“There are a lot of pieces of a puzzle that have to be put into place at the same time… The COVID-19 pandemic turned the process upside down.” – Chief of WHO Operations Support & Logistics
15 May 2020 — As COVID-19 spreads to countries with poor health systems, the United Nations and its partners are racing against time to ensure that life-saving personal protective equipment and other supplies reach frontline health workers in need.
“There are a lot of pieces of a puzzle that have to be put into place at the same time,” said Paul Molinaro, Chief of Operations Support and Logistics at the World Health Organization (WHO), describing the difficulty of moving supplies to countries hardest hit by the virus.
In normal times, WHO fulfills country requests by placing orders through long-term contracts with vendors who ship cargo via freight forwarders. “The COVID-19 pandemic turned the process upside down,” he said.
Disruptions to manufacturing in China fractured global supply chains, creating shortages as demand soared. Commercial flights were grounded, trade restrictions implemented and market competition increased. These challenges created a whole new level of complexity, he explained.
“We’re sort of sailing the ship while building it at the same time,” said Mr. Molinaro. “Right now, we have a ship, and there’s a lot of holes in it. But we have a ship.”
COVID-19 Supply Chain Taskforce
In early April, the United Nations launched the COVID-19 Supply Chain Taskforce – coordinated by WHO and the World Food Programme (WFP) – to massively scale up the procurement and delivery of personal protective equipment, testing and diagnostics supplies, and biomedical equipment like ventilators and oxygen concentrators.
“Those who have the means - and the means to pay, and the means to pay it very quickly and upfront - benefit the most,” Mr. Molinaro said. Those without means could easily be left out.
The Taskforce, which also includes the World Bank, the Global Fund and others, leverages the expertise of each partner to identify procurement needs and better negotiate with suppliers. Medical supplies are a “global good” that must be accessible, he said.
After allocations are negotiated, the Taskforce puts down a funding guarantee – partly with funds raised by the COVID-19 Solidarity Response Fund for WHO.
WHO’s strength lies in offering expertise on purchasing decisions as to which rapid diagnostic tests perform best, while WFP takes care of logistics, including establishing air routes and global distribution hubs, and chartering aircraft.
The overall supply chain will be spread out across hubs in eight countries: Global hubs in are Guangzhou (China), Dubai (United Arab Emirates) and Liege (Belgium). Regional hubs are in Kuala Lumpur (Malaysia), Addis Ababa (Ethiopia), Panama City (Panama), Accra (Ghana) and Johannesburg (South Africa).
WHO Director-General Tedros Adhanom Ghebreyesus said that each month, WHO would need to ship a minimum of 100 million medical masks and gloves; up to 25 million N95 respirators, gowns and face-shields; and up to 2.5 million diagnostic tests.
Leveraging Comparative Advantage: ‘You need people who can make things move’
Learning from past experiences, World Food Programme staff members Natasha Nadazdin and Aboubacar Koisha attest to the critical importance of moving medical supplies to the frontline quickly.
Ms. Nadazdin, WFP Senior Programmer Adviser for the West Africa region, said the death toll during the 2014 Ebola crisis would have been much higher if WFP had not ventured out of its traditional areas of expertise.
“The initial thinking was: this is a medical crisis, and we cannot cross lines and we shouldn’t be doing things WHO should be doing,” she said. “But when we became aware of the potential dimensions of that crisis, then it became clear that WFP would have to get involved in a very serious way because of our logistics capacity to procure quickly and organise the supply chain.”
Mr. Koisha, WFP Regional Officer in Dakar who focused on monitoring and evaluation during the Ebola outbreak, agreed: “You need people who can make things move,” he says. “This is where WFP has a comparative advantage. We have the logistical skills — we are not doctors but we can help the doctors do their work by facilitating the right environment.”
‘Solidarity Flight’ takes off
COVID-19 presents a unique difficulty in that it has grounded most commercial cargo and passenger flights.
Tackling the problem head-on, the Supply Chain Taskforce facilitated a shipment of WHO medical cargo from Dubai to Addis Ababa by mid-April, thanks to a free flight offered by United Arab Emirates. This cargo, together with medical supplies donated by Ethiopia’s Prime Minister Abiy Ahmed and the Jack Ma Foundation, was then transported on chartered planes to other parts of Africa.
The first cargo flight, which departed Addis Ababa on 14 April, came to be known as the “Solidarity Flight,” as acts of solidarity had made it possible. It was also the first test run of the Addis Ababa hub, Mr. Molinaro said, a crucial hurdle to clear, as estimates project that 300,000 to 3.3 million Africans could perish if proper intervention measures are not taken.
The cargo included one million face masks, face shields, gloves, goggles, gowns, medical aprons – enough to protect health workers treating more than 30,000 patients across the continent. It also included thermometers, ventilators and laboratory supplies to support surveillance and detection.
“When we get the plan together, the stuff shows up, we’re able to put it on, we’re able to move it, we’re able to ship it, and it’s in quantities that make it worthwhile,” Mr. Molinaro said. “It’s fantastic. It’s why we do it.”
Despite ongoing supply chain disruptions, WHO has managed to purchase and ship millions of personal protective gear to 133 countries and diagnostic kits to 126 countries, he said.
Funding still needed
But logistics operations continue to require funding, as the World Food Programme establishes the necessary transport hubs, charters vessels and provides aircraft for cargo, health workers and other essential staff.
On 19 April, the United Nations launched an urgent appeal for $350 million to rapidly scale-up common logistics services. In a letter signed by the heads of various UN bodies, the Office for the Coordination of Humanitarian Affairs (OCHA) called on donors to support the global emergency supply system provided by WFP.
“Without these logistics common services, the global response could stutter to a halt,” they said.
WFP administration officer Chiara Camassa recalled that deploying staff was not difficult during the Ebola outbreak. But COVID-19 presents a new challenge: border closures and movement restrictions. “The effectiveness of our response ultimately depends on our staff,” she said.
By early May, WFP had set up passenger air services for United Nations and non-governmental organization staff working on the COVID-19 response, routing workers and medical cargo to the frontlines with flights to and from hubs, and a fleet of smaller aircraft moving them on to priority countries.
We are ramping up the @UN’s logistics and supply systems as part of our #COVID19 response.— António Guterres (@antonioguterres) May 4, 2020
This week a @WFP plane departed Belgium for Burkina Faso & Ghana, carrying medical cargo and personal protective equipment.https://t.co/6goD6diUV5 pic.twitter.com/hj98belDeq
Once this humanitarian air bridge is fully up and running, as many as 350 passenger and cargo flights could fly each month. The United Arab Emirates is helping to advance the cause, announcing that it will dedicate a fleet of three aircraft until the end of the year.
The United Nations Children’s Fund (UNICEF) is also involved, with warehouses and distribution centres around the globe allowing it to coordinate agile responses to emergencies. Its global supply hub in Copenhagen is home to the world’s largest humanitarian warehouse, while regional hubs in Brindisi, Dubai and Panam enable the agency to working around the clock to ensure that supplies reach children in need. (See photo essays from UNICEF.)
Partnering to scale-up local production, increase ‘tech access’
Local production of medical supplies is also an essential piece of the supply chain puzzle.
As demand for medical supplies increases, countries with limited resources are often unable to purchase or produce the tools they need to mount effective responses to COVID-19. Lack of access to technical expertise, training and regulatory frameworks limit local production of essential equipment, particularly for more complex products like ventilators.
To address critical shortages, the Tech Access Partnership was launched on 12 May as part of a coordinated approach to developing countries increase their access to life-saving health technologies.
The partnership – which brings together the United Nations Technology Bank, United Nations Development Programme (UNDP), United Nations Conference on Trade and Development (UNCTAD) and WHO - aims connect manufacturers with critical expertise and emerging manufacturers in developing countries. It will also help countries develop affordable technologies and equipment that meet quality and safety standards.
“By enabling developing countries to produce these technologies themselves, we can help set them on the path to recovery,” said United Nations Technology Bank Managing Director Joshua Setipa.