Project Last Mile

Thanks, Robert for your note.

The management burden is centered around the capability of health supply chains to manage an ultra-cold chain distribution model using dry ice. PLM has seen in many countries in Africa that there is a relative inability at the health facility level to manage inventories of and perform effective order management of essential medicines, with little understanding of true off-take. This leads to significant out-of-stocks, expires, and waste of essential medicines at health facilities, which is compounded by a lack of data visibility through the supply chain. If this occurs when handling ambient commodities, then supplying the correct quantities of vaccines to minimize wastage on a much higher delivery frequency may prove challenging, whilst the increased complexity of managing inventory movements requiring dry ice to maintain a minimum temperature will pose a significant issue.

The analysis was done on 1% of the population over a 30-day period because when the study was initiated back in November 2020 it was expected that the supply of the vaccines would be severely limited. In addition, the original intention of the feasibility study was to review the dry ice needed for only the initial vaccination of health and frontline workers in each country. The analysis does not refer to the potential rate of vaccination, so it is entirely possible to increase the proportion of the population to match the supply of vaccines as long as the increase in the volume of dry ice required is available to be supplied. PLM has modeled up to 40% of the population vaccinated over a 6-month period, and there is sufficient local dry ice capacity in place in many of the countries across the 3 regions.

The number of vaccination sites was determined by the demand model given to PLM. The demand model used the number of health facilities in-country as a proxy for the number of vaccination sites. PLM used the health facility numbers from this source:

www.tropicalmedicine.ox.ac.uk/news/launch-of-comprehensive-public-health-facility-inventory-for-sub-saharan-africa

The demand model assumes that the vaccinator teams travel to the vaccination site with sufficient dry ice and vaccine doses for a single day of vaccine administration. Thus the volume of dry ice will not get used up based on the assumptions used in the demand model provided. No analysis was made on the effort required for people to travel to the vaccination sites, as the analysis was a feasibility study of the availability of supply of dry ice and liquid CO2 to support an ultra-cold chain distribution model for COVID vaccines.