ATLANTA, Georgia – The necessity of upgrading current practices in vaccine logistics has come to the forefront of conversation in the global health community as the World Health Organization and public health officials continue to battle complications of Syria’s polio outbreak. The current situation in the region poses unique challenges to aid workers attempting to reach displaced and at-risk populations with much-needed vaccines.
The outbreak, confirmed in mid-October, has required an international effort to identify and vaccinate 20 million children in the war-torn nation and six of its neighbors. Children under two years old are the campaign’s focus, as they are at highest risk of contracting polio, chicken pox, measles, and mumps – all of which spread rapidly in situations with intense human traffic between nations. Overcrowding caused by this rapid migration (at present, over two million Syrian refugees are registered with the United Nations) not only increases the likelihood that a communicable disease will take hold, but also poses unique challenges for doctors and aid workers attempting to reach all at-risk individuals.
Prior to the Arab Spring, Syria’s capable public health system vaccinated over 90% of children. However, due to years of civil conflict, chaos has ensued, dropping the vaccination rate to approximately 68%. Continued military conflict has both contributed to and complicated the campaign; the outbreak’s epicenter in the Deir ez-Zor province is one of the most hotly contested areas in the country. Without the “vaccine cease-fire” requested by Save the Children at the outbreak’s onset, it is unlikely that vaccination targets will be reached.
As Dr. Fouad, a Syrian epidemiologist, remarked recently, “It’s not the cost of the vaccine, but the logistics of how to reach every child” that requires immediate attention.
Project Optimize, a collaborative effort between the World Health Organization and PATH, has the unique challenge of maximizing the capacity and efficiency of vaccine supply chains. Supply chain managers are responsible for the oversight and execution of vaccine distribution in their regions, and are especially critical in controlling unexpected outbreaks of disease. Optimize’s 2013 Action Plan includes provisions for addressing human resource challenges to immunization supply systems, including competence, number, motivation, and compartmentalization of supply chain managers (SCMs).
At present, SCMs in underdeveloped countries are not considered instrumental to the success of their organizations and do not receive opportunities for training and advancement. A significant amount of trained SCMs are required to bridge the gap between current numbers and the logistical need. Additionally, the compartmentalization of disease-specific programs and lack of cooperation between the public and private sectors prevent the effective use of those limited resources that do exist.
The 2013 Action Plan’s specific policy, leadership, financing, and educational activities for SCMs include: establishing a model competency framework and certification, the creation of professional networking opportunities, allocation of additional funding for human resources, and educational opportunities for new and current management professionals. A new generation of supply chain management would allow for a public health infrastructure capable of handling large volumes of vaccinations in vast geographic areas.
A well educated, funded, and appreciated global team of supply chain managers will manage crews capable of navigating the human resource nightmare currently unfolding in the Middle East’s public health perfect storm.
– Casey Ernstes