Hot Topics and Lingering Questions from TechNet 2020

The TechNet Conference convenes immunization and supply chain professionals from all over the world to learn about and share new approaches to immunization, keeping vaccines cold, and making sure all children get the vaccines they need. 

This year, as with everything else, the conference was virtual, with attendees using Zoom to hear more than 100 global leaders in over 30 sessions and plenaries. We came away inspired by new ideas and different technologies, and a renewed commitment to continue striving for improved immunization supply chain performance.

A few hot topics bubbled up during the two days:

• • COVID-19 has been very disruptive, but it is also an opportunity to strengthen health systems. During the plenary, a colleague from WHO shared insights from more than 50 countries on the disruptions to immunization coverage, but noted that countries were quick to adjust service delivery approaches to reach children who may have missed routine immunization doses during the initial wave of lockdowns. (Learn how India adjusted its routine immunization system.) Another session covered new WHO guidance for planning and implementing catch-up vaccination, both as part of essential and routine immunization programs and in the context of COVID-19-related immunization service disruptions. 

Plenary presenter Sena Kwawu, a board member of VillageReach, had some poignant things to say about disruptive change. He recalled that the private financial sector rebounded from the financial crisis of 2008 by rethinking the overall system, finding ways to be more adaptive and resilient to future disruptions. That is our current situation with COVID-19 and immunization. Everything is being disrupted, but we can leverage the disruptions to build a better and stronger overall immunization system.

• All participants shared a drive for innovation and motivation to improve immunization services. Some of the innovations were the “new shiny object” of optimal Performance, Quality and Safety (PQS)-approved cold chain equipment or micro-array patches for administering measles vaccines, for example. Other innovations were less about a new “invention” and instead involved different approaches to standard practices, such as integrating cold chain products in the vaccine cold chain or how to adjust National Logistics Working Group roles to address the current COVID-19 pandemic. Regardless of the session topic, the ongoing commitment to ensuring all children receive vaccines was clear.
• Given COVID, cold chain equipment was a significant topic during the conference, but we also saw more attention paid to the overall system that supports cold chain equipment functionality. Gavi, the Vaccine Alliance, has significantly invested in new equipment around the world in the past few years, but immunization stakeholders have noted that all equipment still needs maintenance, including temperature monitoring, spare parts need to be managed, and equipment needs to be inventoried. It’s a welcome shift to see the conversation broaden to system components that will keep the cold chain cold.
• Demand and supply must go hand-in-hand. This is an obvious point, but at the last TechNet Conference we realized we needed more insight and sharing from the ‘demand’ and program perspective, so the supply chain can be more adaptive and meet the true needs of the community and program, not just those on a national level planning form. Colleagues from CDC, JSI, and inSupply had a great session, demonstrating how data use and triangulation can involve both perspectives—the supply side and the demand side—to improve program performance. Another session brought in the service experience perspective, which influences how a caregiver seeks vaccines and how that can impact supply decisions. 

There were also a few lingering questions raised that we will need to consider as we advance our work post-conference:

• What needs to be done to prepare for a future COVID-19 vaccine introduction?

• • • Supply chain—planning around transport, storage, and distribution: Though exact details on requirements for a future vaccine are still unknown, there are some basic parameters and likely requirements that we can plan for, starting now. This type of undertaking is new to most countries and possible ultra cold-chain requirements may necessitate a rethink around air transport, freezer placement at national and sub-national centers or the use of dry ice, and last-mile delivery needs—requiring strong planning processes and different strategies for reaching the target population, starting now and building on current systems. 
    • Service delivery—drilling down on target groups: Given expected initial supply constraints, discussion on prioritizing target groups has centered on where and how to reach “high-risk” populations including healthcare workers, adults over 65, and adults with comorbidities with a future COVID-19 vaccine. However, there is a need to consider this in relation to the country’s level of coronavirus transmission, vaccine availability, and perhaps additional factors. WHO has just published its SAGE roadmap for prioritizing uses of COVID-19 vaccines in the context of limited supply which should further inform deliberation about target groups. That said, countries will need to consider their situations, begin to outline target groups with more specificity, and begin critical microplanning to find and reach these key groups not typically targeted by national immunization programs.
• How can we scale-up innovations sustainably? Various conference sessions on innovative products demonstrated that there is usually funding for initial innovative ideas and donor-funded pilots; but, as was noted in the private sector engagement session, how do we finance scale up? There is a need to attract investors, shape healthy markets for cold chain-related products, build capacity of local logistics firms to compete, and once and for all end reliance on donors for piloting and scaling solutions.

Although we didn’t have the face-to-face interactions like we normally would, we came out of TechNet 2020 feeling like we, as the global community of immunization professionals, have the ideas, creativity, motivation, and commitment to leverage the disruptions that COVID-19 has brought the world to strengthen the overall immunization system.

Written by: Wendy Prosser and Adriana Almiñana