How Changes in Leadership Have Changed the Immunization Supply Chain

Published by Leo Almonte on

Vaccines with Project PATH

How have changes in leadership changed the immunization supply chain? The Decade of Vaccines

In May 2012, the World Health Assembly (WHA) endorsed Global Vaccine Action (GVAP) to achieve the vision of delivering universal access to immunization. The “Decade of Immunization” initiative, supported by 194 member states of the WHA, aims to “improve health by extending by 2020 and beyond, the full benefits of immunization to all people, regardless of where they are born, who they are, or where they live”.

If GVAP achieves its goals as planned, between 24.6 and 25.8 million deaths could be averted by the end of the decade. Aside from putting into good use billions of dollars’ worth of productivity, the Decade of Vaccines forecast contributed to the Millennium Development Goal 4 target to reduce the under-five mortality rate.

The alliance of international and distinguished private organizations is committed to this global health initiative to save millions of lives. Among its stakeholders are the United Nations Millennium Declaration, the United Nations Secretary-General’s Global Strategy for Women’s and Children’s Health, Bill & Melinda Gates Foundations, GAVI Alliance, UNICEF, US National Institute of Allergies and Infectious Diseases, and WHO.

Added to this, GVAP forged partnerships with global health professionals, academia, manufacturers, international agencies, development partners, civil society, media, and private companies.

 The VillageReach Initiative and the Last Mile Distribution

Proponents launched the Decade of the Vaccine to focus on the critical objective of providing the final 20% of children with access to life-saving vaccines. The degree to which the vaccines reach the communities is part of the success indicator.

One challenge in reaching those goals, is the effective, safe delivery of vaccines to underserved populations. The cold chain is one piece of achieving those goals. Various stages in the cold chain must be handled efficiently from manufacturing, storage, transport, distribution and immunization. The success or failure of the so-called “last mile” distribution may result in either millions of lives lost or saved.

Supported by the Bill & Melinda Gates Foundation, VillageReach worked for over a decade to improve, develop, test, and refine the systems that deliver in-country immunization supply chain (iSC). Committed to addressing the last mile distribution issues and challenges, the organization participated in a multi-year Mozambique program.

VillageReach focused on improving the immunization supply chain’s performance, especially in rural communities comprising 50% of the country’s population. It developed the Dedicated Logistics Systems (DLS)  in partnership with provincial governments and Fundação para Desenvolvimento da Comunidade (FDC).

DLS improves supply chain effectiveness and efficiency by using dedicated logisticians, level jumping, reliable resources and service delivery-level data. 

Change Leadership and the Modernization of the Supply Chain

 Any improvement and innovation that must take effect in a program or organization begins with effective leadership. Without competent and purpose-driven leaders in the different immunization program tiers, Vaccines’ Decade would not accomplish its objectives. The focus shifted from improving systems, to change leadership, since qualified people must manage, monitor, and implement the strategic plan for immunization.

Realizing the need for qualified people for the program, the stakeholders created People that Deliver (PtD), a global partnership that develops human resources to lead and manage the health supply chain. The organization has the mission to establish a global and national capability that runs sustainable evidence-based strategies.

In 2015, VillageReach became a board member of PtD to pursue an agenda on leadership development. Change leadership is critical in innovating iSCs and managing it through challenges in various operational terrains.

The Gavi Alliance pointed out that low-income countries have ineffective supply chains that fall way below international standards. The influx of vaccines is bound to quadruple in the decade, and their governments are not prepared to handle such extensive immunization operations.

There is an evident need for new leaders with better knowledge, training, and competency to manage modern cold supply chains. Systems are evolving alongside processes and strategies. Old leadership must eventually give in to the new generations.

Modern pharma cold logistics require installing new cold chain equipment, training competent logisticians, managing transport loops into system design, and understanding data management systems, among several other functions.

In a highly specialized field that requires a background in public health management, logistics, program administration, data analysis, and pharma cold chain, the big question pops out: Who can lead the change?

Hiring the wrong leader is worse than not having one, so change leadership is critical to the Decade of Vaccine’s success. According to a VillageReach position paper, the five building blocks for human resource guidance are :-

1. Engagement of stakeholders around the theme of HR for supply chain management can prioritize the importance of leadership and effective management.

2. Policies and plans can be optimized to have more effective recruitment plans, well-defined standard operating procedures, and a strategic plan for HR growth.

3. Workforce development can clarify job descriptions and define education and training plans.

4. A focus on increasing performance and staff retention will result in actionable guidelines for supportive supervision and performance management practices.

5. Professionalization of supply chain managers will place personnel in groups of peers from which to learn and develop professionally.

GVAP stakeholders believe that these five building blocks will help leaders and managers become effective in bringing change and sustaining an effective supply chain system built for the future. 

Milestones in Change Leadership

The change leadership has encouraging results in Mozambique. Being a case study of VillageReach on change leadership, it monitored results coming from the partnership of the Ministry of Health and the Provincial Directorates of Health (DPS). 

Success stories in the immunization supply chain due to change leadership are as follows:

The use of the Dedicated Logistics System (DLS) in Mozambique resulted in a more efficient supply chain due to its transport loops, level jumping, direct data collection, and dedicated logisticians, Update reports, and better data transfer processes result into improved decision-making.

The supply chain’s computer modeling had promising results and showed that a province had the transport and cold chain capability to reach a delivery area every two months.

An EPI manager in Mozambique created an enabling environment that ensured vehicle availability, so delays and stock-outs were avoided. Another DPS medical officer committed to fueling the supply guarantee so delivery vehicles could fulfill schedules without any hitches.

A medical officer efficiently used the Dedicated Logistic System (DLS), which resulted in higher vaccine coverage and a streamlined distribution system in his province. Using the DLS, he displayed how advantageous it was, compared to the multi-tiered government system that was prone to wastage and delays.

In Burkina Faso, a medical officer rejected outdated supply chain and immunization processes and established an appropriate system to fit his province’s needs. He led in introducing next-generation iSC even without a mandate from national officials, and pursued solutions based on the actual conditions in the locality.

Leadership Challenges and HR Solutions  

The success stories are good indicators of effective leadership in improving the cold chain and immunization. It isn’t just about management skills and competency, but also about value, and purposeful attitudes toward attaining a global goal.

Leaders create an enabling environment by empowering subordinates, initiative and informed decision-making. They must have a change mindset and overcome obstacles from government bureaucracy, geographical limitations, lack of resources, and opposition.

Even natural-born leaders must acquire expert knowledge and a broad understanding of how the next generation iSC can run effectively. Thus, the change leadership program resolved to provide high-level training and human resource development.

VillageReach articulates this need through their analysis:

The challenge comes when people in decision-making roles related to the immunization supply chain are not these natural born leaders or are not at the appropriate level in the HR system, with authority to take action. Management training from a technical aspect has been a mainstay of donors and projects to varying effects, yet there is still a gap for general leadership competency training. The Gavi Alliance, through a partnership with UPS, is filling that gap through a leadership development program to develop the core leadership and management skills for health supply chain management professionals and decision-makers. The stakeholders and advocates of iSC implemented the Strategic Training Executive Program (STEP). This continuous learning experience addressed both the technical competencies of supply chain management and the ‘soft skills’ imperatives like people management, problem-solving, communication, and professional development.

Goals and Success Indicators

In assessing the Decade of Vaccines’ success, we must review the results against its goals and strategic objectives

Decade of Vaccines Goals
1. Achieve a world free of poliomyelitis
2. Meet vaccination coverage targets in every region, country and community
3. Exceed the Millennium Development Goal 4 target for reducing child mortality
4. Meet global and regional elimination targets
5. Develop and introduce new and improved vaccines and technologies
Decade of Vaccines Strategic objectives
1. All countries commit to immunization as a priority
2. Individuals and communities understand the value of vaccines and demand immunization as both their right and responsibility
3. The benefits of immunization are equitably extended to all people
4. Strong immunization systems are an integral part of a well-functioning health system
5. Immunization programmes have sustainable access to predictable funding, quality supply, and innovative technologies
6. Country, regional, and global research and development innovation maximize the benefits of immunization

Based on the report  entitled  The Global Vaccine Action Plan and the Decade of Vaccines: Review and Lessons Learned, the change leadership initiative and the immunization program in general had significant success, although it has not fully met its target.

Graph 1: Global coverage for selected vaccines (Source: GVAP, 2019)
Graph 2 : New vaccine introductions between 2010 and 2017 in low- and middle-income countries  (Source: GVAP, 2019)
Graph 3 : Global number of deaths of children under five for selected vaccine-preventable diseases between 1990 and 2017 (Source: GVAP, 2019)


Although the graphs above are not absolute indicators of success, they show an evident increase in the coverage of the immunization program and the number of deaths due to lack of vaccination. Change leadership is just one of the key results areas in the Decade of Vaccines, and other critical factors contributed to its significant success. 


VillageReach (2016) Change Leadership: The Making or Breaking of an Immunization Supply Chain, accessed from

World Health Organization, Decade of Vaccines ― Global Vaccine Action Plan 2011-2020, accessed from

World Health Organization. 2019. The Global Vaccine Action Plan and the Decade of Vaccines: Review and Lessons Learned,  accessed from


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