Globally Resilient Supply Chains for Seasonal and Pandemic Influenza Vaccines (2022) / Chapter Skim
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5 Frameworks, Tools, and Innovations for Distribution Readiness
5 Frameworks, Tools, and Innovations for Distribution Readiness
Pages 131-154
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The chapter presents the committee's review and analysis of several major country assessment tools relevant to pandemic preparedness, including those that evolved from the COVID-19 response. We first review three initiatives: the Immunization Agenda 2030; ACT-Accelerator and COVAX, which was launched in 2020;1 and national immunization technical advisory groups.
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/International incentives Finance Corporation • U.S. President's Emergency Plan for AIDS Relief • WHO/World Bank/IMF Recommendation 5-3: Regional pandemic • Africa Centres for Disease response coordination and Control and Prevention engagement • Pan American Health Organization • G20 Recommendation 5-4: • HHS Vaccine innovations review INITIATIVES Immunization Agenda 2030 Developing targets for global immunization coverage is critical to advancing health goals.
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The focus on coordination among stakeholders from country to global levels provides an advanced model for reaching global health goals that are fitted to regional contexts. In addition, the focus on pandemic preparedness
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It is important to ensure that lessons learned from COVID-19 vaccine deployment and response are captured to inform and strengthen equitable immunization programs and highlight the need for global immunization coordination in response to pandemics. ACT-Accelerator and COVAX In anticipation of a need for equitable global distribution of COVID-19 vaccines, ACT-Accelerator (ACT-A)
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The committee believes that a comprehensive review of the achievements, financing, and governance of ACT-A would be a valuable step to develop a more robust and fit mechanism for an extended purpose. Issues that need to be addressed include access, equity, and allocation, in addition to a shortage in operational funding for supporting extra cold chain capacity, vaccine rollout, and associated supplies.
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From 2013 to 2018, PIVI partnered with 17 countries, leading to sustained and increased support for influenza vaccine introduction. An increase in influenza vaccination in these countries suggests PIVI as a suitable model for building countrylevel self-reliance in building influenza vaccination coverage (Bresee et al., 2019)
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Pandemics require a significant diversion of resources, including workforce and supply chain capacity, leaving non-pandemic routine and emergency health services vulnerable (Bell et al., 2017; World Bank, 2021b)
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Cold chains have proved to be a persistent bottleneck in global vaccine distribution. As detailed in Chapter 4, cold chains require significant costly infrastructure and energy inputs to meet vaccine temperature requirements from manufacturing to point of administration (Ashok et al., 2017; Bangura et al., 2020)
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Better tools are needed to help decision makers understand cold chain equipment and tradeoffs when upgrading cold chain systems. Expanding cold chain equipment will be necessary to facilitate equitable global vaccine distribution (Sustainable Energy for All, 2021)
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However, instead of relying on such plans, many countries continue to use top-down approaches to assess country readiness that are based on global cost estimates. While these methodologies are faster and less expensive, they do not capture the granular level of detail afforded by the vaccine introduction readiness assessment tool and the COVID-19 vaccine introduction and deployment costing tool (World Bank, 2021b)
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. Introducing additional vaccines into a national immunization schedule is a challenge, as the addition of an extra vaccine can further strain already limited supply chains. Among countries that do have frameworks, they generally need improvements.
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. Better-aligned vaccine procurement could lead to improved demand consolidation, better funding, and better manufacturing supply chain visibility, which could ultimately improve access.
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To the extent possible, there is need to harmonize these evaluation efforts to lessen the burden on countries and improve their access to the resources made available by these agencies. Private-sector entities with expertise in supply chains and product movement can also contribute knowledge and capacity to enhance supply chains.
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They include tools for developing national deployment and vaccination plans for COVID-19 vaccines, and the COVID-19 vaccine introduction and deployment costing tool (described above)
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. With regard to readiness, gaps remain in each of the country assessment tools, as they are not designed to manage and implement mass vaccination at scale with novel vaccines that may have different requirements from existing immunization programs.
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Department of Health and Human Services and with the Expert Committee on Influenza of the World Health Organization, along with other global stakeholders, should periodically convene to identify the challenges in global preparedness for influenza, as well as overall preparedness for emerging pathogens, benefiting from the lessons learned from recent disease outbreaks to address global supply chal lenges, and support cold chain infrastructure needs across the tempera ture spectrum, as well as to plan mock drills and tabletop exercises to test these systems. The outcome of these meetings should inform national authorities on approaches and best practices to prepare and periodically update their national preparedness plans, with technical support from different agencies, so that the resulting plans are high quality, granular, relevant, and actionable.
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Agency for International Development and the President's Emergency Plan for AIDS Relief, to include pandemic preparedness as an input into coun try funding proposals for various health programs and provide financial support and technical assistance if deficiencies in pan demic preparedness plans are uncovered. • Global institutions, including G20, the World Bank, the International Monetary Fund, and the International Finance Corporation, and regional multilateral development banks should integrate country preparedness assessments into their country economic assistance programs, such as development assistance, loans, and grants, and they should advocate for financial support.
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In the United States, the American Logistics Aid Network (ALAN) could serve as a promising model for private partnerships for vaccine supply chains.
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. Coalition for Epidemic The CEPI global public–private partnership, established in 2017 Preparedness Innovations for pandemic research, proved instrumental during COVID in (CEPI)
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. World Economic Forum The WEF Supply Chain and Transport Industry Team convened (WEF)
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in resource-constrained settings. New strategies and lessons learned from the task force for global health's partnership for influenza vaccine introduction.
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Operation Warp Speed: Implica tions for global vaccine security. Lancet Global Health 9(7)
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2018b. A practical guide for developing and conducting simulation exercises to test and validate pandemic influenza preparedness plans.
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2019. The Global Vaccine Action Plan 2011-2020: Review and lessons learned.
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