Do the LAST KILOMETER – IMF F&D

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Improving logistics in sub-Saharan Africa could be key to successful vaccine delivery

Sub-Saharan Africa still has too few vaccines for too few people. Providing more vaccines to the region deserves a top priority in the effort to eliminate new variants that could further derail a global recovery. However, policymakers and the international community are likely to have another obstacle to overcome in order to successfully deploy vaccines: the poor quality of trade and logistics in the region.

No trip is more critical in determining the fate of a pandemic than the distance a vaccine must travel from the production line to a person’s arm. In sub-Saharan Africa, the last kilometer of this important race is essential.

Data from the World Bank’s Logistics Performance Index (LPI) database, a good indicator of transport and distribution logistics, shows that Africa’s LPI score is only about 2.5 on average. The score ranges from 1 to 5, with higher scores representing better performance in logistics, the service network that supports the physical movement of goods both within and across the borders of a country. The region’s score lags all major regions in the world in six key categories of logistics performance, including punctuality and follow-up. For more than a decade, its negative impact on the region’s trade has been well documented. For example, customs delays are estimated to add 10 percent to the cost of imported goods, which is higher than the average impact of tariffs in some cases.

But it is also becoming clear how poor transport logistics could derail the already slow attempts to vaccinate the region’s population and do so quickly. When completely thawed, some vaccines have a short shelf life. This increases the risk of destroying perfectly good doses when the logistical challenges of the region are taken into account. Looking more closely at the reasons given for the destruction of vaccines, the common thread is poor logistics and transport infrastructure. In Malawi, for example, health officials cited the short delay between vaccine delivery and expiration and the need to reduce hesitation as the rationale for incinerating nearly 20,000 doses of AstraZeneca vaccine.

Addressing vaccine reluctance is essential for a successful mass immunization campaign, and overcoming logistical challenges plays an important role. Skeptical individuals have little incentive to get vaccinated if they have to travel miles and spend hours to reach the nearest vaccination centers, often unconvinced that temporary health workers will show up on their own. Places that are poorly served by road also tend to have limited access to information and telecommunications technologies, making it difficult to access official vaccine information. In addition, while bringing vaccine manufacturing closer to Africa to speed up supply is important for capacity building in the region, it is less important in the short term whether vaccines are shipped from Germany or South Africa to , say, the Democratic Republic of the Congo if at the last mile the distribution chain is interrupted by gaps in transportation and logistics.

Before vaccines were rolled out globally, a World Health Organization (WHO) assessment conducted to assess global readiness for COVID-19 inoculation showed Africa has an average readiness score of 33% for the COVID-19 vaccination program, well below the desired baseline of 80%. in key areas, including quality and logistics performance. Emerging data seems to confirm that the quality of logistics performance is positively correlated with the COVID-19 vaccination rate in Africa (see graph).

In this regard, it is interesting to compare the vaccination rates of countries with a relatively low LPI (like the Democratic Republic of the Congo) with those with a relatively higher LPI (like South Africa). The Democratic Republic of Congo’s low LPI score of 2.43 reflects its problem with a very poor transport network. This has made it difficult to deliver vaccines to remote areas and partly explains why nearly zero percent of the population is fully vaccinated. In addition, the Democratic Republic of the Congo and other landlocked African countries naturally face geography and economies of scale when it comes to connecting to global supply chains. This resulted in logistics delays in transport and distribution, leaving Malawi, South Sudan and the Democratic Republic of the Congo unable to deploy and administer vaccines in the short term. In contrast, South Africa, with a score of 3.38, stands out as the best performing, thanks to its large economy (which allows economies of scale in supply chain connections), its network superior and much wider health services, its access to the sea, and proximity to major transport hubs.

In the short term, measures to dramatically increase vaccine delivery and uptake are essential.

On the other hand, Zimbabwe, Equatorial Guinea and Comoros have relatively better vaccination rates but lower LPI scores, which suggests that other factors are contributing to vaccine uptake in Africa. For example, when authorities in Zimbabwe announced that those who refused COVID-19 vaccines could be denied jobs and services in the public sector, the vaccination rate increased dramatically in major cities. This has made Zimbabwe one of the African countries with the highest vaccination rates despite its poor logistics performance.

Cover the last mile

Having addressed the issue of vaccine supply, it is essential to address the logistical performance gaps that persist across the continent to alter the current course of the pandemic in Africa. In the short term, measures to dramatically increase vaccine delivery and uptake are essential. The good news is that useful lessons can be found in the area. For example, when Côte d’Ivoire launched its vaccination campaign, centers equipped to vaccinate 300 people per day were struggling to vaccinate 20 per day. Then the government adopted innovative ways to meet the last mile challenge. It deployed mobile clinics and medical buses that went to the busiest areas to immunize people, albeit at a significant cost. There are now fixed or mobile vaccination centers in 113 districts, and almost all of them are operating at almost full capacity. Ghana has done the same. This could be replicated across the region in the short term with the support of development agencies.

The region can also take advantage of digital platforms for registration and information on vaccine availability, learning from South Africa. A new electronic appointment system allows citizens to schedule their own COVID-19 vaccination appointments at a convenient time and at a nearby center. This should increase the vaccination rate by reducing travel distances and allowing families to make appointments together. Vaccination campaigns should target large cities and densely populated areas where the risks of transmission are greater and disruption to economic activities is severe in the event of mass containment.

In the medium term, it is essential to develop supply chain infrastructure inputs that affect logistics performance, especially in cold chain capacity. The COVID-19 vaccine requires special handling and handling during transport and during administration. AstraZeneca vaccine can be safely stored in refrigerated conditions for up to six months. Pfizer and Moderna vaccines require temperatures of –20 degrees Celsius or less. It is therefore of some concern that a WHO survey in 34 countries revealed widespread deficiencies in the capacity of cold chain refrigeration in Africa. About 30 percent of the countries surveyed have gaps in cold chain refrigeration capacity in more than half of their districts. It is estimated that only 28 percent of health facilities in sub-Saharan Africa have access to reliable power. This presents logistical obstacles for vaccine storage in most districts. Solving these structural problems should be a medium-term development priority.

Poor quality transport and distribution logistics stifles trade and competitiveness and, as now seen, will also be a major obstacle to pandemic vaccination once current supply constraints are resolved. The COVID-19 crisis offers Africa the opportunity to leverage financial assistance from the IMF and other multilateral institutions to invest in infrastructure and trade facilitation measures that support strong logistics performance. These investments will also improve trade and competitiveness and strengthen health systems to cope with current and future shocks.

The opinions expressed in articles and other materials are those of the authors; they do not necessarily represent the views of the IMF and its Executive Board, or the policy of the IMF.