African countries

African countries need to fix their distribution chains

Sub-Saharan Africa still has too few vaccines for too few people. Bringing more vaccines to the region deserves top priority. But there is another hurdle to overcome for successful vaccine deployment: the region’s poor commercial and logistical quality. Logistics is a network of services that supports the physical movement of goods both within and across a country’s borders.

No journey 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 race is essential.

That of the World Bank Logistics performance indexa good indicator of transport and distribution logistics, places Africa 2.5 on average. The score ranges from 1 to 5, with the higher score being an indicator of better performance.

Africa’s score lags all major regions of the world in six key categories of logistics performance, including speed and tracking. For more than a decade, its negative impact on trade in the region has been well documented. For example, customs delays are estimated to add ten% the cost of imported goods, which is higher than the average impact of customs duties in some cases.

But it is also becoming clear how poor transport logistics could derail already slow attempts to vaccinate the region’s population. Once 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 denominator is poor logistics and transport infrastructure. In Malawi, for example, health authorities cited the short time between delivery and expiration of vaccines and the need to reduce hesitation as justification for the incineration of nearly 20,000 doses of AstraZeneca vaccine.

Addressing vaccine hesitancy is critical to the success of a mass vaccination campaign. But overcoming logistical challenges also plays an important role. Bringing vaccine manufacturing closer to Africa to accelerate supply is important for building capacity in the region. But it doesn’t matter in the short term whether the vaccines are shipped from Germany or South Africa to, say, the Democratic Republic of Congo (DRC) if, at the last mile, the distribution chain is interrupted by gaps in transport and logistics.

Logistics at a glance

Before COVID-19 vaccines were rolled out around the world, a World Health Organization (WHO) Evaluation showed that Africa has an average readiness score of 33% for the COVID-19 vaccination program. This is well below the desired benchmark of 80% in key areas including quality and logistics performance.

Emerging data (see graph below) seems to confirm that the quality of logistics performance is positively correlated with the rate of vaccination against COVID-19 in Africa. It is interesting to compare the vaccination rates of countries with a relatively low logistics performance index (such as the DRC) with those with a relatively higher index (such as South Africa).

DRC’s low 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. Additionally, the DRC and other landlocked African countries are understandably challenged by geography and economies of scale when it comes to connecting to global supply chains. This has resulted in logistics-induced transport and distribution delays, preventing Malawi, South Sudan and DRC from deploying and administering vaccines on short notice.

On the other hand, South Africa, with a score of 3.38, stands out as the best performer. This is due to its large economy (which allows economies of scale in supply chain connections), its superior and much wider network of health services, its access to the sea and its proximity to major transport hubs.

Quality of logistics performance and vaccination rates against COVID-19 across Africa.
Eugene Bempong Nyantakyi and Jonathan Munemo

In contrast, Zimbabwe, Equatorial Guinea and Comoros have relatively better vaccination rates but lower logistics performance index scores. This suggests that other factors are contributing to vaccine uptake in Africa.

For example, when authorities in Zimbabwe announcement that those who refuse COVID-19 vaccines could be denied jobs and services in the public sector, the vaccination rate has increased significantly in major cities. This has made Zimbabwe one of the African countries with the highest vaccination rates despite its poor logistics performance.

Fill gaps

Having addressed the issue of vaccine supply, closing the gaps in logistics performance is critical to changing the course of the pandemic in Africa.

In the short term, measures to dramatically increase vaccine delivery and use are essential. Useful lessons can be found in the area. For example, when Côte d’Ivoire launched its vaccination campaign, the centers equipped to vaccinate 300 people per day struggled to vaccinate 20 per day. Then the government deployed mobile clinics and medical buses that traveled to the busiest areas to vaccinate people, albeit at significant cost. There are now fixed or mobile vaccination centers in 113 districts, and almost all of them are operating near full capacity. Ghana did the same. This could be replicated across the region in the short term with support from development agencies.

The region can also leverage digital platforms for registration and information on vaccine availability – learning from South Africa. A new online appointment system allows citizens to schedule their own COVID-19 vaccination appointments at a convenient time and at a nearby center.

In the medium term, it is critical to develop supply chain infrastructure inputs that affect logistics performance, especially cold chain capacity. COVID-19 vaccines require special handling and handling during transport and during administration. The AstraZeneca vaccine can be safely stored under refrigerated conditions for up to six months. Pfizer and Moderna vaccines require temperatures of -20 degrees Celsius or lower.

It is therefore quite worrying that a WHO investigation from 34 countries found widespread gaps in cold chain refrigeration capacity in Africa. About 30% of the countries surveyed have gaps in cold chain refrigeration capacity in more than half of their districts. It is estimated that only 28% of health facilities in sub-Saharan Africa have access to reliable power supply. Solving these structural problems should be a medium-term development priority.

Poor transport and distribution logistics are stifling trade and competitiveness and, as seen now, will also be a major impediment to pandemic vaccination once current supply constraints are resolved. The COVID-19 crisis presents an opportunity for Africa to leverage financial assistance 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 deal with current and future shocks.

This is an edited version of an article co-authored by Eugene Bempong Nyantakyi and Jonathan Munemo published by F&D.