Going the LAST MILE
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- Authors: EUGENE BEMPONG NYANTAKYI, JONATHAN MUNEMO
- Published: December 3, 2021
Overview
- Improving sub-Saharan Africa’s logistics could be the key to successful vaccine delivery.
- Sub-Saharan Africa still has too few vaccines for too few people; poor trade and logistics quality is a major additional hurdle to rapid, equitable deployment.
- No journey is more critical to determining the fate of a pandemic than the distance a vaccine must travel from the production line to a person’s arm; the last mile is all-important.
Logistics performance and vaccination outcomes
- World Bank’s Logistics Performance Index (LPI) Database:
- Africa’s LPI score is only about 2.5 on average.
- The LPI score ranges from 1 to 5, with higher scores representing better logistics performance.
- The region’s score trails all major regions of the world in six key categories of logistics performance, including timeliness and tracking.
- Trade and cost impacts:
- Delays at customs are estimated to add 10 percent to the cost of imported goods.
- Vaccine-specific logistics issues and consequences:
- Once fully thawed, some vaccines have a short shelf life, raising risk of destroying perfectly good doses when logistics challenges are present.
- Example: In Malawi, health authorities cited the short time between delivery and expiration of vaccines and the need to reduce hesitancy as the rationale for incinerating close to 20,000 doses of AstraZeneca vaccine.
- WHO preparedness and correlation with vaccination rates:
- WHO assessment showed Africa has an average preparedness score of 33 percent for the COVID-19 vaccination program, far below the desired benchmark of 80 percent in key areas, including logistics quality and performance.
- Emerging data appear to confirm that logistics performance quality is positively correlated with the COVID-19 vaccination rate across Africa.
- Country comparisons:
- Democratic Republic of the Congo:
- LPI score of 2.43.
- Close to zero percent of the population is fully vaccinated.
- South Africa:
- LPI score of 3.38.
- Top performer due to large economy, wider network of health services, access to the sea, and proximity to major transportation hubs.
- Other observations:
- Zimbabwe, Equatorial Guinea, and Comoros have relatively better vaccination rates but lower LPI scores, indicating that non-logistics factors (for example, policy actions) can influence uptake.
- Example policy effect: Zimbabwe announced that those who refuse COVID-19 vaccines could be denied public sector jobs and services, leading to a significant increase in urban vaccination rates.
Short-term measures to cover the last mile
- Operational tactics proven within the region:
- Côte d’Ivoire:
- Initial centers equipped to vaccinate 300 people a day were struggling to inoculate 20 a day.
- Government deployed mobile clinics and medical buses to busy areas; resulted in fixed or mobile vaccination centers across 113 districts, and nearly all operating close to capacity.
- Ghana implemented similar mobile outreach approaches.
- Digital interventions:
- South Africa’s e-appointment system allows citizens to schedule COVID-19 vaccination appointments at a convenient time and at a center close by.
- Expected benefits: reduce commuting distance, allow families to schedule together, and increase vaccination rates.
- Targeting strategy:
- Vaccine campaigns should target large cities and densely populated areas where transmission risks are higher and economic disruption from lockdowns is severe.
- Short-term financing and support:
- Replication of mobile and digital solutions across the region can be undertaken with support from development agencies.
Medium-term infrastructure and supply-chain priorities
- Cold-chain and power capacity:
- Vaccine storage requirements:
- AstraZeneca vaccine can be stored safely in refrigerated conditions for up to six months.
- Pfizer and Moderna vaccines require temperatures of –20 degrees Celsius or less.
- WHO survey of 34 countries found widespread gaps in cold-chain refrigeration capacity in Africa.
- About 30 percent of countries surveyed have gaps in cold-chain refrigeration capacity in more than half of their districts.
- Only 28 percent of health facilities in sub-Saharan Africa are estimated to have access to a reliable power supply.
- Addressing these structural issues should be a development priority in the medium term.
- Broader logistics and trade facilitation investments:
- Poor-quality transport and distribution logistics stifle trade and competitiveness and will be a major impediment to pandemic vaccination once supply constraints are resolved.
- The COVID-19 crisis presents an opportunity to leverage financial assistance from the IMF and other multilateral institutions for investment in infrastructure and trade facilitation measures that support strong logistics performance.
- Such investments will also improve trade and competitiveness and strengthen health systems to deal with current and future shocks.
Policy recommendations and implications
- Immediate priorities:
- Scale mobile clinics and vaccination buses to reach busy public areas and poorly connected communities.
- Deploy digital registration and e-appointment systems to reduce travel distances and improve scheduling reliability.
- Focus short-term campaigns on large cities and densely populated areas to reduce transmission and economic disruption.
- Medium-term priorities:
- Invest in cold-chain refrigeration capacity and reliable power supply for health facilities.
- Strengthen transport and distribution logistics (roads, customs, tracking, timeliness) to reduce delays and costs (noting delays at customs add 10 percent to import costs).
- Leverage IMF and multilateral financial assistance for infrastructure and trade facilitation to improve logistics performance and health system resilience.
- Behavioral and policy levers:
- Combine logistics improvements with measures to reduce vaccine hesitancy, including ensuring convenient, reliable access to vaccination services and clear information through telecommunications channels.
Source: Going the LAST MILE; EUGENE BEMPONG NYANTAKYI and JONATHAN MUNEMO; F&D Magazine; December 2021.
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