Abstract

Sara, the head of logistics for an international humanitarian organization, must find the safest, most effective way to deliver vaccines to a number of locations in South Sudan experiencing an outbreak of measles, one of the deadliest, vaccine$-$preventable diseases. Speed is essential. So is protecting the vaccine from damage. Emergency situations, however, mean unpredictability, uncertainty, and uncon$-$ ventional conditions. This case enables students to put themselves in Sara$$s shoes to plan a success$-$ ful emergency vaccine delivery strategy using a logistics method known as cold chain management.

Case Study

Planning an Emergency Vaccination Campaign

Sara is the head of logistics for Doctors on the Road $($DOR$),$ an international humanitarian organization pro$-$ viding medical assistance in South Sudan. It is Monday morning. At her office in South Sudan$$s capital, Juba, in the Central Equatorial State, she receives an e$-$mail notification outlining a potential measles outbreak in Warrap State, approximately $500$ km to the northwest. Field teams have been monitoring the slow but steady increase in cases over the past two weeks and are concerned about the future progress of the disease, since they have also been receiving some reports of cases in the neighboring state of Western Bahr el Ghazal.

Sara shares this information with her European HQ and receives the go$-$ahead to receive European vaccines at an existing Juba central warehouse. It will be distributed to Kuajok city in Warrap State and the city of Wau in the State of Western Bahr el Ghazal. There seems to be no need to transport the shipment immediately because the state health centers report they still have a supply of vaccine. The stockpile means there is no need to order vaccines from the manufacturer.

DOR operates a hub in the Puerto de la Torre district of the city of M$$laga$,$ Spain, near its international airport. A few hours after contacting the hub to discuss preparations for a possible shipment of vaccines, Sara gets a call from the Kuajok health center. Field teams now have reliable reports of many measles cases in nearby villages. The same update comes from the Wau health center and from a new source, the health center in the city of Jallab, far to the west of Wau. These reports make it clear that the existing stockpile of vaccines in South Sudan will not be sufficient to cover the need. Therefore, the shipment has to be dispatched to the Warrap State as soon as possible. Sara$$s specific task is to plan safe vaccine transport from the Puerto de la Torre hub to all outbreak sites in Kuajok, Wau and Jallab.

South Sudan

The Republic of South Sudan became the world$$s youngest nation in July $2011.$ However, the civil war out$-$ breaks in December $2013$ and in July $2016$ affected the country$$s development and caused a severe, long$-$ term humanitarian crisis $($World Bank, $2022).$ According to the United Nations Office for the Coordination of Humanitarian Affairs $($OCHA$,$ n$.$d$.),$ more than two$-$thirds of the population need protection or humanitarian as$-$ sistance. Around $7\mathrm{.}7$ million people face severe food insecurity and the country deals with climate shocks as well as economic crises exacerbated by the global food shortages and the COVID$-19$ pandemic $($WFP$,2022).$ Due to water contamination and poor sanitation, many South Sudanese people are at risk for epidemics such as cholera $($WHO$,2019).$ In addition, ongoing problems of human rights violations and violence force people to flee their homes, leaving more than $2$ million people internally displaced. At the same time, another $2\mathrm{.}3$ million South Sudanese refugees search for safety in neighboring countries $($UNHCR$,2023).$

South Sudan$$s total estimated track length is around $90,200$ km$.$ Approximately $14,000$ km are primary and secondary roads and $6,000$ km are tertiary tracks. South Sudan has only one rail connection, from Babanusa

$($in Sudan$)$ to Wau. The country controls the Nile river$$s upper reaches, offering $1,400$ km of navigable in$-$ land waters. Although South Sudan is easily accessible by air, thanks to hundreds of helicopters and fixed$-$ wing landing sites, large aircraft can be handled only at Juba, Wau, Malakal, and Paloich airports, which are equipped with asphalted runways $($Logistics Cluster, n$.$d$.).$ Figure $1$ shows the map of South Sudan and its major cities.

Figure $1.$ South Sudan Map

Source: NordNordWest$/$Wikipedia$,2011$

South Sudan experiences only two seasons, rainy and dry. Therefore, the country is at risk for both flooding and drought. The rainy season negatively affects infrastructure. For example, only around $5,000$ km of roads may remain passable and some parts of the country can be entirely inaccessible for months. Also, large num$-$ bers of airstrips become unusable by fixed$-$wing planes because of their gritty surfaces. But weather condi$-$ tions are not the only danger to infrastructure. Most incidents of conflict are record