Last year it was Ebola, this year it's Zika. Disease outbreaks are in the news and people are rightly worried. And each time this happens, people ask "isn't there a vaccine for that?" Nearly one-hundred years ago, 500 million people around the world were infected by influenza (H1N1) and between 50 and 100 million people died (today, we do have a vaccine for that). In the 1940s and 1950s, polio disabled more than half-a-million people a year. Today, we not only have a vaccine for that, but polio is nearly eradicated: last year only 47 wild polio cases were reported. Also in the 20th century, smallpox claimed the lives of 300-500 million people, and hundreds of years before that it had nearly wiped out indigenous peoples in the Americas, Australia, and the Pacific Islands. By 1980, vaccines and immunization programs eradicated smallpox. Vaccines are among the most effective and inexpensive ways to fight infectious diseases and help people stay healthy. While there are a few people in affluent societies and troubled corners of the world who distrust vaccines, the history cannot be more clear: vaccines work. Unfortunately, not everyone has access to them. Globally, one-in-five children has not been fully immunized against common, vaccine-preventable diseases. Many of those children, known as "the fifth child(ren)", are in Africa, where equitable access to routine health services--including immunization--is particularly problematic due to poverty, lack of education, and weak health systems. Supporting essential routine immunization systems requires robust supply chains with functioning cold chain equipment to maintain vaccine potency all the way to the rural villages and shantytowns where so many unimmunized children live. But in too many places, supply chains are simply not strong enough to make that happen. According to the World Health Organization, "Much of the [world's] burden of disease can be prevented or cured with known, affordable technologies. The problem is getting drugs, vaccines, information, and other forms of prevention, care, or treatment--on time, reliably, in sufficient quantity and at reasonable cost--to those who need them." Too often an afterthought, relegated to untrained and poorly managed staff, and woefully under-resourced, health supply chains in many low-income countries cannot cope with the increasing demands of global health programs. The international commitment to universal health coverage by 2030 cannot be achieved if the medicines, vaccines, diagnostics, and other supplies required are not universally available. On February 24th and 25th, African health and finance ministers will convene at the African Union in Ethiopia to talk about immunization for the first time. They will focus on equity and coverage to reach and vaccinate the fifth child and the leadership and policies required to succeed. Strategies, such as Reaching Every Child, designed to identify and reach underserved communities will be high on the agenda and will generate the energy to move the needle to sustained equitable coverage. Vaccines must be consistently available if these goals are to be reached. Although supply chain is not on the official agenda, it's going to be on the menu, with a lunch-time discussion among a few ministers of health from the region who are working to improve their vaccine and medicine distribution. They will talk about adapting private-sector solutions, using data to drive supply chains, optimizing distribution networks, deploying solar-powered cold chain equipment, and developing supply chain experts to focus on performance and continuous improvement. As we call attention to the critical importance of stronger support and attention to build essential routine immunization systems to reach every child, governments and development partners must allocate more funding so that immunization supply chains can deliver more vaccines to more people. In the last decade, many new vaccines have been introduced and many more are in the pipeline including for Ebola, malaria, HIV, and even Zika. This is great, but even now, the volume of new vaccines are overburdening the old supply systems that immunization programs have long relied upon. Ministers of health and their colleagues have an opportunity to understand why supply chains are important, how they must change, and what governments must do to make change happen. They must understand that supply chains are integral to broader health system's ability to deliver the right services and supplies at the right time to the right place and the right people.
Amazon, Toyota, Boeing, Unilever, Starbucks, Microsoft, and many other global companies know that their bottom line depends on high-performing supply chains. In the public health sector, our bottom line is measured not in dollars, but in lives saved and diseases prevented. Investing in stronger immunization supply chains will yield long-term dividends in healthier children and communities.