the adverse impact
of disruptions on the operational performance of supply chains has been suggested to emanate from existing vulnerabilities. This
study investigated strategic responses that could minimise the effects of the Covid-19 pandemic disruption on South African
pharmaceutical industry supply chains, adding to the body of knowledge about mitigation plans and the factors that determine the
pharmaceutical strategic response for a mitigation strategy in this industry. The disruption of PSCs in South Africa owing to the
Covid-19 pandemic could be minimised using a competitive strategic response developed by the study.

Research & Methodology
Research design
This study aimed to better understand how the pharmaceutical business in South Africa can respond strategically to the supply-chain
disruptions caused by Covid-19 pandemic and their potential long-term effects. An in-depth qualitative investigation was deemed to
be the most appropriate to provide the new perspectives and justifications due to the exploratory nature of the study and the
distinguishing features of the Covid-19 pandemics. It was deemed that semi-structured qualitative interviews were the best strategy

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to use in order to gain such perspective and promote adequate clarification and contextualisation (Saunders, Lewis & Thornhill,
2023). A purposeful sample of twenty-five PSCs professionals in South Africa participated in this study after being identified as
having expert knowledge of the pharmaceutical industry in the country. These individuals were sought out using professional
networking sites like LinkedIn as well as through personal connections. After the twentieth interview, data saturation was observed,
and interviews twenty-one through twenty-five served to confirm this. Following a constructivist methodology, it was determined
that the sample size was sufficient to enable in-depth analysis (Flick, 2018; Sebele-Mpofu, 2020; Crick, 2021). Information about
the participants is listed in Table 1.
Table 1: Demographic information on interviewees

ID Gender Position Years of Player/actor/ category Province
experience
P01 Male Owner/Chief Executive 30 Drug manufacturer KwaZulu-
Officer (CEO) Natal
P02 Male Chief Executive Officer (CEO) 19 Drug distributor / wholesaler Gauteng
P03 Male Chief Executive Officer (CEO) 20 Independent retail pharmacy Western Cape
P04 Male Chief Operating Officer (COO) 28 Drug distributor / wholesaler KwaZulu-
Natal
P05 Male Procurement and Planning 6 Pharmaceutical supplier Gauteng
Manager
P06 Female Regional Sales Manager 15 Primary pharmaceutical Kwazulu-
importer Natal
P07 Female Sales Manager 25 Drug manufacturer Gauteng
P08 Female Professional Sales 24 Primary pharmaceutical KwaZulu-
Representative importer Natal
P09 Female Sales Manager 19 Drug manufacturer KwaZulu-
Natal
P10 Female Sales Representative 20 Pharmaceutical supplier KwaZulu-
Natal
P11 Female Sales Representative 25 Drug manufacturer KwaZulu-
Natal
P12 Female Sales Representative 30 Drug manufacturer KwaZulu-
Natal
P13 Female Sales Representative 12 Primary pharmaceutical KwaZulu-
importer Natal
P14 Male Business Analyst 10 Pharmaceutical supplier Gauteng
P15 Female Sales Representative 23 Drug distributor / wholesaler KwaZulu-
Natal
P16 Male Supply Chain Team Lead 12 Drug manufacturer Gauteng
P17 Male Supply Chain Professional 21 Pharmaceutical supplier Gauteng
P18 Female Senior Supply and Demand 7 Drug manufacturer Gauteng
Planner
P19 Male Responsible Pharmacist 10 Retail Pharmacy Gauteng
P20 Female Supply Chain Specialist 9 Drug manufacturer Gauteng
P21 Male Demand Planner 6 Drug manufacturer Gauteng
P22 Female Demand planning lead 16 Drug manufacturer Gauteng
P23 Male Supply Chain Planner 7 Drug distributor / wholesaler Gauteng
P24 Male Supply Chain professional 24 Drug manufacturer Western Cape
P25 Female Demand Manager 14 Drug manufacturer Gauteng

Participants were given consent documents outlining their rights throughout the research process before any interviews commenced.
These included the ability to decline participation in the study, revoke consent at any time, and prohibit tape recording at any stage.
In order to protect the privacy of the participants, their signed consent forms were kept in a secure location, apart from the recordings.
After gathering standard biographical data, we turned to qualitative exploratory questions to learn more about the actual experiences

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of PSCs professionals in their role in the reaction to the Covid-19 pandemic. Questions were designed to probe interviewees'
understanding of the South Africa’s pharmaceutical industry's approach to strategic risk response and their thoughts on the aftermath
of the Covid-19 pandemic response. The interview questions were developed in accordance with the study's aims and the literature's
coverage of relevant topics, and they were structured so that participants could provide details about their personal experiences during
the Covid-19 pandemic and their thoughts on the South Africa’s pharmaceutical industry's potential future as a result of the response
to the Covid-19 pandemic.

Researchers double-checked the questions to make sure they made sense, were relevant to the topic at hand, and did not miss anything
out. One participant from the sample was then used in a pilot study. The pilot's findings led to the consolidation of two related
questions that had yielded identical responses. As a result, data collecting continued without any additional changes. All 25 interviews
had a duration ranging from 30 minutes to an hour and a half, with 35 minutes being the median.
With participants' agreement, interviews were videotaped using Zoom and Microsoft Teams and then manually transcribed right
away so that we could keep better track of the data and get more reliable results.(Creswell & Creswell, 2023).
Thematic analysis was used to examine transcripts for recurring and new themes (Linneberg & Korsgaard, 2019; Saldaña, 2022).
Researchers read transcripts numerous times in order to find relevant topics and citations. The recordings from the online interviews
were transcribed and uploaded into ATLAS.ti. These documents were then coded using ATLAS.ti by assigning codes to each
appropriate quotation in the documents. In their own time, the researchers looked for a range of both new and established topics.
Social isolation, hand sanitizer use, staff cutbacks or salary cuts, and the fluctuating cost of drugs are just a few examples. Measures
were analysed and categorised according to their outcomes, with the goal of countering the wellbeing-related effects of Covid-19
pandemic and bolstering the long-term viability of the companies. These were categorised as either particular responses or generic
responses in the subsequent analysis.

Discussion
Analysis of the interviews revealed multiple emerging themes. Though some concepts were first explored in this study, others have
been discussed in other works. In the first place, participants discussed their supply chain's responsiveness, which they extended to
the product design strategy. The second theme that surfaced was the measures taken by PSCs to deal with the Covid-19 pandemic.
This theme was split into two subthemes, pricing and inventory responses, to account for the unique effects that the Covid-19
pandemic had on efficient supply chains. A participant's view of how their response would affect strategic alignment was the theme
of the final section. This was broken down into the following three subthemes: supplier strategy response, manufacturing strategy
response, and lead-time strategy response.

Supply chain's responsiveness

Participants explained product design approach when asked what the pharmaceutical business did in response to the Covid-19
pandemic and why they made those choices.

Product design strategy
Participants described the most important and frequent factor which affected their decision-making process concerning their response
was based upon product availability. When determining what course of action to take, pharmaceutical industry first needed to address
relevant and constantly achieve strategic fit while serving many customer segments with a variety of products across multiple
channels:

From the perspective of medication or medical products coming into the country or manufacturing or materials or producing, so in
terms of product having enough supply of medication, I think from the pharmaceutical industry background, companies actually
normally make reservations to have at least three to six months’ worth of stock on hand at any given time. (P09)

Moreover, the pharmaceutical industry had to react to the product design; in addition to addressing the crisis to restore business, the
sector had to deal with the lack of product availability, which led to a decline in revenue as markets dried up and many pharmaceutical
companies went out of business:

So, in my experience, I believe, you know, that it has influenced you know accessibility mostly and availability of products. Especially
of particular products. (P18)

Similar to how companies' access to a variety of pharmaceutical items was hampered by the closing of ports of entry:
In the height of Covid-19 the delayed imports, increasing cost of shipping were huge external factors affecting the market - The
inconsistent supply and substantial increase in cost of goods put a lot of pressure on companies to maintain their supply as well as
running a cost-effective business. Single price exit products’ price increases is determined by legislation every year. (P21)
In addition, participants voiced concerns about the regulations' lack of adaptability and their instability:

The implications, Like I said, there's a shortage of supply and then they lead to high demand and supply. So, you know, for them, it's
the basic economics. A pandemic will cause a negative shift in the supply and when demand is not checked. It leads to a high price,

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low supply price. And we have seen that and we've applied to DOH get most of our products that contains paracetamol, to get
increased regulation might be increased, which is above the normal annual increase. So, the implication it eats into surplus.
(Difficulties in predicting stock level; Negative shift in supply leads to high price) (P07)

Therefore, government regulations had an impact on the pharmaceutical business in two key areas. The regulations mandated a
particular reaction to the pharma industry, for example, more social distance and increased sanitization methods. Second, the
regulations created a secondary crisis to which the pharmaceutical companies had to respond. Pharmaceutical companies, for
instance, were compelled to adjust to falling demand and supply as a result of government rules capping production and restricting
borders.

Efficient supply chains

The availability of information about the company's streamlined supply chains was a second element that influenced their reactions
and choices. Participants described how they would respond using their existing efficient supply chains management plans as the
efficiency took shape. Although all participants had effective supply chain management plans in place, not all addressed pandemic
conditions, and those that did tended to focus on regional considerations based on historical pricing and inventory tactics:

I believe they tried to respond, but it wasn't it wasn't easy, you know, not to mention, you know, that they were flying stuff and they
got to find an airplane that was flying, you know, because a lot of the aircraft were grounded, you know, so they tried to get stop.
And the problem being was that, you know, if it was a pharmaceutical, they had to sell it at the same price. But when they were flying
masks and the masks, that only cost 50 cents, you know, people were selling at twenty-five rand, you know, so the prices went up,
you know, they imported to stock, you know, finished product and created shifts so they could work with longer manufacturing hours.
(P06)

Participants also voiced worry that the strategies rarely addressed the possibility of persistent or ongoing disruptions. Emerging
disruption mitigation strategies are inadequate to direct the pharmaceutical industry's response to the Covid-19 pandemic, which is
still having a significant impact on firms a year after it first emerged.

So, the strategic response and maybe we just need to first define what is the strategy, so the strategy is a way of doing things that is
aligned to achieve your goals as an organization, given the scarcity of resources. And when I say scarcity of resources, it covers a
lot wider that it can be human resources, it can be issues like raw materials. When I get the strategic response, it means what are
you in putting in your strategy to ensure that you are well prepared for the unforeseeable challenges. (P07)

Following government rules, the pharmaceutical industry planned its response to the supply chain disruptions with the use of strategic
response methods. Many of the participants, however, realised that their solutions did not adequately address pandemics or did not
account for the long-term nature of disruptions like the one caused by the Covid-19 pandemic.

Pharmaceutical supply chain strategic response
The pharmaceutical industry's responses to the Covid-19 pandemic can be broken down into two broad categories: pricing response
and inventory response.

Pricing response
As the initial impact of the COVID-19 pandemic was on the pharmaceutical supply chain, the initial response focused on those
industries' needs. This was necessary for the company to ease customers' minds, but it was also required by law in some places. Some
participants stated how they had to modify education and training and customer services, in addition to regulating the usage of PPE,
and reminders to keep social distance between employees and customers:

I think that the disruption comes from a couple of elements. Number one, the logistical issues. Let's start with the logistical issues.
So, we have to send a delivery person now that has to be fleet, so there is Personal protective equipment (PPE) restraints, he has got
to have his mask, he has got to be in his van, he has got to be sanitized. (P01)
Staff members required further training in order to become familiar with the new processes. The methods by which these trainings
were provided have to vary in order to meet regulatory requirements, with examples including Microsoft Teams and television
commercials:
I think it will help with customers then knowing what they want when they walk into a pharmacy, so to cut down the time of just
walking around and looking around, you know, with which is which is not an ideal situation, I think with this response of the TV
advertising, with the pharmacy assistance, giving them advice and setting in the basket of products, maybe, you know, the training
is always asking questions and increasing the basket of products for the customer instead of the customer walking in and grabbing
something and walking out. So that's where the training comes in. (P03)
While some tried to use their unique reaction to the Covid-19 pandemic as a selling point, others tried to play it safe:

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So, it has been quite disruptive for them. And they've also found that there's a lot of stock that's expiring because different things are
selling now as to previous, you know, before the covid. So, we've had a lot of expired stock as well. For instance, the front shop items
people were not coming in to buy the front shop items anymore. So, yes, it's being quiet, disruptive. (P03)

The specifics of this supply chain disruption, a nationwide lack of pharmaceuticals, were homed in on by the responses. In additional
remarks, the need for better inventory management was raised:
Inventory response

Like any other form of disruption, this one also has secondary effects on businesses, mostly in the form of decreased demand and the
need to cut expenses. As demand dwindled, participants repeatedly recounted measures they had to take to reduce expenses:

I think that the demand planning is critical now and the time spent in understanding statistics, understanding the and what is
happening around the world, maybe looking at other trends. I can't say what went wrong because everybody was caught off guard
with regards to the pandemic. We were not prepared for it because obviously we were we were working on history with regards to
supply chain and what, you know, supply and demand. And all of a sudden you have a huge demand. And then within 11 months of
this time, the time is progressing. You see the marketing starting to become stable again. And then all of a sudden now it's becoming
more erratic again. You're getting pockets of demand and pockets of upholds, of all the stocks. So, it really has affected the supply
chain services in the pharmaceutical industry negatively in the beginning. (P05)
Four of the interviewees also mentioned reviewing contracts with vendors, freelancers, and temporary workers as a cost-cutting
measure at their pharmaceutical companies.

I think it’s out of their control. I don't think it is. I mean, you can plan for a pandemic, but who knows when you're ever going to get
one? I mean, did we even know we were going to be like this? You know, and we are basically the world shut down. And especially
because we have so many different suppliers overseas and manufacturing and things like that. (P04)
The pharmaceutical industry was forced to revise its demand forecasts for the following the economic trends:

I think, like I say, you can increase your forecast in your supply chain to help, but as I say, you know what? Companies are wary to
increase that drastically because you don't know if you're going to sit with that stock. And it's actually money that's sitting there and
raw materials. And if it doesn't get used or it expires before time, then again, it's money lost. (P02)

There were also three respondents whose companies had moved resources like dividend payments to bolster operations:
Obviously, it can also be financial in the sense that you know sales are not recorded as it was supposed to be in terms of delayed
revenue. Right. So, if items don’t get to point of consumption on time, then what it means is there will be a delay in sales as well. And
also, we have seen some of the restrictions brought about by most of the participants in the sector, in the sense that maybe sales reps
were not allowed in hospitals. And then, hence, also affecting the number of interruptions. Due to the delayed sales and reduced
sales. (P16)
Strategic alignment

Supplier strategy response.

Supplier strategy response was the focus of the pharmaceutical industry's final strategy implementation. This usually meant focusing
on the domestic market and encouraging getaways when this disruption occurred:

I think what you're going to find is my belief that it's going to be market forces that rescue the day, not necessarily an industry
response. Yeah, I think it's going to really boil down to supply and demand where the demand comes from and who can meet the
supply. (P01)

Five of the PSC professionals indicated they had shifted their focus to prioritize long-term suppliers:
It is all about political willingness and government intervention in this regard. I have a framework that can actually work, which is
building the strategic partnership with our suppliers which is basically supply chain relationship management. You must move all
our strategic suppliers, this how-to save this strategic supplier if they cannot supply us then we are done. We must also improve them
in terms of these are the only supplier within this space so if we do not have a good relationship with them just because there is only
two of them or it is only one of a certain component then we are done. (P17)
According to three interviewees, the lengthened supplier market included clientele who were stranded internationally due to the
closure of global markets:
Okay, so, with the COVID-19 pandemic I would like to think that there was an impact in terms of items or products coming into the
country and also cross border movement in the pharmaceutical industries. This is not only in the pharmaceutical industry, it is all
over all commodities. There were disruptions in terms of movement during the first lockdown when they first announced that there
would be lockdown all over the globe. (P25)

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Two important long-term repercussions, including production shutdown and lead-time delays, were predicted as a result of Covid-
19 and the pharmaceutical industry's countermeasures to the pandemic.
Manufacturing strategy response

Many drug manufacturers were forced to temporarily shut down as a result of weak demand. The majority of respondents were of
the opinion that currently closing businesses might remain closed for longer than expected, if they remained open at all:
The disruption, you know, and then without mentioning names, certain pharmaceutical companies closed because they started to
sanitize the whole warehouse, all that. And then it opened for three days and then that closed again. So it was it was a nightmare
from that side of things. OK, so the other nightmare was everyone was wearing masks, so it was not normal cold and flu virus. So
we bought in stock for cold and flu season and there wasn't one. So then you had this situation where the stock was expiring and that
we didn't sell through a cold and flu season. It was in stock. So there wasn’t a cold and flu season because everyone was isolated
home wearing masks. (P06)

Since larger PSCs would be able to continue operating thanks to higher profits, it was predicted that only smaller pharmaceutical
enterprises would be seriously impacted by the indefinite shutdown. As a result, as the recovery from the Covid-19 pandemic sped
up, participants believed that a number of pharma and related businesses would close permanently, lowering the overall level of
competition in the sector. As a result of these closures, other businesses may seek to combine, amplifying the impact.
Lead-time strategy response

The ultimate effect dealt with the lead-time approach to boost productivity or modify the customer's experience. A consensus emerged
amongst the study participants that the pharmaceutical industry might stand to improve its efficiency by studying the lessons of the
Covid-19 pandemic's disruption:

Obviously, I think the delivery side of things was affected severely in terms of delivery standard times was affected in the sense that
capacity from transport service providers made it impossible for our goods to go through from point of origin to point of consumption.
Due to the limitation brought about by the COVID-19 in terms of allowing a certain number of people at a point in time, in maybe
say office space or warehouse space, you know. Such was reduced. Capacity was reduced. Hence, then also are affecting the lead
times that delivery standard lead times that we are used to prior COVID-19. (P22)

Similarly, participant 05 anticipated a higher level of involvement from top management in day-to-day operations, which would
decrease stock delays and, hopefully, out-of-stocks.

Because things will be quicker. OK? You're not are you cutting out the delay process where we can go from the stocks coming in to
actually getting out to the customers. So, I can give you an accurate assessment. We have a infill rate of 90 percent. OK. In other
words, that we're able to replenish 92 percent of our stock. About seven percent of it has been supply out of stock and one percent is
of our own.
As a whole, these three participant-provided themes point to a more dynamic industry in the near future to foreseeable future and the
possibility of additional innovative technologies in the years to come. There will be more commercial interest and conflict between
well-established drug chains vying for the same consumer and investor market in the coming future, leading to fewer buyers, venture
capitalists, new entrants, and local producers overall. Because of this, and the other strategic shifts brought on by the Covid-19
pandemic, there will be lasting advances in technology that propel effectiveness in strategic response.
The analysis shows that government restrictions and strategic reactions had a major impact on South Africa's pharmaceutical industry
actions during the Covid-19 pandemic. While both influenced pharma's responses to the induced supply chain disruption, government
laws appeared to have had a more direct impact on pharma's industry-specific responses, such as social distance and mask use. The
pricing strategy response and the inventory strategy response seemed to be more influenced by the strategic response strategies. The
pricing and inventory answers were additionally impacted by the particular responses. Although respondents agreed that product
design, supplier strategy response, and lead-time strategy response were all likely to have long-term effects, they were unable to say
whether or not any given approach was more likely to have a particular effect.

Discussion of results
Preparedness for Covid-19 pandemic, the South Africa’s pharmaceutical industry
Both the interviews and the literature agree that contingency planning is a strategy that can aid in the recovery of firms and help to
discover strategic opportunities (Bø, Hovi & Pinchasik, 2023). Even though the participants knew about these strategies and agreed
with the policy process, they said that the strategies depended on actual fact although they did not take into account how long the
turmoil would last (Olutuase, Iwu-Jaja, Akuoko, Adewuyi & Khanal, 2022). This sentiment was also voiced by pharmaceutical staff
in China during the Covid-19 epidemic, which concluded that contingency planning protocols for pandemics were in place, but
ultimately proved to be ineffective (Almurisi, Al Khalidi, AL-Japairai, Mahmood, Chilakamarry, Kadiyala & Mohananaidu, 2020).
Those who have researched the impact of a Covid-19 pandemic on the pharmaceutical business have long been worried about this

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very issue (Zwanka, 2022). A failure to undertake a thorough investigation was perceived by those who lived through the Covid-19
pandemic in 2020 as a lack of implementing the strategy to solve complex problems from the pandemic(Afrin, Chowdhury &
Rahman, 2021). Given the persistence of the turmoil, it is probable that even more well-being-concentrated strategies would not have
been sufficient for pharmaceutical industry. When thinking about the future, it is important to not just account for well-being issues,
but also for the possibility that they shall last longer than expected.
The strategic response to Covid-19 induced supply chain disruption.

Like the SARS epidemic, the COVID-19 pandemic was a shocking and unexpected development that took most companies off
unprepared. Because of this, firms have to make most of their choices on the run, as opposed to the careful planning advocated for
by Ivanov (2020). Due to the fluid nature of the Covid-19 pandemic, updates on the evolving situation were constantly relayed to
corporate offices, necessitating reevaluation and revision of response measures (Lee, Chen, McDonald & O’Neill, 2020).
Pharmaceutical supply chain's responsiveness

The strategic response to the Covid-19 pandemic can be broken down into six segments, each of which can be compared to the
responsiveness, efficiency, flexibility, or long-term availability of the response at that stage. These segments are product design
strategic response, pricing strategic response, supplier strategic response, manufacturing strategic response, and lead-time strategic
response (Alzoubi, Elrehail, Hanaysha, Al-Gasaymeh & Al-Adaileh, 2022). However, these sections cannot be grouped into a single
stage because of the variety of responses received and the continuous complexity of the Covid-19 pandemic.
The first section, product design strategic response, discussed the measures taken by the pharmaceutical industry in response to the
medicine shortages caused by the disruption in the drug supply chain (Tirivangani, Alpo, Kibuule, Gaeseb & Adenuga, 2021). Among
these were facilitating access to medical care, insurance, and certifications of good health, as well as the distribution of personal
protective equipment. During past instances of infectious illnesses including HIV/AIDS, tuberculosis (TB), and malaria, similar
measures were taken (Tessema, Kinfu, Dachew, Tesema, Assefa, Alene, Aregay, Ayalew, Bezabhe & Bali, 2021). The removal of
potentially contaminated things from guest rooms and public places is a sanitary practice that is rarely highlighted during epidemics.
The pharmaceutical supply chain is the primary target of these measures (Nguyen, Lamouri, Pellerin, Tamayo & Lekens, 2022).
A second of pharmaceutical supply chain's responsiveness set of replies addressed the issue of strategic pricing. These aimed to
reduce higher margins because pricing is not a primary consumer motivator, help efficient and responsive supply chains, and perhaps
compensate for lost income as a result of the secondary Covid-19-induced disruption (Forman & Kohler, 2020; Phuong, 2021).
According to participant reports and prior research, these measures included requests for employees to take time off (both paid and
unpaid), salary reductions, contract terminations, and the elimination of superfluous expenditures as supply and other costs are quite
high the rising cost of operations is a direct result of the logistics industry's constant evolution (Almurisi et al., 2020). The study
indicated that online pharmaceuticals sectors are anticipating a fall in worldwide pharmaceutical demand until the year 2023, thus a
longer-term correction was necessary than after the Covid-19 pandemic, which caused a decline in the Indian market for only one
economic downturn (Konar & Pitroda, 2022). Many of these widespread interruptions have bought companies some time to get used
to the Covid-19 pandemic's long-term effects on their operations, their customers' behavior, and their ability to generate revenue. In
order to buy companies some time to come up with more substantial answers, these measures are increasingly centered on attaining
strategic fit in the face of supply chain disruption (Po-Lynn, 2019; Kaur & Kaushik, 2022).
Finally, we looked at inventory strategic response and discussed pharmaceutical's attempts to recover business as part of our
examination of the responsiveness of the pharmaceutical supply chain. Both minimising inventories to cut costs and keeping a buffer
inventory to deal with demand/supply unpredictability were mentioned by participants as being important strategies. It has been
stated that, in times of crisis, people often take the action of reducing their stock levels in order to save money (Goodarzian,
Taleizadeh, Ghasemi & Abraham, 2021). However, research did not previously highlight the need of buffer inventories in coping
with demand/supply unpredictability. Some respondents identified the need for managers to make decisions and balance competing
impacts in the areas of forecasting, planning, procurement, financing, stock levels, and marketing strategies in order to help their
organizations reach their objectives (Moosivand, Ghatari & Rasekh, 2019). Both tactics for reviving the economy involved expanding
into different markets, which shows the resilience and adaptability of this tactic (Munyaka & Yadavalli, 2022). Given its prevalence,
this strategy probably needs further formalization inside companies in order to facilitate quicker adoption and promote more strategic
uses. Despite the fact that the inventory holding cost works to minimize the total cost of supplying demand and, so, must make the
right cost tradeoffs when making the lot-sizing choice, it is noteworthy to observe that participants rarely spoke about cycle inventory
levels in practice for business (Alfares & Ghaithan, 2019).
Pharmaceutical industry: efficient and strategic alignment

Participants worried that some pharmaceutical enterprises that closed due to lack of financial flow, insolvency, or low demand would
never reopen, making the disruption to the pharmaceutical supply chain a chronic issue. Due to the worldwide and extended character
of the Covid-19 epidemic, this phenomenon was not detected in the existing research on supply chain disruptions (Ivanov, 2019).
Put together, this information points to a market dominated by a handful of huge pharmaceutical firms that not only weathered the
Covid-19 epidemic, but also acquired their smaller, struggling competitors. Since the effects of such a prediction would be felt for

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such a long period of time, manufacturing, lead-time, and supplier strategy response to such a disruption would be difficult to align
in an efficient and strategic manner, and thus the topic has received relatively little attention in the literature.
Many of the remarks made by participants have literary backing, suggesting that there are lessons to be learned from past disruptions
that might promote reintegration (Roscoe, Skipworth, Aktas & Habib, 2020). The mixed outlook on disruption's future and the
influence on the industry's sustainability are only two examples of the statements that seem to go counter to the literature or have not
been considered before. Differences between the research and the remarks of participants can be explained in one of two ways. To
begin, the Covid-19 pandemic has a wider geographical and longer-lasting temporal impact than previously mentioned supply chain
disruptions, covering more of the world and for a longer time than past pharmaceutical disruptions. Because of this, businesses have
felt a stronger effect, which may result in more profound, long-term transformation (Sharma, Talan, Srivastava, Yadav & Chopra,
2020). The second observation is the emergence of new technologies, such as 4IR technologies, that may be used as a practical
substitute for conventional business methods used before the year Covid-19. It is possible that the Covid-19 outbreak will serve as
the impetus for businesses to put their doubts about these technologies to rest and instead take use of the new possibilities they present
(Ahmad, Alshurideh, Al Kurdi & Salloum, 2021).

Conclusions
Ultimately, our research has made a substantial contribution to our comprehension of the appropriate strategic response that the
pharmaceutical industry in South Africa should adopt in light of the supply disruption resulting from the COVID-19 epidemic.
According to the findings of this study, it is imperative to take prompt measures to guarantee the uninterrupted availability of essential
medications and healthcare services in the nation, given the ongoing spread of the pandemic.

The study has identified and recommended many crucial steps that can help in establishing a more resilient and robust pharmaceutical
supply chain to address these challenges. The initial and paramount strategic response is to diversify the supply base, as this reduces
dependence on a limited number of worldwide suppliers. To mitigate the dangers linked to concentrated supply chains, the
pharmaceutical industry might establish collaborations with several suppliers and actively pursue local sourcing.
South Africa has the potential to gain advantages from resource, manufacturing capacity, and infrastructure synergies by establishing
regional alliances with its neighboring countries. The second strategy entails leveraging digital transformation and state-of-the-art
technologies like as big data analytics, artificial intelligence, and blockchain to improve supply chain performance.
Two further advantages include enhanced data-driven decision-making and expedited response times to unforeseen fluctuations in
demand or supply. One possible approach is to allocate resources towards research and development (R&D) and foster a culture of
innovation. South Africa has the potential to reduce its dependence on imports by allocating resources to research and development
and fostering the expansion of domestic manufacturing capacities.

Encouraging innovation and establishing public-private collaborations can foster the development of novel solutions to current
healthcare challenges.

Lastly, robust policy and regulatory frameworks are essential. The integrity and resilience of the pharmaceutical supply chain rely
on heightened regulatory oversight, the adoption of rigorous quality control protocols, and the promotion of cooperation among
stakeholders. Enhancing the proficiency of regulatory authorities and promoting collaboration with international organizations will
assist in protecting public health and effectively addressing future pandemics or health emergencies. Hence, it is imperative to develop
a comprehensive approach to address the disruptions in South Africa's pharmaceutical supply chain caused by the COVID-19
pandemic.

If the recommended procedures are executed, the country will build a pharmaceutical supply chain that is more resilient, self-
sustaining, and capable of lasting for a long time. Consequently, this will enhance public safety, increase the accessibility of life-
saving drugs, and stimulate South Africa's economy.

Acknowledgement

All authors have read and agreed to the published version of the manuscript.
Author Contributions: Conceptualisation, B.T., and E.M.; methodology, B.T.; formal analysis, B.T., and E.M.; investigation, B.T., and E.M.;
resources, B.T., and E.M.; writing—original draft preparation, B.T., and E.M.; writing—review and editing, B.T., and E.M.
Funding: This research was NOT funded by neither the government nor any private or nonprofit organisations
Informed Consent Statement: Informed consent was obtained from all subjects involved in the study.
Data Availability Statement: The data presented in this study are available on request from the corresponding author. The data are not publicly
available due to restrictions.
Conflicts of Interest: The authors declare no conflict of interest.

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