by Michel Zaffran, WHO In December 2007, a team of talented individuals from PATH and the World Health Organization (WHO) came together to form project Optimize, a five-year collaboration to identify ways in which supply chains can be optimized to meet the demands of an increasingly large and costly portfolio of vaccines. Our goal was to help define an ideal vaccine supply chain that can be used to develop stronger, more adaptable, and more efficient logistics systems, extending the reach of lifesaving health technologies to people around the world. We decided to put our energy into three parallel streams of work: 1. Innovate—create an environment more conducive to innovation in both products and processes. 2. Demonstrate—generate more evidence on new ideas about supply chains and how they work. 3. Facilitate—inspire partner organizations and governments to invest in supply chain improvements over the long term. As we look back, we can point to important achievements in each of these areas. Innovate In the area of innovation, Optimize played a role in reestablishing the Vaccine Presentation and Packaging Advisory Group. Optimize also contributed substantially to the first generic preferred product profile for vaccines as well as to WHO’s Programmatic Suitability for Prequalification guidance on vaccine products. We supported innovation in the cold chain equipment industry by issuing challenges for industry to develop new equipment such as battery-free solar refrigerators, long-life cold boxes, and large-capacity cold boxes. We also worked closely with WHO to help develop specifications for the prequalification of these new types of products and field-test new products in different countries around the world. Demonstrate In our collaborations with countries, we sought to document country experiences with innovative processes and systems including integrated supply chains, mobile warehouse delivery systems, a controlled-temperature chain for last-mile delivery of certain vaccines without ice, carbon-neutral supply systems, and several different types of immunization information systems. Facilitate We have facilitated the development of a multi-partner vision for vaccine supply and logistics systems in 2020 and a plan of action for its implementation. These efforts have generated momentum toward longer-term commitments from partner agencies and governments to invest in supply chain system improvements and product innovations over a longer time horizon. For example, the GAVI Alliance is working on an end-to-end supply chain strategy to complement new vaccine introductions. WHO and United Nations Children’s Fund (UNICEF) have also started working together on a major project to help countries make informed operational and strategic decisions about their supply chain systems following Effective Vaccine Management assessments. Nonprofit, government, academic, and industry partners, including PATH, Agence de Médecine Préventive, People that Deliver, the Bill & Melinda Gates Foundation, the Clinton Health Access Initiative, John Snow Inc., the University of Pittsburgh, VillageReach, Logistimo, OpenLMIS, and the Developing Countries Manufacturers Network, as well as UNICEF and WHO, have ongoing programs to tackle issues related to vaccine products, supply system design, information systems, human resources, and equipment. As Optimize closes its books this month, we are happy to see that work in these areas will continue and that countries will be supported as they strive to manage larger and more complex immunization programs. At the global level, and in partnership with the vaccine industry, stakeholders are now shifting their focus from the procurement price of vaccines to the development and licensing of products that minimize total system costs and complication at the country level. At the regional level, partners are working hard to help countries choose the right vaccine and cold chain products and make strategic decisions about how their supply chains are designed and managed. At the national level, governments and immunization partners are beginning to invest in systems, processes, equipment, and professionals to ensure that newer vaccines are handled properly and reach the people who need them. The immunization supply chain is the backbone of immunization programs and can also become a backbone for other health interventions. It can support successful health interventions and help ensure that more people live a healthier life. We are grateful to all those who have contributed to the Optimize effort: Ministry of Health colleagues in Albania, Guatemala, Senegal, South Sudan, Tunisia, and Vietnam, as well as the many colleagues in the public and private sectors who have helped to create the momentum for improved immunization supply and logistics systems. Last but not least, we are grateful to the Bill & Melinda Gates Foundation for making this enterprise possible.
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