ISLAMABAD: A joint study of Unicef and the Ministry of National Health Services has come out with a roadmap for Pakistan to strengthen the vaccine supply chain structure in the country for an efficient and uninterrupted service delivery with a view to accommodating rapid changes in the immunisation system.

The Pakistan immunisation supply chain (PISC) manages about $151million worth of vaccines every year, and this amount is increasing as more vaccines are introduced into the immunisation schedule coupled with the increasing population.

The immunisation supply chain structure and practice varies from province to province, depending on the population, distribution and settlements and administrative levels.

The country is changing demographically, with the 2017 census highlighting population increase as well as a need to focus on immunising children in urban areas, which are now home to nearly 18 per cent of the country’s population.

In only a few years, Pakistan will begin with the transition from funding of the global Vaccine Alliance, Gavi, and need to make the EPI supply chain more efficient to make it sustainable.

While the country is on the path to improvements, interruptions in vaccine supplies recently was cited as one of the major barriers to comply with vaccination schedules in Pakistan, says the report

It further says that now is the time to ensure that supply chain investments can support the third Sustainable Development Goal (SDG) and achieve universal health coverage and ultimately prevent unnecessary disease and death in Pakistani children.

One of the key metrics used to access changes in supply chain was risk. Distance is a key metric used to assess supply chain risk through in-country distance travelled by vaccines.

The 2017 Temperature Monitoring Study report showed that temperature excursion was seen when vaccines were transported from federal EPI to some provincial EPI warehouses, with a freeze alarm observed for Punjab and heat alarm observed for Sindh and Balochistan. Reducing the in-country distance travelled by vaccines in a supply chain reduces the risk to vaccine potency.

Pakistan currently follows a traditional multi-tiered system where stock is first received at a national warehouse and then moved from a national warehouse to several provincial warehouses.

Each provincial warehouse then moves stock to its respective division or district warehouses responsible for ultimately stocking EPI centres in their jurisdiction.

Published in Dawn, February 13th, 2019