I was thrilled to witness President Nyusi launch the rotavirus vaccine in Mozambique last fall. Tens of thousands of little Mozambicans will be spared severe dehydration, even death, due to rotavirus-induced diarrhea – if the vaccine reaches them. And herein lies the problem. When a vaccine sits in a national or district warehouse, a truck, or a broken “fridge,” it cannot save lives.
Over a four-year period, the Mozambique government, supported by Gavi and its donors will spend over $19M to purchase the rotavirus vaccine. At roughly $3.50 per dose, it is one of the most expensive vaccines the country has ever helped purchase. To protect the investment in providing rotavirus and other vaccines for Mozambique’s children, we must ensure they are available when families visit health centers.
Mozambique has developed and implemented a new approach for vaccine distribution. This next-generation supply chain is now serving more than 500 health centers and eight million people. Vaccine availability in these health centers has increased from an average of 64 percent in 2011 to an average of over 95 percent today. Investments in data, people, and infrastructure are all required for these gains. But one of the biggest impediments to making sure vaccines reach children is operating expenses that are needed to actually distribute them.
Recent studies estimate that for every $.99 spent on vaccines in a low-income country, an additional $.32 is needed for supply chain costs including transportation, labor and storage.[1] To bring this point home, let’s look at how this translates at a local level. 
Niassa is Mozambique’s most sparsely populated province. Trucks carrying vaccines must travel 4,583 kilometers a month on average, or 230 kilometers each day. It requires significant maintenance to ensure these trucks are in working order to travel Mozambique’s poor roads. Drivers and field coordinators must be paid daily to cover travel expenses. This means that in Niassa, about $4,500 must be available on a monthly basis to ensure vaccines can get to all 135 health centers.
With its next-generation immunization supply chain system, Mozambique has proven it can make sure vaccines are available for children. There are ten provinces, though, and each one of them needs funds available at the local level on a monthly basis – a total of approximately $500,000 annually. When transportation or funding for fuel isn’t available, or when the cold chain is inoperable, vaccine programs ground to a halt. Such delays can have deadly consequences.
[1] Vaccine, Portnoy et. al. “Costs of vaccine programs across 94 low- and middle-income countries” 2015