{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,24]],"date-time":"2026-08-24T06:19:34Z","timestamp":1787552374055,"version":"build-2736575974"},"reference-count":45,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,8,24]],"date-time":"2026-08-24T00:00:00Z","timestamp":1787529600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Faculty of Arts Prince Takamado Japan Centre (PTJC) for Teaching and Research Seed Grant Program"},{"name":"Faculty of Pharmacy and Pharmaceutical Sciences summer studentship program"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Public Health"],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Anthropogenic and natural hazards increase reliance on donated medicines. However, inappropriate donations (e.g., expired, unlabeled, or poorly matched to local needs) remain common and create negative impacts on disaster-affected communities. In Japan, the coordination mechanisms and roles among stakeholders remain insufficiently characterized. This study aimed to identify and characterize stakeholders involved in the donated medicine cycle in Japan and to examine their relationships. In addition, this study also obtained stakeholder opinions on our proposed collaborative initiative, to build transparency within the donated medicine systems and increase the proportion of donated medicines that meet the health needs of disaster affected populations while complying with the World Health Organization (WHO) guidelines.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Method<\/jats:title>\n                    <jats:p>This study applied stakeholder analysis combined with social network analysis to examine the existing collaboration network within the Japanese donated medicine system. The analysis followed three phases: stakeholder identification, stakeholder categorization, and analysis of stakeholder relationships. Between June and August 2025, an online questionnaire was distributed to 18 stakeholders asking for their attributes, interests, desire for involvement, concerns, and the level of collaboration they had with other stakeholders. Data analysis combined descriptive quantitative analysis and social network analysis.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>The analysis identified 18 stakeholders across nine groups, of which 15 organizations responded and participated in the study. Eight stakeholders were considered critical to the proposed initiative. These belonged to seven groups including pharmacy professional bodies, national and regional government, humanitarian organizations, pharmaceutical companies, regional hospitals, and the national pharmaceutical manufacturers association. A collaboration network existed between 17 stakeholders. National-level stakeholders emerged as the most strategically positioned for controlling the flow of information and resources within the Japanese donated medicine system. Two of the eight critical stakeholders were pharmacy professional bodies, highlighting their important role in Japanese donated medicine system.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>This study revealed collaboration patterns and highlighted contextual insights required for the successful implementation of the proposed initiative. These insights provide practical guidance for building transparency, and better alignment of donated medicines with local health needs.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fpubh.2026.1866926","type":"journal-article","created":{"date-parts":[[2026,8,24]],"date-time":"2026-08-24T05:31:06Z","timestamp":1787549466000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Navigating the Generosity of Medicines (Gen-MED): characterizing the complex relationships of medication donations in Japan through stakeholder and social network analysis"],"prefix":"10.3389","volume":"14","author":[{"given":"Naoko","family":"Arakawa","sequence":"first","affiliation":[{"name":"Division of Pharmacy Practice and Policy, School of Pharmacy, University of Nottingham","place":["Nottingham, United Kingdom"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carol","family":"Namata","sequence":"additional","affiliation":[{"name":"Faculty of Pharmacy and Pharmaceutical Sciences, College of Health Sciences, University of Alberta","place":["Edmonton, AB, Canada"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eiko","family":"Kobayashi","sequence":"additional","affiliation":[{"name":"Department of Pharmacy, International Medical Relief, Japanese Red Cross Medical Center","place":["Tokyo, Japan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kayoko Takeda","family":"Mamiya","sequence":"additional","affiliation":[{"name":"Department of Pharmaceutical Education, Faculty of Pharmaceutical Sciences, Hokkaido University of Science","place":["Hokkaido, Japan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tetsumi","family":"Irie","sequence":"additional","affiliation":[{"name":"Department of Pharmaceutical Packaging Technology, Faculty of Life Sciences, Kumamoto University","place":["Kumamoto, Japan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Takashi","family":"Egawa","sequence":"additional","affiliation":[{"name":"Department of Pharmaceutical Sciences for Health Crisis Management, Faculty of Pharmaceutical Sciences, Fukuoka University","place":["Fukuoka, Japan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kaitlyn E.","family":"Watson","sequence":"additional","affiliation":[{"name":"Faculty of Pharmacy and Pharmaceutical Sciences, College of Health Sciences, University of Alberta","place":["Edmonton, AB, Canada"]},{"name":"Women and Children\u2019s Health Research Institute, University of Alberta","place":["Edmonton, AB, Canada"]},{"name":"Epidemiology Coordinating and Research (EPICORE) Centre, University of Alberta","place":["Edmonton, AB, Canada"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,8,24]]},"reference":[{"key":"ref1","volume-title":"Humanitarian crises are growing. So how do we make crisis response more efficient. InWorld Economic Forum. Available online at:","author":"Saba","year":""},{"key":"ref2","doi-asserted-by":"publisher","first-page":"28","DOI":"10.1186\/s40545-015-0045-3","article-title":"Improvements for international medicine donations: a review of the World Health Organization guidelines for medicine donations","volume":"8","author":"Ca\u00f1igueral-Vila","year":"2015","journal-title":"J Pharm Policy Pract"},{"key":"ref3","volume-title":"Access to Medicines","year":"2023"},{"key":"ref4","first-page":"1","volume-title":"Pharmaceutical donations. MDS-3: managing access to medicines and health technologies. Arlington, VA: Management Sciences for Health","author":"Clark","year":"2012"},{"key":"ref5","doi-asserted-by":"publisher","first-page":"1539","DOI":"10.1016\/j.japh.2023.05.020","article-title":"Patterns of pharmaceutical supplies and medicines donations received during a natural disaster","volume":"63","author":"Schlottke","year":"2023","journal-title":"J Am Pharm Assoc"},{"key":"ref6","doi-asserted-by":"publisher","first-page":"922","DOI":"10.2471\/BLT.10.079764","article-title":"To give is better than to receive: compliance with WHO guidelines for drug donations during 2000-2008","volume":"88","author":"Bero","year":"2010","journal-title":"Bull World Health Organ"},{"key":"ref7","doi-asserted-by":"publisher","first-page":"594","DOI":"10.2471\/BLT.16.186650","article-title":"Threats posed by stockpiles of expired pharmaceuticals in low- and middle-income countries: a Ugandan perspective","volume":"95","author":"Kamba","year":"2017","journal-title":"Bull World Health Organ"},{"key":"ref8","volume-title":"Guidelines for Medicine Donations Revised 2010. 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Australian Centre for Excellence in Risk Analysis (ACERA) Project","author":"Gilmour","year":"2007"},{"key":"ref23","doi-asserted-by":"publisher","first-page":"1933","DOI":"10.1016\/j.jenvman.2009.01.001","article-title":"Who's in and why? A typology of stakeholder analysis methods for natural resource management","volume":"90","author":"Reed","year":"2009","journal-title":"J Environ Manag"},{"key":"ref24","doi-asserted-by":"publisher","first-page":"213","DOI":"10.1016\/j.jenvman.2012.06.026","article-title":"A framework to implement stakeholder participation in environmental projects","author":"Luyet","year":"2012","journal-title":"J Environ Manag"},{"key":"ref25","doi-asserted-by":"publisher","first-page":"338","DOI":"10.1093\/heapol\/15.3.338","article-title":"A stakeholder analysis","volume":"15","author":"Varvasovszky","year":"2000","journal-title":"Health Policy Plan"},{"key":"ref26","volume-title":"Innovation meets tradition to transform how Japan prepares for natural disasters. World Economic Forum.","year":"2025"},{"key":"ref27","doi-asserted-by":"publisher","first-page":"718","DOI":"10.1248\/bpb.b23-00107","article-title":"Strengthening the competitiveness of Japan\u2019s pharmaceutical industry: analysis of country differences in the origin of new drugs and Japan\u2019s highly productive firm","volume":"46","author":"Okuyama","year":"2023","journal-title":"Biol Pharm Bull"},{"key":"ref28","first-page":"12","volume-title":"Ucinet for Windows: Software for social Network Analysis","author":"Borgatti","year":"2002"},{"key":"ref29","volume-title":"NetDraw: Graph Visualization Software","author":"Borgatti","year":"2002"},{"key":"ref30","doi-asserted-by":"crossref","DOI":"10.4135\/9781036236021","volume-title":"Analyzing social networks. SAGE publications Ltd","author":"Borgatti","year":"2024"},{"key":"ref31","doi-asserted-by":"publisher","first-page":"90","DOI":"10.1016\/j.socscimed.2014.10.057","article-title":"Social network analysis of public health programs to measure partnership","volume":"123","author":"Schoen","year":"2014","journal-title":"Soc Sci Med"},{"key":"ref32","first-page":"11","volume-title":"In: Carrington P, Scott J, Eds. Thousand Oaks: Sage","author":"Marin","year":"2011"},{"key":"ref33","author":"Zhang","year":"2017"},{"key":"ref34","doi-asserted-by":"publisher","first-page":"111","DOI":"10.1177\/1558689812437185","article-title":"Triangulation, respondent validation, and democratic participation in mixed methods research","volume":"6","author":"Torrance","year":"2012","journal-title":"J Mixed Methods Res"},{"key":"ref35","doi-asserted-by":"crossref","first-page":"191","DOI":"10.1016\/B978-0-323-99277-0.00029-2","volume-title":"Pandemic Risk, Response, and Resilience","author":"Jiang","year":"2022"},{"key":"ref36","volume-title":"Domestic Disaster Response","year":"2021"},{"key":"ref37","doi-asserted-by":"publisher","first-page":"49","DOI":"10.1620\/tjem.2024.J046","article-title":"Disaster pharmacists\u2019 support and challenges faced by hospital pharmacy departments in the disaster response for the 2024 Noto peninsula earthquake","volume":"264","author":"Tai","year":"2024","journal-title":"Tohoku J Exp Med"},{"key":"ref38","volume-title":"OECD Reviews of Public Health: Japan: A Healthier Tomorrow.","author":"OECD","year":"2019"},{"key":"ref39","doi-asserted-by":"publisher","first-page":"8306","DOI":"10.3390\/su17188306","article-title":"Cross-national analysis of marine spatial planning (MSP) frameworks: collaboration, conservation, and the role of NGOs in Australia, Germany, Seychelles, and England","volume":"17","author":"Charles","year":"2025","journal-title":"Sustainability"},{"key":"ref40","doi-asserted-by":"publisher","first-page":"30","DOI":"10.1109\/mcom.2014.6766081","article-title":"What is the role of universities in disaster response, recovery, and rehabilitation? Focusing on our disaster victim identification project","volume":"52","author":"Aoki","year":"2014","journal-title":"IEEE Commun Mag"},{"key":"ref41","first-page":"27","article-title":"Disaster management in Japan","volume":"59","author":"Ogata","year":"2016","journal-title":"Japan Med Assoc J"},{"key":"ref42","volume-title":"Takeda Expands Moderna\u2019s COVID-19 Vaccine Supply in Japan in Partnership with the Japanese Government","year":"2021"},{"key":"ref43","doi-asserted-by":"publisher","first-page":"67","DOI":"10.1186\/s12992-023-00964-3","article-title":"Medicine donations: a review of policies and practices","volume":"19","author":"Flores","year":"2023","journal-title":"Glob Health"},{"key":"ref44","volume-title":"A Decade and Future of Recovery Support in the wake of the Great East Japan Earthquake","year":"2026"},{"key":"ref45","doi-asserted-by":"publisher","first-page":"124","DOI":"10.1016\/j.envdev.2017.04.005","article-title":"Stakeholder analysis and social network analysis to evaluate the stakeholders of a MSWM system\u2013a pilot study of Maputo City","volume":"24","author":"dos Muchangos","year":"2017","journal-title":"Environ Dev"}],"container-title":["Frontiers in Public Health"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpubh.2026.1866926\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,24]],"date-time":"2026-08-24T05:31:10Z","timestamp":1787549470000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpubh.2026.1866926\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,8,24]]},"references-count":45,"alternative-id":["10.3389\/fpubh.2026.1866926"],"URL":"https:\/\/doi.org\/10.3389\/fpubh.2026.1866926","relation":{},"ISSN":["2296-2565"],"issn-type":[{"value":"2296-2565","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,8,24]]},"article-number":"1866926"}}