The Africa Resource Centre (ARC) has spearheaded an integrated centre of excellence model for supply chain and logistics management, to help build more efficient and effective supply chain systems in Nigeria and across Africa. Nigeria-based supply chain transformation expert Azuka Okeke, regional director, ARC in this interview with Anthonia Obokoh, speaks on what needs to be done to deepen access to vaccines and immunisations in Nigeria.
How prepared is Nigeria to receive the COVID-19 vaccine?
As countries around the globe prepare to roll out highly complex COVID-19 vaccination, misinformation and pervasive myths about COVID-19 and vaccine programs in general undermine confidence and acceptance may fuel mistrust, and in turn success. There are Different COVID vaccines coming up and there are more still being manufactured. About nine vaccines are in the pipeline.
The Mordena vaccine is the one Nigeria is expecting and what we can use in Africa based on our weather conditions. Moderna COVID-19 vaccine can be stored in the freezer between -25°C and -15°C (-13°F and 5°F). These temperatures are within the appropriate range for other vaccines stored in the freezer but the temperature range for this vaccine is tighter. If storing the vaccine in a freezer with routinely recommended vaccines, carefully adjust the freezer temperature to the correct temperature range for this vaccine.
I believe it is more suitable for our temperature, if Nigeria is going with the Mordena vaccine which is suitable for our weather condition, the temperature differences would not be an issue. We have been able to keep all other vaccines that required +2 – and +8 degrees in Nigeria and even we can do much better. It is not about the temperature but the issue would then be storage and the logistics of moving the vaccines to the areas of need and even defining the areas of need. All countries are required to put in place an ethical distribution framework once a vaccine that is safe and effective becomes available. Countries have to decide to prioritise, that is, those that are most vulnerable to severe illness – such as the elderly, people living with chronic illness given their risk of having a severe illness and potentially death.
Delivering vaccines once available in Nigeria, the National Primary Health Care Development Agency (NPHCDA) leads on Nigeria’s vaccination policy and implementation. However, from its work on delivering on campaigns for vaccine-preventable diseases in Nigeria, including polio, it has shown that it can effectively and efficiently deliver vaccines to populations. However, never before has this volume of vaccines been required to vaccinate such a large number of people, at once. The delivery of the required doses of the COVID-19 vaccine will face challenges, requiring the implementation of innovative delivery mechanisms, especially to reach the last mile. This may be further complicated if the vaccines need extreme storage conditions such as -80 degree freezers.
We know immunization goes on all across the country; there is no state where we don’t immunize children and even adults. So, I believe there are cold storage facilities where we can manage our vaccines. But what one would be thinking of is if those storage facilities are adequate in case we are bringing in COVID vaccines into the country. To bring vaccines into the country there should be an immunization plan. How many people are we targeting, is it the entire continent? are we targeting a certain segment where there are those segments that would then want to now review and assess if the cold storage facilities are adequate as it is we have cold stores across the country and we are using them to help bottom.
What are the challenges you foresee?
In Nigeria, the COVID pandemic has not had much impact when compared to the Western world, even if the second wave seems to be glaring. Looking at how the country is functioning, people are pretty much going about the duties, schools have opened; the pandemic so to say has not affected our paralysed system.
The major issue we would have is being able to segment who needs vaccines and where they are. If it is the health care workers, the logistics would be pretty much easy because even for the Western world they have prioritized the vaccine for different categories. Do we have a segment of people that we feel must take the vaccine or is it something that we do like what we did for yellow fever, where some countries are placing some embargoes to accept you coming in only with your yellow card as evidence because that’s the beginning of the preparation. In the UK they are starting with the aged, you could readily go to an old people’s home and a lot of places and immunize them. In America, they are looking at the health care workers
For Nigeria, we need to come with a plan and if we have a plan, getting the number we need is what we need to do. We do not need to have so much vaccine that is not according to the plan of the nation. The vulnerable such as front-line health workers, nurses, doctors, lab personnel, and other health workers likely to be in contact with patients and their samples need the vaccine. If the vaccine would be used more for health care workers, it is for logistics to get into the capitals of cities where you get the healthcare workers to prioritize and give the vaccines. Nigeria would not have much problem because we have the logistics for every urban community in the country, so it is not an issue. But if we are trying to immunize the aged, we do know that most of our aged lives in remote villages, which is where we would have a challenge in terms of logistics.
The major challenge Nigeria needs to look at to address is communication and raising the right awareness that vaccines are useful. The government should prioritize a plan for communication by doing more on sending the right information. We did very well when the pandemic came into or when we were preparing by setting up like the update from the presidential Task Force, so people had access and even links to help or questions on vital information. Most importantly, the right updates and sources of information to go out to the masses. One of the things the national Primary Health Care development agency should look into this issue of communication. In general, a lot more work needs to be done in the area of communication, people need to know the value of the COVID vaccine for them as it applies to them and preparation comes from a level of awareness.
How can Nigeria strengthen its health supply chain?
The supply chain (SC) for immunisation comprises all individuals, activities, structure, resources, and planning relevant for facilitating effective and safe delivery of vaccines to those that need them. In developing countries, such as Nigeria, SC capacity is inadequate to meet the ever-increasing population needs. To improve immunisation coverage and subsequently reduce infant and child mortality, a strong SC system is essential, requiring advanced technology to be applied to all aspects of the SC system; from planning to cold chain equipment, data management, and distribution of commodities. At the heart of these at all levels of health, the system is the need for SC leadership which requires skilled and competent individuals who are empowered to deal with the present and future challenges.
Nigeria has developed supply chain leaders who will advance the transformation of effective and efficient immunization delivery. Strengthen the SC leadership in governments, the Vaccine Alliance (GAVI), in collaboration with United Parcel Services (UPS) (a private global logistics company), developed the Strategic Training Executive Programme (STEP). One of the key areas of focus of the STEP training in Nigeria is building strong leadership at national and state government levels that will drive ownership of health programs beyond Vaccines Management. ARC led the adoption of the STEP by the Nigerian government by providing insight on the relevance of the program to the decision-makers’ immunisation. The National Primary Health Care Development Agency (NPHCDA) through the advocacy support of ARC made a formal request to GAVI to implement the STEP strategy in Nigeria.
How can you rate the healthcare supply chain in Africa?
Chaotic supply chains are negatively impacting health, development, and economic outcomes in Africa. The shortage of skilled supply chain personnel has been identified as a key driver of logistics under-performance in countries. A functional supply chain ensures that health facilities are always stocked above a certain minimum level, ensuring the availability of commodities. Since logistics costs represent 20 to 40 percent of commodity costs, it follows that efficient local supply chain management can help to achieve a significant reduction in commodity prices, too. If less money must go out of Africa to design, plan, and implement healthcare supply chains, there will be more left to get medicines to the last mile.
To this end, the Africa Resource Centre (ARC) has spearheaded an integrated centre of excellence model for supply chain and logistics management, to help build more efficient and effective supply chain systems in Nigeria and across Africa. ARC – an initiative of Bill and Melinda Gates Foundation is an independent strategic advisor, promoting collaboration to improve the availability of medicines and health products in Africa. Our model encompasses short, medium, and long-term elements to rapidly develop supply chain management and logistics expertise in Nigeria and beyond and our key objectives are to rapidly strengthen and scale-up in-country capacity, skills, and expertise to meet local and regional needs and to leverage and contribute to the global network focused on advancing supply chain excellence.
How is ARC Nigeria, championing supply chain revolution in Nigeria’s healthcare system?
Indeed, the role of supply chain and logistics systems through which medicines and health commodities are delivered to the last mile cannot be overemphasized. The goals of the Universal Health Coverage (UHC) to deliver access to required health services of sufficient quality cannot be achieved without access to medicines and health commodities. Equally, the manpower that oversees, manages, and operates supply chain and logistics systems become paramount. Functional supply chain systems manned by capable logisticians across tiers ensure health facilities are adequately stocked at all times, ensuring the availability of commodities and access to healthcare at the last mile.
Nigeria ranks low on logistics competence evidenced by the World Bank’s 2016 Logistics Performance Index (LPI) report, which ranks Nigeria within the bottom 2 quintiles, characterized by very low availability of skilled logisticians, especially in mid-level management roles. ARC Nigeria primarily seeks to deliver impact by raising the performance of health supply chains to increase the availability of medicines and health commodities at the last mile – through capacity enhancements of public health logisticians, supply chain process improvements, among others.
Therefore, one major focus area of the ARC is to support the effective development of local talent pools adequately trained to manage and operate public health supply chain and logistics systems, as well as for private sector supply chain systems in Nigeria and subsequently within West-Africa. In effect, the ARC seeks to foster a supply chain revolution in Nigeria by facilitating local and international partnerships to foster in-country capacity for sustainable supply chain Education, Research, and Innovation.