Protecting the front line: why access to quality PPE remains critical during the pandemic

Despite universal attention on COVID-19 vaccines, the need for countries to access quality-assured PPE remains crucial. Can you explain why?

I can’t overstate the importance of PPE for those on the front lines of the COVID-19 response, especially health workers who are at the highest risk of infection. Without the proper combination of PPE, they run the risk of contracting COVID-19 and potentially spreading it to their families and within their communities. As we know, this also puts pressure on health systems as the more health workers test positive for COVID-19, the fewer essential care services are available for patients. 

We’re all aware that the appropriate use of PPE, regular handwashing, physical distancing and indoor ventilation are very effective tools to reduce the spread of COVID-19. This needs to continue, because while vaccines provide protection, they alone cannot eliminate transmission. Another issue is that vaccination coverage remains inequitable across the globe. Currently, only 7.5 per cent (as of 20 December 2021) of the population of low-income countries have received at least one dose of a COVID-19 vaccine, leaving many front line workers unprotected and exposed to infection.

With the Omicron variant driving new waves of COVID-19 infections across many parts of the world, this is likely to lead to increased demands on national health systems. This means we continue to rely on PPE to protect health care workers, particularly in regions with low vaccination coverage.

Demand for PPE skyrocketed at the beginning of the pandemic. We know that production ramped up to meet it, sometimes at the expense of quality. What is UNICEF doing to ensure its PPE meets global standards?

When we think of PPE, we think of medical masks, medical gowns, examination gloves and other items that are commonly used in health care systems. But of course, the onset of COVID-19 firmly brought PPE and its importance into public life.

In order for PPE to work effectively, strict technical performance specifications and standards need to be met so that it can protect the person wearing it. The material PPE is made from, the filtration, breathability and fit [for masks], and even the length of some items all come into play.

The World Health Organization (WHO) has issued guidance on the technical specifications and standards for quality PPE, and UNICEF only procures and delivers PPE that complies with this.  

But it is not just UNICEF that has access to these items. Through a joint-tender in 2020, 11 United Nations agencies and 2 international non-governmental organizations worked together to establish long-term supply agreements (LTAs) with PPE manufacturers. Aside from affordability and access, quality was a non-negotiable element. Today, the agreements ensure we can prevent stockouts in the event of a future health crisis.

How many items of PPE has UNICEF shipped since the pandemic began and can you give us a sense of the scale of this operation? 

Since January 2020, UNICEF has shipped over 895 million items of PPE to 141 countries (as of 20 December 2021). This includes medical masks, N95 respirators, goggles, gloves, medical gowns and more. As you can imagine, a significant percentage of these supplies has been delivered to low- and middle-income countries that qualify for support under UNICEF’s Humanitarian Action for Children (HAC) Appeal, which has been instrumental in financing the procurement and delivery of PPE.

There has been no let-up in demand either. In fact, when we look closely at the order figures, the number of PPE items shipped in 2021 has been higher than in 2020 when there was a surge in demand as COVID-19 took off. Thankfully, we planned ahead to make sure that PPE would be available depending on the trajectory of the pandemic. From UNICEF global supply hubs in Copenhagen, Dubai, Guangzhou and Panama City, we stand ready to process requests for this equipment. We are sending PPE by the fastest, most cost-effective means possible. This is usually by sea-freight but in some instances, for smaller quantities and urgent needs, we also use air transport.

What about emergency settings? Have there been challenges getting PPE into any countries? 

UNICEF Supply Division has decades of experience delivering life-saving supplies for children in emergency settings. We have drawn on this expertise throughout the COVID-19 response so that we can move supplies quickly from our warehouses or directly from manufacturers to countries without delay. Delivering PPE is no different.

As an example, in early December 2021 we shipped nearly 2 million items of PPE to Syria. This first went to Beirut, Lebanon, by plane and was trucked to Syria from there. We are also delivering large quantities of PPE to Afghanistan, Ethiopia, Sudan and Yemen to support health and other front line workers. Often custom transport solutions, such as charter cargo flights, are needed. The logistical effort is immense because it’s not as simple as just booking a flight. There are import licenses, in-country transport needs and security issues we must deal with, all set against a backdrop of constrained global supply chains.

Beyond emergency settings, we’re getting PPE to countries that are quite hard-to-reach and doing so in an innovative way. In August 2021, we chartered a plane to Timor-Leste that had ultra-cold chain vaccine freezers, routine vaccines and PPE on board, bundling supplies to reduce the number and cost of flights needed.

Do countries have different PPE requirements, for instance in the type of equipment needed for specific purposes? What is UNICEF doing to make sure they are met? 

Countries with limited resources face numerous challenges implementing infection prevention and control measures within health care settings during the pandemic, and there is no one-size-fits-all solution in supporting them. These challenges can increase depending on the scope of countries’ COVID-19 and routine vaccination programmes, as well as in providing primary health care services, especially outside of urban areas. In some of these settings, the risk can be from lack of sufficient hand hygiene facilities and supplies, while others face challenges in terms of physical distancing due to crowded hospitals and clinics.

To meet those needs, UNICEF has designed four PPE kits with different supply item combinations to make it safer for health and front line workers to go about their jobs, protecting themselves and the communities they serve. The kits were created to broadly support COVID-19 vaccination activities, routine immunization programmes for children against diseases such as measles and polio, and for use in primary health centres and outreach activities. They are assembled to cover both low- and high-risk infection exposure scenarios and include PPE to use during cleaning activities.

We’re bundling medical masks, gloves, medical gowns, coveralls, boots and a range of other items together. It’s another example of how we keep on our toes and think outside the box so countries receive the right supplies at the right time as they respond to the pandemic.