Since the introduction of vaccines to the developing world in the 1970s, millions of deaths have been prevented globally. The reach of immunizations is only growing as new vaccines are becoming available and new technologies are improving access to vaccines and to the health system. One area that is receiving more and more needed attention is how vaccines are delivered to all health facilities particularly in hard-to-reach areas in low- and middle-income countries.
The latest Vaccine Journal Special Edition, Building Next Generation Immunization Supply Chains, was put together to raise awareness of the need for improved supply chain performance and highlight the opportunities and challenges we currently face.
When countries began setting up their immunization programs and supply chains, the supply chain would largely follow administrative tiers. To put that into context, if Amazon followed the same logic as the immunization programs of the 1970s, and you lived outside of Nashville, Tennessee, Amazon would ship your item from their national warehouse in Seattle, Washington, to possibly a regional warehouse in the south, and then on to their state capital warehouse in Nashville, TN. From there, it would go to your county warehouse that would then be responsible for delivering to your house. If you live just a few blocks from the next county over, closer to their warehouse, you would still have to receive your item from the warehouse in your county. That other county is the responsibility of a different driver, a different truck, and a different delivery service. No administrative lines are crossed.
That system is just not logical, cost-effective, or efficient. Just as Amazon is adapting traditional approaches to package delivery using new technology and innovative ideas, immunization supply chains managers should also be thinking about how to use new thinking to deliver more product, faster, and at a lower cost.
This article in the Vaccine Journal documents the process that two countries undertook to put logic back into their logistics through a redesign of their supply chain system. Both Benin and Mozambique used computer modeling to design and test a more efficient supply chain. Results of the demonstration projects showed that reducing a level of the supply chain improved the availability of vaccines at health facilities where children need them, improved cold chain performance to ensure vaccines are potent, and reduced the cost per dose of vaccines administered in children. Simply put, more kids in Benin and Mozambique now have access to life-saving vaccines.
As the article notes, a key driver of the improvements was country leadership and their willingness to question the status quo. Ministry of Health decision makers at both national and sub-national levels identified the inefficiencies in the original supply chain system and were committed to finding improvements.
Around the world, each country has a different context and should seek to find improvements in the immunization supply chain in different ways – some countries need significant changes such as reducing a layer of the supply chain like Benin and Mozambique did; others may look at only minor tweaks like changing delivery frequencies. But what is consistent across all countries is the need for leaders to commit to excellence and be willing to question the status quo.
We aren’t looking for Amazon Prime and delivery in an hour (although that would be nice). What is needed, though, is a reliable and efficient supply chain system that guarantees that all children can be immunized.