The March Towards Resilience and Readiness

A strong vaccine supply chain system is the backbone of sustained routine immunization. Without it, supply doesn’t match demand, unmet need becomes the tragedy of hard-won vaccine acceptance and, ultimately, children become susceptible or even lost to vaccine preventable diseases.

The quest for an effective system was central to the work of the Kano State Primary Healthcare Management Board (SPHCMB). Located in northwest Nigeria, Kano was still battling polio as recently as 2012, and was regarded at the time as the Nigerian epicenter of wild poliovirus transmission. While Kano did not lack health facilities, the vaccine delivery architecture suffered a lack of streamlining, resulting in inefficient delivery of vaccines from the state stores to health service delivery points.

An early step was the formation of a State Logistics Working Group (SLWG), comprising government officials and supporting partners, to coordinate the delivery of vaccines within the state. The group also served as the platform where technical issues could be resolved. Next, vaccine stock dashboards were introduced to ensure visibility into vaccine stocks at all levels of operations from facility to zone to state. To ensure that this new system would be sustainable, regular maintenance plans for all solar direct drive refrigerators and walk-in cold rooms were included in the regular monitoring.

Cognizant of the challenge facing their state, in 2012 the SPHCMB partnered with The Bill & Melinda Gates Foundation and Aliko Dangote Foundation in an effort towards polio eradication through strengthening of Kano’s routine immunization including its supply chain system.

Dr. Tijjani Hussaini, the current Executive Secretary of the SPHCMB, acknowledges the key role the partnership between donors and the Kano state government played in combating the challenges that faced routine immunization. For him, setting up an effective and sustainable system that would resolve the problem of inefficient vaccine delivery was the key goal and one of the partnership’s successes. The main objectives were to install and maintain a functioning cold chain system in major locations across the state; to ensure adequate storage space and distribution architecture to reduce the frequency and magnitude of vaccine stockouts, which stood at over 40% in 2012; to upskill various cadres of health workers along the system; and finally, ensure proper quantification along the chain. The expectation was substantial given the under-one target population was in the hundreds of thousands, however, with the resources in place from all stakeholders, the SPHCMB began its concerted effort towards change.

Today, Kano state continues to use the Direct Vaccine Delivery System. Transportation of vaccines is done from state central cold stores to the satellite stores at the zones, and thereafter to facilities– ensuring all levels receive necessary vaccines directly. Over the last nine years, the investments that were spurred by the Direct Vaccine Delivery System have turned around the state’s performance on immunization. Stockout rates have persistently stayed above 40% over the last 4 years while immunization coverage has increased from 16% to 43% between 2012 and 2018 (Source: National Demographic Health Survey).

While there is still work to be done, this change in one of the last endemic areas for wild polio virus and other childhood killer diseases is noteworthy.

More significant though, is the result of the investment in light of the COVID-19 pandemic. When news of the spread of coronavirus hit Kano, a well-functioning vaccine delivery system was in place. Dr. Tijjani Hussaini and his team at the SPHCMB leveraged the vaccine delivery system and dashboards to quantify and distribute essential personal protective equipment (PPE) that was provided to health workers and ensured continuity of lifesaving interventions which was threatened due to fears among health workers and caregivers alike. Officers like Ibrahim found themselves at the forefront of a new challenge, but this time with the experience and tools to meet it head on. The logistics system that was now in place pivoted quickly to roll out health worker training and sensitization around COVID-19. Ibrahim and his colleagues were able to use the capacity building approach they had used in the past, while leveraging the interpersonal engagements both with fellow health workers and into the community. “At first a lot of people were scared to even engage with health workers, but we used the same approach we used for vaccine hesitancy around polio to challenge a lot of the myths and rumors that were circulating around COVID-19. Those ties we had built made the difference. The community leaders trusted us.” From his perspective, the rollout for testing and information dissemination was successful because it relied on a trusted system that had proven results.

As the focus shifts to rolling out the new COVID-19 vaccine, which will require additional support and resources to reach a larger target population, Ibrahim is already looking to the investments of the past as well essential future investments to support the path forward. Backed by a functioning cold chain system, a streamlined push system and widespread zonal storage facilities, the overall vaccine supply chain system displays all the hallmarks of resilience and readiness.