Immunisation supply chain

Credit: Gavi/2015/GMB Akash.

A PREREQUISITE FOR FULL, EQUITABLE COVERAGE

The immunisation supply chain encompasses all the people, activities, infrastructure, resources and planning necessary to ensure that vaccines stay safe and effective and reach the children who need them. Strong supply chains are a prerequisite to improving immunisation coverage and equity, and they contribute to reduced child mortality.

SAFEGUARDING VACCINE INVESTMENTS

Gavi spends more than US$ 1 billion on vaccines every year. In 2017 alone, this investment catalysed an additional US$ 136 million in country co-financing. Supply chain improvements are critical to safeguarding these investments.

AN URGENT CHALLENGE

Immunisation supply chains of many countries were designed as EPI was being established 40 years ago. These resilient supply chains have allowed the world to reach over 85% of the world’s children who receive at least three doses of basic, routine infant vaccines.

Improvements have not kept pace with the massive increase in the value and quantity of vaccines that they now safeguard. Parts of these supply chains are even more outdated, unreliable or unequipped to “go the last mile”. Common challenges include old equipment, weak distribution systems, shortage of trained staff, and a lack of reliable data and comprehensive evaluations to facilitate concrete improvement plans. Yet improvements are more urgent than ever as vaccine volumes are expected to quadruple between 2010 and 2020.

THE VACCINE ALLIANCE SOLUTION

In 2015, a supply chain strategy was developed by Vaccine Alliance partners including Gavi, WHO, UNICEF and the Bill & Melinda Gates Foundation with input from Gavi-supported countries and other partner organisations. It covers the supply chain from end to end, focusing particularly on the country level.

Improving the supply chain is a long-term undertaking, which complements Gavi’s broader health system strengthening efforts. It does this by supporting countries to deliver vaccines in an equitable and timely manner as part of a comprehensive package of primary healthcare services.

GAVI’S SUPPLY CHAIN SUPPORT TO COUNTRIES

Gavi supports countries’ efforts to strengthen their supply chains by:

• leveraging financial support and evaluation mechanisms;
• ensuring adequate technical support;
• facilitating the alignment of work and investments from a range of organisations;
• developing relevant tools and resources;
• collaborating with equipment manufacturers and the private sector, including through market shaping; and
• supporting relevant policy changes.

Gavi supports countries to make improvements across five interconnected components of the immunisation supply chain, known as the “five fundamentals”. We make sure our investments in this area work in synergy with those of other partners, such as the Global Fund, USAID and the Bill & Melinda Gates Foundation.

1. SUPPLY CHAIN LEADERSHIP

Well-functioning supply chains need dedicated and competent leaders. They also rely on adequate numbers of skilled, motivated and accountable personnel at all levels of the health system. The Vaccine Alliance provides focused technical assistance, tools and training to help countries strengthen the capacity of their supply chain managers.

2. CONTINUOUS IMPROVEMENT PLANNING

Supply chains are dynamic systems that must be continuously monitored, managed and improved. The comprehensive effective vaccine management (EVM) approach provides a structure for continuous improvement planning. It is integrated within the broader national health management and monitored yearly. The Vaccine Alliance provides guidance and technical assistance to countries as they engage in this process.

3. SUPPLY CHAIN DATA FOR MANAGEMENT

Supply chain personnel rely on reliable and relevant data to manage crucial aspects of vaccine stock management, quality, storage and transport. The Vaccine Alliance offers guidance and technical assistance to help countries tailor data solutions and personnel capacities to their needs, and to upgrade information management systems and integrate them within the broader national health system.

4. COLD CHAIN EQUIPMENT MANAGEMENT

A complex and expanding portfolio of vaccines needs to be stored in reliable, well-maintained and cost-effective cold chain equipment (CCE). The Vaccine Alliance provides guidance, technical assistance and financial support to countries to help them better plan for, select, install and manage their CCE.

We also work to shape the market for CCE by accelerating innovation and helping to lower prices over time. Gavi has created an innovative mechanism to shape the cold chain equipment market and incentivise countries to transition to more reliable cost effective and sustainable cold chain equipment. In addition, we support studies that help improve temperature monitoring technologies – a crucial component in protecting vaccine potency and reducing wastage.

5. SUPPLY CHAIN SYSTEM DESIGN

Evidence-based and tailored improvements in supply chain system design can help countries achieve better supply chain performance and greater health impact. System design improvements can also reduce risks, improve efficiency and extend the reach of the supply chain.

The Vaccine Alliance collaborates with public and private sector partners to provide technical support to countries that embark on system redesign projects.

Effective vaccine management (EVM) data helps countries to guide and prioritise investments in strengthening supply chains, from the national level down to health facilities and communities.

SUPPLY CHAIN PERFORMANCE

In 2017, Gavi-supported countries achieved an average EVM score of 68%, up from 67% in 2016. It is clear that countries and partners have made important strides towards implementing our supply chain strategy:

• By the end of 2017, 34 countries had been approved for funding for more than 66,000 new, energy-efficient refrigerators under our cold chain equipment optimisation platform.
• Supply chain leaders in 15 Gavi-supported countries met competency requirements, having completed the STEP leadership programme to build management skills and competencies.
• 54 countries have conducted at least two supply chain management EVM assessments, 35 of which demonstrated improvements.
• More than 30 countries are using various information systems to monitor their stock and manage their cold chain inventories.
• System design analyses had been initiated in 11 countries by the end of 2017; 7 of these were already implementing their findings to improve the efficiency of their supply chains.

EVM-DRIVEN IMPROVEMENTS

Pakistan: leadership, accountability and better equipment

Pakistan has established supply chain working groups at both federal and provincial levels of government, and made them fully accountable for monitoring and implementing supply chain improvement plans. UNICEF provides capacity building support.

The working groups and other stakeholders now have access to better data and real-time stock information thanks to improvements in vaccine logistics management information systems, guided by private sector partners. This has already led to a successful review of cold chain equipment inventory and needs, and the subsequent approval of Pakistan’s application for support through the Gavi cold chain equipment optimisation platform.

Mozambique: data, modernisation and system redesign

EVM data suggested significant gaps in Mozambique’s cold chain equipment. As a result, the country is using Gavi health system strengthening funding to invest in high-performing cold chain solutions that can carry vaccines over the last mile. Mozambique is also rolling out remote temperature monitoring devices. These help technicians and logisticians ensure that cold chain equipment can function continuously, reducing the risk of damaged and wasted vaccines.

With support from Village Reach, the country has rolled out a nationwide project to redesign the supply chain at the provincial level. The initiative is overseen by a national committee funded through the Gavi partners’ engagement framework.

The Democratic Republic of the Congo: Improvement planning and redesign

Using Gavi HSS funds, the Democratic Republic of the Congo’s (DRC’s) Ministry of Health is preparing to build a new warehouse that will provide storage for vaccines and immunisation products alongside products for other public health programmes. This will help to strengthen integrated health delivery.

Learnings from the redesign work have also helped to inform DRCs selection of more than 2,500 new high-performing cold chain devices procured with Gavi HSS funds. Collaboration with the private sector helped ensure that all of the devices were installed in just 10 months – a record achievement.

PARTNERSHIPS AND INNOVATION

Creating better leaders

Since 2015, Gavi has partnered with the global logistics company United Parcel Service (UPS) and the International Federation of Pharmaceutical Wholesalers (IFPW) among others, to roll out the Strategic Training Executive Programme (STEP) for supply chain managers.

Read about the STEP programme in Rwanda  

Read about the STEP programme in Benin  

In addition to IFPW’s support to STEP, the industry association has worked to launch the East African Community’s Centre of Excellence in Rwanda, through direct funding and managerial support and has committed to support the centre up to 2019. In addition, IFPW’s support has provided scholarships and technical assistance to the LOGIVAC Centre in Benin The partnership continues to support the fundamental pillar of Alliance Supply Chain strategy, building capacity at all levels of the supply chain.

Going the last mile

A partnership between Gavi, UPS and the Government of Rwanda leverages robotics expertise from the company Zipline. The partnership uses unmanned aerial vehicles, or drones, developed by Zipline to overcome barriers to last-mile delivery of critical health products – eventually including vaccines. Read more  

Efficient logistics

The Government of Kenya and Gavi are partnering with global logistics company DHL to develop and test a “transport support hub” aimed at improving the country’s vaccine supply chain logistics. The hub provides end-to-end visibility of the supply chain, helping to ensure maximum efficiency in the shipment and delivery of goods and products.

This solution could significantly reduce vaccine wastage and remove warehousing and transport inefficiencies. If expanded to other Gavi-supported countries, it could potentially save millions of dollars across supply chains in coming years.

Harnessing data for decision making

Through the Innovation for Uptake, Scale and Equity in Immunisation (INFUSE) initiative, Gavi is partnering with Nexleaf Analytics and Google.com to help countries modernise their cold chains. The "intelligent maintenance and procurement tool", developed by Nexleaf, evaluates refrigerator temperature data collected by remote temperature monitoring and maintenance devices across the cold chain. It has the potential to help countries make better, data-driven decisions about cold chain equipment, as well as facilitates long-term maintenance strategies. Read more