3.1 Single-dimensional analysis: Issuing agency
Through the analysis of all policy texts included in the study, it was found that many subjects issued documents for relevant policies. In this study, 15 subjects with many documents issued were selected for feature analysis based on the number structure of documents issued. In terms of the total number of documents issued, the units that issued more documents were often the government, public finance department, Drug Administration, Health Security Administration, Administration for Market Regulation, Health Commission, Development and Reform Commission, and Transportation Department, which accounted for approximately 89.45% of the total (Fig. 5). The number of documents issued jointly and those issued separately for statistical policies showed that drug supply guarantee policies in China were predominantly issued separately, 66.55% of the time. The number of joint documents issued by multiple departments was less than 30% (Table 2). Overall, the synergy between our policy subjects is not high, and it is necessary to strengthen the coordination and cooperation between various policymaking bodies.
Table 2
Situation of policy making bodies issuing policies jointly
Issuing agency | Number of documents issued | Percentage of the number of documents issued to the overall number (%) |
Two issuing bodies | 32 | 5.72% |
Three or more issuing bodies | 50 | 8.94% |
3.2 Single-dimensional analysis: Public health emergency development phase
The number of policies experienced a surge in the outbreak period, followed by a rapid decrease, and subsequently a gradual increase through each developmental stage of the pandemic (Fig. 6). Owing to the different durations of each developmental stage, the number of policies were affected by timespan. To ensure the scientific validity of the research results, this study presents a trend diagram of the number of policies issued at each stage in the following calculation mode: the number of policies at each stage of the pandemic’s development (i.e., the number of policy codes) divided by the month that this stage lasted for. Overall, the number of policy releases during the development phase of the pandemic surged during the outbreak period, first presenting the characteristics of a rapid decline, followed by a slow recovery. Policymaking agencies in China have issued relevant policies to guide and improve drug support at various stages of the pandemic.
3.3 Single-dimensional analysis: Policy tools
According to statistics from the coding results, the balance between the internal use capacity-building and command and regulation tools must be improved. As per the proportion of the four types of policy tools, symbolic and hortatory tools are most preferred at the national level, but are used less frequently in provinces. National policymakers tend to guide relevant parties in values and lead social identities in the form of calls to achieve their goals, so that provinces issue more operable policies in response to national calls.
At both the national and provincial levels, policymakers in China tend to use incentive tools, of which the green channel is most widely used in overall secondary policy tools, although it has rarely played a role in guaranteeing drug supply during the pandemic through more direct investment in platforms, technologies, manpower, and funds. Judging from the secondary classification of policy tools compared to the provincial level, national policymakers adopt more means of social mobilization and call on the whole society to guarantee the supply of drugs while paying more attention to the quality of drugs under strict supervision.
In addition, national and provincial policymakers favor a fast track, code of conduct, capital investment, and financial incentive policy tools. However, there are a few concerns regarding human resource and monitoring shortages. In addition, the internal use of capacity building, command, and regulation tools must be balanced when policymaking agencies formulate policies (Fig. 7–8).
3.4 Single-dimensional analysis: Drug supply chain
The policies regarding drug supply issued by the state during the pandemic intervened in different processes of the drug supply chain, paying more attention to drug distribution and less attention to raw material supply. The highest frequency of use was in the circulation of drugs, with a frequency and proportion of 635 times (59.96%), indicating that the state attaches significant importance to drug distribution. In order to ensure drug supply, multiple measures are taken to organize the source of goods and ensure the smooth transportation of drug logistics; the policy role of manufacturing and drug R&D is generally maintained at a relatively high level, with a frequency and proportion of 343 times (32.39%) and 116 times (10.95%) (Fig. 9), respectively, indicating that the state is strengthening the R&D of drugs for pandemic prevention and control, expecting to provide strong scientific and technological support for overcoming the pandemic, while guiding pandemic prevention and control enterprises to return to work and production, accelerating manufacturing progress and attempting to meet the needs of pandemic prevention and control treatment on the basis of ensuring drug safety and effectiveness; after the pandemic occurred, enterprises had to dispatch raw materials to intensify production; however, China has less than 1% of policies for raw material supply, with much needed attention in this regard.
3.5 Multidimensional integrated analysis of policy tools and the drug supply chain
(1) Less use of incentive tools in drug R&D
During the pandemic, therapeutic drugs targeting COVID-19 were in a state of deficiency for a long time. Therefore, capacity building in drug R&D was more important [13], especially accelerating the improvement of R&D capacity in China and adopting a series of incentive tools to ensure that R&D products were marketed faster, while improving the motivation of R&D subjects. In this process, the division of labor between national and provincial policymakers in China was clear, and national authorities tended to adopt more direct capacity-building tools to enhance the overall drug R&D capacity, while all provincial regions paid more attention to adding fast tracks to the process of drug R&D review and approval, adopting financial incentives to accelerate the speed of R&D review and approval, and enhance R&D motivation of relevant organizations. However, the use of incentive tools by national policymaking agencies is relatively lacking, accounting for only 1.12% of all policies (Fig. 10–11).
(2) Less use of capacity-building tools in manufacturing
Drug production is crucial for the drug supply chain. During the pandemic, owing to the sudden occurrence of events and shortage of a healthy labor force in all links [14], production capacity could not keep up in a timely manner. It also takes time for manufacturers to create an expansion plan. Therefore, national and provincial policymaking institutions tended to use incentive policy tools to accelerate the review and approval of enterprise expansion, solve enterprises’ worries by promising to recover the remaining products, and take relevant financial incentive measures to enhance drug manufacturers’ motivation to return to work, production, and expanding production lines. To improve drug supply, policymaking institutions should also pay attention to capacity-building tools and adopt capital investment, human resource assistance, and other means to mitigate the cost of building or restarting production lines and the lack of a healthy labor force. China’s policy-formulating institutions are relatively deficient in the use of capacity-building tools in this process (Fig. 10–11).
(3) Circulation and utilization of chain policy tools used rationally with a clear division of labor
During the process of drug distribution and use, drugs must be transported, sold, and distributed to patients in a timely manner, requiring the active response of multiple subjects throughout society. Therefore, more policy tools symbolizing, admonishing, ordering, and regulating drugs should be adopted to ensure a reasonable distribution of drugs by guiding social values or formulating relevant rules, mobilizing the active participation of members of society, and ensuring the orderly passage of drugs through the distribution link. In this regard, China’s national policy-formulating institutions tend to use relatively mild symbolic and hortatory tools, whereas provincial policy-formulating institutions use more command and regulation tools. (Fig. 10–11)
3.6 Multidimensional integrated analysis of policy tools and COVID-19 developmental phases
(1) Lack of use of capacity-building tools during outbreaks, remissions, normalization, and high-speed transmission
The outbreak of COVID-19 was a serious and urgent issue. At the end of 2019, the domestic situation became relatively chaotic after the sudden outbreak of COVID-19, and people's lives, health, and safety were significantly threatened [15]. In this emergency situation, the government should strongly intervene in drug supply, stabilize people's mentality, standardize drug purchase behavior, focus on pandemic prevention and control of scientific research, accelerate the speed of R&D, and provide scientific and technological support for the prevention and control of the pandemic. Therefore, command, regulatory, and capacity-building policy tools are more appropriate during the outbreak. In this period, China's policy-making institutions have the most use of incentive tools; the division of labor at national and provincial levels is clear, symbolic, and hortatory; command and regulation tools are fully used; and there is a slight lack of use of capacity-building tools.
During the remission and normalization periods of the COVID-19 pandemic, pandemic prevention and control achieved phased results, and the pandemic remained sporadic. The CPC Central Committee made major decisions on the overall planning, pandemic prevention and control, economic and social development, and the orderly resumption of work and production [16]. Under the condition that the pandemic situation is actively improving, the government should prioritize the use of symbolic, hortatory, and capacity-building tools; continue to strengthen the R&D of drugs and medical equipment while calling for social mobilization; and strengthen the construction of scientific research, research systems, and relevant platforms for epidemic prevention and control. In these two periods, national and provincial policy-formulating institutions mostly used command and regulatory tools. The national level also tended to use symbolic and hortatory tools, while the provincial level tended to use incentive tools. However, China's policy-formulating institutions still lacked capacity-building tools.
Omicron, a novel coronavirus infection with a high transmission period, is a novel variant that has more than twice the comprehensive infectivity of Delta and a strong immune escape ability to vaccines [17]. The nucleic acid detection level and vaccine function in China must be improved. With the increase in the number of new coronavirus infections by the end of 2022, the demand for medication has surged over a short period of time, and some varieties of antipyretics and cold medicines are temporarily deficient. Therefore, when using command and regulation tools, the government should consider capacity-building tools. On one hand, it takes mandatory measures for the production and distribution of drug companies and the purchase of drugs by the people; on the other hand, it strives to improve the quality and level of nucleic acid detection, vaccine R&D and vaccination, and the production of special pharmaceutical articles. During this period, symbolic and hortatory tools were used more frequently at both the national and provincial levels; incentive tools tended to be used at the national level; command and regulation tools were used more frequently at the provincial level; leading calls at the national level; and strong implementation at the provincial level, but full utilization of capacity-building tools were also lacking. (Fig. 12–13)
(2) Lack of incentive tool use during dropout period
After three years of scientific and technological research, various new coronavirus therapeutic drugs have been marketed [18]. The infection index was stable and then declined. The government should continue to use symbolic and hortatory tools while strengthening the use of incentive tools, calling on relevant parties to abide by the order of drug supply, and providing corresponding preferential policies to ensure a stable supply of drugs. At this stage, the national level uses symbolic and hortatory tools the most, while the provincial level uses command and regulation tools the most, both of which lack incentive policy tools. (Fig. 12–13)