No product, no program: The critical role of supply chains in closing the immunization gap

Immunization supply chains—the network of staff, equipment, vehicles, and data needed to get vaccines safely from the manufacturer to the people who need them—were first developed in the late 1970s with the launch of the Expanded Program on Immunization. They were designed to manage distribution of a small number of vaccines to a limited number of locations. Since then, the immunization program landscape has changed radically because of growth in the number of vaccines available, changes in storage requirements, increases in vaccine costs, and other factors. Between 2010 and 2020, for example, immunization services will require storage and transport capacity to manage four times the volume of vaccines [2]. Health workers will administer six times as many doses per person—including older children, adolescents, and adults—and in more settings. Storing and transporting a larger number of vaccines to more delivery points requires continuing to update supply chains accordingly. Between 2011 and 2015, low- and middle-income countries had requested US$289 million from Gavi to update and strengthen their immunization supply chain systems, complemented by government and other sources of funding for supply chain improvements. Given the many competing budget priorities, finding new funding for further investment for this social good is particularly challenging. Yet the cost-effectiveness of investments is compelling: recent research suggests that for every dollar invested in childhood immunization, there is a return on investment of US$16 through savings in health care costs, wages, and productivity due to illness [3].