GAVI Partners’ Forum WHO – UNICEF – GAVI - BMGF

1. National Vaccine Supply Chain Innovations:Country Commitment to Ownership, Sustainability & Impact GAVI Partners’ Forum WHO – UNICEF – GAVI - BMGF

2. Universal Child Immunization Achieved in 1990 • Thirty years ago we had a bold vision: to establish a cold chain in every country that enabled universal child immunization. WHO, UNICEF, countries, and suppliers collaborated to assemble the expertise, funding, leadership, and logistics capabilities into a system that brought immunization coverage to nearly 80% of the global birth cohort. This system has worked well for 30 years.

3. New Challenges on the Horizon… • The (a) introduction of new vaccines and (b) increased coverage targets have increased demands on the system in a way that puts business as usual at risk. Diseases vaccinated against 2.5x Vaccine doses per child (#) [assuming receives vx listed above] ~3x 4x increase in needed fridges btw. 2001 and 2020 without mitigation Vaccine volume per fully immunized child (cm3) 4x 50 200 2010+ $30+ Immunization cost per child ($) (including delivery cost) ~6x 2008 $17 1980$5 Across life course Age groups targeted for immunization 1980s realities 2010 and beyond realities Graphic: McKinsey for BMFG – August 2012

4. Vision 2020 & NUVI Call for Action Funding (Capital & Operational) Advocacy Data Systems Optimization (incl. Technology & Equipment) VaccineProducts & Packaging HR forLogistics Human Resources Supply Systems Optimization & Equipment Information Systems & LMIS Environmental Impact Governance Governance

5. Areas of Activity Governance • National: • Strengthen national plans by analyzing the return on investment in vaccine supply chains, and communicate that value to key decision-makers • Link EVM assessment and improvement plan to key country planning processes for resource allocation • Leverage and coordinate with other health programmes to optimize delivery • Encourage vaccine supply chain funding through establishment of dedicated supply chain technical committees that report to ICC (or similar) • Integrate vaccine supply chains with other health supply chainswhere appropriate. • Global: • Provide leadership of global activities in vaccine supply chain systems strengthening for maximum impact • Facilitate use of GAVI HSS funds to strengthen vaccine supply chains • Establish a technical knowledge hub in support of countries and global partners

6. Areas of Activity Human Resources • National (as part of broader government HR policies and needs): • Develop career structure • Develop and support vaccine supply chain employment market • Build HR capacity through training methods and tools, including for M&E • Global: • Set HR standards for vaccine supply chain-specific tasks • Identify priority needs and develop competency-based training materials and methods for country adaptation

7. Areas of Activity Supply Chain Optimization • Global: • Develop and enhance HERMES and other tools to support design and implementation • Develop metrics to assess optimization of supply chains • National: • Engage stakeholders in re-design of national supply chains (including private sector) and introduction of innovations • Employ models to develop and evaluate scenarios for decision support and investment cases

8. Areas of Activity Technology & Equipment • Global: • Enhance existing protocols and mechanisms to analyze and provide systematic feedback on field performance. • Identify and quantify the full life-cycle costs of equipment, and provide this information as part of PQS to support country choices • Implement a process to enable rapid prototyping, market shaping and delivery of user-focused solutions that address country needs. • Industry employs user feedback to better meet user needs • National: • Implement available and emerging new technologies to close key gaps (e.g., temp-monitoring; transition from gas/kerosene to solar-powered refrigeration) • Collect data on equipment performance to enable WHO/UNICEF to inform industry.

9. Areas of Activity Data-Driven Management • National: • Establish systems that collect and use data on equipment, temperature alarms, and vaccine stocks to monitor and improve vaccine supply chain systems performance. • Global: • Use existing and new technologies to develop solutions for automating data collection, analysis, feedback and use for management. • Implement a process to enable rapid prototyping, market shaping and delivery of user-focused solutions that address country needs.

10. Areas of Activity Measuring Progress • Our success can be measured by the establishment of national systems that monitor and improve performance on these key indicators: • Stock-outs (any vaccine, all levels) • Vaccine utilization (initial focus on closed vial wastage) • Cold chain storage capacity for present and planned needs • Vaccine supply chain costs per dose delivered, per child protected, per daily loss prevented

11. How do we do this…. • Working together we will create actionable, sustainable solutions with a focus on local contexts and user needs. We will build on what works, filling in existing gaps with new, innovative solutions to reach the fifth child. We are seeking countries to explore this exciting opportunity with us. • Are we heading in the right direction? • Which few actions will have the greatest impact? What other actions do we need to think about? • Is it worth the investment? • How do we leverage new technologies and innovations to facilitate change? • How do we learn from our past failures? • How do we build on success to scale-up quickly? • How do we leverage the power in partnerships?