A new think piece from Transaid, an international transport NGO, explores the challenges of distributing the COVID-19 vaccine to people in Sub-Saharan Africa and proposes some ways to deal with such unprecedented logistical issues.
Bernard Obika, Team Leader of the High-Volume Transport Programme funded by UK Aid commented; ‘There is a consensus that the pandemic has exposed the fragility of transport systems and that they are not as resilient we’d thought. It is by no means clear how the transport system in the most rural areas will respond to the additional demands that will be placed on it by the vaccine distribution.’
Most of Africa is likely to receive vaccine supplies through the COVAX initiative, led by the Global Allied Vaccine Initiative (GAVI), the World Health Organisation (WHO) and others who are working to ensure vaccines are available to low-income countries (LICs).
Aside from the difficulties in gaining public trust for vaccines, logistics and distribution issues loom large.
The WHO has found that not many African nations are ready to roll out a vaccination programme. Only 49% of African countries have identified the priority populations for vaccination and have plans in place to reach them, and 44% have co-ordination structures in place. Only 24% have adequate plans for resources and funding, 17% have data collection and monitoring tools ready, and just 12% have plans to communicate with communities to build trust and drive demand for immunisation.
Transportation is at the heart of the problem due to the importance of maintaining a cold chain, re-supplying communities with repeat doses or different vaccines and the perennial issues associated with the ‘last mile’.
The cold chain is critical
Africa will likely receive a range of vaccines which need different storage and distribution models. All of them require a cold chain but the Pfizer vaccine requires an ultra-cold chain at some -70 to -80°C.
Vaccines must be kept cold on their journey into the countries (most likely by air), through to central medical stores, onwards to district hubs and to the communities. This is a real challenge in some parts of Sub-Saharan Africa where only 28% of health facilities are estimated to have access to reliable electricity or to refrigerated delivery vehicles.
Companies around the world are looking at a range of solutions such as dry ice cooled boxes with thermal sensors and investment in solar-panelled fridges etc. to responds to the likely surge in demand.
Multiple dosing complicates the situation still further
The need for multiple doses (taken several weeks apart) adds another layer of complexity to distribution and redistribution strategies. And, if new vaccine versions are developed to fight new variants, the possible recall of less-effective vaccines and the redistribution of new ones will present a significant logistical and supply chain challenge.
Emergency transport systems may be used to support the complex supply and re-supply efforts.
The ‘last mile’
Reaching individuals in communities – the so-called ‘last mile’ in the pharma supply chain is already a challenge in many parts of Africa. This is an especially pronounced problem for people in fragile states or those that do not have an official national identity.
Transaid has found that 84% of health facilities surveyed in rural Zambia in July 2020 were experiencing stock related issues that they attributed to COVID-19. And, to compound this issue, there may be a need for large scale household visits/mobile clinics for people unable to travel to health facilities and to avoid mass vaccination gatherings that may spread infection if not carefully managed.
Opportunity to strengthen the supply chain
Whilst there are huge challenges to COVID-19 vaccine distribution, there is also a golden opportunity to build forward better by strengthening resilience of the supply chain and the cold chain for pharma grade products.
Transaid identifies three ways to optimise success:
- Take a locally-led approach to response
Local community health workers have strong relationships with their communities which can help design distribution solutions that will work in practice – especially if they are informed by lessons from previously successful health initiatives. Africa is not new to mass vaccination programmes and there is considerable expertise to be harnessed. However, a vaccination programme of this scale will bring unprecedented challenges.
- Harness private sector partnerships to support Ministries of Health
Developing new partnerships with the private sector logistics service providers and supply chain partners is likely to be required. For example, Union Bancaire Privée (UBP) is already collaborating with Gavi and COVAX and several organisations are looking at the use of drones for last mile delivery where time is of the essence. Developing partnerships of all kinds will require careful co-ordination.
- Prepare for bottlenecks
It will be important to map out the logistics requirements and identify potential bottlenecks along the whole supply chain – from intermediate transport, intercontinental shipment, warehousing, downstream distribution, and final short-term storage at the point of use. The challenges may include supply/demand mismatch, allocations in-country, transportation into country, cold chain requirements, limited volumes on airplanes due to dry ice, storage facilities especially if the ultra-cold-chain is needed and issues associated with dispensing the vaccine.
Image credit: A community health volunteer cycling to provide emergency transport services to the community, Transaid/ Toby Madden