Improving the Concept of Medication Vending Machine
in the Light of COVID-19 and other Pandemics
Dragan S. Jankovic1, Aleksandar M. Milenkovic2 and Andjelija I. Djordjevic3
Abstract – Pandemics are usually followed by a large number
of infected people, enormous number of critical patients and
unavoidable fatal outcomes. If the disease is transmitted by
contact, one of the most important measures for preventing the
spread of the disease is social distancing. Ensuring social
distancing is one of the most difficult tasks of the governments of
countries during the pandemic. It has been shown in practice
that any measure or way to increase social distance significantly
reduces the number of victims and shortens the duration of the
pandemic. This paper proposes a modification of the existing
concept of a vending machine for distributing drugs (medication
vending machines – MVM), which would enable better social
distancing in the case of pandemics/epidemics, such as the
current COVID-19 pandemic. The proposed modification is
adapted to the healthcare system organization that exists in the
Republic of Serbia and can be implemented in similar health
care systems, such as in the neighboring countries (Western
Balkan countries).
Keywords – Medication vending machine, COVID-19,
Pandemic, Social distancing, Smart city.
I. INTRODUCTION
Vending machines are widely used in many domains
around the world, such as a vending machine for food, drinks,
cigarettes, newspapers, etc. They started a long time ago. The
first vending machine was the coin-operated machine for holy
water dispensing constructed in 17th century by Hero of
Alexandria, Greek mathematician and engineer from
Alexandria [1].
The first modern coin-operated vending machines were
introduced in London, England in the early 1880s, dispensing
postcards. The machine was invented by Percival Everitt in
1883 and soon became a widespread feature at railway
stations and post offices, dispensing envelopes, postcards, and
notepaper. The Sweetmeat Automatic Delivery Company was
founded in 1887 in England as the first company to deal
primarily with the installation and maintenance of vending
machines. In 1893, Stollwerck, a German chocolate
manufacturer, was selling its chocolate in 15,000 vending
machines. It set up separate companies in various territories to
manufacture vending machines to sell not just chocolate, but
cigarettes, matches, chewing gum and soap products [2].
1Dragan S. Jankovic is with University of Nis, Faculty of
Electronic Engineering, Aleksandra Medvedeva 14, 18000 Nis,
Serbia, E-mail: dragan.jankovic@elfak.ni.ac.rs
2Aleksandar M. Milenkovic is with University of Nis, Faculty of
Electronic Engineering, Aleksandra Medvedeva 14, 18000 Nis,
Serbia, E-mail: aleksandar.milenkovic@elfak.ni.ac.rs
3Andjelija I. Djordjevic is with University of Nis, Faculty of
Electronic Engineering, Aleksandra Medvedeva 14, 18000 Nis,
Serbia, E-mail: andjelija.djordjevic@elfak.ni.ac.rs
42
© IEEE 2020. This article is free to access and download, along with rights for full text and data mining, re-use and analysis
The first vending machine in the US was built in 1888 by
the Thomas Adams Gum Company [3] selling gum on New
York City train platforms. The idea of adding games to these
machines as a further incentive to buy came in 1897 when the
Pulver Manufacturing Company added small figures, which
would move around whenever somebody bought some gum
from their machines. This idea spawned a whole new type of
mechanical device known as the "trade stimulators".
One of the challenging areas of using a vending machine is
the pharmacy. There are examples of medicine vending
machines (MVM) which are used in the last ten years in
different countries. The drug vending machines have been
used in many countries for the last ten years (US, Canada,
UK, Switzerland, and South Africa).
Despite all current usage of medicine vending machine, we
cannot say that they are widely used and that all potential
which they offer is appropriately and adequately exploited.
There are restrictions to the list of available drugs which is
distributed by means of drug vending machines. Usually in
this way painkillers, oral contraceptives (“morning after pill”),
baby food, etc. are distributed.
There are different types of MVM but more or less they
have the same set of components and supported
functionalities. In [4] is considered one variant of MVM. The
major MVM components are: a scanner to take the input from
a user, a system that includes servo motors for dispensing the
medication, large storage space to store the pills, sensors to
detect the motion of pills, an inventory monitoring system to
keep track of the storage, an industrial standard vertical foam
fill machine to pack the medication separately and a non-
contact laser inkjet printer to print the description which
includes the time at which the medicine must be taken. The
inventory monitoring system also keeps track of the expiry
date of each batch of medicine and sends alert to refill the
storage when the pills run out. It also holds an inbuilt system
to receive money from the user for the drugs that are
dispensed. All these systems are monitored by a central
microprocessor, which is programmed to receive input from
the user via the scanner and to actuate and control all the
necessary components required to dispense the medication
requested by the user.
Different realization of MVM offers a different realization
of some parts of MVM, for example payment system (coins,
banknote, pay card, e-Banking, etc.). Therefore, it is not
surprising that the price of some MVM is only around 1000
euros.
There are different stories of MVM use. In 2014 Arizona
State University has approved InstyMed machines on its
campus. After the drug store at the health services facility in
Arizona State University was closed, school officials set to
 Fig. 1. Top 10 prescribed drugs at Health Center Nis
replace it with a vending machine for dispensing prescription
medication [5]. The InstyMed sending machine was available
to students and university employees with approved
prescription which could be used during the next month.
Customers have a voucher with unique ID information and a
24-hour-only code that can transfer over a secure connection
from the prescription doctor to the machine.
A very interesting real-life story in COVID-19 times comes
from Vancouver [6]. The opioid epidemic, which caused the
declaration of public health emergency in Vancouver four
years ago, is made worse by the COVID-19 pandemic. It is a
crisis on top of a crisis. The usual harm-reduction approach, a
designated location where drugs can be taken with oversight
by first aid-trained staff, is problematic. Such sites constitute a
public gathering place and have been closed in order to avoid
public gatherings. The illegal drug supply is getting more
expensive and less predictable. Overdose deaths still happen
often. MySafe, Dispension Industries’ opioid-dispensing
ATM, debuted in Vancouver in December 2019 as part of
Tyndall’s plan to replace risky street drugs with safe,
pharmaceutical-grade opioids and reduce the staggering rate
of overdoses. About a dozen patients use the machine. All
report an improved quality of life and less involvement in the
dangerous street activities that used to pay for their habit.
Previously described cases show that MVM can have a very
good perspective and there are a set of reasons to use them.
But it is the fact that today’s potential of MVM is not well
exploited. There are several reasons. Some of them will be
discussed in the next chapter. It is quite clear that for the
expansion of MVM use some concepts of MVM should be
changed and adapted to a concrete scenario of use.
One modification we proposed in this paper inspired by the
actual COVID-19 pandemic and effort of all countries to
reduce virus SARS-CoV-2 [7] expansion by providing better
social distancing as one of the most efficient activities in the
suppression of the spread of an epidemic.
43
The proposed use of MVM can be considered as one of the
services provided by smart cities, because the smart city
concept includes improvements in health-care domain too [8].
II. REASONS AGAINST USING MVM
There are many obstacles and open-ended issues that have
prevented the mass use of medication vending machines.
Some of them are universal while some are specific to some
country or region, for example different law regulations. We
will number some of them. It is the fact that the number of
medications is huge and that it is not possible to make it
available through the vending machines. So, medication
vending machines can be used for a restricted amount of
medications. In many cases patients ask a pharmacist for some
explanation therefore, a simple MVM cannot cover these
cases and patients should request assistance directly at the
pharmacy, where the staff is available, instead of using MVM.
There are different models of paying for medications. It
differs from country to country. For example, in the Republic
of Serbia for a huge number of medications patients should
pay only part of price or nothing, while for others they should
pay full price. Therefore, MVM should support different
pricing/paying models. For most medications, patients must
have an adequate prescription. So, MVM should be able to
“read” prescriptions and verify a patient’s request. Of course,
there are other practical open questions: where to install
MVM (near a pharmacy or not), the capacity of MVM,
security (especially if there are narcotics), how and when to
add new medications in a machine, etc.
III. COVID-19 AND EPIDEMICS – NEW CHANCE FOR
MEDICATIONS VENDING MACHINES
The emergence and rapid expansion of major epidemics
have an important influence on the daily lives of people
through changing health, economic, working style, social and
political routines. During outbreaks, especially those with a
pandemic character, a set of key activities [9] which are
updated with COVID-19 strategy [10] have been identified
whose strict implementation has an impact on the reduction of
a number of infected people and suppression of the spread of
an epidemic. One of the most important activities is
movement reduction and social distancing [11] (decreasing
the number of possible contacts) especially for vulnerable
groups (elderly people, chronic patients) [12]. It is quite clear
that health facilities and pharmacies are high-risk places in
relation to the possibility of infection with the virus,
especially if the virus is transmitted by droplets i.e. by air such
as SARS-CoV-2 virus. Therefore, the need for people to come
to pharmacies should be reduced, i.e. they should be allowed
to take their medications without entering pharmacies. This
fact again puts the focus on MVM but it is clear that the
existing concept and implementations of vending machines
must undergo significant modification and become part of the
health care system, and not just independent devices that
potentially reduce the cost of dispensing some drugs.
One of the limitations of MVM is their capacity, because it
is not possible to store all existing medicines. It is quite clear
if we have in mind that the number of medications on the
Republic Fund of Health Insurance (RFZO) list in the
Republic of Serbia is higher than 3966 while the capacity of a
machine is less than 200 different kinds of medications.
Therefore, MVM could be modified in direction to provide
only the most frequently prescribed medications. The
drawback of this approach is the fact that usually one visit
results in more than one prescription i.e. more prescribed
medications. That means that patient will get prescribed
medications from MVM only if all prescribed medications are
on the list of most frequently prescribed medications.
Otherwise, the patient again should go to the pharmacy to get
medications which are not on the list of the most frequently
prescribed medications.
Fig. 1 shows top-ten medications prescribed in the Health
Center Nis. We can see that in top-ten medications we have
medications for different diagnoses, but also different
medications used for the same illness (Tensec and Concor are
used for heart illness as well as Binevol which is dominantly
used for hypertension). Practically, that means that a huge
number of medications will not be completely on this list.
So, we must modify MVM in a different way. We propose
a modification of MVM in the way described in the rest of the
paper.
IV. IMPROVED CONCEPT OF MVM
Improved MVM should solve most of the above-mentioned
problems. So, our proposal for improvements follows.
The concept of MVM as a machine for purchasing
medications from a set of medications available through
machine should be changed to machine for obtaining
medications prescribed by general practitioners to the concrete
patient. In this scenario, the patient has a prescription for
some medications given by a general practitioner in some
healthcare institution (HCI) and it is registered in the medical
information system (MIS) of HCI. All prescription data
registered in MIS are sent to the central state repository. This
information should be available to a pharmacy that has an
44
MVM placed outside of the pharmacy. Based on some
identification method (ID, password, QR code at
prescriptions, etc.) the patient gets medications from the
machine (which is previously prepared by a person from the
pharmacy). The activity diagram for this scenario is shown in
Fig. 2. A small drawback of this concept is the time delay
needed until medications become available to the patient from
the time when it notices which of various medications MVM
will use.
Based on proposed concepts MVM should be able to:
1. Receive a patient request – there are two scenarios: patient
sends QR code from the prescription to the concrete
pharmacy which has MVM; a health-care institution is
connected with pharmacies indirectly via RFZO and all
prescriptions are available to pharmacies;
2. To provide a correct price according to each separate
request (the price of a medication is not same for all
patients because some patients have a reduction in price
(different type of health insurance); to provide payment by
coins, banknote (it must return the change) and credit
cards or e-Banking;
3. To provide a required medication within a reasonable time
from the arrival of the request and inform the patient about
it (or to provide medication within a predetermined time,
for example 1 hour);
4. To withdraw medications from MVM if they have not
been taken by the patient within the appropriate time
period (for example 24 hours) and to remove the requests;
5. To note the number of empty slots in machine i.e.
readiness to accept medication for new patients.
Fig. 2. Sequence diagram
Since very often patients ask the pharmacist for instructions
for the use of the drug (each prescription has a part related to
the way of use and daily doses and frequency), a function
which can be added to the MVM, where MVM is printing a
short instruction for the use of the medication at the request of
the patient. It is similar with the interaction with other
medications and contraindications. On the other hand, these
services can be independent of MVM and realized as a part of
the MIS, or as a part of the pharmaceutical information system
(PIS).
The proposed concept of using MVM implies that the
device is located within the pharmacy and is available to
patients outside the pharmacy.
V. POSSIBILITY AND PERSPECTIVE OF USING MVM
IN SERBIA
The proposed concept of MVM can be applied fully in the
Republic of Serbia. The facts supporting this claim are as
follows. The healthcare system of the Republic of Serbia is
mainly based of state healthcare institutions divided into
three-levels: primary (infirmaries which are spread throughout
he whole country), secondary (hospitals which support more
specialties), and tertiary – high specialized hospitals, usually
as a part of clinical centers). Patients can get prescriptions
only from the primary health level institution. On the other
hand, all primary health level institutions have MIS which
send data about all prescriptions to the central system (e-
Recept in RFZO) which is connected with pharmacies (Fig.
3). So, when patients wish to get medications they should go
to any pharmacy, identify themselves (each patient has the
health-care card and unique health-care number (LBO)) and
pay for medications. A special case is provided for chronic
patients who have prescriptions for a 6-month-long therapy
(which is extended in COVID-19 pandemic period to 9
months). So, in this period chronic patients should go to the
general practitioner only once and repeat it after 6 or 9
months. It is an important feature that directly reduces the
number of healthcare institution visits and reduces the chance
that the patient will be infected with the virus during the visit
[11]. Information from pharmacies go to the RFZO
centralized system i.e. for each prescription RFZO has
information when medications are taken by the patient.
Fig. 3. Health-care system in Republic of Serbia
VI. CONCLUSION
This paper proposes a modification of the MVM that should
affect the level of social distancing, which is one of the main
measures in preventing the spread of pandemics such as
COVID-19. The proposed modification can have significant
success in the Republic of Serbia if we have in mind that all
primary health care institutions have adequate MIS connected
with RFZO while RFZO is connected with all state
pharmacies. So, there are real conditions for installing MVM
in pharmacies where patients can get prescribed medicines
without entering pharmacies which will significantly reduce
social contacts inside pharmacies and reduce the spread of the
virus.
The proposed modification of MVM concept is adapted to
the healthcare system organization in the Republic of Serbia,
45
however, it can be used in all countries with a similar
healthcare system, such asex-YU countries.
Besides social distancing there are also some other positive
effects: patients can get medication 24/7, pharmacies can
work more efficiently (inexpensive distribution of medication
and increased number of patients who can be served).
In general, the use of proposed MVM can be considered as
one of highly important services (in health-care domain)
provided by smart cities, because the health of citizens is the
most important goal for all governments.
ACKNOWLEDGEMENT
This work has been supported by the Ministry of Education,
Science and Technological Development of the Republic of
Serbia.
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