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Vaccine supply chain operations - COVID-19 roll out in a LIC context
Risk matrix = Key controls matching heighted COVAX risks
Key area Risks
Without proper guidance from a COVAX National
Governance roles and responsibilities Coordinating Committee and/or other supporting
working groups, key activities may not be initiated.
Insufficient preplanning of core functions and Properly articulated NDVP is not supported with all
logistics. necessary supporting activites being undertaken.
Procedures to timely receive vaccines, PPE and
Reception of vaccines and ancillary products.
ancillary products are not established.
Procedures to establish sufficient capacity store
Storage of vaccines and ancillary products. vaccines, PPE and ancillary products are not
established.
Procedures are not in place to maintain vaccines
Repacking of vaccines and ancillary items.
within the recommended storage temperature.
Controls Reference documents
With respect to COVID-19 resources, ensure that the assignation and delegation for receiving
and acceptance of responsibilities to the proper entities, functions and stakeholders is in
place.
An overall system design is in place documenting the national logistics framework should be in
place.
Key logistics, HR and vaccine management activities needs to be sufficiently articulated and
developed, in preparation for distribution from the national stores up to the last mile,
consistent with the country’s national deployment vaccination plan (NDVP).
A country-led NDVP plan is developed in line with WHO SAGE guidance and the selected
vaccination strategy to equitably reach the identified target populations is determined prior to
vaccination beginning. Details of the prioritisation of this plan are appropriately
disemminated to immunisation teams.
Accurate estimates of target subpopulations; suitable micro-plans developed in line with
clearly documented programme objectives. Front line health workers have timely access to
PPE.
Forecasts and delivery plans - vaccine volume forecasts are aligned with storage and
distribution capacity.
For each vaccine store, a stock level alert system is established to address and minimise any
avoidable over-stocking or stock-out incidents. A log of all such incidents is documented and
regularly reviewed by management.
Insurance: the MOH has put in place appropriate insurance cover for vaccines, assets and
other ancillary products against potential risk of theft or loss.
In place: documentation and alert pre-arrival checks; customs clearance and transport to
national store; inspection of shipment; stocking procedures; independent checks/ sign-offs.
Segregation of duties - there is a proper segregation between the following functions: stock
custody, processing, and approval.
A suitable problem reporting system in place (VAR, etc.) with necessary recourse/ follow-up
actions documented.
Cold chain capacity planning - sufficient storage capacity at national and subnational levels.
Inventory counts are regularly performed and documented, with due regard for
independence and segregation of duties. Results are reconciled to stock records, any
variances between records and physical inventory are documented, investigated, and
appropriate adjustments are recorded and validated.
Vaccines are shelved and properly stored, according to ther batch numbers and expiry dates,
in compliance with best practices. Similarly for ancillary products.
If own storage capacity requirements are insufficient, additional options to procure, lease of
fitting additional storage capacity is in place.
Vaccines are to be packed inside appropriate insulated package or containers.
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Procedures are not in place to maintain vaccines
Repacking of vaccines and ancillary items.
within the recommended storage temperature.
Transportation of vaccines and products is not timely
Transportation of vaccines
or secure, resulting in loss or theft.
Refrigerated water and coolant packs are available and are stored at the correct temperature
prior to use.
Determine how to transport vaccines and products, including the number and location of
transport means available. Establish delivery and shipment calendars.
Map and identify the routes that are high risk - to due geographical or security conditions.
Work with law enforcement agencies to provide security, establish processes to detect and
mitigate security risks/threats, and monitor the progress of ongoing shipments.
Ensure that peripheral/ receiving distribution sites/ warehouses promptly report the arrival
and condition of shipments.
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Observe the cold rooms, fridges and freezers and check whether the vaccines are stored appropriately:
- vaccines are not piled in boxes but shelved to allow air circulation;
- vaccines are shelved per antigen and batch number/expiry date;
- access to the cold room is cleared to ensure access to any batch;
- each antigen is stored according to its properties;
- expired or damaged vaccines are removed from the cold chain.
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Preplanning: core functions and logistics

1 Background
Explain, the scope of the vaccination campaigns in term of:
• target population
• vaccines that will be used
• delivery sites.
2 Coordination and monitoring
Build the structures for coordination and vaccine
management (CTWG/NLWG) at all levels of the health service.
Monitor progress using methods such as a dashboard with
key indicators, readiness assessment tools, etc.
3 Logistics structure
Explain the distribution and collection pattern and how
campaign logistics will be different from the routine
structure, and the reasons for the difference.
4 Cold chain
Give details on cold chain capacities with a gap analysis and
plans to fill the gaps.
5 Transport
Give details on transportation capacities and plans for the
distribution.
6 Waste management
Explain the national policy in term of COVID-19 vaccine waste
management and give details on practical ways (routes,
methods, disposal sites) to safely collect, treat/dispose the
waste.
7 Risk mitigation
Detail the strengths, weaknesses, opportunities and threats
related to all components of vaccine management for this
vaccination: human resources, information management,
cold chain management, waste management, recalls and
others related to country context.
8 Accountability framework (before/during/after)
Give information on the activities that must be conducted,
with person in charge, timetable and expected deliverables.
Discuss procedures related to reverse distributions.
9 Human resources
Give details on the people in charge, with their roles and
responsibilities.
10 Training
Detail the training plan, schedule, audience, duration and content.
11 Procurement and distribution
Give a summary of the forecast and distribution plan.
12 Reverse logistics
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Explain how and when the usable and unusable vials will be
collected from the vaccination teams.
13 Information management
Identify and explain tools and forms from the routine logistics
management information system (LMIS) or tools designed
specifically for this response.
14 Chronogram of the supply and logistics activities
Give details on the timeline of the supply and logistics
activities.
15 Budget
Estimate the costs of all activities and identify funding