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No product, no program: The critical role of supply chains in closing the immunization gap

Thursday, 30th of March 2017

Vaccine

Volume 35, Issue 17, 19 April 2017, Pages 2101–2102

Editorial

No product, no program: The critical role of supply chains in closing the immunization gap ^☆

• Matshidiso Moeti
• Regional Director for Africa, World Health Organization, Brazzaville, Peoples Republic of Congo
• Robin Nandy
• Principal Advisor and Chief of Immunization, UNICEF, New York, NY, USA
• Seth Berkley
• CEO, Gavi, The Vaccine Alliance, Geneva, Switzerland
• Steve Davis
• President and CEO, PATH, Seattle, WA, USA
• Orin Levine^, 
• Director, Vaccine Delivery, Bill & Melinda Gates Foundation, Seattle, WA, USA

Available online 30 March 2017

http://dx.doi.org/10.1016/j.vaccine.2017.02.061

Thanks to decades of global investment in vaccine development and immunization programs, childhood vaccination now prevents 2–3 million deaths each year. Yet in 2015, an estimated 19.4 million infants worldwide had not been fully immunized, resulting in approximately 1.5 million preventable deaths [1]. To extend the benefits of immunization to all people by 2020, the 194 member states of the World Health Assembly committed in 2012 to an ambitious Global Vaccine Action Plan.

This commitment was made amid unprecedented growth in immunization programs. Immunization programs now deliver more doses of more vaccines to more people in more locations than ever before. Nevertheless, there are too many places in the world where vaccines are still not reaching the people who need them most. In addition, there are instances when vaccines are lost, damaged, or expired before they reach local health clinics or other points of use, hindering efforts to boost coverage. A renewed focus on next-generation supply chains that can safely and reliably manage, store, transport, and deliver vaccines to the point of use is vital to closing the immunization gap.

Immunization supply chains—the network of staff, equipment, vehicles, and data needed to get vaccines safely from the manufacturer to the people who need them—were first developed in the late 1970s with the launch of the Expanded Program on Immunization. They were designed to manage distribution of a small number of vaccines to a limited number of locations. Since then, the immunization program landscape has changed radically because of growth in the number of vaccines available, changes in storage requirements, increases in vaccine costs, and other factors. Between 2010 and 2020, for example, immunization services will require storage and transport capacity to manage four times the volume of vaccines [2]. Health workers will administer six times as many doses per person—including older children, adolescents, and adults—and in more settings. Storing and transporting a larger number of vaccines to more delivery points requires continuing to update supply chains accordingly.

Between 2011 and 2015, low- and middle-income countries had requested US$289 million from Gavi to update and strengthen their immunization supply chain systems, complemented by government and other sources of funding for supply chain improvements. Given the many competing budget priorities, finding new funding for further investment for this social good is particularly challenging. Yet the cost-effectiveness of investments is compelling: recent research suggests that for every dollar invested in childhood immunization, there is a return on investment of US$16 through savings in health care costs, wages, and productivity due to illness [3].

Reaching health workers in remote communities with the supplies needed for vaccination is challenging. It requires meticulous temperature control of vaccines during storage and transport, specialized cooling equipment, and logistical expertise to avoid breakdowns in delivery systems or cold chain equipment. However, the benefits of efficient and effective supply chains are substantial. Not only do such supply chains increase vaccine availability at the point of use and improve equity in coverage, but they also help to ensure the timely introduction of new vaccines and minimize waste of these public health assets.

As the articles in this special issue of Vaccine show, a number of innovations required to transform existing systems to next-generation supply chains are now known and ready for implementation at scale. They employ the latest refrigeration and monitoring technologies and reflect new strategies for transport, management, and data tracking.

“No product, no program” is a phrase commonly used by immunization program leaders, and it underscores the role of a strong supply chain in a successful health program. Closing the immunization gap is within our reach, but it will require targeted investments to build and strengthen immunization supply chains. Its time to build next-generation immunization supply chains that are thoughtfully designed and continuously re-evaluated to keep pace with the changing world of new vaccines, technologies, and health threats. Doing so will extend the benefits of immunization to everyone and help us achieve universal health coverage. National and global leaders can show their support by increasing their ongoing investments in supply chains and engaging partners in designing and implementing distribution systems with the characteristics needed for optimal performance. Together, we can bring the benefits of immunization to all.

References

1.  

• [1]
• WHO Fact Sheet on Immunization. Available at: <http://www.who.int/mediacentre/factsheets/fs378/en/>.
•  

1.  

• [2]
• World Health Organization. Immunization supply chain and logistics: a neglected but essential system for national immunization programmes. Call to Action. Geneva: WHO/IVB/14.05; 2014.
•  

1.  

• [3]
• S. Ozawa, S. Clark, A. Portnoy, S. Grewal, L. Brenzel, D. Walker
• Return on investment from childhood immunization in low- and middle-income countries, 2011–2020
• Health Affairs, 35 (2) (2016), pp. 199–207
• CrossRef

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Citing articles (7)

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Open Access provided for this article by the Gates Foundation.

Corresponding author.

© 2017 The Authors. Published by Elsevier Ltd.

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 This article belongs to a special issue

1. Building Next Generation Immunization Supply Chains
2. Edited By Bruce Y. Lee, Benjamin Schreiber and Raja Rao
3.  
4. Immunization supply chains: Why they matter and how they are changing
5. Raja Rao, Benjamin Schreiber, Bruce Y. Lee,

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2. The potential of next-generation supply chains to ease DRCs “Casse-tête”
3. Felix Kabange Mukwapa Numbi, , Blanchard Mukengeshayi Kupa,

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2. Transforming cold chain performance and management in lower-income countries
3. Mike Brison, , Yann LeTallec,

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