Getting vaccinated may seem simple: a nurse, a syringe, a quick jab, and a lifetime of protection from disease. Yet organizing emergency vaccinations can pose a real logistical challenge. Behind the high-profile staff—physicians, nurses, surgeons—Doctors Without Borders/Médecins Sans Frontières (MSF) logisticians are the back-stage managers who ensure that projects run smoothly.
In Guinea, MSF has deployed 400 personnel to support the Ministry of Health with a measles vaccination campaign. Among them are logisticians like Grégoire Putz. Here, he describes how the team plans to vaccinate 500,000 children in two weeks.
How are MSF teams organized?
MSF teams are organized in pairs: a logistics supervisor and a medical officer. They leave every morning at 6:30 with cold boxes filled with vaccines and thinners, medical kits containing gloves and syringes, and the logistical tools needed for the vaccination sites.
On site, they meet up with the teams of vaccinators and advanced personnel made available by the Ministry of Health and recruit people to keep records, give directions, and keep order. In the end, each team consists of at least nine people. But, if there are many children to be vaccinated, more are hired. For example, there may be up to 14 attendants at a single site to manage the crowd. If the route is not marked out and people are not directed, it is very easy to become overwhelmed and even unable to work. On average, 400 people are working daily on this vaccination campaign, but the number varies depending on the day and the needs.
In the evening, the “cold chain” team takes over from 8:00 PM to midnight. The measles vaccine must be kept cold, and this requires a major logistical effort. All the vaccines have to be taken out, counted, and put in the refrigerator; the cold boxes prepared and the icepacks made ready for the next day’s vaccination.
Can you explain why the cold chain is important?
This is a crucial step that makes vaccination particularly delicate. If the vaccines are not kept at a precise temperature—between 2 and 8 degrees [Celsius]—they are unusable. This is not easy in a country where the temperature can easily reach 30 to 35 degrees during the daytime and where the electrical supply is highly uncertain!
We have 17 freezers for the refrigerating units and 14 refrigerators to keep the vaccines. When the teams go out to the vaccination sites, the cold boxes serve to maintain the temperature of the vaccine. For this purpose, we have 5,000 frozen icepacks, and when they have to be replaced because they are no longer maintaining a low enough temperature, which happens every 48 to 72 hours, 1,100 of them have to be changed.
Since we store several hundred thousand doses of vaccine, we cannot allow the temperature to vary, so we use generators round the clock. In case there are serious problems, we have to ensure backup, because we cannot rely on the Guinean electrical grid. Our backup plan is a rented refrigerated container normally used to transport fish!
What is special about this vaccination campaign?
This is an urban vaccination, which makes it very different from other more rural situations, [such as those] in the Democratic Republic of Congo. Here, in the cities, we have no problem finding people, but we face other problems related to urban density and a lack of space to set up vaccination sites. We have set them up in various places, such as in an unused factory, a private courtyard or warehouses.
There are 10 to 12 million inhabitants in Conakry, and it takes a lot of time to get around. As for exact population figures, there are surprises! In some places, we expect 1,000 people per day and get 1,500. In others, it’s the opposite. We therefore make adjustments as we go to the vaccination planning and to our initial expectations.