In 2018, pharmaceutical distribution in Japan faced an unprecedented issue, a serious shortage of a critical antibiotic drug named Cefazolin. This shortage had been caused by unpredictable environmental regulation affecting the production of its ingredient in China. Supply of Cefazolin was completely disrupted. To make matters worse, it was difficult for drug manufactures to find alternative suppliers, because the Chinese company was the sole producer of this ingredient. Doctors and pharmacists were deeply concerned and they urgently requested the Government （Ministry of Health, Labor and Welfare, MHLW） to address this shortage. In March 2020, MHLW convened the expert meeting to examine and discuss how to address the problem. After several meetings, MHLW identified a list of some key drugs known as Anteikakuho Iyakuhin（key drugs whose supply requires special consideration） and proposed a program for monitoring and securing their supply chain in case of emergency.

This concept is based on supply chain management and shares same ideas with the “building resilient supply chain of specified critical products” articulated in Act on the Promotion of Ensuing National Security through Integrated Implementation of Economic Measures.

In 2020, a serious shortage of generic drugs occurred because some major generic manufactures failed to comply with GMP（Good Manufacturing Practice） and they were penalized. As a result, wholesalers, hospitals and pharmacies across Japan fell into confusion. After several expert meetings, MHLW began implementing measures to improve the quality management of generic manufacture and amended the Act on Pharmaceuticals and Medical Devices, and Medical Care Law to help secure and stabilize the pharmaceutical supply chain.

To build an efficient and stable supply chain, trade practices in distribution must be improved and modernized. Recently, there have been some reports of conflict between wholesalers and agents on price negotiation and payment collection for small pharmacies. Increasing number of pharmacies using these agents is placing a burden on wholesalersʼ operation. However, the business models of these agents remain largely unknown. Through further analysis, we aim to identify the ways to normalize trade practices in pharmaceutical distribution.

There has been a growing movement to reflect the voices of service users in the support service systems. Although there is some knowledge about environments that promote help-seeking behavior, no research has indicated the needs among young adults who could not seek help（poor help-seeking）despite requiring support. This study examines the environment desired by young adults with poor help-seeking toward supportive service systems.

We analyzed 206 responses from open data of a survey of young residents aged 18-39 conducted by the Komae city, Tokyo. Respondents were classified into three groups based on the presence or absence of burdens and related help-seeking behavior: the non-difficult group（50 respondents）, the help-seeking behavior group（91 respondents）, and the poor help-seeking group（64 respondents）. Sociodemographic factors and life satisfaction were compared by chi-squared tests and t-tests. Logistic regression analysis was conducted to examine the responses of human and environmental resources for facilitating help-seeking behaviors in each group.

One in two to three individuals classified into poor help-seeking group reported positive response（Yes）to some potential human and environmental resources for facilitating help-seeking behaviors such as anonymity, acceptable characteristics of service provider to consult their distress, and availability of service. However, lower rates of the positive response, lower life satisfaction, and more financial problems were found in poor help-seeking group than in other groups. It was also shown that most of reasons for the poor help-seeking were due to not knowing where to seek help.

The results suggest that young adults with poor help-seeking is unable to express their needs despite requiring support. Expanding the availability of remote service through SNS and developing the support system considering disparities related to financial problems and health literacy would be helpful for facilitating help-seeking behavior among poor help-seeking group.