Armed conflict and regional instability can no longer be regarded as distant threats unfolding in far-flung parts of the world. Across Europe, these realities are prompting a reassessment of everyday life and our preparedness for the unexpected. After all, the strength of any system is determined by its weakest link. For Latvia, on the EU’s eastern frontier and close to the war zone, strengthening societal resilience and our collective ability to withstand unexpected challenges is a clear priority.
Experts point out that Latvia needs to develop a unified action plan that clearly and comprehensively sets out how the healthcare and pharmaceutical sectors will ensure the provision of medical care and access to medicines for the population in times of crisis. The plan should establish a clear division of responsibilities and duties, as well as practical arrangements for cooperation between government institutions, healthcare providers, emergency medical services, pharmacies, medicine supply companies and manufacturers. The need for such a plan was reiterated at the international conference The First Line of Defence: Healthcare and Pharmaceuticals in National Resilience, held on 15 October in Rēzekne, eastern Latvia.
As both Latvian and international experts emphasised at the conference, crisis preparedness cannot rely solely on the internal plans or medicine stockpiles of individual institutions or companies. The entire system must be co-ordinated in advance: how patients access medical care; how healthcare facilities and pharmacies continue operating during power cuts or communications outages; how the supply and manufacture of medicines are maintained; and how information is shared and responses co-ordinated.
The experience of Estonia and Ukraine, examined by experts at the conference, offers practical examples of how to maintain strategic reserves and ensure continuity of medicine supply and production.
Healthcare companies, pharmacies and medicine manufacturing are all part of the country’s critical infrastructure and play an essential role in emergency situations. There is a shared understanding across the sector that the resilience of the healthcare system is part of the country’s overall defence and requires co-ordinated action. However, awareness alone is not enough. There is an urgent need for a concrete and clearly understood co-ordination plan. That is why we expect the state to finally take the lead and establish dialogue and co-operation with the sector in order to develop a unified resilience plan.
Signe Jantone, Executive Director of the Latvian Pharmaceutical Manufacturers Association.
She further notes that medical facilities, laboratories, emergency medical services, hospitals, family doctors, medicine manufacturers and suppliers, and patient organisations must all be incorporated into a common operational
framework for national crisis management, so that patients can continue to receive the treatment and medicines they need. This is a matter of saving lives.
Furthermore, the resilience of the system is not just about stocks of medicines and other medical supplies held in hospital warehouses. An essential element of resilience is also having the capacity and expertise to manufacture medicines when they are needed and deliver them to patients.
Assistance and resource allocation in a crisis must be planned in advance
Colonel Arvis Zīle, Head of the Crisis Management Centre at the State Chancellery (Latvia), noted that a crisis is certain to occur, even though we do not yet know when. He added that an emergency rarely affects just one sector, and that its consequences depend to a large extent on how well prepared we are and how effectively we can act in a co-ordinated manner.
Continuity of healthcare is closely linked to the availability of electricity, mobile communications, water, fuel and payment services. Crisis preparedness must therefore be developed by co-ordinating the actions of different sectors and determining in good time which services must be maintained continuously, which must be restored as quickly as possible, and which can be temporarily restricted. These priorities must be established before a crisis, taking into account public safety and available resources. The public must also know what assistance they can expect to receive.
Colonel Zīle emphasised the role of the Crisis Management Centre in co-ordinating co-operation across sectors. Information about the healthcare sector’s needs must reach the Centre in good time and according to clear criteria, while the provision of generators and fuel to hospitals and pharmacies must be co-ordinated. He also highlighted the importance of joint exercises in which the sectors involved test their ability to provide assistance to casualties according to a common scenario, including in the absence of electricity and communications.
Resilience in a crisis involves identifying risks and preparing for them in advance, as well as maintaining essential functions during emergencies of different scales and causes, reallocating resources flexibly and restoring operations following disruption. Crisis response plans must therefore be tested and improved regularly in the light of practical experience.
Ukraine’s experience: the entire supply chain must be protected
At the conference, Andrii Metelskyi, Head of the Ukrainian subsidiary of Latvian pharmaceutical manufacturer AS “Olpha”, highlighted that crisis preparedness in the pharmaceutical sector encompasses raw materials, manufacturing, logistics, regulation and employees’ ability to continue working. When international supplies are disrupted, local manufacturing capacity becomes a strategic advantage.
According to data from Ukraine’s Ministry of Health as at 1 September 2026, 2,687 healthcare infrastructure facilities across 854 institutions had been damaged or destroyed. Of these, 340 facilities across 127 institutions had been completely destroyed. A further 650 emergency medical vehicles had been destroyed, damaged or seized. These figures show that, in the event of a military threat, medical infrastructure can also become a target, making it essential to develop and plan for its resilience in a deliberate and systematic manner.
Metelskyi identified the initial concentration of medicines and raw materials in one or two large warehouses as one of the most significant vulnerabilities in Ukraine’s case. Instead, he called for a more dispersed supply network and alternative supply routes to be planned, with partnerships with neighbouring countries identified and established in good time. He also called for national reserves to include not only specific medicines and products, but also raw materials sufficient for at least three to six months. Stocks of finished medicines help overcome initial disruptions, while the availability of raw materials makes it possible to continue manufacturing during a prolonged crisis. In addition to backup electricity supplies, continuity of manufacturing requires planning for the availability of fuel and water, as well as the protection of employees.
Ukraine’s experience also highlights the risk of a sudden surge in demand, when demand can exceed the usual three months’ sales within just a few days. Metelskyi therefore emphasised the importance of timely data sharing on stock levels and demand, as well as the ability to redistribute medicines between healthcare facilities.
In Estonia, state medicine reserves are maintained in co-operation with wholesalers
Ando Leppiman, Head of the Estonian Strategic Reserves Agency, presented Estonia’s strategic reserves management model, under which the state makes use of the existing medicine supply infrastructure. Additional stocks of medicines are held by wholesalers, who ensure their circulation and logistics, while the state purchases and pays for the reserve maintenance service. This model covers approximately 200 medicines, representing one month’s consumption. The main focus is on commonly used outpatient medicines and medicines for which no alternatives are available. The selection of medicines to be included in the reserves is recommended by Estonia’s medicines regulatory authority, and the list is regularly adjusted to reflect risks and market conditions.
The Head of the Estonian Strategic Reserves Agency emphasised that this approach keeps medicines in circulation at all times: medicines with the nearest expiry dates are distributed first, and stocks are replenished. Estonia has also identified critical pharmacies for which the state provides generators, while businesses adapt their infrastructure to accommodate their installation and operation.
Estonia’s approach links household preparedness, company stockpiles, national strategic reserves and international assistance. Each of these levels provides time for the next support mechanisms to be activated. Alongside establishing reserves, Estonia is also developing ways to maintain access to services during power cuts and communications outages.
By the end of 2026, 110 shops adapted for crisis situations are planned across the country. Contracts have reportedly been signed for 79 shops, while 46 are already operating according to this model. The state reserves agency provides the generators, while retailers adapt their infrastructure. The model provides for offline payment facilities, and backup power supplies are also provided to pharmacies and cash machines.
Economically viable manufacturing is essential for medicine supply security
At the conference, Riccardo Rubini, Policy Director at the international organisation Medicines for Europe, highlighted market conditions that affect manufacturers’ ability to ensure continuity of supply. He drew attention to the risks created by prolonged downward pressure on prices and tenders in which only one bidder is selected. Manufacturing viability and supply predictability are also affected by fragmented orders and short delivery lead times.
Another problem he identified was that, in larger procurement processes, a single supplier often wins the contract. Such concentration creates a risk that, if the dominant supplier experiences disruption, other companies will be unable to replace the missing volumes quickly enough. These examples highlight the need for Latvia’s unified action plan to assess not only medicine prices and reserve volumes, but also supplier diversity, domestic manufacturing capacity and the availability of raw materials. Rubini emphasised that clear arrangements for co-operation and financing must be established in good time so that the parties involved can act immediately in a crisis.
At the conference, Liene Cipule, Director of the Emergency Medical Service, and Māris Rēvalds, Chair of the Board of the Healthcare Employers’ Association, signed a memorandum of co-operation on identifying the resources available at private healthcare facilities to meet the needs of the disaster medicine system. This was a practical step towards strengthening co-operation between the public and private healthcare sectors and developing a clearer picture of the resources that could be mobilised to provide medical assistance in a crisis.
The conference was held in Rēzekne because, on Latvia’s eastern border, the continuity of healthcare and the availability of medicines make the link between public health and national security particularly clear. It was organised by Dienas Bizness together with the Latvian Pharmaceutical Manufacturers Association, the Latvian Pharmaceutical Care Association, Healthcare Employers’ Association of Latvia and AS Olpha.
Photos: A.Liepiņš
Map: AI edit
