INVESTIGATING THE FACTORS AFFECTING THE DISTRIBUTION OF VACCINES AMONG FIVE SELECTED HEALTH FACILITIES IN AKURE SOUTH LOCAL GOVERNMENT AREA.

Vaccine is preparation that is used to stimulate the body’s immune response against diseases (CDC, 2021). Vaccines are usually administered through needle injections, but some can be administered by mouth or sprayed into the nose (CDC, 2021). “The impact of vaccination on the health of the world’s peoples is hard to exaggerate. With the exception of safe water, no other modality has had such a major effect on mortality reduction and population growth” (Plotkin and Mortimer, 2017). The development of safe and efficacious vaccination against diseases that cause substantial morbidity and mortality has been one of the foremost scientific advances of the 21st century. Vaccination, along with sanitation and clean drinking water, are public health interventions that are undeniably responsible for improved health outcomes globally. It is estimated that vaccines have prevented 6 million deaths from vaccine-preventable diseases annually (Ehreth, 2003). 

By 2055, the earth’s population is estimated to reach almost 10 billion (United Nations Department of Economic and Social Affairs, 2019), a feat that in part is due to effective vaccines that prevent disease and prolong life expectancy across all continents. That said, there is still much to be done to ensure the financing, provision, distribution, and administration of vaccines to all populations, in particular those which are difficult to reach, including those skeptical about their protective value and those living in civil disruption. Agencies including the World Health Organization (WHO), United Nations Children’s Fund (UNICEF). Vaccines reduce risks of getting a disease by working with your body’s natural defenses to build protection. When an individual gets a vaccine, their immune system responds. We now have vaccines to prevent more than 20 life threatening diseases, helping people of all ages live longer, healthier lives (WHO, 2021). Immunization currently prevents 2-3 million deaths every year from diseases like diphtheria, tetanus, pertussis, influenza and measles (WHO, 2021). 

A study conducted in Kenya in the year 2014 showed that out of 300 sub-county vaccine stores across the country only 55% had an adequate cold chain storage (Ministry of Health Kenya, 2019). This had implications on vaccine availability, as depots could not hold sufficient stocks. The report also revealed that although the national immunization program outsourced transport services for vaccine distribution between national and regional vaccine stores, there was no reliable transportation between regional and sub country vaccine depots as well as to the public health facilities. The mandate for transport and distribution to sub county and public health facilities lies with the county governments. The factors that affected vaccine availability included insufficient knowledge of forecasting, monitoring and resource management. Others were high staff turnover and wastage (Kenya National Bureau of Statistics, 2014).

The Expanded Programme on Immunization (EPI) has proved its place as a corner stone in the Primary Health Care (PHC) strategy. Not only is it a cost-efficient intervention that prevents common childhood diseases, it also provides an entry-point into communities for other Reproductive and Child Health (RCH) interventions, such as vitamin A supplementation and growth promotion (CDC, 2016). Global coverage dropped from 86% in 2019 to 83% in 2020, an estimated 23 million children under the age of one year did not receive basic vaccines, which is the highest number since 2009. In 2020, the number of completely unvaccinated children increased by 3.4 million, only 19 vaccine introductions were reported in 2020, less than half of any year in the past two decades. 1.6 million more girls were not fully protected against human papillomavirus (HPV) in 2020, compared to the previous year (WHO, 2021).  

During 2020, about 83% of infants worldwide (113 million infants) received 3 doses of diphtheria-tetanus-pertussis (DTP3) vaccine, protecting them against infectious diseases that can cause serious illness and disability or be fatal. While immunization is one of the most successful public health interventions, coverage has plateaued over the last decade. The COVID-19 pandemic and associated disruptions have strained health systems, with 23 million children missing out on vaccination in 2020, 3.7 million more than in 2019 and the highest number since 2009.(WHO, 2021). Immunization programmes depend greatly on efficient and effective supply chain systems to store, transport and distribute these vaccines and health commodities, which ensures that the right products are available at the right place, at the right time and in the right condition in order to provide efficient health services to the communities (Chiodini, 2014). 

The Effective Vaccine Management (EVM) initiative, launched in the year 2010 by World Health Organization (WHO) and United Nations Children’s Fund (UNICEF) is a comprehensive assessment of the vaccine supply chain system of immunization programmes in low and lower-middle income countries. The focus of the initiative is to uncover the shortcomings in the performance of immunization supply chain so as to provide basis for improvement (WHO & UNICEF, 2014). EVM initiative assesses nine criteria of vaccine management performance from the national through to the service delivery points and benchmark this performance against global set standards. The nine criteria for satisfactory vaccine supply chain are; (i) vaccine arrival procedures ensure that every shipment from the 3/>manufacturer reaches the national store in right condition; (ii) temperature monitoring—vaccines and diluents are stored and distributed within recommended temperature ranges; (iii) cold storage, dry storage, and transport capacity—warrant the sufficiency of storage and transportation of all vaccines and supplies needed for the immunization programme; (iv) buildings, cold chain equipment, and transport systems are appropriate; (v) maintenance of buildings, cold chain equipment, and vehicles; (vi) stock management systems; (vii) vaccine distribution between each level in the supply chain; (viii) implementation of appropriate vaccine management policies are adopted; and (ix) satisfactory information systems and Supportive management functions, (WHO & UNICEF, 2014.,Diamenu et al., 2015).

Each of the nine criteria is assessed at each level of the supply chain from the national through to the service delivery level by observation, inspection of infrastructure and records, and by interview of health staff involve in vaccine handling and management (WHO & UNICEF, 2014). In Nigeria, where this study was based, routine vaccination coverage for all recommended vaccines has remained poor though there has been a gradual rise in vaccination coverage from 21% of eligible children (0–11 months of age) in 2003 to 25% a decade later. (Nigeria Demographic and Health Survey, 2013). 

The potency of vaccine needed to be maintained right from the manufacturer to users. Some health facilities do not have effective storage facility to maintain the potency of these vaccines, some of the areas where the health center are located do not have adequate lightning, some of the staffs does not carry out their duty effectively due to poor payment of their salaries. Government pays less attention to those health facilities that need assistance. Therefore, there is need to assess the factors that affecting vaccines distribution in Akure South Local Government Area.

This study aims to study the factors affecting effective distribution of vaccines among five (5) selected health facilities in Akure South Local Government. 

The Objectives of the study are to;

To examine the vaccine distribution process in selected health care facilities so as to identify possible loopholes in the process.

To access the roles of health workers in effective distribution of vaccines in those selected health facilities.

To examine the adequacy of the roles of government in effective vaccine distribution. 

What are the vaccine distribution process in selected health care facilities so as to identify possible loopholes in the process?

What are roles of health workers in effective distribution of vaccines in those selected health facilities?

What are the adequacy of the roles government in effective vaccine distribution?

It is comprehensively clear that vaccines' potency needs to be maintained, and effectively distributed. This study will help to identify factors affecting vaccine distribution, and find solution to those identified factors problems. This study will also help the general public to assist the neighboring health centers around them. This will also make the health workers and governments to identify their roles in achieving effective vaccine distribution. It will also serve as foundational knowledge for other researchers.

Disease: Is a disorder of structure or function in a human, animal, or plant, especially one that produces specific symptoms or that affects a specific location and is not simply a direct result of physical injury.

Health: refers to a state of complete emotional and physical well-being. Healthcare exists to help people maintain this optimal state of health.

Health facilities: are places that provide health care.

Sanitation: refers to public health conditions related to clean drinking water and treatment and disposal of human excreta and sewage.

Vaccine: Is a substance given to stimulate the body's production of antibodies and provide immunity against a disease without causing the disease itself in the treatment, prepared from the agent that causes the disease (or a related, also effective, but safer disease), or a synthetic substitute.

Vaccination: is a simple, safe, and effective way of protecting people against harmful diseases, before they come into contact with them.

Vaccine-preventable diseases (VPDs): are diseases caused by bacteria and viruses that can be prevented by vaccines.

Population: the whole number of people living in a country, city, or area. 

Immunization: is the process by which an individual's immune system becomes fortified against an infectious agent.

Measles: Is a highly contagious illness caused by a virus that replicates in the nose and throat of an infected child or adult.

Centre of Disease Control (CDC): Is a national public health agency of the United States.

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