The United States government has identified the health care sector as part of the critical infrastructure for homeland security to protect citizens against health risks arising from terrorism, natural disasters, and epidemics. Citizens also have expectations about the role that health care plays in enjoying a good quality of life, by providing response systems to handle emergencies and other illness situations adequately. Among the systems required to support desired performance levels is a

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... st and resilient pharmaceutical supply chain that is free of disruption. Shortages of drugs place undue pressure on healthcare providers to devise alternative approaches to administer patient care. With climate change expected to result in increasingly severe weather patterns in the future, it is critical that logistics engineers understand the impact that a catastrophic weather event could have on supply chain disruption to facilitate the design of supply systems that are robust and resilient. This study investigates the main causal and intermediate events that led to risk propagation in, and disruption of, the U.S. pharmaceutical supply chain following Hurricane Maria. A causality Bayesian model is developed to depict linkages between risk events and quantify the associated cumulative risk. The quantification is further examined through different advanced techniques such as predictive inference reasoning and sensitivity analysis. The general interpretation of these analyses suggests that port resilience is imperative to pharmaceutical supply chain performance in the case of Puerto Rico.