6th Global Meeting on Implementing New and Under-utilized Vaccines, 15-17 May 2012
Workgroup 4 - Supply Chain and Logistics - Country Preparedness for NUVI
Background
As the new wave of pneumococcal and rotavirus vaccine introductions is well on its way, traditional logistics coping mechanisms have reached their limits. In 2011, up to2.8 million doses of vaccines may have been lost in GAVI-supported countries in AFR because of cold chain & logistics (CCL) challenges. Of these, more than 600,000 doses were of the GAVI-funded pentavalent vaccine, representing a loss of approximately USD 1.8 million . Unless these bottlenecks are addressed, the financial loss of vaccine will keep growing with pneumococcal and rotavirus.
Main topics of Discussion
Due to limited supply and increasing cost per dose, supply chain inefficiencies can no longer be mitigated by keeping the stock levels high. This calls for new strategies to address stock management systems constraints in the short and medium term.
As GAVI ISS cash support dries up, there are fewer options for funding CCL needs. Over time the investment in health logistics has fallen behind investments in new vaccines. With just 4% of GAVI HSS funds estimated as being invested in vaccine cold chains, non GAVI support for CCL is urgently required. While incremental ad hoc ‘fixes’ of national supply chains are often inefficient, the structural imbalance is putting immunization programmes at risk.
To address the widening gap between existing systems capacity and pressures from new vaccine introductions, there is a need for transformational change in the partners’ approach to funding and the countries’ approach to managing vaccine logistics.
Recommendations
The workgroup concluded with the Call for Action: ‘Move beyond “business as usual”, through predictable funding, supply chain optimization, better information systems and professionalization’, comprising the following key messages:
- A whole-systems approach to funding should be adopted to mainstream balanced investments in supply infrastructure. Pursuit of successful introductions of new vaccines should be systematically anchored to the strength of national supply chain systems. ‘Bundling’ of investment in vaccines & delivery systems is a recommended way forward. Leveraging national legislation for the purpose (akin to ‘vaccine laws’ in a number of PAHO countries) should be promoted. GAVI is called upon to fund CCL as part of its NUVI window of support.
- While the need for continuous scaled-up investment in CCL is urgent, countries must adopt a new structural approach towards CCL management. CCL systems should be optimized to deliver better performance. The CCL scale-up effort presents an opportunity for optimal systems re-design. New modeling tools enable countries to identify and eliminate redundant distribution levels and optimize vaccine and ‘dry stock’ distribution costs. Whole life-cycle costing approaches should inform prudent cold chain equipment choices. As the cost of fossil fuels keep rising and given the unreliable performance of absorption-based equipment, fuel & petrol-based equipment should be phased out in favour of new supply chain & logistics technologies. Technical assistance to countries in achieving the optimal design of the supply chain, should be scaled-up and funded accordingly. Meanwhile, national leadership remains essential in bridging the funding and accountability fragmentation that impede the whole-systems approach from realizing its full benefits.
- Bottom-up real-time monitoring of supply chain performance in terms of vaccine availability, utilization and quality, is a practical means to improve CCL systems. Active temperature monitoring based on alarms should be implemented throughout the supply chain. Manual stock management should be phased out at national level by the end of 2013 in favour of computerized systems. Key stock management indicators should be reported from lower levels of the systems alongside monthly coverage reports.
- Professionalization of supply chain management across the health sector is a prerequisite for systems sustainability. There is an urgent need for mechanisms to encourage retention of staff with supply chain responsibility including through promotion of global policies to guide national human resources rules, training, certification and classification of healthcare personnel with supply chain responsibility. Stakeholders should scale-up their support to the 2020 Optimize vision tenet 5, ‘People that deliver’ consortium for health logistics, promotion of a francophone network of logisticians, and the Logivac project.
- Partners should scale-up their effort to raise the public profile of routine immunization. There is a need for consistent public messaging that CCL is a bottleneck to delivery of essential vaccines, and that an overhaul of traditional approaches to logistics must happen now. GAVI should consider outreach and dissemination to the public to demonstrate their commitment and their investments in building a strong national health system.