The long journey of vaccines to the last link in the supply chain

For many of us, the vaccination process begins and ends at the vaccination center, when a caregiver disinfects our arm before injecting the dose of vaccine and then sending us home.

In reality, this is only the last stage of the vaccine’s life cycle. Getting a dose from point A to point B requires more than ordering, delivering and administering it, especially if it is destined for an isolated rural community.

Indeed, an army of stakeholders comes into play: to recover the doses of vaccine from a production plant, transport them to an airport, then on the ground of the recipient country, before delivering them to physical or mobile vaccination centers communities. This process requires meticulous documentation and monitoring, rigorous logistical organization and the mobilization of trusted vaccination ambassadors embodied by members of the community.

From factory to airport

The vaccine procurement process begins when countries place their orders for vaccine doses. If a country is facing an epidemic, the government can request doses of the vaccine through the World Health Organization (WHO) emergency stocks. This resource is available for cholera, ebola, meningitis and yellow fever. Once the order has been validated, UNICEF procures the vaccines and organizes their delivery, ideally within a week.

Since no stocks of COVID-19 vaccines were available at the start of the pandemic, wealthier countries ordered doses directly from the manufacturer. By contrast, those without the necessary means had to rely on vaccine supplies from the COVAX initiative, the World Bank, or direct donations from other countries.

COVAX, an initiative launched in April 2020 in response to the pandemic, is a funding tool that aims to ensure equitable and fair access to COVID-19 vaccines. It is co-led by Gavi, the Vaccine Alliance, the Coalition for Epidemic Preparedness Innovations (CEPI) and WHO.

If a country obtains doses of COVID-19 vaccine through COVAX or the World Bank, their order details are forwarded to UNICEF, which pays for vaccine procurement and transport. From then on, officials organize the logistics to obtain doses from manufacturers and find flights to transport the vaccines to their respective countries.

The process is similar for routine immunizations, including those against polio, measles and human papillomavirus (HPV), which are made more accessible for low- and middle-income countries through global partnerships, such as Gavi. The doses are then paid for and delivered by UNICEF.

Once the ordering and transport details are settled, the vaccine doses hit the road. Manufacturers process orders, confirm batch distribution times and package doses for transport.

For many vaccines, including those against COVID-19, the distribution of doses requires compliance with the cold chain, in order to keep the doses at the recommended temperature. The cold chain maintains the effectiveness of vaccines from their manufacture until the moment of vaccination. The Pfizer laboratory, for example, has developed temperature-controlled thermal carriers, which use dry ice to keep vaccines cold. These containers can maintain recommended temperature conditions for up to 10 days unopened, allowing doses to travel between the manufacturing plant in one country and the airport in another.

From the airport to the vaccination center

Once the vaccines have landed in the recipient country, the next step is to distribute them regionally. They are first unloaded from the plane and placed in cold rooms. Then, managers generally carry out an inventory of the doses, in order to ensure that they correspond to the quantity ordered. They then take care of determining which quantities will go to which districts.

Setting up Sierra Leone’s vaccine supply chain strategy is one of Joyce Mariana Kallon’s primary responsibilities. As supply chain and logistics manager for the country’s Expanded Program on Immunization, she develops matrices to determine the flow of vaccines to the country’s 16 districts.

Health authorities consider several factors when determining the number of doses delivered to each district, including the number of medical teams present in the area, the number of people they wish to vaccinate per day, and the number of days they plan to carry out the vaccination campaign. Joyce Mariana Kallon explains that these factors can be limited by a lack of caregivers, a shortage of cold storage facilities and vaccine expiry dates.

As part of the COVID-19 vaccines, the doses are then placed in cold boxes filled with conditioned ice packs, which are designed to maintain a stable temperature for 72 hours. They are then loaded into refrigerated trucks with syringes, screening forms and vaccination cards.

“At each stage of the supply chain, we want to keep the vaccines at the standard temperature of 2 to 8 [degrés Celsius]. We don’t want to compromise the temperature,” says Joyce Mariana Kallon.

The trucks then take the road to health facilities in each district of the country. In Sierra Leone, the distribution of vaccines to the districts is handled by two trucks: one covers the north and west of the country, the other the south and east.

When they arrive at the vaccination centre, the vaccines are immediately placed in refrigerators. If a district does not have refrigerators, the doses assigned to it are stored in a neighboring district that has the necessary storage resources. If it is a remote area, with no other facilities nearby, district staff keep the vaccines inside the cold boxes they arrived in and change the cold packs every 72 hours to maintain temperature.

From the vaccination center to the local community

But the process does not end there. Once the vaccines have been distributed regionally, they still need to be distributed in villages and towns. Country caregivers load the determined amount of doses for a given population into another vaccine container with conditioned ice packs, and move around either by motorbike, donkey, on foot or by any other means available to administer vaccines to local communities.

Savior Flomo Mendin, Head of Last Mile Health in Grand Bassa County, Liberia, oversees the local distribution of vaccines in his country. In Liberia, where 1.2 million people live on the margins of the health system, long distances and poor road conditions remain significant barriers to vaccine distribution in remote communities, she said.

“It sometimes takes up to four or five hours for the most remote communities [pour atteindre le centre de santé le plus proche] “said Savior Flomo Mendin to Global Citizen. “Some communities are very remote and also occupy singular terrains, so it can take all day, up to eight hours. »

In communities that do not have cold rooms, caregivers set up mobile vaccination units and usually have to administer the doses on the day they are delivered, to ensure their effectiveness. This requires significant planning in advance, especially to ensure that a considerable part of the community is ready and willing to receive the vaccine, at the risk of the doses being wasted otherwise.

At this stage, immunization education and building trust are key to successespecially in communities where people are hesitant to get vaccinated.

In Sierra Leone, Joyce Mariana Kallon explains that certain community actors, such as chiefs, presidents and religious representatives, are called upon to encourage the population to be vaccinated.

Joyce Mariana Kallon continues: “When it’s your own people talking to you, you feel safe, unlike someone who comes from far away to tell you to do something. This is why our social mobilization effort not only includes national representatives, but the team also includes members of the community, on the ground. »

Similarly, in Liberia, community caregivers play an important role in the local immunization effort.

Savior Flomo Mendin’s work supports the training of community caregivers, providing them with advice on handling and storing vaccines, as well as how to challenge vaccine stigma and mobilize people to get vaccinated. These links between the community and health systems have played a key role in the general opinion of vaccination and in the increase in the vaccination rate.

“We saw a great receptivity when community caregivers came in and got vaccinated [contre la COVID-19] Said Savior Flomo Mendin. “Most community members already trust them and respect their decisions, so if they get vaccinated, it encourages other community members to understand the value of the vaccine. »

Community outreach has proven to be crucial, not only for the COVID-19 vaccine campaign, but for many vaccination efforts that were at work before this pandemic.

Caregivers who link local communities to the health system have played an indispensable role in helping theGlobal Polio Eradication Initiative (IMEP) to vaccinate more than 2.5 billion children. Similarly, the success of Gavi’s routine immunization efforts, which have helped vaccinate more than 888 million children in 77 countrieswould not have been possible without the support of civil society organizations that provide up to 65% of immunization services in some countries.

So here are the steps needed to get the vaccines to the final link in the chain. It all starts with a manufacturer and international organizations, such as COVAX, Gavi, the World Bank or UNICEF, but the whole process is based on many more factors: planes, refrigerated trucks, coolers and ice packs are also necessary. This entire protocol ultimately relies on the planning, strategies, and crucial action of caregivers around the world.

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The long journey of vaccines to the last link in the supply chain

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