Joseph Oliver
Cold Chain Last-Mile Vaccine Distribution - Constraints in Emerging Economies and Future Opportunities
Summary
Abstract: In emerging economies, an adequate cold chain for the distribution of vaccines appears to have many constraints to factor, when addressing the existing environment found today (2022), or when designing and deploying future systems. Cold chain systems are inherently struggling to effectively and efficiently support immunization programs within emerging economies to ensure safe, reliable, and potent vaccines. The daily struggles found through systemic, infrastructure, human, and material constraints that workers encounter across the last-mile of vaccine distribution are both a concerning and inhibiting factor for all the stakeholders involved today. This research explores how viable it would be for stakeholders to adopt simple, incentivized programs that affect sustainable change. This was achieved through substantial desktop research and review of peer research materials on this subject, combined with interviews of participants with last-mile subject matter expertise. Additionally, a validated service blueprint map was collaboratively developed. The scenarios detailed in this research examine approaches that mitigate many of the primary constraints uncovered in this study; some of these constraints include real-time data capture and cold chain equipment maintenance. This study offers insights into key areas for improving performance and achieving equitable delivery of immunizations to children in emerging economies.
Additional info
Author: Joseph Oliver is a London-born, and Brighton-raised, British/American designer. His career started in Silicon Valley, in the late 1990s, and during this tenure has been involved in designing and building flagship products for companies that have gone on to be acquired by Apple, Adobe, Nokia, Nvidia, and Virgin. Joseph has received a number of accolades and honors for his agency-based design work, that include: iF Design, Red Dot, Webby, Frost & Sullivan, Technical Emmy, CES ‘Best in Show’, and BOAT International Awards.
In the context of this academic research, Joseph recently led a research design team exploring the impact Amazon, Inc. is having on the commercial third-party logistics (3PL) space in North America, for FedEx.
Context: The research examines the distributed touchpoints of vaccines during the last-mile of the journey to destination endpoints (clinics and patients). Specifically, the research study goal is to highlight how the use of cold chain technology is applied, where the service disconnects are often presented, and what methods are currently being utilized by the local people to solve their constraints and service disruptions. This study also explores whether researchers within this field should be looking at innovators such as Coca- Cola, via its Project Last Mile in Africa, to help address and alleviate the systematic problems and real-world challenges presented today. Could the existing commercial distribution networks be utilized effectively and efficiently? And, could governments and NGOs tap into this local network of entrepreneurs?
Method: The study adopted a mixed method approach utilizing an abstracted process of systematic mapping, as described by Moher D, Liberati A, et al., and the inductive approach of Thematic Analysis described by Braun & Clarke, 2006.
The goal of a systematic mapping study was to rapidly gain a focused overview of the research area. This was complemented by investigating the state of evidence within specific areas identified thematically from deeper research. The research was then merged with a combination of primary interviews, service blueprint mapping, and participant working collaboration, to enable this research study to identify possible areas of research knowledge or service gap.
Results: Throughout this study and the multitude of participant interviews, the theme of Data occurred with the highest incidence, and it was attributed to many of the major underpinned constraints preventing equitable vaccine distribution, temperature control management, vaccine tracking, patient tracking, and provisioning. Resource churn, adequate training, and poor maintenance of the facility and refrigeration storage units were the other prevailing core themes that occurred with frequency within the individual interviews and themes generated through analysis.
Conclusions: There are twenty independently unique conclusions presented within this study. Two are presented below for context:
1. This study discovered there is a consistent core group of themes that present themselves as critical constraints to the success of cold chain vaccine delivery in emerging economies. This core group consists of legacy and/or poorly maintained infrastructure, lack of training and maintenance, obsolete methods of data capture and utilization, geographic infrastructure deployment challenges, the high churn of human resources, and budgetary constraints. Of all the materials reviewed, few have focused on new or alternative methods of reaching those affected at the end of the chain, or the last-mile. As a result, this ‘last-mile’ remains a glaring problem, with a world of opportunity for addressing in the name of human good.
2. There is no reliable mechanism utilized today by which to determine the viability of the vaccine once it’s reached the last-mile. Though GAVI estimates that spoilage is between 10-30%, theoretically ‘total’ spoilage may have occurred.
General Summary: This study uncovered that health solutions are not reaching every community, clinical healthcare is spread incredibly thin, and due to numerous areas outlined, there is a high incidence of resource churn. Many of the NGOs working within this area have identified these factors as the key constraints impeding successful vaccine coverage, and as such, investing in programs pinpointing what health workers need to ensure that health care and vaccinations are being delivered to the most rural and underserved communities. However, this research has also identified that the problems impacting the last-mile are like a jigsaw puzzle, with numerous factors and different pieces driving the overall challenges found today across this last-mile. NGOs and the public and private sectors will need to work collectively to address these pieces of that puzzle, so that as each piece is alleviated, a more complete picture of change can occur. The greatest likelihood for near-term change will likely be found by placing clear and supported responsibilities into the hands of a small group of people at the last-mile, ensuring that vaccines get out to everybody. Once this has occurred, providing them with the necessary infrastructure, communications networks, power, and transport to support the network, it is highly probable that equitable last-mile vaccination could possibly become yesterday’s challenge. It is therefore vital that workers are not only well-equipped, trained, and supported, but also compensated based on workload and outcome.
