The majority of the world’s condoms, for example, are made in Malaysia and Thailand, home to natural-rubber industries. The paper for cardboard condom packages then comes from China, Indonesia, and Europe, Paul Liang, the marketing director at Karex Berhad, one of the world’s biggest condom producers, told me. India and China are leading manufacturers of generic pharmaceutical products and cheap drugs, although many Indian drug companies rely on Chinese firms for APIs. Products made in one country might also be shipped to a lab in another for quality testing. Once they’re ready for export, they travel by air or sea, depending on the size of the shipment, the urgency of demand, and other factors. Today, many of these travel routes are closed down, severely restricted, or drastically more expensive.
Even without the coronavirus pandemic, which has spurred new quarantine measures and waiting periods, these products were typically subject to inspection once they landed. In Uganda, for example, condoms must be sampled and tested by a regulator. In Kenya, each three-pack of condoms carries a small sticker saying they’ve met regulatory standards before it can be sold to consumers, which requires unpacking every shipment for manual labeling. Reduced manpower as a result of social distancing and evening curfews in Kenya meant that labeling that normally takes two weeks stretched to more than a month. Had the process been delayed any further, Lauren Archer, the DKT Kenya and Uganda country director, told me, her team would have run out of stock.
Companies such as DKT struggle even to substitute identical products in times of need: Importing countries register drugs, such as injectable contraception or the abortion pill, and medical devices, such as condoms or kits used to provide abortions, by manufacturer and country of origin, not just based on the active ingredient or product category. The process of registering a new drug or medical device with the appropriate national agency can take anywhere from six months to several years. “Let’s say you have a stockout from China. It’s not a simple matter of ‘Well, okay, I’m just going to go buy from India now,’” Purdy told me. “You can’t simply switch to a new manufacturer without undergoing re-registration.”
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Large parts of the world do not have domestic manufacturing capacity for these vital health products, leaving them deeply vulnerable to any glitch or disruption to the supply chain. Even countries that have some domestic capacity are not wholly self-sufficient: Iran does have pharmaceutical production, but does not make its own intrauterine devices, or IUDs, the long-acting reversible contraceptives that prevent pregnancy for several years at a time. When I spoke with Purdy at the end of May, a container holding 50,000 IUDs bound for Iran had been stuck in a Dubai port for nearly three months.