We often talk about generating demand for childhood vaccinations—that is, getting parents to bring their babies to clinics for life-saving shots. But there is another important side of getting children vaccinated: ensuring that vaccines are available at clinics when parents arrive with their babies in tow. 

In this post, we talk about how we support our government partners in making sure there is sufficient vaccine supply to meet the increased demand that our program generates.

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The long, cold journey of a vaccine

The first thing to understand about getting children vaccinated in a remote, low-resourced setting like northern Nigeria is just how difficult it is to get a vaccine from its arrival in the country to a remote clinic. It requires many steps and many dedicated government staff, called cold chain officers, to move the vaccine from location to location while keeping it cold. The officers are also responsible for allocating vaccine stock at the subsidiary level, keeping track of stockouts, requesting top-ups, coordinating distribution, and other tasks. 

Our colleague, the Zonal Cold Chain Officer of the North West Zone, Pharmacist Nafiu Roni, shares, “Logistics is the most important part of the Immunization Supply Chain, yet the most neglected in the whole process.”

Along the way, there are many roadblocks that can make it difficult for vaccines to move smoothly through the chain. These obstacles include but are not limited to:

• Keeping vaccines at the right temperature with unreliable electricity: Vaccines need to be kept cold, between 2℃ and 8℃. Facilities are equipped with the required refrigerators and even backup generators, as electricity is not reliable. However, in the case of long-term power cuts, the cost to fuel these large generators can become exorbitant. 
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• Extreme weather, especially flooding: Flooding is very common in the rainy season (June - September), making it difficult to travel and transport vaccines. Every rainy season, routine immunization staff from facilities in Jigawa and Kano have to transport vaccines via canoe. Unfortunately, this process can be very unsafe for these healthcare workers. 
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• Safety and security: Kidnapping and banditry are major issues in many states where we operate. When vaccines are transported through unsafe areas, armored guards can be required. With the recent elections, there were increased instances of vandalism. One cold store was totally destroyed, with thousands of vaccines lost. 
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• Funding challenges: Funding is not fully streamlined. Some states use a push method where funding comes from the state and is pushed down to lower-level facilities, while some use a pull method where clinics and health facilities have to travel to apex facilities and the LGAs for the vaccines (see image above). States with push systems are sometimes able to procure a larger supply upfront that lasts longer and results in fewer stockouts. 
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• Sheer remoteness: Parent stores (a store one step above in the supply chain) are sometimes located at far distances from lower-level facilities. Staff often have to travel a long way to remote clinics by motorcycle, by canoe, or on foot. 

In addition, states have to keep constant tabs on where supplies are low, where a stockout is imminent, and how to avoid stockouts in the future. This is where we provide support.

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Ways we support the supply chain

New Incentives maintains strong relationships throughout the vaccine supply chain, from the clinic to the national level. Every day, our supply-side officers engage with local cold chain officers to notify them of stockouts, request top-up supplies, or communicate other supply-side concerns. 

But it is government agencies and immunization partners, not New Incentives, who procure vaccines and play all active roles in the supply chain. Our role involves coordination and communication to identify and resolve supply issues and bottlenecks. All of this supportive work is carried out with our government partners at the local, state, zonal, and national levels. 

Coordinate with states to request additional vaccines when supplies run low ‍

States conduct weekly physical stock counts of vaccines at cold stores, where vaccines are kept. Our team touches base with the states after these weekly stock counts to compare availability estimates and share information we may have from other levels. New Incentives can provide funding for vaccine transportation when urgently needed. Usually, this occurs when local government areas (LGAs) need to collect top-up supplies from the states between quarterly distributions. 

Host monthly roundtable meetings with the state and zonal cold chain officers 

During these meetings, stockout and runout data is shared with the states. Patterns in this data are highlighted and reviewed, with strategies discussed for improvements. It’s also an opportunity to resolve logistics issues through interagency support. For example, in July, the North East Zone was able to resolve a shortage of the specific syringe needed for BCG vaccine administration through coordination among the supply-chain officers at the meeting.

Conduct daily supply-side availability assessments 

This data is reported to key internal staff in addition to tracking the metrics reported in a supply-side dashboard. Through daily calculations, we can observe trends and track the impact of the previous days’ and weeks’ actions. We also check the day’s performance against an allowable threshold of stockouts for each state, based on their relative percentage of the disbursement days. These metrics, plus the data in the dashboard, help us triangulate the data to determine the source of the stockout and focus on resolving priority cases (e.g., those that contribute most heavily to vaccine stockouts).

Investigate why each stockout occurred ‍

Our unit of supply-side officers collects information on locations of stockouts, runouts, and infants not served, then looks into each of these cases by making calls to field staff, clinic staff, local cold chain officers, or anyone else who may have information on the reason for the stockout or the ability to procure additional vaccines for a subsequent session. 

While we focus on incentivized vaccine stockouts for our own internal monitoring, we monitor all supplies, including non-vaccine supplies such as syringes, diluent, and safety boxes. (Read more about how we directly and indirectly incentivize vaccines.) 

Recognize and appreciate our partners’ contributions, dedication, and commitment ‍

Getting sufficient vaccines to many thousands of clinics across the country is a gargantuan task, and we’ve only scratched the surface in this short blog post. We’re proud to support the government’s efforts in small ways to ensure that, as the demand for vaccinations increases, sufficient life-saving vaccines are available when caregivers come to the clinics. 

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Thanks to Pharmacist Nasir Roni, the Zonal Cold Chain Officer of the North West Zone, for reviewing this post.

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