{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"institution":[{"name":"medRxiv"}],"indexed":{"date-parts":[[2026,5,9]],"date-time":"2026-05-09T19:09:38Z","timestamp":1778353778150,"version":"3.51.4"},"posted":{"date-parts":[[2026,5,7]]},"group-title":"Pharmacology and Therapeutics","reference-count":125,"publisher":"openRxiv","license":[{"start":{"date-parts":[[2026,5,7]],"date-time":"2026-05-07T00:00:00Z","timestamp":1778112000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"accepted":{"date-parts":[[2026,5,7]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                <jats:sec>\n                  <jats:title>Objectives<\/jats:title>\n                  <jats:p>To evaluate supply-chain vulnerabilities affecting medications essential for treating sexually transmitted infection in the United States and identify disruption mechanisms that may predispose these therapies to shortages.<\/jats:p>\n                <\/jats:sec>\n                <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>We conducted a qualitative, structured supply-chain vulnerability assessment of first-line medications for five priority sexually transmitted pathogens recommended by the Centers for Disease Control and Prevention and the World Health Organization: azithromycin, doxycycline, ceftriaxone, benzathine penicillin G, metronidazole, tinidazole, acyclovir, and cefixime. Using a predefined framework derived from pharmaceutical supply-chain disruption literature, we evaluated 13 disruption categories spanning raw material sourcing, active pharmaceutical ingredient production, manufacturing, distribution, market dynamics, information systems, and post-distribution loss mechanisms. Each category was assessed using four binary indicators and classified as relevant when at least two criteria were satisfied.<\/jats:p>\n                <\/jats:sec>\n                <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>Multiple disruption domains applied across the drug set. Recurrent vulnerabilities included geographically concentrated active pharmaceutical ingredient production, limited manufacturing redundancy in low-margin generic markets, manufacturing constraints affecting sterile injectable products, reliance on consolidated distribution networks, and susceptibility to demand surges and information-system disruptions. All eight drugs exhibited at least one regulatory or market signal consistent with potential supply vulnerability, including documented shortages, product discontinuations, or limited manufacturer participation.<\/jats:p>\n                <\/jats:sec>\n                <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>Supply-chain vulnerabilities were identified across multiple first-line sexually transmitted infection therapies, indicating that disruption risk is not confined to a single drug. There is a need for policy interventions to strengthen supply-chain resilience, including diversification of active pharmaceutical ingredient sourcing and distribution networks, as well as incentives for sustainable generic production.<\/jats:p>\n                <\/jats:sec>","DOI":"10.64898\/2026.05.06.26352546","type":"posted-content","created":{"date-parts":[[2026,5,7]],"date-time":"2026-05-07T23:15:18Z","timestamp":1778195718000},"source":"Crossref","is-referenced-by-count":0,"title":["Supply Chain Vulnerabilities in First-Line Treatments for Sexually Transmitted Infections: Implications for U.S. Public Health Preparedness"],"prefix":"10.64898","author":[{"ORCID":"https:\/\/orcid.org\/0009-0009-2986-4770","authenticated-orcid":false,"given":"Coby Y","family":"Garcia","sequence":"first","affiliation":[{"name":"Harvard University, Cambridge, MA, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0009-1119-027X","authenticated-orcid":false,"given":"William","family":"Leung","sequence":"additional","affiliation":[{"name":"Harvard University, Cambridge, MA, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Amelia","family":"Shirley","sequence":"additional","affiliation":[{"name":"Boston College, Boston, MA, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ian","family":"Zhao","sequence":"additional","affiliation":[{"name":"Brigham and Women\u2019s Hospital, Boston, MA, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4077-3476","authenticated-orcid":false,"given":"Lao-Tzu","family":"Allan-Blitz","sequence":"additional","affiliation":[{"name":"Brigham and Women\u2019s Hospital, Boston, MA, USA"},{"name":"Division of Infectious Diseases, Department of Medicine, University of California, Los Angeles, Los Angeles, CA, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"54368","reference":[{"key":"2026050911451399000_2026.05.06.26352546v1.1","doi-asserted-by":"publisher","DOI":"10.1093\/ofid\/ofaf695.935"},{"key":"2026050911451399000_2026.05.06.26352546v1.2","doi-asserted-by":"publisher","DOI":"10.2471\/BLT.20.267724"},{"key":"2026050911451399000_2026.05.06.26352546v1.3","doi-asserted-by":"publisher","DOI":"10.3389\/fphar.2021.693426"},{"issue":"2","key":"2026050911451399000_2026.05.06.26352546v1.4","doi-asserted-by":"crossref","first-page":"e70107","DOI":"10.1002\/pds.70107","article-title":"Impact of antibiotic shortages on antibiotic utilisation in the community","volume":"34","year":"2025","journal-title":"Pharmacoepidemiol Drug Saf"},{"issue":"1","key":"2026050911451399000_2026.05.06.26352546v1.5","doi-asserted-by":"crossref","first-page":"121","DOI":"10.1007\/s43441-022-00446-5","article-title":"Relative risk assessment for substandard antibiotics along the manufacturing and supply chain: a proof-of-concept study","volume":"57","year":"2023","journal-title":"Ther Innov Regul Sci"},{"key":"2026050911451399000_2026.05.06.26352546v1.6","doi-asserted-by":"publisher","DOI":"10.1097\/OLQ.0000000000002126"},{"key":"2026050911451399000_2026.05.06.26352546v1.7","unstructured":"Pfizer Inc. 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