## Going the LAST MILE ## Source details **Canonical URL:** [Going the LAST MILE](https://www.imf.org/en/publications/fandd/issues/2021/12/last-mile-improving-sub-saharan-africa-vaccine-access-bempong-munemo) ## Other formats - [Markdown version](/en/publications/fandd/issues/2021/12/last-mile-improving-sub-saharan-africa-vaccine-access-bempong-munemo/index.md) - [Structured JSON version](/en/publications/fandd/issues/2021/12/last-mile-improving-sub-saharan-africa-vaccine-access-bempong-munemo/index.json) - [Bundle manifest](/en/publications/fandd/issues/2021/12/last-mile-improving-sub-saharan-africa-vaccine-access-bempong-munemo/bundle-manifest.json) ## Bibliographic details - 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.* --- ## Content in this bundle - **قَطْع الميل الأخير** - [قَطْع الميل الأخير (Markdown version)](/-/media/files/publications/fandd/article/2021/december/ar/nyantakyi.pdf.md){rel="alternate" type="text/markdown"} - [قَطْع الميل الأخير (PDF)](/-/media/files/publications/fandd/article/2021/december/ar/nyantakyi.pdf){rel="external" type="application/pdf"} - **Recorrer el último tramo ● Finanzas y Desarrollo ● Diciembre de 2021** - [Recorrer el último tramo ● Finanzas y Desarrollo ● Diciembre de 2021 (Markdown version)](/-/media/files/publications/fandd/article/2021/december/es/nyantakyi.pdf.md){rel="alternate" type="text/markdown"} - [Recorrer el último tramo ● Finanzas y Desarrollo ● Diciembre de 2021 (PDF)](/-/media/files/publications/fandd/article/2021/december/es/nyantakyi.pdf){rel="external" type="application/pdf"} - **Nyantakyi** - [Nyantakyi (Markdown version)](/-/media/files/publications/fandd/article/2021/december/fr/nyantakyi.pdf.md){rel="alternate" type="text/markdown"} - [Nyantakyi (PDF)](/-/media/files/publications/fandd/article/2021/december/fr/nyantakyi.pdf){rel="external" type="application/pdf"} - **Going the Last Mile** - [Going the Last Mile (Markdown version)](/-/media/files/publications/fandd/article/2021/december/nyantakyi.pdf.md){rel="alternate" type="text/markdown"} - [Going the Last Mile (PDF)](/-/media/files/publications/fandd/article/2021/december/nyantakyi.pdf){rel="external" type="application/pdf"} - **Улучшение логистики в странах Африки к югу от Сахары может стать залогом успешной доставки вакцин** - [Улучшение логистики в странах Африки к югу от Сахары может стать залогом успешной доставки вакцин (Markdown version)](/-/media/files/publications/fandd/article/2021/december/ru/nyantakyi.pdf.md){rel="alternate" type="text/markdown"} - [Улучшение логистики в странах Африки к югу от Сахары может стать залогом успешной доставки вакцин (PDF)](/-/media/files/publications/fandd/article/2021/december/ru/nyantakyi.pdf){rel="external" type="application/pdf"} - **走完最后一英里 ● 《金融与发展》● 2021年12月号** - [走完最后一英里 ● 《金融与发展》● 2021年12月号 (Markdown version)](/-/media/files/publications/fandd/article/2021/december/zh/nyantakyi.pdf.md){rel="alternate" type="text/markdown"} - [走完最后一英里 ● 《金融与发展》● 2021年12月号 (PDF)](/-/media/files/publications/fandd/article/2021/december/zh/nyantakyi.pdf){rel="external" type="application/pdf"} --- _Source: https://www.imf.org/en/publications/fandd/issues/2021/12/last-mile-improving-sub-saharan-africa-vaccine-access-bempong-munemo_