Lack of access to vaccines leads to 1.5 million preventable deaths each year[1]. In Africa alone, approximately one in five children do not receive all of their necessary vaccines. For many of the unvaccinated, a key barrier is location. Obstacles to accessing vaccines exist around the world, with cost, time commitment, distance, and political will and stability all playing a part.

In Africa, there are approximately 700 million citizens residing in remote locations[2] and getting vaccines to these groups can be difficult. In some remote areas – where grid electricity is often unavailable or unreliable – temperature control infrastructure is typically inadequate, and further difficulties can arise with the transport of vaccine doses to target communities who live far from or are inaccessible to health facilities.

In fact, for the last mile, the final link in the cold chain prior to vaccines being administered to end users, 15 to 20% of cold-chain devices currently installed are non-functional[3].

Addressing these supply and cold chain issues is imperative. Many vaccines must be stored at precise temperatures for safety reasons and to maintain efficacy.

Could the malaria vaccine pave the way?

Malaria remains a primary cause of childhood illness and death in sub-Saharan Africa. In recent years, the World Health Organisation (WHO) reported a stagnation in progress against the disease. Creating equity in access to its detection and treatment in hard-to-reach communities is essential in sustaining efforts to eliminate the disease. This aim is stated as one of the core objectives of the WHO Global Technical Strategy for Malaria 2016–2030.

But recent developments in malaria vaccination have the potential to correct this imbalance. In October 2021, the WHO recommended widespread use of the RTS,S/AS01 (RTS,S) malaria vaccine in children living in sub-Saharan Africa and other regions with moderate to high P. falciparum malaria transmission[4]. However, even in areas of seasonal transmission in combination with seasonal malaria chemoprophylaxis the vaccine impact was remarkable.

“This vaccine has been in development since mid ‘80s thanks to a unique public/private partnership that has included vaccine developers in the industry, research institutions across the region and globally, CROs that have facilitated study conduct, funding agencies, and the communities where trials were conducted,” says Jacob Odika Apollo, consultant at Oximio. “I have been involved at clinical research site level and as a CRO staff member overseeing conduct of clinical trials on behalf of sponsors.”

Developers have made rollout of the vaccine feasible through the incorporation of the programme with other routine immunisation programmes, mitigating the need to build costly and time-consuming infrastructure while circumventing Covid restrictions. But there are still lessons to be learnt and challenges to be faced, not only for the malaria vaccine, but across all immunisation efforts and even clinical trials in hard-to-reach populations.

“Local challenges in remote and difficult to reach areas call for local solutions within the supply chain such as partnerships amongst cold chain handlers to ensure last-mile delivery of vaccines to end-users, while in acceptable controlled conditions,” says Apollo. “The availability of experienced facilities along supply-chain routes with scalable facilities also remains a challenge and can limit the supply of vaccines.”

How sponsors and manufacturers can build viable supply chains in hard-to-reach areas

  • Additional cold chain capacity preparation: Ensure that any additional cold-chain capacity is adequately prepared for. This could take the form of a permanent ultra-cold chain system, freezer, or cold-room capacity, a private sector temporary warehouse, such as a pharmaceutical storage unit, or even a portable freezer or freezer truck.
  • Smaller shipment volumes: Determine whether larger shipments can be split and dispatched over a few days. Assuming that each small shipment is moved down the supply chain before the next shipment is delivered, the amount of any new cold-chain capacity required can be significantly reduced.
  • Communication with communities: The ability to facilitate communication between target communities is essential for a successful vaccination programme. This means that existing relationships with local MOHs and relevant departments become extremely beneficial, as does an established connection with local medical sites, or even previous activity in clinical trials in these locations. An external partner that can consult with sponsors on vaccination supply chains could prove beneficial to rollout, too, ensuring the fastest timelines for sponsors thanks to local and global support.
  • Local courier network: The district distribution route to hard-to-reach areas remains under-developed but can be addressed via access to a robust local courier service. An audited network allows sponsors to guarantee delivery dates to specified regions, but often requires collaboration with a local partner to access the benefits.
  • Validated packaging: Utilising packaging that isvalidated and tested to maintain the required temperature can help to minimise the risk of temperature excursions and the associated risks and costs. An expert partner can determine exactly how the packaging should be configured depending on the material it contains, and the conditions and length of the journey.
  • Tapping into the latest technologies: The rapid adoptionof new technologies for access to hard-to-reach areas, such as drones, and evaluation of their applicability to specific scenarios.  

The value of logistics expertise

Ultimately, in failing to implement a robust rollout program that addresses challenges around the last mile, a continuation of reinfections and a resurgence of a disease is a risk – an issue with direct community impact and potentially global repercussions. This is likely to create sponsor fatigue with ultimate loss of gains already made on the target diseases.

What’s more, a badly managed and under-resourced logistics system has the potential to weaken what are already very delicate immunisation programs. This will inevitably result in significant wastage and stock-outs, increasing programme costs, straining thin resources, and causing delays to delivery.

For sponsors, this can mean millions, if not billions, of dollars down the drain, and a devastating impact on the populations requiring vaccination. But with an expert distribution partner to guide sponsors through the logistics process, implementing a robust supply chain and getting products over that last mile is now within reach physically or remotely.

“Oximio has invested heavily in setting up a warehouse facility in Nairobi with state-of-the-art storage facilities with a variety of temperature conditions, right down to ultra-low temperatures such as -80c,” says Rob van den Bergh, managing director, sub-Saharan Africa at Oximio. “Our local network of courier companies is well-versed in being audited to ensure that we achieve deliverables on time. Plus, with our validated, temperature-controlled shippers, which have an expiry time of 96 hours, we have enough time to get to the those marginalised and difficult to reach areas and make a difference.”

And for Africa and its children that difference can be between life and death. While there is still progress needed to close vaccine equality gaps across the region, continued efforts in life-saving immunisation programmes alongside improvements in African supply chains suggest that the final steps on that last mile are slowly being made.

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