Supply Chain Saves Lives
Preventing stockouts of anti-malaria supplies amid COVID-19 pandemic
A pharmacist checking his stock of malaria commodities. / USAID
Hundreds of trucks were lined up as far as the eye could see outside of Malaba, Uganda, a town at the Kenyan border. Stuck for days at the checkpoint, these trucks were carrying precious cargo: lifesaving malaria tests, medicines, and mosquito-killing nets. People across sub-Saharan Africa depend on these supplies to protect and treat them from malaria. As the COVID-19 pandemic brought the world to a halt, sights like in Malaba became all too common.
During the COVID-19 pandemic, government-imposed lockdowns and travel restrictions delayed delivery of malaria commodities to health facilities, imperiling the progress made to reduce infections and deaths from malaria. Ingredients and staff that produce malaria medicines couldn’t get to factories, ports became backlogged with weeks’ worth of goods, and truckers got stuck in days-long queues waiting to cross checkpoints.
Scourge of Malaria
Malaria kills more than 600,000 people in Africa each year, especially women and children. Rapid test kits, insecticide-treated nets, and antimalarial medicines are tools the U.S. President’s Malaria Initiative (PMI), country governments, and other partners use to protect millions of people around the world from malaria. Few of these supplies are produced in the countries that need them.
As COVID-19 started making its way into communities around the world, the threat of stockouts posed a challenge to PMI and its 27 partner countries.
Mosquito nets, provided by PMI-supported programs, are a proven and effective intervention to reduce malaria infections.
USAID
Taking stock of the problem
In 2020, when the first manufacturer told PMI’s largest supply chain partner about COVID-19 disruptions, PMI took action to prevent a stockout of malaria supplies in partnership with other global donors, companies, and governments.
The first step was to get a complete picture of what was happening at every level of the supply chain by monitoring and analyzing existing and potential disruptions with suppliers, global logistics companies, and companies that test the quality of the goods before they are shipped around the globe.
A dire picture began to emerge. Due to country lockdowns, ingredients that were on their way from China to produce medicines in India were getting stuck. Packaging suppliers, considered non-essential, shut down. Employees who lived in one state of India were no longer allowed to cross the border to their factories in another state. Ships were being detained outside of ports and crews required to quarantine. Flights were being canceled or re-routed.
And around the world, people were racing to buy items like gloves and alcohol swabs to prepare for their own fights against COVID-19, increasing the demand for items that usually would go to clinics. To make matters more complicated, quarantine rules, transport availability, and pricing were changing rapidly, sometimes multiple times in a single day. The lockdowns in China and India were directly affecting the availability of antimalarial drugs in sub-Saharan Africa.
Warehouse manager Tsanko oversees commodity distribution activities in March 2021.
USAID
Leaping into Action
Recognizing that strong supply chains have to be resilient and flexible, PMI quickly sprung into action to reduce the risk of stockouts.
When PMI and its partners identified potential stockouts, they redirected newly finished supplies from shipping to the country that placed the order to the country that would experience a stockout sooner. The original country’s order would then be backfilled. Across the board, people worked together to ensure no one would experience a stockout.
Collins Ngosa loads bed nets onto his motorbike to take to a distribution site.
USAID
PMI began advocating with governments to ensure malaria supplies were classified as essential goods. This allowed employees to work so that ingredients, packaging, and finished products would be granted transportation waivers and truckers could cross borders. As India plays a critical role in manufacturing malaria products, PMI hired a local expert to identify critical manufacturing and logistics bottlenecks and work with the government and manufacturers to rapidly address them.
Types of shipments were adjusted to be as flexible as possible. From manufacturer to destination country, supplies are transported either by ship or by air freight. During COVID-19, PMI continuously assessed the best options based on time and cost and made quick adjustments as needed. In the case of shipping backlogs, for example, some shipments were made by air freight instead.
PMI also encouraged creative shipment strategies. In one case, PMI and other partners collaborated to book a charter flight that would carry urgently needed malaria and HIV/AIDS supplies to Nigeria, even though these supplies typically don’t ship together.
A charter flight filled with malaria and HIV/AIDS supplies getting ready to leave for Nigeria.
USAID
Even before COVID-19 arrived in many PMI-supported countries, teams prepared for potential disruptions. Countries placed orders far in advance of need, increased buffer stock, increased temporary storage space, moved products further down the supply chain to be closer to the patient, prepared and protected warehouse staff, and ensured routine work could continue. This enabled health facilities to receive the malaria supplies they needed to protect and treat patients.
Finally, PMI started planning ahead for the long term. Together with partners like the Global Fund to Fight AIDS, Tuberculosis and Malaria and the World Health Organization, PMI continues to assess and coordinate actions to reduce the impact of COVID-19 on malaria commodities.
Many malaria supplies have long lead times — or time from when an order is placed until the time the goods arrive at their final destination. Partners agreed to be more transparent about their needs and resources to ensure supplies were available to all malaria programs. This collaboration also strengthened markets for some supplies by improving business relationships between donors, buyers, and manufacturers.
Mosquito net distribution campaign in Kenya.
USAID
The Work Continues
Early into 2023, supply chain constraints continue globally. Essential commodities are in short supply with constant price increases. PMI and its partners work with countries to mitigate the adverse effects of stockouts.
Since 2000, PMI has played a leading role in preventing 2 billion malaria cases and 11.7 million deaths worldwide. COVID-19 was a test of the strength and resilience of malaria services and supply chain systems. By intervening early and working with other parties, possible stockouts were averted, essential malaria programs continued, and the health of certain commodity markets improved.
ABOUT THE AUTHOR
Ayida Abate is a Communications Advisor with the U.S. President’s Malaria Initiative (PMI). PMI, led by USAID and co-implemented with the U.S. Centers for Disease Control and Prevention, supports 24 partner countries in sub-Saharan Africa and three programs across the Greater Mekong in Southeast Asia to control and eliminate malaria.