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Excerpt below; full text is at http://www.sciencedirect.com/science/article/pii/S0264410X17300488
Volume 35, Issue 17, 19 April 2017, Pages 2110–2114
Commentary
Available online 30 March 2017
http://dx.doi.org/10.1016/j.vaccine.2016.12.072
Under a Creative Commons license
In the 40 years since the advent of the Expanded Programme on Immunisation (EPI), incredible progress has been made towards universal vaccine coverage. Today, more than 80% of the worlds children receive at least three doses of basic, routine infant vaccines [1]. Many diverse stakeholders, policies, technologies and efforts are behind this advancement. At its core, however, are the primary healthcare systems, supported by the vaccine supply chain infrastructure of countries that deliver vaccines. This infrastructure includes the equipment that keeps vaccines cool, the logistics and information systems that tracks and manages flows of supplies, to the design of the national distribution systems and the people that manage them. It has served the global health community well and along the way its components have had to adapt, innovate and scale-up to meet not only the expanding portfolio of vaccines but also new immunisation priorities and challenges.
However, in many cases these components have not been able to evolve fast enough, or they have met systemic challenges, such as poor roads or electrical grids. As a result, todays immunisation supply chains are frequently outdated and struggle to deliver the full schedule of WHO-recommended vaccines. They are often under-equipped to go the last mile and reach the large numbers of children globally who still lack access to a complete course of life-saving vaccines. Moreover, these supply chains need to be capable of absorbing shocks from unexpected health emergencies – as the lessons of the recent Ebola outbreak have taught us – as well as to be solid enough to leverage synergies and efficiencies with competing health priorities.
Moving forwards, the situation is likely to become even more challenging: estimates from the Gavi supply chain strategy suggest that by 2020, in Gavi-supported countries, the storage volume required to fully vaccinate a child will increase fourfold compared to 2010; the number of doses ordered, tracked and administered will grow sixfold; and systems will need to handle double the number of stock-keeping units [2]; [3] ; [4]. Newer vaccines are being introduced that tend to be more effective, but they also tend to be more expensive: up to five times costlier per dose than existing vaccines [5]. These newer vaccines will make up more than 40% of total vaccine costs by 2020, meaning there is more at stake for protecting domestic and global investments made in vaccines [6]. If ever there was a time that a major leap forward was needed with immunisation supply chains, it is now.
Gavi, the Vaccine Alliance is a global public-private partnership with the goal of supporting the national governments of low-income countries in their efforts to increase equal access to vaccines. Gavi aims to immunise 300 million children between 2016 and 2020, preventing 5–6 million future deaths in the process. One precondition to achieving this goal, however, is strong, adaptable and resilient supply chains. Through its supply chain strategy, the Alliance supports countries in driving change and delivering improvements across five fundamental supply chain components – thus helping to realise the next leap forwards. These components are: an evidence-based, continuous improvement approach; robust data and information management systems; sufficient and skilled staff; reliable and efficient equipment; and, optimised design of systems.
Today, these supply chain components often constitute bottlenecks and national governments and their local partners find that efforts to reach many communities are impeded [7] ; [8]. Too often, focus is limited to just one aspect of one supply chain component, lacking sufficient scale and breadth to drive sustainable, systemic improvements [7]. For example, countries might purchase more of the same cold chain equipment without systematic efforts to introduce devices that offer better value, more appropriate size or greater reach to under-served parts of the country [9]. Similarly, an array of diverse information management systems have been developed to meet countries specific needs, but in the absence of clarity on how the data will be managed across the country or how the computer programme will be maintained [10]. What is more, to overcome the diffuse and deep-rooted causes behind these bottlenecks, improvements must take place in parallel, because the components are often so closely interconnected. Like the cogs of a machine, as one part turns, so must the rest.
Driving change across each component, and in parallel, calls on coordinated responses from the full range of immunisation supply chain stakeholders. Yet too often, individual organisations work on tools, policies or funding without interconnection, or without linking to the countries and logisticians that will utilise them. The Vaccine Alliance sits at the intersection between the manufacturers of supply chain products and their end-users, between immunisation policy-shapers and those who help fund programmes. The wide range of Alliance partners offer their comparative advantages from the technical expertise of development organisations, like the World Health Organization (WHO) and UNICEF, to the market knowledge and innovations of industry. The crucial alignment of actors that makes up the Vaccine Alliance is well-placed to support transformational change.
Under the auspices of its supply chain strategy, Vaccine Alliance partners and countries are able to develop collaborative and sustainable solutions together with national governments and local partners, answering to their critical supply chain bottlenecks. These solutions inform the development of national strategies and guidelines, and “right-size” supply chain interventions to specific country needs. As it has done for the vaccine market, Gavi can also help shape the supply chain market and drive uptake of new solutions that extend service delivery. It is critical to continue building on the strength of the Alliance to support countries in engineering modern, continuously evolving supply chains that are capable of delivering safe, potent vaccines to every child, in the right place, at the right time.