HLA Board member Dr Sarah Schiffling and Nikolaos Valantasis Kanellos analyzed five areas that are likely to be impacted in order to highlight how Ukraine is intertwined with major global supply chains. 

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According to The Aid Files 2021 was another incredibly challenging year for NGOs across the world and as we prepare for our third year of global pandemic. This video report from GOONJ in India illustrates how terrible the experience has been for many, and outlines the challenges of the coming year.

It may just be the most sweeping revolution you’ve never heard of, but as the world is transfixed by China’s digital advancements, its internet juggernauts and frenetic innovation in the last decade, India is undergoing its own upheaval measured in terabytes, largely away from the international media spotlight. Some 1.2 billion people are now registered on Aadhaar, the national biometric digital identity programme introduced in 2009. INSEAD’s recent blog notes that more than 80 percent of Indian adults now have at least one digital financial account.

This of course is having a massive impact on the performance of local markets and the ways in which humanitarian assistance can be provided. 2022 will see HLA’s launch of several policy and advocacy groups. The Local Procurement Learning Partnership (LPLP), founded in 2021, will focus on gathering evidence for change within the aid sector. The impact of the pandemic and the huge digital advancements will become a significant focus as will the need to forecast transport capacity requirements ahead of time to help mitigate shipping bottlenecks.

As noted in Bollore Logistics’ recent newsletter, the current health crisis has had a chaotic and never-before-seen impact on both local and international freight transportation and across all modes.

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COVID vaccines: how to speed up rollout in poorer countries

Sarah Schiffling, Liverpool John Moores University

COVID-19 vaccine production has scaled up significantly. Global output is now estimated to be over 1.5 billion doses a month, rapidly propelling the world towards the 11.3 billion doses needed to vaccinate 80% of teenagers and adults and potentially bring the pandemic to an end. Total output may reach that target by the end of 2021.

Protecting the global population will soon no longer be hampered by limited supply. Yet despite production scaling up, for many low- and middle-income countries, access to vaccines continues to be a struggle. Poorer countries lag far behind richer ones in terms of COVID-19 vaccine coverage. Fewer than 3% of people in low-income countries are fully vaccinated.

As the world closes in on having the capacity to theoretically vaccinate everyone, more needs to be done to make sure doses end up being given to those that need them. Here’s what’s standing in the way.

Spreading out production

Part of the problem is that production is concentrated in relatively few countries. Pretty much everyone imports COVID-19 vaccines, but 80% of exports come from just ten countries, and low- and middle-income countries are barely present in COVID-19 vaccine supply chains. As a result, they don’t have ready access to supplies that they themselves are creating, while when trying to secure imports, they tend to be outcompeted by wealthier countries, who typically over-order.

One way vaccine producers are trying to resolve this problem is by diversifying who makes vaccines. AstraZeneca, for example, is working with Siam Bioscience in Thailand to produce vaccines in South-east Asia that are specifically for the region. Johnson & Johnson is working with Aspen PharmaCare in South Africa to increase supply to Africa.

Other countries are becoming producers too. Vietnamese manufacturers are going to make Russia’s Sputnik V vaccine. And Egypt has signed a deal that could see it produce a billion doses of the Sinovac vaccine each year, many of which would be used to supply Africa.

An added benefit of these agreements is that they produce vaccines closer to where they are needed. Stretched supply chains are causing issues around the globe, and medical supply chains have been under pressure throughout the pandemic. Shortening supply chains should hopefully leave low- and middle-income countries less exposed to shortages and pressures elsewhere in the world.

There have also been calls for a patent waiver for COVID-19 vaccines, to legally allow countries to produce doses of the existing vaccines without the involvement of the pharmaceutical companies that developed them. But calls for this so far haven’t been successful.

A vaccine patent waiver also wouldn’t solve access issues on its own. For low-income countries to produce their own doses, technology and knowledge would need to be passed over along with the legal production rights. Financial support would be needed too. At the time of writing, vaccine producers are yet to share freely the knowledge behind their products.

Supply doesn’t end at the border

Transport also needs to be addressed. The logistics of rolling out COVID-19 vaccines in low- and middle-income settings can be very challenging.

Roads to remote communities can be non-existent, dangerous or in a bad state of repair. In Indonesia, for example, authorities have found it hard to get doses to certain island communities. But these challenges can be overcome. In Bhutan, vaccines have got to hard-to-reach mountainous locations by air or on foot. Countries like Malawi and Vanuatu have tested delivering vaccines using drones. Good planning and ingenuity can boost delivery rates.

Meanwhile keeping COVID-19 vaccines at their required temperatures in transit and in warehouses is a particular concern. But this isn’t new. The Ebola vaccine also needs to be stored at ultra-low temperatures and has been successfully distributed to areas like the DRC’s conflict-affected north-eastern region. This experience of combating disease outbreaks should be beneficial in setting up the necessary logistics this time round.

Vaccination requires the human touch

Ultimately, people need to be willing to be vaccinated. They also need people and facilities to administer vaccines to them. There are, however, significant shortages of healthcare workers around the world, with low- and middle-income countries particularly badly affected.

Staff need to be specially trained to give COVID-19 vaccinations, which is why the World Health Organization offers online training for frontline staff in a wide range of languages. Local knowledge is also essential for setting up vaccination points that correspond to the needs of the population – there’s no point offering vaccines where people can’t or don’t want to have them.

Hesitancy is also a barrier in some places – for instance in the east African countries of Uganda and Tanzania. Consistent messaging is needed to overcome it, and authorities need to engage with the public on their specific concerns, which may be linked to religious or cultural factors or fears around safety. Lessons learned in one country are unlikely to be directly transferable to others, but can inform the development effective strategies.

There is extreme inequity in access to COVID-19 vaccines – and the pandemic won’t end until it’s addressed. Only 2.3% of people in low-income countries have received at least one dose. In the UK, that figure is close to 90%. There is a moral imperative to change this, and an economic one too. Global trade cannot properly recover until the virus is suppressed.

Ending the pandemic will mean making more doses available to lower-income countries. It will require getting better at delivering vaccines in difficult-to-reach parts of the world. And it will mean ensuring that people in lower-income countries want to get vaccinated. As vaccine production continues to ratchet up, it’s important to remember that all three of these points need to be addressed.The Conversation

Sarah Schiffling, Senior Lecturer in Supply Chain Management, Liverpool John Moores University

This article is republished from The Conversation under a Creative Commons license. Read the original article.

Published 05 October 2021

Sarah Schiffling, Liverpool John Moores University and Chris Phelan, Edge Hill University

Nearly half the world’s population has received at least one dose of a COVID-19 vaccine. But figures vary widely between countries. Many low and middle-income countries have barely started their vaccination campaigns.

But the tiny Himalayan nation of Bhutan isn’t one of them. By the end of July, it had fully vaccinated 90% of its adults. Despite having few doctors and nurses, across just three weeks in the summer it delivered a second vaccine dose to nearly every adult in the country. This is a remarkable success story for one of the least developed countries in the world.

Health minister Dechen Wangmo credits solidarity, Bhutan’s small size and its science-based policymaking for its success. Its achievement highlights how logistical challenges and vaccine hesitancy can be overcome.

Donations are crucial

Bhutan’s success wouldn’t have been possible without international cooperation. Its first vaccines were donated by India. By March 2021, India had sent 450,000 doses of the AstraZeneca vaccine, enough to give all eligible adults in Bhutan their first dose in the spring.

But getting hold of second doses was a challenge. India’s second wave soon arrived, causing it to prioritise domestic immunisations and ban vaccine exports. Bhutan’s immediate source of doses had dried up, while India’s mounting caseload over the border posed a rapidly increasing infection risk.

After a tense wait, 500,000 doses of the Moderna vaccine came from the US through Covax, the vaccine-sharing initiative. An additional 250,000 doses of the AstraZeneca vaccine came from Denmark, followed by supplies of AstraZeneca, Pfizer and Sinopharm vaccines from Bulgaria, Croatia, China and other countries.

Planning makes the logistics work

Distribution was another big part of the puzzle. Bhutan is remote. Land access is only possible on a few roads from India. The Covax vaccines arrived by air at Paro International Airport. One of the most challenging landings in the world, Paro sits in a deep valley. The surrounding peaks are as high as 5,500 metres.

Domestic transport is also challenging. Bhutan’s population of almost 750,000 is scattered over an area roughly the size of Switzerland. Not all of the mountainous country is accessible by road.

Because of this, the health ministry had to plan in detail how to get all adults their first and second doses as quickly as possible. This involved extensive field visits to remote districts, to map where people were and identify possible vaccination sites. The visits also established ways of supplying these sites – by road, air or even on foot for the most inaccessible areas.

Schools, monasteries and other public buildings were used as vaccination centres. Keeping vaccines sufficiently cold at smaller locations could be challenging, so district hubs were created across the country to store vaccines and coordinate distribution to smaller sites as doses were needed. Domestic flights and a helicopter shuttle service were used to move doses around the country.

And a digital platform – the Bhutan Vaccination System – helped speed up the rollout of second doses. It allowed people to pre-register online before receiving their jab and so not waste time filling in personal details at the vaccine centre.

User research was also central to Bhutan’s planning phase. The health ministry ran online conferences with healthcare workers and authorities at district and village level to highlight expected challenges. Simultaneously, the ministry mobilised and trained healthcare workers to vaccinate and monitor patients.

But with only 376 doctors in the country, the planning phase soon identified a shortage of medical personnel. So 50 registered doctors known to be studying overseas were recalled.

Nurses and healthcare workers were supported by the “Guardians of the Peace” – a part volunteering, part national service programme that has been run in Bhutan for the last decade and has 4,500 members. These guardians encouraged people to get vaccinated and helped manage vaccine centres.

Set a good example

Good leadership has also been a hallmark of Bhutan’s vaccine rollout. There are high levels of trust in the country’s political leaders. This has been helped during the pandemic by the government having two doctors and two public health experts in its 11-member cabinet. The prime minister and the health minister have spent substantial time on the national response to COVID-19.

The role of King Jigme Khesar Namgyel Wangchuck should also not be underestimated. While Bhutan became a constitutional monarchy in 2008, transitioning to having a democratically elected government, the king is still much revered. His presence has been felt throughout the country, as he has travelled to remote settlements to oversee protection measures.

One such journey was a five-day trek to meet and thank healthcare workers. Leading by example, he quarantines in a hotel whenever he returns to the capital.

Bhutan’s politicians also engaged with the public to overcome vaccine hesitancy. A survey studied the public’s concerns, with the government’s response focusing on communicating the science behind the vaccine. Uptake was promoted by social media influencers and television and film personalities.

Cultural sensitivity was also crucial to ensuring public support. For example, Buddhist monks determined when to roll the vaccines out and picked the most auspicious time (the majority of the population is Buddhist). Monks also determined that the first dose should be administered by a women and given to a women born in the Year of the Monkey.

Not every country can achieve what Bhutan has. Having a small population and high trust in authorities facilitated this rollout. But Bhutan demonstrates that a fast and equitable vaccine rollout is possible in low and middle-income countries.

What’s clear is that the international community has to work together on the provision of vaccines. Support may also be needed to manage distribution, as getting doses to remote parts of the world’s least developed countries is a huge challenge. Bhutan, though, should offer encouragement that meeting it is possible.The Conversation

Sarah Schiffling, Senior Lecturer in Supply Chain Management, Liverpool John Moores University et Chris Phelan, Senior Lecturer in Business and Management, Edge Hill University

This article is republished from The Conversation under a Creative Commons license. Read the original article.

Published 28 September 21

The Health and Humanitarian Logistics Conference 2021 took place last week, closing after a successful three days of excellent presentations, conversations and collaborative networking that will keep the momentum for change going into our continued work and upcoming events.
Opening with Africa and the Middle East, the huge value in developing stronger connections with local supply chain networks was highlighted. Knowledge sharing, training for local manufacturers and suppliers, and evidence gathering efforts was noted as being essential to supporting access to good quality health and humanitarian products, supply chain services, and information on globally acceptable standards. Day two focussed on Asia, and found that there is a need to advocate for long-term government policies and strategies that better enable health and humanitarian supply chain capacity strengthening. The final day of the HHL conference focused on the Americas, which recognised that current international procurement processes risk limiting business opportunities for local manufacturers and cooperatives; there needs to be a structural change in aid sector procurement to improve national resilience to emergencies. 
Our excellent speakers, panellists, facilitators and presenters made the conference a rich, diverse and truly collaborative event. We thank each and every one of our attendees for joining us and for the many valuable contributions to each day's discussion. Our heartfelt thanks go out to our sponsors and supporters throughout the event.
A full summary, session recordings, detailed outputs and next steps will shortly be made available, watch this space and our social media!

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