In early 2013, GAVI assessed the greatest challenges to increasing the efficiency of vaccine delivery, and identified key areas where private funding, expertise, and know-how have the potential to make a significant impact. Within the scope of its global supply chain strategy, the GAVI Alliance commits to launching two private sector initiatives to address the critical gaps identified: 1) a Supply Chain Center of Excellence to incubate new private sector partnerships and solutions to address GAVI-supported country needs; and 2) a Supply Chain Targeted Improvement Facility to provide funding to GAVI-supported countries, aimed at addressing critical supply chain challenges.
The Center of Excellence will convene approximately 4-6 leading global companies in a forum for sharing ideas and devising innovative solutions to improve the efficiency of vaccine supply chains in partnership with GAVI-supported countries. The center's activities and deliverables may include: barcode tracking and analytics, training for healthcare professionals, effective vaccine management, single-land supply chain analysis, and support. Deliverables could also include providing advice to GAVI on its global supply chain strategy implementation and specific challenges raised through the strategy. Center of Excellence members will also contribute to identification of best practices applicable to GAVI within their expertise, contribution of capabilities and skills for implementation, and assessment of needs at country level in terms of assets, services or technologies, and identification of possible solutions. Members will meet on a regular basis and each member will provide individual support through a project plan
The Supply Chain Targeted Improvement Facility (SCTIF) is a funding mechanism that will help GAVI-supported countries improve supply chain management and cold chain systems in a nimble, expedited, needs-based, and fully accountable manner. Funding provided through SCTIF will be utilized based upon country demand for technical assistance to address specific supply chain challenges and bottlenecks that can help improvement vaccine delivery.
The GAVI Secretariat will manage both initiatives. For the center, GAVI will act as the convener between the governments and private sector partners and act as a catalyst among the stakeholders for identifying and implementing new solutions. For the facility, GAVI will be the custodian of the funding, and the GAVI Secretariat will seek to approve the funding in the most optimal way, taking into account initiatives by the center membership and other participants in GAVI's broader supply chain strategy. For both initiatives, GAVI will guide and monitor activities to maximize collaboration in ways that promote long-term sustainable solutions and best practices that can be replicated.
Private sector donations and in-kind commitments through the center and the facility will be made through the GAVI Matching Fund, which will match each contribution, bringing the total value of both initiatives to an estimated $12 million.
The Supply Chain Center of Excellence and the Supply Chain Targeted Improvement Facility are key components of GAVI's global supply chain strategy, to be reviewed and approved by the GAVI Board in November 2013. While one project by a center member is already underway (see below), further activities will begin in Q1 2014 when the global supply chain strategy begins its implementation phase. Work will then be on-going, and will bring together the private sector, governments, technical partners and other specialists, such as UNICEF and WHO, to develop country-specific plans aimed at tackling critical supply chain challenges.
The supply chain challenges to be addressed by the Center of Excellence will be identified by GAVI-supported countries. The GAVI Secretariat will then convene conversations with Center membership to identify if one or more members can assist in addressing a specific challenge and if so, will work with all those involved to develop a suitable implementation plan. The aim is to initially engage four firms as center members. Countries currently being explored as first partners for involvement in the center include DRC, Nigeria, Bangladesh, Lesotho, and Vietnam.
A project plan has already been developed with Vodafone, which is implementing a mobile solution specifically aimed at improving immunization coverage and program management in Mozambique. After an initial project phase involving 100 facilities, the Ministry of Health will consider the results to determine whether the project will be extended nationally. To date, health worker testing of the prototype is underway in Mozambique. Additionally, there will be field-testing in 10 clinics and a 3-month long base line study of 100 implementation sites.
Similarly, negotiations are underway with other potential center members to develop individual project plans. These project plans and others will be developed by the end of 2013. Projects will begin implementation in 2014, and first measures and evaluations will take place in 2015.
Under the Supply Chain Targeted Improvement Facility (SCTIF) mechanism, GAVI-supported countries will make formal requests to the GAVI Secretariat, which in turn, will evaluate each proposal and decide on funding. In some cases, the approved funding could be applied to work undertaken by Center of Excellence members (for example, to scale up the Vodafone project, if the pilot is successful) or be used for other technical partners not in the center.
Beginning in Q4 2013, eligible countries will be invited to apply for funding from the facility and SCTIF-related tools will be developed by 15 November 2013. Key staff will be deployed by 15 December 2013, and GAVI will review requests within one month of receipt and communicate funding decisions to countries no more than 2 months after receipt of request. Approved country requests are funded with all relevant contracts in place within three months of request approval assuming no constraint on the part of the contracting partner and assistance activities will start within two weeks of contract start date.
Although difficult to measure at this preliminary stage, the potential impact of the Center of Excellence and the SCTIF for GAVI-supported countries could include improved data collection, more efficient stock management and delivery, fewer stock outs, more timely delivery, and less wastage. And, as a result, more children vaccinated.
As one of the most cost-effective and affordable health interventions today, vaccines are credited with greatly reducing illnesses that once ravaged the world. Each year, an estimated 2.5 million deaths are averted thanks to immunization, equating to 7,000 lives each day. For example, although the world's population has more than doubled between 1980 and 2009, the number of diphtheria cases fell by 99% and polio cases were reduced by 97%. Often pennies a dose, vaccines provide life-long benefits: increased lifespans, reduced morbidity, and more productive and happier lives for vaccine recipients, and the communities and countries in which they live.
Each year, however, 1.7 million children still die from vaccine-preventable diseases. The vast majority of these deaths occur in developing countries. Without this protection, these children live risky lives. If they are fortunate enough to escape death, they tend to survive only with disabilities. The economic and social impact of caring for children and adults who have been debilitated by disease is huge: education is often not completed, labor productivity remains low, and long-term health costs skyrocket.
While there has been dramatic progress in recent decades in most developing countries, nearly one quarter of the world's children still go unvaccinated. This is due in part to inadequate vaccine delivery systems - experts estimate that poor vaccine management contributes at least a third of the problem of high numbers of unimmunized children. Common challenges within the delivery chain include weak information systems, outdated supply chain processes, and a lack of cold chain infrastructure. In addition, the supply chains built to deliver vaccines are under immense pressure due to ever-increasing demand by developing country governments, as well as growing complexities with new, more expensive, vaccines. Since 2000, the portfolio of antigens recommended by the World Health Organization has doubled from 6 to 12, and most vaccine systems are unable to keep pace with this growth. Improvements in the supply chain are thus critical to reducing the health system barriers that currently hinder the expansion of vaccine distribution.
The GAVI Alliance believes that all children should have the same right to good health, including the right to be protected by vaccination. As part of GAVI's mission to save lives and improve health by increasing access to immunization, the organization has increasingly placed emphasis on the key role that the private sector and other partners can play in developing innovative solutions to the complex challenges within the global vaccine supply chain. In this vein, the Alliance is seeking long-term sustainable business solutions - and encouraging private-public partnerships - to ensure that life-saving vaccines are available for all the world's children.