Improving Last Mile Equity in Immunization through Strategic Public-Private Partnerships

Recent publications[1][2][3][4] by the International Pharmaceutical Federation (FIP) stressed the importance of pharmacists in the immunization chain. From industrial manufacturing, distribution, and marketing of vaccines to the running of pharmacy-based immunization services, pharmacists play a critical role in enhancing vaccine coverage and ensuring vaccines remain safe and efficacious throughout the pipeline.

The reports show that some low and middle income countries in Africa, Asia-Pacific, and the  Americas already allow pharmacists to administer immunization shots via community pharmacies3.  In addition to providing immunization shots, community pharmacies have also been at the forefront of educating and advocating on the benefits of vaccination at the community level1. This goes a long way in increasing vaccine availability and global immunization coverage. These findings are highly encouraging. However, the findings of most interest were from the Latin American countries, whose healthcare systems are a close proxy to those in Africa, with similar disease patterns and challenges.

Firstly, incorporating immunization education into undergraduate education and offering continuing education to professionals is of high importance and priority. Competency-based curriculums are essential in ensuring graduating pharmacists are equipped with the right knowledge and skills to effectively execute pharmacy-based vaccinations. Some countries have already incorporated this into some of their higher learning institutions, and trained pharmacists are allowed to administer vaccines.

Secondly, patient education is critical in improving the immunization coverage puzzle and enhancing  last-mile equity in immunization. The reports emphasize the need for pharmacists to be core members of the multidisciplinary teams tasked with providing health information and education with regard to immunization. Lastly, the reports stressed the importance of pharmacists being part of and participating in public policy management teams.

Kenya as a nation has done relatively well in strengthening the healthcare workforce through capacity building initiatives in collaboration with the private sector such as through the accreditation of private universities to offer medical education programs e.g., Mount Kenya University, USIU Africa among others. Additionally, through the Kenya Expanded Program on Immunization(KEPI), the government adequately offers vaccines to all Kenyans through public health facilities.. However, the public health pipeline is marred with logistical issues that prevent the reach of vaccines to all parts of the country[5]. As such, access to immunization services remains insufficient.

Small private facilities primarily serve the health needs of Kenyans living in rural areas. These private healthcare facilities have become popular among Kenyans who dislike government services due to frequent stock outs and/or poor service[6]. As a result, government-run immunisation services are underutilised, particularly for vaccines that fall outside the infant immunisation schedule. A good example is the high hesitancy rate associated with COVID-19 vaccines, with many of the vaccines expiring before they are used5.

The government must acknowledge that they are pragmatically unable to ensure last-mile coverage and equity, and seek out alternative solutions to this problem. How then can the government extend such services to areas where they cannot practically reach?

I believe the answer to this is a strong push for public-private partnerships (PPPs). The government needs to partner with the myriad of existing private healthcare facilities to increase access to vaccines and expand the immunization chain. The national COVID-19 vaccine deployment plans already support the administration of the COVID-19 vaccine via public and private healthcare facilities approved by the Kenya Medical Practitioners and Dentists’ Council[7].

Where do pharmacists come in? Pharmacists, in particular community pharmacists, provide an alternative route for vaccine deployment. Using adequately equipped and pre-approved pharmacies should further enhance vaccine coverage by bringing the service even closer to the patient. Pharmacists already have the technical and cold-chain knowledge and skills needed to effectively handle vaccine storage and administration.Additionally, numerous pharmacy chains are spread throughout the country. These retail pharmacy chains are privately owned, and if the government can form strategic alliances with them, access to vaccines will improve across the country.

There is a global need to improve access to vaccines and vaccination services. To deliver on this mission, we have to strategically engage with allies. Pharmacists have a critical role to play in health communication, social mobilization, vaccine logistics management, immunization, and policy development to anchor health systems to deliver on this critical mandate.

[1] International Pharmaceutical Federation (FIP). An overview of pharmacy’s impact on immunization coverage: A global survey. The Hague: International Pharmaceutical Federation; 2020.

[2] International Pharmaceutical Federation (FIP). FIP vaccination handbook for pharmacists: Procedures, safety aspects, common risk points and frequent questions. The Hague: International Pharmaceutical Federatiobn; 2021.

[3] International Pharmaceutical Federation (FIP). Advocating expansion of pharmacist’s role in immunization: A focus on diphtheria-tetanus-pertussis booster, COVID-19, and meningitis vaccinations. The Hague: International Pharmaceutical Federation; 2022.

[4] International Pharmaceutical Federation (FIP). FIP vaccination reference guide: Knowledge and skills to support professional development and inform pharmacy education in vaccination. The Hague: International Pharmaceutical Federation; 2022.

[5] Over 40m Covid vaccines in state stores at risk of expiry due to apathy, logistics. (2022). Retrieved 12 May 2022, from

[6] Azevedo M. J. (2017). The State of Health System(s) in Africa: Challenges and Opportunities. Historical Perspectives on the State of Health and Health Systems in Africa, Volume II: The Modern Era, 1–73.

[7] Ministry of Health. (2021). National COVID-19 Vaccine Deployment Plan. Ministry of Health

Article written by Dr Genuine A. Desire, Associate Detailer, inSupply Health

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