Like many global health professionals, I've spent days traveling by airplane, bus, motorcycle and foot to remote villages in Africa and Asia, only to find Coca-Cola distribution businesses thriving, while children visiting health centers remain unimmunized and without essential medicines. This observation gained public notice when it was voiced aloud by singer Annie Lennox, who once famously asked, "why can we distribute Coca-Cola all around the world, but we can't seem to get medication to save a child from something as simple as diarrhea?"
Nobody dies from failing to get their hands on a Coke, but diarrhea kills more than 1.5 million children every year -- so Ms. Lennox's question deserves an answer. But overhauling distribution systems requires more than just a charming anecdote, no matter how true or compelling in its simplicity. It requires evidence and analysis.
Recently, my colleagues at Johns Hopkins' International Vaccine Access Center (IVAC), Kyla Hayford and Lois Privor-Dumm, and I joined together with a team of experts at McKinsey & Co to try to put some evidence behind the anecdote. The results of our work will be published today in a report, "Improving Access to Essential Medicines through Public-Private Partnerships." What we found, is that while essential health supplies certainly face challenges that a Coke bottle or calling cards do not -- such as strict temperature or humidity requirements, closer tracking systems and sometimes even the need for skilled staff to administer the product -- there are other areas where global health can learn valuable lessons from the private sector.
The way we analyzed the situation was by looking for consumer packaged goods (CPGs) that shared key characteristics with essential health products (EHPs) and then comparing key distribution indicators for the same geographic areas. The first key finding from our report -- which may be the most important -- is that private sector distribution systems have better data than public sector systems for health products. In short, comparisons were hard to do because we need better data on distribution system effectiveness for health products.
The one indicator of distribution system effectiveness that we could reliably find for both consumer and health products is the "out of stock" rate. This measure indicates how often either a retailer was out of a consumer product (like beer, cigarettes or mobile phone cards) or how often a health center or hospital had not a single dose of a vaccine or life-saving antibiotics. The results confirmed our initial suspicion.
Out of stock rates were generally higher and more variable for essential health products than for consumer goods -- and the levels of out of stock rates were unacceptably high. Imagine that in parts of Africa some injectable antibiotics were out of stock more often than they were in stock, and at the same time, these communities were out of mobile phone cards at rates of less than 5 to 10 percent.
Examining practices in the private sector also generated some ideas for how to improve distribution of health products. For example, health supplies in parts of Africa might only be restocked every 90 days, while consumer goods are restocked every four to 14 days. Moving to constant, lower inventory levels through frequent and responsive deliveries would reduce waste, lessen storage space requirements and reduce the risk of being out of stock. Similarly, we also could learn from a beer company that increased their frequency of deliveries in order to overcome local stores' natural inclination, not to invest too much in inventory. Our estimates indicate that up to 30 million doses of vaccines and $80-160 million might be saved each year from better distribution systems.
Our study concluded with four calls to action that include:
1) Standardizing the data for monitoring health supplies distribution
2) Building partnerships to exchange knowledge on distribution practices
3) Sharing infrastructure among partners
4) Encouraging research and product innovation to lower distribution barriers
What makes this field so exciting is that knowledge truly can come from any source. DHL recently partnered with UNICEF Kenya and helped drive a 10-fold increase in the number of children sleeping under bed nets. Partnerships like these could be the next great breakthrough in global health if the innovation of business is harnessed for the cause of saving children's lives.
This explains why, instead of announcing the launch of this report in a traditional global health environment, I'm here today at the Cannes Lions International Festival of Creativity, a hub of private sector creative thinkers, looking for partners interested in harnessing their private sector know how for global health success.
Anyone interested?
Follow Dr. Orin Levine on Twitter: www.twitter.com/orinlevine
Today, even though almost all US infants receive vaccines for rotavirus, and despite efforts to improve the management of childhood rotavirus-associated diarrhea, hospitalizations of children in the U.S. with the disease have not significantly declined in the past two decades: the CDC says rotavirus infection is still responsible for an estimated 400,000 doctor visits; more than 200,000 emergency room visits; and 55,000 to 70,000 hospitalizations in the US.
The CDC also says that 20 to 60 infant deaths now die every year in the US due to rotavirus infection. The CDC says that children ages 6 months to 24 months old are most at risk for serious complications or death from rotavirus, when supportive treatment, or re-hydration, is not given during the illness.
http://www.nvic.org/vaccines-and-diseases/Rotavirus.aspx
“There is a possibility that the live vaccine virus can be transmitted to non-vaccinated contacts. The potential for transmission of vaccine virus following vaccination should be weighed against the possibility of acquiring and transmitting natural rotavirus.â€
Merck’s RotaTeq product information insert contains nearly the same language:
“RotaTeq is a solution of live reassortant rotaviruses and can potentially be transmitted to persons who have contact with the vaccine. The potential risk of transmission of vaccine virus should be weighed against the risk of acquiring and transmitting natural rotavirus.â€
http://www.nvic.org/vaccines-and-diseases/Rotavirus.aspx