## Improving sub-Saharan Africa’s logistics could be the key to successful vaccine delivery

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**Canonical URL:** [Improving sub-Saharan Africa’s logistics could be the key to successful vaccine delivery](https://www.imf.org/-/media/files/publications/fandd/article/2021/december/nyantakyi.pdf)

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### Logistics constraints and vaccination outcomes
- Sub-Saharan Africa’s Logistics Performance Index (LPI) score is only about 2.5 on average (scale of 1 to 5).
- The LPI measures six key categories of logistics performance, including timeliness and tracking.
- Delays at customs are estimated to add 10 percent to the cost of imported goods.
- Countries with poorer logistics performance generally have lower vaccination rates (chart evidence cited).
- Examples:
  - Democratic Republic of the Congo: LPI score of 2.43; close to zero percent of the population fully vaccinated.
  - South Africa: LPI score of 3.38; higher vaccination performance attributed to large economy, economies of scale in supply chain connections, wider network of health services, access to the sea, and proximity to major transportation hubs.
  - Zimbabwe, Equatorial Guinea, and Comoros: relatively better vaccination rates despite lower LPI scores, indicating other factors (for example, Zimbabwe linked increased uptake to announcements that refusal could mean denial of public sector jobs and services).

### Causes of vaccine wastage and impediments to last-mile delivery
- Short shelf life after thawing raises the risk of destroying doses when logistics are poor.
- Malawi incinerated close to 20,000 doses of AstraZeneca vaccine; cited reasons included short time between delivery and expiration and the need to reduce hesitancy.
- WHO assessment of COVID-19 vaccination readiness: Africa average preparedness score of 33 percent (benchmark desired: 80 percent) in key areas, including logistics quality and performance.
- Landlocked countries and weak transport networks produce logistics-induced delays that have left Malawi, South Sudan, and the Democratic Republic of the Congo unable to deploy and administer vaccines on short notice.

### Short-term operational responses and examples
- Côte d’Ivoire: vaccination centers designed for 300 people a day were initially vaccinating 20 a day; government deployed mobile clinics and medical buses to busy areas; now fixed or mobile vaccination centers exist across 113 districts and nearly all operate close to capacity.
- Ghana implemented similar mobile approaches.
- South Africa introduced an e-appointment system allowing citizens to schedule COVID-19 vaccination appointments at convenient times and nearby centers; expected to reduce commuting distance and increase uptake.
- Recommendation: prioritize vaccine campaigns in large cities and densely populated areas to reduce transmission risk and economic disruption.

### Medium-term infrastructure priorities
- Cold-chain capacity gaps:
  - AstraZeneca can be stored safely in refrigerated conditions for up to six months.
  - Pfizer and Moderna require temperatures of –20 degrees Celsius or less.
  - WHO survey of 34 countries found about 30 percent of countries surveyed have gaps in cold-chain refrigeration capacity in more than half of their districts.
- Power reliability:
  - Only 28 percent of health facilities in sub-Saharan Africa are estimated to have access to a reliable power supply.
- Policy implication: developing infrastructure inputs to the supply chain, particularly cold-chain capacity and reliable power, is critical in the medium term.

### Policy recommendations and financing opportunities
- Short-term: replicate mobile clinics, medical buses, and digital registration/e-appointment platforms across the region with support from development agencies to substantially increase vaccine delivery and uptake.
- Medium-term: invest in transport, cold-chain infrastructure, and reliable power to strengthen last-mile logistics and health-system resilience.
- Financing: leverage financial assistance from the IMF and other multilateral institutions for investment in infrastructure and trade facilitation measures that support strong logistics performance.
- Broader benefits: improving transport and distribution logistics will also improve trade, competitiveness, and the capacity of health systems to handle current and future shocks.

*EUGENE BEMPONG NYANTAKYI and JONATHAN MUNEMO — Finance & Development, December 2021.*

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_Source: https://www.imf.org/-/media/files/publications/fandd/article/2021/december/nyantakyi.pdf_