The delivery of vaccines to all corners of the world is a complex undertaking, as it requires a chain of precisely coordinated events in temperature-controlled environments to store, manage, and transport these life-saving products.
Populations living at the last mile in countries like those in Africa, with insufficient vaccine cold chains, have the highest risks of not being able to access vaccines, specifically due to cooling requirements.
From the time vaccines are manufactured until the moment of vaccination, they must be continuously stored in a limited temperature range. This temperature requirement is critical to maintain the potency of vaccines, as too high or too low temperatures result in a loss of vaccine potency which cannot be regained or restored.
Unfortunately, for many countries in Africa, the vaccine supply chains lack the capacity to maintain vaccine temperature requirements, particularly over the long distances needed to reach remote populations.
Lack of access to vaccines is a critical public health challenge, accounting for about 1.5 million preventable deaths each year. In Africa alone, approximately one in five children do not receive all of their necessary vaccines, and for many of the unvaccinated, a key barrier is location.
…getting vaccines to these rural populations can be difficult. In many remote areas, electricity is unreliable or unavailable; hence temperature control is typically inadequate
Challenges confronting last-mile vaccine delivery in Africa
In Africa, approximately 700 million people live in remote locations and compared to urban dwellers, getting vaccines to these rural populations can be difficult. In many remote areas, electricity is unreliable or unavailable; hence temperature control is typically inadequate.
Often, long distance travel is required to transport vaccine doses to these rural communities. Health workers have to carry vaccines in cold boxes and vaccine carriers, travelling by car, motorcycle, bicycle, donkey, and camel or even on foot to reach the most remote of villages. Thus, posing a greater risk of vaccine spoilage in transit over long distances.
In fact, it is estimated that in Africa, for the last mile, the final link in the cold chain prior to vaccines being administered to end users, 15 to 20 percent of cold-chain devices currently installed are non-functional. The availability of adequate facilities along remote supply chain routes remains a challenge and can limit the supply of vaccines.
Another challenge is that many remote communities live far from or are inaccessible to health facilities. Where health facilities are available, they are often grossly underequipped and many lack functional refrigerators for vaccine storage. Other obstacles include cost, time commitment, and political will and stability.
Failure to address the challenges in last-mile vaccine delivery has direct community impact, increasing the risk of continuation of reinfections, and potentially national and continental repercussions, leading to the loss of gains already made on target diseases or resurgence of diseases.
Strategies to strengthen last mile vaccine delivery in Africa
Addressing the challenges of last-mile vaccine delivery in remote and difficult-to-reach areas to ensure vaccines reach end-users in acceptable controlled conditions requires concerted efforts and collaborations among relevant stakeholders including governments, local and international funders, pharmaceutical manufacturers, cold-chain handlers, and health workers.
Read also: Challenges affecting the development of Africa’s supply chains
Bloom Public Health recommends the following strategies to strengthen last-mile vaccine delivery in Africa:
• Leveraging public-private partnerships (PPPs) for sustainable investment and capacity-building: African governments can complement public sector efforts by leveraging strategic PPPs to strengthen health systems in remote areas.
This includes investment in additional infrastructure, services, and equipment to improve current cold chain systems, such as permanent ultra-cold chain systems, freezers or cold-room capacities, and temporary warehouses, such as pharmaceutical storage units, or even portable freezers or freezer trucks.
Investments in off-grid renewable energy solutions for health facilities can deliver reliable and cost-effective electricity in countries with electricity access gaps.
However, it is essential that short-term impacts be matched with commitments to long-term financing, better data, and enabling policy environments at the local level to achieve sustainable result.
A good example is the Health Supply Chain Transformation Project Consortium comprising Bloom Public Health, Zipline, Health Spaces, and Sterling Bank, which has partnered with several State Governments in Nigeria to implement an innovative and sustainable healthcare supply chain system in their states.
• Adoption of innovative technologies: There is an urgent need for the rapid adoption of new technologies, such as drones, to access hard-to-reach areas and the evaluation of their applicability to specific scenarios.
Bloom Public Health’s partner, Zipline, has transformed healthcare delivery worldwide through automated, on-demand delivery using drones that travel up to 100 km per hour at a time, reducing delivery time from hours by road to minutes.
• Communication with communities: Local challenges in remote and difficult to reach areas call for local participation for sustainable solutions within the supply chain. Hence, the ability to facilitate communication between target local communities and build on existing relationships with local MOHs and relevant departments is imperative for the success of supply chain interventions and vaccination programmes.
Ultimately, robust vaccine supply chains that address challenges around the last mile are essential to close vaccine equality gaps across Africa and make progress towards universal health coverage.
Anyakora is the CEO of Bloom Public Health and a public health expert & Odibeli is a pharmacist and the regional communications manager at Bloom Public Health