Abstract:

Vaccine logistics in low-resource settings remain a significant bottleneck in the effort to ensure equitable and timely immunization coverage. These challenges manifest in chronic underfunding, unreliable infrastructure, inefficient cold chain systems, fragmented coordination, and limited last-mile delivery capacity—ultimately affecting health outcomes, especially among vulnerable populations. This paper reviews and synthesizes global and regional evidence on the challenges and innovations in vaccine logistics in resource-constrained environments, with reference to sub-Saharan Africa. The review highlights recurring themes, including poor transport networks, lack of real-time inventory visibility, and inconsistent power supply impacting cold chain integrity. It also draws attention to emerging opportunities such as digital temperature monitoring, solar-powered cold storage, drone-assisted deliveries, and alternative financing strategies. The paper identifies successful models from countries such as India, Kenya, and Rwanda that have adopted hybrid approaches leveraging technology, community partnerships, and public-private collaboration to strengthen immunization systems. The findings underscore the importance of coordinated investment, systemic reforms, and adaptive strategies in addressing vaccine distribution challenges. It concludes by recommending a strategic, context-specific framework that integrates technological tools, sustainable financing, and cross-sectoral partnerships to build resilient vaccine logistics in low-resource settings.

References:

[1]. World Health Organization, 2022, Immunization coverage. Date of access: 21/04/2025. https://www.who.int/news-room/fact-sheets/detail/immunization-coverage

[2]. UNICEF, 2023, Vaccine cold chain: The backbone of immunization programs. Date of access: 21/04/2025. https://www.unicef.org/immunization/cold-chain

[3]. Adepoju, P., 2020, Nigeria's vaccine delivery challenges. The Lancet Global Health, 8(9), e1145–e1146. https://doi.org/10.1016/S2214-109X(20)30349-2

[4]. Gavi, the Vaccine Alliance, 2022, Reaching every child: Vaccine delivery in remote settings. Date of access: 21/04/2025. https://www.gavi.org

[5]. PATH, 2021, Delivering vaccines with drones: Lessons from Rwanda and Ghana. Date of access: 21/04/2025. https://www.path.org/articles/drones-vaccine-delivery

[6]. Mukherjee, S., & Sahay, S., 2021, Strengthening vaccine cold chains through digital innovation: A case study from India. Journal of Health Logistics, 6(2), 89–102. https://www.healthlogisticsjournal.org

[7]. CSIS Global Health Policy Center, 2022, The importance of public-private partnerships in vaccine distribution. Date of access: 21/04/2025. https://www.csis.org

[8]. Thomas, J., & Harden, A., 2008, Methods for the thematic synthesis of qualitative research in systematic reviews. BMC Medical Research Methodology, 8(1), 45. https://doi.org/10.1186/1471-2288-8-45

[9]. USAID | DELIVER Project, 2011, The Logistics Handbook: A Practical Guide for the Supply Chain Management of Health Commodities. Arlington, VA: USAID. https://www.jsi.com/resource/the-logistics-handbook/

[10]. Gavi, the Vaccine Alliance, 2023, Immunization Financing Toolkit. Date of access: 21/04/2025. https://www.gavi.org/programmes-impact/our-impact/immunization-financing

[11]. World Bank, 2021, Transport Infrastructure for Health Access in Africa. Date of access: 21/04/2025. https://www.worldbank.org

[12]. UNICEF, 2022, Cold Chain Logistics in Humanitarian Emergencies: South Sudan Case Study. Date of access: 21/04/2025. https://www.unicef.org

[13]. WHO, 2021, Global Vaccine Cold Chain Status Report. Date of access: 21/04/2025. https://www.who.int/publications

[14]. Adamu, A. A., et al., 2020, Evaluation of Cold Chain Infrastructure in Uganda and Ethiopia. Vaccine, 38(5), 1182–1190. https://doi.org/10.1016/j.vaccine.2019.12.030

[15]. Ozawa, S., et al., 2019, Health Worker Shortages and Vaccine Logistics: A Global Review. Health Policy and Planning, 34(5), 357–366. https://doi.org/10.1093/heapol/czz014

[16]. PATH, 2020, Strengthening Immunization Supply Chains through Coordinated Governance. Date of access: 21/04/2025. https://www.path.org/resources

[17]. USAID Global Health Supply Chain Program, 2022, Tanzania and Zambia eLMIS Evaluation Report. https://www.ghsupplychain.org

[18]. Nexleaf Analytics, 2021, ColdTrace Technology Overview. Date of access: 21/04/2025. https://www.nexleaf.org/coldtrace

[19]. WHO, 2023, Solar Direct Drive Refrigeration: Global Deployment Status. Date of access: 21/04/2025. https://www.who.int/initiatives/cold-chain-equipment-optimization-platform

[20]. Clough, B., 2021, Zipline's Drone Delivery of Medical Supplies in Rwanda: A Case Study. Technology and Development, 9(3), 221–230. https://doi.org/10.1177/09720634211008441

[21]. Healthcare Federation of Kenya, 2022, Public-Private Partnerships for Vaccine Logistics. Date of access: 21/04/2025. https://www.hfk.co.ke

[22]. Pan American Health Organization, 2022, Revolving Fund Annual Report. https://www.paho.org/en/documents

[23]. Ministry of Health and Family Welfare (India), 2018, Mission Indradhanush: A Success Story. Date of access: 21/04/2025. https://www.mohfw.gov.in

[24]. UNICEF India, 2019, The Impact of Mission Indradhanush on Full Immunization Coverage. Date of access: 21/04/2025. https://www.unicef.org/india/reports

[25]. Pan American Health Organization, 2020, Case Studies on Revolving Fund Success in Latin America. https://www.paho.org/en/documents

[26]. Ghana Ministry of Health, 2020, Annual Health Sector Performance Report. Date of access: 21/04/2025. https://www.moh.gov.gh

[27]. USAID, 2022, Mozambique Health Logistics Resilience Case Study. Date of access: 21/04/2025. https://www.usaid.gov

[28]. WHO, 2020, Status of Cold Chain Equipment Functionality: Global Inventory. Date of access: 21/04/2025. https://www.who.int

[29]. Federal Ministry of Health (Ethiopia), 2021, Immunization Cold Chain Status Report.

[30]. UNICEF Supply Division, 2019, Human Resources for Supply Chain in Zambia. Date of access: 21/04/2025. https://www.unicef.org/supply

[31]. National Primary Health Care Development Agency (Nigeria), 2023, Logistics Performance Monitoring Summary.

[32]. World Economic Forum, 2022, Unlocking Drone Delivery in Emerging Markets. Date of access: 21/04/2025. https://www.weforum.org

[33]. IRC Kenya, 2020, Understanding Missed Immunization Opportunities in Turkana. Date of access: 21/04/2025. https://www.rescue.org

[34]. Ghana Health Service, 2023, Annual Immunization Program Review.

[35]. Gavi, the Vaccine Alliance, 2022, Cold Chain Equipment Optimization Platform Progress Update. Date of access: 21/04/2025.

[36]. UNICEF Malawi, 2021, Drone Corridors and Innovation in Health Supply Chain Delivery. Date of access: 21/04/2025. https://www.unicef.org/malawi

[37]. World Health Organization, 2007, Everybody’s Business: Strengthening Health Systems to Improve Health Outcomes. Date of access: 21/04/2025. https://www.who.int/publications

[38]. Chee, G., Pielemeier, N., Lion, A., & Connor, C., 2013, Why differentiating between health system support and health system strengthening matters. Health Policy and Planning, 28(5), 427–434. https://doi.org/10.1093/heapol/czs123

[39]. USAID Uganda, 2021, Evaluation of the National Logistics Outsourcing Pilot. Date of access: 21/04/2025. https://www.usaid.gov/uganda

[40]. Global Health Workforce Network, 2019, Gender and Health Workforce: Evidence and Policies. Date of access: 21/04/2025. https://www.who.int/hrh/resources

[41]. PATH, 2020, Integrating Gender into Immunization Supply Chain Design in Senegal. Date of access: 21/04/2025. https://www.path.org/resources