Getting humanitarian supplies where they need to go is a game of precision and meticulous planning under normal circumstances.
Try adding a global, rapidly evolving pandemic to the mix, and you've described the current reality of World Health Organization (WHO) Operations Support & Logistics Chief Paul Molinaro. He is WHO's point man for procuring life-saving COVID-19 equipment and supplies destined for countries hit hardest by the virus.
"There are a lot of pieces of a puzzle that have to be put into place at the same time," Molinaro said.
Scaling Up the Orders
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. Disruptions in Chinese manufacturing fractured global supply chains, creating shortages in the face of soaring demand. Market competition increased, trade restrictions were implemented, and commercial flights were grounded. These challenges created a whole new level of complexity.
"We're sort of sailing the ship while building it at the same time," Molinaro said. "Right now we have a ship, and there's a lot of holes in it. But we have a ship."
In early April, the United Nations launched the UN COVID-19 Supply Chain Task Force – coordinated by WHO and the World Food Programme (WFP) – to massively scale up the procurement and delivery of personal protective equipment (PPE), testing and diagnostics supplies, and biomedical equipment like ventilators and oxygen concentrators. The Task Force leveraged the capabilities and expertise of each partner into a mega-consortium to identify procurement needs and better negotiate with suppliers. Members include the United Nations Children's Fund (UNICEF), the United Nations Office for Humanitarian Affairs), the World Bank, The Global Fund, the United Nations Office for Project Serves (UNOPS), United Nations Development Programme (UNDP), United Nations Fund for Population Activities (UNFPA), United Nations High Commissioner for Refugees (UNHCR), NGOs, Red Cross and Federation and other WHO health cluster partners. The goal: to make supplies available to everyone, wherever they are needed.
"We need to approach the market in a way that can give us success because unfortunately it's unbalanced," explained Molinaro. "Those who have the means and the means to pay, and the means to pay it very quickly and upfront benefit the most." Those without means, could easily be left out. Medical supplies are a "global good," Molinaro said, which WHO can make accessible by using its leverage to secure large quantities.
"We're trying to bring some kind of order to a very fragmented, duplicative, and competitive procurement process," Molinaro told us.
Delivering the Goods
After allocations are negotiated, the Task Force puts down a funding guarantee – partly with money raised by the COVID-19 Solidarity Response Fund for WHO – and can then figure out how to get the goods sent out to countries.
In the Task Force, WHO wears the technical hat. They know medical equipment well, and in the quickly changing context, can offer expertise on purchasing decisions such as which rapid diagnostic tests perform best. 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: Belgium, China, Ethiopia, Ghana, Malaysia, Panama, South Africa, and the United Arab Emirates (UAE). WFP plans to use eight 747 aircraft and eight medium-sized cargo aircraft to move supplies. Dr. Tedros Adhanom Ghebreyesus, WHO Director-General, said the WHO may need to "cover more than 30% of the world's needs in the acute phase of the pandemic."
Dr. Tedros described 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.
"What we're trying to do now is hugely ambitious," Molinaro said. "Sometimes I think we're going to attempt the impossible, but the alternative is what? If we don't do this, what happens? We don't get anything."
Determining who gets what depends on several factors, including what the countries request themselves through an online platform. It also depends on the health systems and infrastructure countries have in place. Daily risk analysis is also important to determining types and amounts of supplies as rapidly shifting contexts can suddenly change needs.
Sometimes, shipments don't go according to plan – and sometimes, that's a good thing.
The Emiratis recently called WHO to let them know they had a plane going to Tehran. They had extra room to carry supplies – would WHO be interested? Getting supplies to Iran isn't easy; WHO's answer was a resounding 'yes.' Within days, 7.5 tons of medical equipment and supplies were delivered to health workers at a pivotal point in Iran's pandemic timeline.
"There are these opportunities that are going to come up, so you need to take advantage," said Molinaro. "You'll take advantage of the one-off and hope to turn it into something else."
Solidarity, Solidarity, Solidarity
Another lucky opportunity came up when the United Arab Emirates (UAE) offered WHO a free flight from Dubai to Addis Ababa. The timing was perfect –Addis Ababa had just received a large donation from the Jack Ma Foundation and the Alibaba Foundation of masks, test kits, and protective clothing and face shields for Africa's 54 countries. WHO was able to send cargo from Dubai to Addis to join the large number of flights going out to countries.
A shipment of one million face masks, gloves, goggles, ventilators and other essentials – including supplies donated by Ethiopian Prime Minister Abiy Ahmed – was then prepared and sent from the newly established Addis Ababa Humanitarian Air Hub on a number of Ethiopian Airlines charters. The first flight was christened as the first "Solidarity Flight," sending enough equipment to health care professionals to help them treat more than 30,000 COVID-19 patients across Africa.
Molinaro mentioned that some of the Solidarity Fund money has been going to this. Can we confirm again?
"This is by far the largest single shipment of supplies since the start of the pandemic and it will ensure that people living in countries with some of the weakest health systems are able to get tested and treated, while ensuring that health workers on the frontlines are properly protected," WFP spokesperson Elisabeth Byrs said.
From Addis Ababa, the supplies were distributed to an initial set of five countries across the continent: Djibouti, Sudan, Eritrea, Somalia and Tanzania. Supplies are accepted either directly by the country's health ministry or entity tasked with the COVID-19 response. As of April 24, the Solidarity Flight shipment has reached more than 80 percent of the continent.
This was also the first test run of the Addis Ababa hub, a crucial hurdle to clear as the United Nations estimates that between 300,000 and 3.3 million African people could perish if proper intervention measures are not taken. These figures make every flight and every show of solidarity that much more critical. They also make the meticulous, second by second planning of the Supply Chain Task Force worthwhile.
"Everything has to sequence and come together, and when it does, it's enormously satisfying," Molinaro told us. "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, it's fantastic. It's why we do it."
Support the WHO's Efforts
Despite ongoing difficulties with supply chain disruptions, WHO has so far managed to purchase and ship millions of items of PPE to 133 countries, and diagnostic kits to 126 countries. However, more still needs to be done to get life-shaping shipments to places around the world where COVID-19 has hit the hardest.
Please consider donating to the COVID-19 Solidarity Response Fund to support WHO's work to fight this pandemic.