The Covid-19 pandemic has had a devastating human impact and exerted unrelenting pressure on healthcare supply chains. Vaccines are widely viewed as one critical step to end the ongoing pandemic and have started to become available in some African countries.
Due to funding gaps, weak health systems, poor supply chain infrastructure and undefined eligibility, the delivery of Covid-19 vaccines to African countries requires thoughtful planning and unprecedented coordination across a wide-range of stakeholders. To vaccinate at least 60% of the population, Africa will need around 1.5 billion vaccine doses and, as urged by Gavi, the Vaccine Alliance, the time to put suitable structures in place for effective immunisation is now.
PSA recently investigated how ready the supply chains in various countries are to support the roll-out of Covid-19 vaccinations. This research uncovered what effective African health supply chain leaders should do to prepare their supply chains.
Each aspect of vaccine adoption and the logistic chain will need to be addressed in an effective strategy. Countries, on the other hand, are starting from different places, and some components can pose greater challenges than others. These eight steps can help ensure vaccines are readily accessible while taking strategic factors into account.
1. Assess and prepare transport options for importing vaccines
The current lack of local pharmaceutical manufacturers in Africa means that vaccines will need to be imported. Airlines can play a key role in moving medical supplies, helping overcome infrequent shipping services or poor infrastructure for ground transportation, and Ethiopian Airlines has signed a partnership agreement to launch a cold chain air freight for transporting temperature-controlled medicines, including the Covid-19 vaccine with the logistics arms of China’s Alibaba Group. Planners should assess all available transport options and check whether airports or ports can handle the increased traffic and map routes.
2. Set up cold chain storage facilities as a priority
Some vaccines require ultra-cold storage to remain effective, and it is important for all facilities to have power back-up to ensure this can be maintained and avoid wastage. Organisations should procure Covid-19 vaccine storage facilities as a priority, due to the different temperatures required by the Covid-19 vaccine compared with vaccines stored for routine immunisations. For efficiency and to save on costs, Covid-19 vaccine supply chains should also be integrated with existing, modified cold chain management systems where possible.
3. Train the workforce
Governments should ensure that there are sufficient, well-trained staff, who are aware of relevant Standard Operating Procedures and plans and have adequate personal protective equipment to ensure their safety. Specific staff should be hired to manage vaccine products; and decision-makers, health workers and populations should be quickly trained on the Covid-19 vaccination (particularly its different storage temperatures and handling requirements). This will help avoid wastage, keep staff safe and support a fast roll-out of the vaccine.
4. Communicate with the community to address vaccine hesitancy
The Africa Dialogues webinar on country readiness for Covid-19 vaccines urged that governments should engage communities to address mistrust and minimise vaccine hesitancy and this was supported by the PSA research findings. It is vital to overcome vaccine hesitancy to ensure vaccine up-take is high enough to provide herd immunity to the overall population. Ongoing conspiracy theories and rumours lead to vaccine hesitancy and clear communications are extremely important – especially on when, where and how vaccines will be available. It would also be beneficial for governments to spend more time disseminating information and promoting awareness campaigns.
5. Use robust mechanisms for traceability, forecasting and decision-making
Logistics Management Information Systems (LMIS) should effectively support vaccine-needs forecasting, helping the right quantity of vaccines to be efficiently supplied at the right time and to the right place. LMIS can be used by governments to manage Covid-19 vaccine inventory for traceability, use and accountability and to conduct needs assessments. Monitoring & Evaluation (M&E) should inform decision-making and include opportunities for reviews, which will help ensure that standards are high, that vaccines are safe and there is continuous improvement. Technology can also be used to help overcome identification barriers and ensure that everyone receives a Covid-19 vaccine.
6. Conduct regulation quickly – but safely and effectively
The quicker a safe and effective vaccine can be rolled out, the faster it can start to have a positive impact. Any barriers preventing the timely approval of the Covid-19 vaccines across Africa should therefore be removed. Harmonised regulatory processes and fast-tracking country authorisation of safe and effective vaccines could help achieve this. To facilitate regulatory alignment, the WHO has developed product-specific roadmaps to assess specific vaccine candidates.
7. Secure available funding
The lack of funding availability remains a major obstacle for the vaccine rollout. Where possible, governments should act swiftly to secure further funding. COVAX is an example of an initiative strengthening the bargaining power of existing countries and negotiating lower prices, although it has been criticised for not going far enough. For example, researchers have argued that COVAX does not get to the root causes of unaffordability as it does not address intellectual property rights or technology transfers that would allow African countries to affordably manufacture their own vaccines.
8. Contingency planning
The pandemic has taught us the importance of being prepared for contingencies in different scenarios. Supply chain experts and policymakers should think about how to always maintain a double watch on the vaccine. It is essential to establish protocols for reacting quickly when an unplanned incident occurs or if vehicles are forced to make unplanned stops.
It is clear there are still many areas where supply chain preparation can be improved, including securing adequate funding, hiring and training staff and putting cold chain infrastructure in place. Given the overwhelming nature of the mission, countries should complete end-to-end supply chain preparation as soon as possible.
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