Emma Stewart, Policy & Advocacy Officer at PATH, and Heidi Lasher is an independent consultant working with PATH.
Once considered a niche technical area, immunization supply chains – the network of staff, equipment, vehicles, and data needed to get vaccines safely from manufacturer to clinic – haven’t always been recognized for the important role they play in reaching ambitious health goals. In recent years, however, new technologies and practices have been developed and field tested; some have reached scale. Global performance standards have been deployed to identify common patterns, pitfalls, and progress on effective vaccine management. Immunization supply chains are starting to change for the better, with people working at all levels of immunization programs, mobilizing to improve performance. All of this was on display at the 15th TechNet Conference held in Portugal in late October.
From theory to practice
About ten years ago, a few organizations begin exploring novel ways to address immunization supply chain issues, both long-standing—high rates of vaccine waste, overburdened health workers, and inaccurate data—and emerging—lack of storage capacity, sensitivity to cold, and poor fridge maintenance.
In 2011, Gavi, the Vaccine Alliance, put money and muscle into leading partners in the development of a global supply chain strategy. UNICEF staffed up its supply chain expertise. Technical partners like John Snow Inc., PATH, VillageReach, and Clinton Health Access Initiative (CHAI) rallied around a common set of fundamentals, working with country governments and industry partners to introduce new supply chain technologies and strategies. Most importantly, countries assessed and improved the performance of their supply chains, striving for the benchmarks set in the World Health Organization’s (WHO) Effective Vaccine Management assessment process.
The hard-won progress in data collection and use, cold chain maintenance, temperature monitoring, and immunization supply distribution, captured in a recent special issue of Vaccine, were presented at the biannual conference.
From analog to digital
One of the most powerful conference themes was the importance of accurate data, and the ability to use this data to make informed decisions. Representatives from Vietnam, Zambia, India, and Tanzania shared their experiences transitioning from paper to electronic data systems, in some cases linking vaccine stock management systems with immunization registries and other e-health programs. Each software solution referenced was on display so conference participants could see them firsthand.
From cold to cool
For decades, WHO, UNICEF, PATH, CHAI, and others have partnered with private companies to develop, test, and sought WHO approval for cooling technologies to protect vaccines from excessively hot or cold temperatures during storage and distribution. Colleagues from India, the Democratic Republic of Congo, and Uganda shared their experiences with new long-term, passive devices, solar-powered cold rooms, and freeze-free technologies that address common temperature control programs. The Uganda delegation reported on their efforts to develop a sustainable maintenance program that maximizes equipment uptime, particularly in remote facilities where equipment failures can go unresolved for years.
From few to many
Making substantial changes to immunization supply chains requires political savvy, financing, collaboration with an array of partners, and a commitment to prioritizing these issues in the face of competing agendas. The conference devoted time to planning how to navigate the changing political environment surrounding supply chains, building new relationships, and making commitments for change. More than 350 attendees representing country programs, industry, academia, donors, and technical partners were introduced to the idea of collective action—a joint planning process that aligns stakeholders around a common set of actions to achieve a shared goal. Participants also recorded and shared actions they plan to take upon returning home.
From here to the next horizon
Throughout the week, TechNet participants shared their vision for the future of immunization supply chains. There is resounding agreement around the need to stop piloting and start scaling what works: more efficient distribution strategies, better data systems, freeze-free technologies, and more robust equipment maintenance programs. The enthusiasm for data—and the role it plays in driving better and more affordable immunization outcomes—was palpable. There is also a desire to support and empower the people who drive systems: training and motivating health workers, deploying new supervision strategies, and creating a new cadre of professional supply chain leaders.
— Dr Karan Singh Sagar (@karanssagar) October 19, 2017
One important issue on the horizon is the need to address environmental sustainability in the context of immunization supply chains.
Behind all of tomorrow’s to-dos was the sense that progress is accelerated through strong relationships, shared goals, and steadfast leadership. If we take away anything from the TechNet Conference, it’s the need to synchronize our actions and pull in the same direction as if our lives depend on it—because so many do.