Designing supply chains to meet the growing need of vaccines: evidence from four countries

Abstract

Background Immunization supply chains (iSCs) move vaccines from manufacturer to point of use with the added complexities of requiring cold chain and an increasing need for agility and efficiency to ensure vaccine quality and availability. Underperforming iSCs have been widely acknowledged as a key constraint to achieving high immunization coverage rates in low- and middle-income countries. This paper details the system design approach used to analyze the iSC network in Sierra Leone, Madagascar, Niger and Guinea and documents six lessons. Methodology Between 2018 and 2020, these countries implemented the system design approach, involving four key steps: (1) advocate and introduce to engage stakeholders and prioritize identification of modeling scenarios; (2) collect data and plan analysis through document review and key informant interviews; (3) analyze system design scenarios using computer software modeling tools (LLamasoft’s Supply Chain Guru and AnyLogic's AnyLogistix) for optimization and simulation modeling as well as further analysis with Excel, Google maps, and OpenStreetMap; and (4) build consensus on optimized model and implementation roadmap using the Traffic Light Analysis tool and building on stakeholder input. Findings Key lessons include the following: (1) define system design objectives based on country priorities; (2) establish consensus with stakeholders on scenarios to model; (3) modeling provides the evidence but not the answer; (4) costs should not be weighted above other decision criteria; (5) data collection—work smarter, not harder; (6) not all questions can be answered with a computer model. Discussion A system design approach can identify changes to the design of the supply chain that can introduce efficiencies and improve reliability. This approach can be more effective when these lessons and principles are applied at the country level. The lessons from these four countries contribute to global thinking and best practices related to system design. The modeling and system design approach provides illustrative results to guide decision-makers. It does not give a "final answer", but compares and contrasts.

Key lessons learned from the immunization supply chain of Malawi, an African country using EVM2.0

“…Various studies have shown that system redesigning in response to the constraints identified in the underperforming iSC by EVM assessment can help in improving efficiencies and reliability of iSC performance and vaccine coverage [12] , [13] . A modeling study using scenarios from three countries (Guinea, Madagascar, and Niger) to analyze the impact of immunization supply chain redesigning showed that country-specific changes to the bottlenecks identified in the supply chain using EVM assessment would help to improve efficiency [14] . A study from the Western Cape Province of South Africa revealed that private outsourced vaccine supply chain segments might perform better than those managed by the government [15] .…”

Improving the last mile delivery of vaccines through an informed push model: experiences, opportunities and costs based on an implementation study in a rural district in Uganda

“…Under-vaccination can result from situations of poor vaccine supply chain systems where vaccines do not reach the target population, stock-out of vaccines or available vaccines that were damaged due to exposure to inappropriate temperatures during transportation [6]. As new vaccines are developed and made available to immunization programs expand, there is a dire and critical need to reduce vaccine wastage, improve efficiencies, reliability, and agility to the immunization supply chain system [15]. Experiences from the recent COVID-19 pandemic have demonstrated a critical need for resilient immunization supply chain systems.…”

Vaccine management practices among healthcare workers in Morogoro, Tanzania: a cross-sectional study

“…The cold chain is used for transporting and storing vaccines from manufacturers to vaccination points, using efficient cold chain systems and equipment to preserve vaccine quality [ 13 , 14 ]. In addition, a strong immunisation supply chain is essential to improve coverage rates, and equity, and equally support strategies to reduce child mortality [ 13 , 15 , 16 ].…”

“…The cold chain is used for transporting and storing vaccines from manufacturers to vaccination points, using efficient cold chain systems and equipment to preserve vaccine quality [ 13 , 14 ]. In addition, a strong immunisation supply chain is essential to improve coverage rates, and equity, and equally support strategies to reduce child mortality [ 13 , 15 , 16 ]. Healthcare systems worldwide rely on a competent supply chain system for the storage and transportation of health supplies at the right time, to the right place and in the proper condition equitably to all children for the welfare of all communities against vaccine-preventable diseases [ 17 ].…”

“…In the Expanded Program on Immunization (EPI), the cold chain system is used for storing, transporting, and distributing vaccines and other biologicals in recommended temperatures until they reach beneficiaries [ 13 , 21 ]. However, health workers and supervisors tend to emphasise protecting vaccines from heat damage, thus creating a risk of exposure to freezing temperatures.…”