# Blockchain for the Healthcare Supply Chain: A Systematic Literature Review
## 4 Discussion
### Drugs and Vaccines  
The traceability of drugs and vaccines is critical in healthcare, as counterfeited products pose unacceptable health hazards for patients [10]. This review found that the topic of the traceability of drugs and vaccines was the most widely explored in the selected articles, comprising 61% of the studies. However, only one real-world application was found in this review [41], which demonstrated the potential of blockchain technology to lower the risk of purchasing fraudulent herbal materials from upstream stakeholders and to improve data sharing and collaboration within the manufacturing and SC of healthcare products.  
Blockchain technology holds promise for providing transparency, privacy, and accountability in the SCs of healthcare products, particularly in low- and middle-income countries, where the failure rate of drugs is estimated to be 10% [10]. This is a pressing issue, as the use of substandard and falsified antibiotics has been linked to excess pneumonia deaths in these countries [63; 64].  
These data highlight the urgent need to address this problem, since these deaths are avoidable. The solution by [PERSON] et al. [32] provides, thanks to a decentralized system, a transparent flow of medicine between entities within an SC. Entities such as hospitals, pharmacies, and government institutions can trace healthcare products back to ensure integrity and avoid counterfeit drugs.  
It must be noticed that the COVID-19 pandemic and its vaccine rush strongly influenced the discourse on blockchain applications in SCHMs regarding vaccines, as confirmed by the fact that the entire set of articles focused on vaccines was published between 2021 and 2022. [PERSON] and colleagues [31], alongside [PERSON] [47] and [PERSON] and colleagues [56], cited the pandemic as a stressor for SCHMs and proposed a blockchain-based solution for digital SCs for a healthcare monitoring system. This technological solution could contribute to effective vaccine distribution and management. Specifically, [PERSON] et al. [31] listed the several potential fragilities of a vaccine SC that could be mitigated by using blockchain technology. Among those fragilities, manufacturers could produce unqualified vaccines, intermediate suppliers could collude to sell and use fake vaccines, and vaccine transportation could fail to comply with strict cold-chain requirements [31]. Currently, traditional SCHMs rely on centralized systems to manage vaccine supervision [31]. Given the fact that these systems do not allow for secure and immutable transactions among keyholders, it is not easy to unconditionally trust an entire SC. Since a central characteristic of blockchain is decentralization--meaning that no single user can control it [8]--this technology can be used to build trustworthy environments with high transparency and security. Unfortunately, no articles tested this approach in real case studies, but all three of them [31; 47; 56] endorsed the implementation of blockchain technology to ensure data integrity and security.  
While promising, the adoption of blockchain for vaccine SCs requires a significant change in organizational structure and policies, as well as the implementation of a large-scale Internet of Things infrastructure and technical expertise [65; 66; 67].