{
  "title": "Going the LAST MILE",
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  "summary": "Eugene Bempong Nyantakyi and Jonathan Munemo talk about how improving sub-Saharan Africa’s logistics could be the key to successful vaccine delivery",
  "sections": [
    {
      "heading": "Overview",
      "content": "- Improving sub-Saharan Africa’s logistics could be the key to successful vaccine delivery.\n- 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.\n- 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."
    },
    {
      "heading": "Logistics performance and vaccination outcomes",
      "content": "- World Bank’s Logistics Performance Index (LPI) Database:\n  - Africa’s LPI score is only about 2.5 on average.\n  - The LPI score ranges from 1 to 5, with higher scores representing better logistics performance.\n  - The region’s score trails all major regions of the world in six key categories of logistics performance, including timeliness and tracking.\n- Trade and cost impacts:\n  - Delays at customs are estimated to add 10 percent to the cost of imported goods.\n- Vaccine-specific logistics issues and consequences:\n  - Once fully thawed, some vaccines have a short shelf life, raising risk of destroying perfectly good doses when logistics challenges are present.\n  - 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.\n- WHO preparedness and correlation with vaccination rates:\n  - 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.\n  - Emerging data appear to confirm that logistics performance quality is positively correlated with the COVID-19 vaccination rate across Africa.\n- Country comparisons:\n  - Democratic Republic of the Congo:\n    - LPI score of 2.43.\n    - Close to zero percent of the population is fully vaccinated.\n  - South Africa:\n    - LPI score of 3.38.\n    - Top performer due to large economy, wider network of health services, access to the sea, and proximity to major transportation hubs.\n  - Other observations:\n    - 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.\n    - 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."
    },
    {
      "heading": "Short-term measures to cover the last mile",
      "content": "- Operational tactics proven within the region:\n  - Côte d’Ivoire:\n    - Initial centers equipped to vaccinate 300 people a day were struggling to inoculate 20 a day.\n    - 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.\n  - Ghana implemented similar mobile outreach approaches.\n- Digital interventions:\n  - South Africa’s e-appointment system allows citizens to schedule COVID-19 vaccination appointments at a convenient time and at a center close by.\n  - Expected benefits: reduce commuting distance, allow families to schedule together, and increase vaccination rates.\n- Targeting strategy:\n  - Vaccine campaigns should target large cities and densely populated areas where transmission risks are higher and economic disruption from lockdowns is severe.\n- Short-term financing and support:\n  - Replication of mobile and digital solutions across the region can be undertaken with support from development agencies."
    },
    {
      "heading": "Medium-term infrastructure and supply-chain priorities",
      "content": "- Cold-chain and power capacity:\n  - Vaccine storage requirements:\n    - AstraZeneca vaccine can be stored safely in refrigerated conditions for up to six months.\n    - Pfizer and Moderna vaccines require temperatures of –20 degrees Celsius or less.\n  - WHO survey of 34 countries found widespread gaps in cold-chain refrigeration capacity in Africa.\n    - About 30 percent of countries surveyed have gaps in cold-chain refrigeration capacity in more than half of their districts.\n    - Only 28 percent of health facilities in sub-Saharan Africa are estimated to have access to a reliable power supply.\n  - Addressing these structural issues should be a development priority in the medium term.\n- Broader logistics and trade facilitation investments:\n  - Poor-quality transport and distribution logistics stifle trade and competitiveness and will be a major impediment to pandemic vaccination once supply constraints are resolved.\n  - 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.\n  - Such investments will also improve trade and competitiveness and strengthen health systems to deal with current and future shocks."
    },
    {
      "heading": "Policy recommendations and implications",
      "content": "- Immediate priorities:\n  - Scale mobile clinics and vaccination buses to reach busy public areas and poorly connected communities.\n  - Deploy digital registration and e-appointment systems to reduce travel distances and improve scheduling reliability.\n  - Focus short-term campaigns on large cities and densely populated areas to reduce transmission and economic disruption.\n- Medium-term priorities:\n  - Invest in cold-chain refrigeration capacity and reliable power supply for health facilities.\n  - Strengthen transport and distribution logistics (roads, customs, tracking, timeliness) to reduce delays and costs (noting delays at customs add 10 percent to import costs).\n  - Leverage IMF and multilateral financial assistance for infrastructure and trade facilitation to improve logistics performance and health system resilience.\n- Behavioral and policy levers:\n  - Combine logistics improvements with measures to reduce vaccine hesitancy, including ensuring convenient, reliable access to vaccination services and clear information through telecommunications channels.\n\nSource: Going the LAST MILE; EUGENE BEMPONG NYANTAKYI and JONATHAN MUNEMO; F&D Magazine; December 2021.\n\n---\n\n Content in this bundle\n\n- قَطْع الميل الأخير\n  - قَطْع الميل الأخير (Markdown version){rel=\"alternate\" type=\"text/markdown\"}\n  - قَطْع الميل الأخير (PDF){rel=\"external\" type=\"application/pdf\"}\n- Recorrer el último tramo ● Finanzas y Desarrollo ● Diciembre de 2021\n  - Recorrer el último tramo ● Finanzas y Desarrollo ● Diciembre de 2021 (Markdown version){rel=\"alternate\" type=\"text/markdown\"}\n  - Recorrer el último tramo ● Finanzas y Desarrollo ● Diciembre de 2021 (PDF){rel=\"external\" type=\"application/pdf\"}\n- Nyantakyi\n  - Nyantakyi (Markdown version){rel=\"alternate\" type=\"text/markdown\"}\n  - Nyantakyi (PDF){rel=\"external\" type=\"application/pdf\"}\n- Going the Last Mile\n  - Going the Last Mile (Markdown version){rel=\"alternate\" type=\"text/markdown\"}\n  - Going the Last Mile (PDF){rel=\"external\" type=\"application/pdf\"}\n- Улучшение логистики в странах Африки к югу от Сахары может стать залогом успешной доставки вакцин\n  - Улучшение логистики в странах Африки к югу от Сахары может стать залогом успешной доставки вакцин (Markdown version){rel=\"alternate\" type=\"text/markdown\"}\n  - Улучшение логистики в странах Африки к югу от Сахары может стать залогом успешной доставки вакцин (PDF){rel=\"external\" type=\"application/pdf\"}\n- 走完最后一英里 ● 《金融与发展》● 2021年12月号\n  - 走完最后一英里 ● 《金融与发展》● 2021年12月号 (Markdown version){rel=\"alternate\" type=\"text/markdown\"}\n  - 走完最后一英里 ● 《金融与发展》● 2021年12月号 (PDF){rel=\"external\" type=\"application/pdf\"}\n\n---\n\nSource: https://www.imf.org/en/publications/fandd/issues/2021/12/last-mile-improving-sub-saharan-africa-vaccine-access-bempong-munemo"
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    "Authors: EUGENE BEMPONG NYANTAKYI, JONATHAN MUNEMO",
    "Published: December 3, 2021",
    "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.",
    "World Bank’s Logistics Performance Index (LPI) Database:",
    "Trade and cost impacts:",
    "Vaccine-specific logistics issues and consequences:",
    "WHO preparedness and correlation with vaccination rates:",
    "Country comparisons:",
    "Operational tactics proven within the region:",
    "Digital interventions:",
    "Targeting strategy:",
    "Short-term financing and support:",
    "Cold-chain and power capacity:",
    "Broader logistics and trade facilitation investments:",
    "Immediate priorities:",
    "Medium-term priorities:",
    "Behavioral and policy levers:",
    "**قَطْع الميل الأخير**",
    "**Recorrer el último tramo ● Finanzas y Desarrollo ● Diciembre de 2021**",
    "**Nyantakyi**",
    "**Going the Last Mile**",
    "**Улучшение логистики в странах Африки к югу от Сахары может стать залогом успешной доставки вакцин**",
    "**走完最后一英里 ● 《金融与发展》● 2021年12月号**"
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