two people looking over some documents

How the COVID-19 Crisis Exposed Weakness in the International Regulatory Supply Chain

The COVID-19 crisis has been a substantial tragedy. It has devastated the health of communities, economies, and our collective sense of normalcy. For medical device companies, the crisis has triggered an assessment of the resiliency of critical medical supply chains and has led to an examination of all aspects of that supply chain. This article addresses one of the most underappreciated and overlooked links in the regulatory support chain that has been dramatically impacted by the crisis.  Specifically, this article addresses the impact that the crisis has had on international document authentication services (apostille and legalization of regulatory support documents) and how the disruption of these services impacted global medical device sales. Finally, the potential for innovative reform of these processes is addressed.

To legally sell medical device products overseas, companies must comply with the regulatory and legal protocols in the destination country. Part of this compliance is to ensure that certain U.S. documents relating to the products intended to be sold have been authenticated in the U.S. prior to selling those products in the country. The authentication process for the document is either “apostille” or “legalization” depending on whether the destination country is a signatory to the Hague Convention on Abolishing the Requirement of Legalisation of Foreign Public Documents(https://www.hcch.net/en/instruments/conventions/specialised-sections/apostille)(“Hague Convention for International Documents”). Signatory countries accept the apostille for authentication of any other signatory member’s documents. Non-signatory countries require the full legalization process, a lengthier authentication process usually requiring hand stamped certification from a state secretary of state, the U.S. Department of State Office of Authentications, and the Embassy of the destination country.

Since the inception of the Hague Convention for International Documents in 1969, the authentication procedures have relied on the authentication of physical documents. Specifically, documents such as Certificates to Foreign Government (CFG), powers of attorney, letters of authorization, and numerous corporate documents have been authenticated via a physical stamp. The stamped document becomes the official document by the legal authority in the destination country.

These procedures were well understood and worked quite well for most companies over the past 50 years. However, the procedures relied on two components that are now understood to be at risk in a global crisis: (i) the assumed operational capability of government agencies and Embassies and (ii) the transport and utilization of physical documents. The COVID-19 crisis undermined both assumptions, resulting in the inability of overseas affiliates to obtain the necessary authorization to sell medical device products in international markets.

Once the crisis was recognized and emergency powers were implemented by federal and state authorities, the State Secretaries of State offices, the U.S. Department of State, and foreign Embassies restricted or eliminated in-person drop off of documents, cut office staff, limited hours of operation, and required mail-in document submissions. The restriction of in-person drop-off and pick up of documents had a dramatic effect on turnaround times for authentication. For example, prior to the Stay At Home orders, the timeframe for document processing at the US Department of State was 4 business days. Since the start of the pandemic, and as of the beginning of June, the timeframe for document process is 5-6 weeks, an unprecedented slowing of the regulatory approval process for international documents. The WCS office saw a reduction in processing requests of 54% in March 2020, 93% in April 2020, and 58% in May 2020. It is noteworthy that the drop in document requests were not a function of the ebb and flow of the market.Instead, document requests were halted due to a lack of processing capability by regulatory authorities.  

Document requests are a reliable indicator of sales and distribution demand. The drop in processing requests translates to thousands of lost hours of effort to sell and distribute medical products overseas, impacting revenues of affected companies and the health of vulnerable populations worldwide. Even as medical device manufacturers were ready to get back to business, authentication procedures could not be adjusted quickly in response to the crisis. A reliable, simple process was not functioning as it had for decades and there were no contingency plans for new document authentication procedures among state, local and national authorities to address the challenge.

While there was some pressure to automate/digitize these processes before the COVID-19 crisis, there is a new sense of urgency to adopt digital authentication technologies to replace the traditional physical document procedures. For example, the National Association of State Secretaries of State (https://www.nass.org) will be considering electronic authentication of documents at its upcoming conference. Other states, including New York, implemented e-marriage certificates, and adopted other digital authentication procedures during the crisis. Nationally, medical device companies and federal agencies are discussing how to innovate to build more resiliency into document regulatory authentication.

The technological challenge is not overwhelming. After all, most agencies and companies have begun using e-signatures and document authentication tools in the past few years. The challenge will be to get state/federal agencies, foreign Embassies, and international health authority representatives to agree on the acceptance of electronically authenticated documents.  Ultimately, this is regulatory, legislative, technological, and a cultural challenge, but one that is now firmly on the radar of the medical device community.

The writer is David L. Watt, Vice President at Washington Consular Services, Inc. dwatt@wcss.com 

A digital world in the hands of a human

COVID 19’s Impact on the Global Health Industry

In the wake of COVID-19, the global health industry has been put to the test. Age-old protocols were threatened as social distancing and illness threatened to wreak havoc on companies. While nearly all industries have had to work to adapt to the rapidly-spreading illness, the global health field has had their work cut out for them. Currently, many of those companies are experiencing or anticipating work stoppages due to COVID-19.

1. RA & Quality Control: Document Authentication Backlog

Document authentication is an often overlooked component of regulatory affairs in the global trade life cycle. In mid-March, embassies began to close, or run on minimal staffing. Now, this created an immense problem for regulated goods headed to Non-Hague countries, as embassy legalization is necessary to export and sell in those destinations. While finalized products face this issue, products on an earlier bend of the quality control cycle risk developmental delays. With social distancing in place and many employees now remote, review cycles and timelines for products have been impacted.

2. FDA Overriding Supply Chain Security Requirements

With the intent of combatting COVID-19 and related illnesses, the FDA issued guidance detailing exclusions and exemptions to certain requirements under the Drug Supply Chain Security Act, due to the urgency of COVID-19 by the end of April.

To keep things moving forward, the FDA has been doing all it can to ensure Med/BioTech companies are able to respond to the rapidly evolving battle against COVID. The FDA published a nine page guidelines document on COVID, and explained their exemptions under the DSCSA. Download the full guidelines from FDA here.

“Under the DSCSA, specific activities are automatically excluded from certain DSCSA requirements upon the declaration of a public health emergency.”

FDA

3. EU MDR Postponed to May 2021

The most massive impact on the industry has been the postponement of the EU’s Medical Device Regulations, introduced in 2017 and originally set to launch in May of 2020. With Notified Bodies already overwhelmed, the delays brought on by COVID forced a delay into 2021.Read our EU MDR updates here.

International Business Map

Notified Bodies Update

Even though the EU MDR was postponed until May 2021, the dwindled-down list of Notified Bodies suggests Regulatory Affairs professionals might not want to kick the can too far down the road.

For those looking at the upcoming IVDR, the situation is even bleaker. The IVDR has not yet been postponed, still facing a May 2022 effective date.

“…with only three notified bodies designated against the IVDR so far, potential delays in further designations because of COVID-19 and social distancing could be a real problem for a diagnostics industry that has been preventing from moving towards compliance when there are so many unfinished structures and documents”

@MedtechAmanda

To search the database of designated NBs on NANDO’s website, click here.

Read our updates on EU MDR by clicking here.

Updates on the EUMDR

In response to the COVID-19 pandemic, EU regulators proposed a one-year delay on the new EU MDR, to May 2021.

The EU MDR Date of Application has officially been extended until May 2021. While most Regulatory Affairs and Quality Control professionals are rejoicing in this push-back, keep the ball rolling on meeting new MDR compliance. Those scrambling to review their products’ compliance may be able to exhale, but the race to completion is still on.

In 2017, EU came out with the new MDR, that would go into effect in 2020. Since then, medical device manufacturers have been tasked with determining which of their products need to be re-registered with participating Notified Bodies, in order to meet the new regulations for export in the EU. However, this posed a new problem for RA professionals.

The once lengthy list of Notified Bodies has now dwindled to only a handful. This poses a great problem for many manufacturers as Notified Bodies become more and more overwhelmed with products to register.

Europe’s New Medical Devices Regulations 2017/745(MDR) deadline is finally here!

European Union Medical Device Regulation 2017/745 deadline approaches on May 26, 2020. Medical device companies must comply with the new regulations to maintain market access and mitigate risk.

Medical devices and implantable objects have not faced the high level of regulation the public might expect. This is beginning to change. The European Commission has deemed regulations passed in the 1990s insufficient, and with the desire to strengthen legislation for public safety, the new European Union (EU) Medical Device Regulation (MDR) 2017/745 was born. The EU MDR, which takes into consideration technological and scientific progress made in the last 20 years, will increase the amount of data required to put medical devices on the market. This includes items that serve cosmetic purposes, which were previously out of scope.

What is EU MDR?

The EU MDR was first proposed in September 2012, and accompanied by a separate, complementary regulation targeting in-vitro devices. These regulations were developed to increase the safety of medical devices for the general public, as well as improve traceability and legal certainty. Regulators devised the EU MDR because the existing regulation, the EU Medical Device Directive (MDD), was outdated and provided insufficient standards for maintaining safe and properly-functioning medical devices. The regulation entered into force on May 25, 2017, with a transition period for manufacturers that will continue until May 26, 2020.

Currently, there are 500,000 existing, registered medical devices. The majority — 314,000 — will need to be re-certified under the EU MDR in order to maintain market access.

EU MDR NEW RULES HIGHLIGHTS FOR MEDICAL DEVICE MANUFACTURER’S
  • Manufacturers will be able to register a device once at the EU level, instead of having to go through multiple registration procedures.
  • Clinical trials taking place in more than one EU member state will be subject to a single coordinated assessment instead of multiple national assessments.
  • The European database will expand to contain extensive information on medical devices, with most made publicly available.
  • Implant cards will include more information for patients
  • There will be a financial plan for patient compensation in cases where people have been harmed by medical devices.
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