Getting COVID-19 vaccines to West and Central Africa

How UNICEF is harnessing decades of expertise to deliver COVID-19 vaccines to the region.

UNICEF
18 January 2021
Djibril, a 2-month-old boy, receives a routine vaccine in Man, Côte d'Ivoire.
UNICEF/UNI322522/Frank Dejongh
Djibril, a 2-month-old boy, receives a routine vaccine in Man, Côte d'Ivoire.

In western Côte d'Ivoire, 2-month-old Djibril is in hospital for an important reason: he’s receiving a routine vaccination that is vital for his health. It’s April 2020, and while COVID-19 has been circulating for two months in the country, his mother insisted on bringing him in. “I don't want my baby to become sick from another disease. Besides, in the hospital they do the birth registration too.”

Djibril is one of 25 million children across the 24 countries of West and Central Africa that receive routine vaccinations annually to protect against diseases such as measles, polio and diphtheria. Without them, it leaves children – and entire communities – exposed to the risk of infection, threatening their long-term health, and frequently their lives.
 

Transporting vaccines

As the largest single vaccine buyer in the world, UNICEF has decades of experience organising the delivery of vaccines for routine immunisations and disease outbreaks such as the Ebola virus. This is why UNICEF, in collaboration with the Pan American Health Organization (PAHO), is leading efforts to procure and supply approved COVID-19 vaccines for 92 low- and lower middle-income countries around the world, of which one-quarter are in West and Central Africa.

But getting these vaccines from manufacturers to countries is a mammoth task. It not only requires that airlines have enough space to transport them, but also that the vaccines are kept at a stable, cold temperature from the moment they leave the manufacturer until they are administered. Ensuring the facilities needed for this are in place – known as the ‘cold chain’ – is a critical part of UNICEF’s current support to governments before COVID-19 vaccines arrive.

Solar powered vaccine storage

“West and Central Africa is one of the most complex environments you will find,” says Jean-Cedric Meeus, UNICEF’s Chief of Supply for the region. “We are dealing with the challenge of delivering COVID-19 vaccines to major cities, but also to extremely remote villages. We are preparing for all scenarios.”

Since 2018, UNICEF – working alongside governments and with support from Gavi, the Vaccine Alliance – began buying and installing solar-powered fridges to store vaccines throughout the region. The idea would be a gamechanger for regional and district health workers who often struggle to carry out routine immunisations for children in places with unreliable electricity and cold storage facilities.

Solar panels that will power a fridge are installed on the roof of a health centre in Sierra Leone
UNICEF/UNI107805/Asselin
Solar panels that will power a fridge are installed on the roof of a health centre in Sierra Leone

“We mapped where the necessary equipment was missing and then set about installing almost 20,000 solar-powered fridges, all the way from the coast to the forests in the interior. It is a huge asset to have countries equipped like this and we will continue to roll them out,” says Jean-Cedric.

The fridges are suitable to store vaccines that require temperatures of 2-8°C, and with several COVID-19 vaccine candidates in this range showing promise, they will be crucial in governments’ COVID-19 vaccine distribution efforts throughout 2021. It is just one element of UNICEF’s continuous support to health ministries on routine immunisation activities in a region where 11% of the world’s children live.
 

Lessons learned during the pandemic

Making sure cold storage facilities are in place from manufacturer to where they will be administered is one big piece of the COVID-19 vaccine delivery puzzle. Another is ensuring that airlines dedicate enough space to transport them across the globe. UNICEF has stepped up its planning with the airline industry for this moment, but it can also rely on the lessons learned from a large-scale vaccine supply effort in the early days of the pandemic.

When the impact of COVID-19 became clear in early 2020, the UNICEF Regional Office for West and Central Africa, with governments and partners, began a stocktake of the number of vaccines needed for routine immunisations in the region. The concern was that after countries introduced travel restrictions and airlines began grounding planes, the entire region could be left short of vaccine doses – leaving millions of children at risk of diseases such as measles and polio.

UNICEF staff support the delivery of a special charter of vaccines at Nouakchott airport, Mauritania in June 2020.
UNICEF/UNI337812/Pouget

“On the continent, UNICEF has the largest immunisation, logistics and cold chain expertise worldwide,” says Jean-Cedric. “Years of working with countries and partners gives us the experience to forecast vaccine demand and put their transport into action, even during a pandemic.”

The operation was a major success. Within weeks, two cargo planes flew to 13 countries delivering more than 11 million doses of vaccines, including diphtheria, tetanus, measles, polio and hepatitis B, ensuring there were enough routine, lifesaving vaccines in stock across countries.

“This is the best lesson we’ve learned during the outbreak and it shows us we can overcome transport challenges for COVID-19 vaccines. When we couldn’t see what tomorrow would look like, we brought together networks of immunisation specialists from across the region, brainstormed with our partners, coordinated with airlines and made sure essential vaccines go to countries that needed them,” says Jean-Cedric.
 

Looking ahead

There is no doubt that the challenge of delivering COVID-19 vaccines around the world in 2021 is a colossal one for UNICEF, but work is well underway to put critical pieces in place to make it happen.

We have already started buying more than 1 billion syringes and safety boxes so we can deliver them to countries before vaccines arrive. Efforts to map and identify gaps in air- and sea-freight capacity is giving us information that helps to close them, ensuring cargo space is available for vaccines to be flown all over the world.

UNICEF is on-the-ground too – and in the 92 low- and lower middle-income countries that will receive vaccines through the COVAX Facility, we are working around the clock to assist governments invest in ‘cold chain’ facilities and support the difficult, but vital efforts, to transport vaccines to those in even the most difficult-to-reach communities.