A Test of Resilience: How Ukraine’s Vaccine Distribution System Withstands War

Ukraine’s public health system has faced unimaginable challenges over the past five years that revealed both its strengths and vulnerabilities. The COVID-19 pandemic, followed by Russia’s full-scale invasion in February 2022, placed unprecedented stress on the country’s health infrastructure, highlighting the urgent need for reform and external support. Ukraine confirmed its first COVID-19 case in March 2020, and a nationwide quarantine was imposed shortly after. Just as the health care system began recovering, the war erupted, creating a new layer of crisis. Despite these challenges, Ukraine, with support from international partners such as the US Agency for International Development (USAID) Safe, Affordable, and Effective Medicines (SAFEMed) for Ukrainians Activity, has adapted its vaccine distribution systems to ensure uninterrupted access to essential health care treatment.

Lessons learned from the pandemic

When the first cases of COVID-19 were detected, Ukraine’s Government quickly established the COVID-19 National Task Force, with the USAID SAFEMed Activity playing a key role in coordinating the delivery and management of essential medicines and equipment. SAFEMed experts contributed to the development of the COVID-19 Vaccination Roadmap and additional MedData platform’s modules, which provide enhanced visibility into the country’s health supply chain. With SAFEMed support, the government expanded MedData to include modules for inventory management and use of medical supplies, including COVID-19 vaccines.

The pandemic revealed a major gap in Ukraine’s vaccine supply system: the country could not store and distribute COVID-19 vaccines that have special temperature requirements. In 2021, SAFEMed helped the government utilize the private sector to fill this gap and signed a fast-track contract with a private supplier, Farmasoft, for low-temperature (-70 degrees) transportation of vaccines. Together with UNICEF, Farmasoft developed standard operating procedures for ultra-cold chain logistics and distribution of vaccines.

By September 2024, SAFEMed had facilitated the logistics for 4.8 million doses of COVID-19 vaccines, demonstrating the resilience of Ukraine’s vaccine supply system. The Government of Ukraine subsequently used SAFEMed-designed methods to procure and distribute COVID-19 vaccine supplies independently.

Sustaining immunization services in wartime

In early 2022, as Ukraine’s health care system began to recover from the COVID-19 pandemic, Russia’s full-scale war posed a new existential challenge. Disrupted supply chains, damaged infrastructure, displaced families, and financial constraints threatened to halt essential health services, including routine immunizations. However, the strong private-sector partnerships and improved data management tools that SAFEMed helped establish allowed the country to manage this next crisis.

“Immunization is a constant priority for the health care sector. Despite the challenges posed by the war, thanks to cooperation with international partners including SAFEMed, the Ministry of Health has managed to ensure an ongoing supply of vaccines for routine immunization in every region. The systematic partnership and flexibility in approaches from the SAFEMed team enable the uninterrupted availability of vaccines in the regions, making immunization accessible for every Ukrainian, regardless of their place of residence,” stated Ihor Kuzin, Deputy Minister and Chief State Sanitary Doctor of Ukraine.

Thanks to USAID SAFEMed’s ongoing support, more than 4.8 million doses of routine vaccines were delivered to the regions by September 2024. In July 2023, the combined measles, mumps, and rubella vaccine was quickly distributed across the regions, reaching over 153,000 children who had missed their vaccinations due to the war and received them during the nationwide catch-up immunization campaign.

Ihor Zastavnyi, co-founder and family doctor of a private outpatient clinic in Lviv Region, shares how routine immunizations helped protect his patients during the war. “One mother returned to thank us after her child was vaccinated against measles. She felt relieved knowing her daughter was protected while many children at her school were unvaccinated and at greater risk. Vaccination is a powerful investment in mental and physical health.”

Strengthening capacity in the regions

In late 2022 and early 2023, management of the immunization program was transferred from regional health departments to the MOH’s Regional Centers for Disease Control and Prevention (rCDCs). USAID SAFEMed supported the transition by helping to develop logistics management regulations, assessing the readiness of the rCDCs, developing standard operating procedures for regional distribution centers, and providing regional vaccine logistics coordinators with training. With international support, the rCDCs received specialized cold-chain equipment and vehicles, improving coordination between the rCDCs and health care providers at the regional level.

Ihor Zastavnyi praised the streamlined cooperation between his outpatient clinic and the Lviv rCDC, which now manages vaccine logistics. “The rCDC set up a communication system to coordinate deliveries and collect vaccine demand data. Colleagues from the rCDC set up a chat group to provide quick updates on new deliveries and send reminders about stock reports. They also gather information on vaccine demand. To get the vaccines, we just need to submit the demand for the month, and then tell them when we come and pick the vaccines up in accordance with cold chain requirements. Working together, we ensure our community receives the vaccines they need. It’s rewarding to be part of such an effective system.”

Looking ahead, USAID SAFEMed continues to enhance regional capacity by providing cold-chain equipment, including 133 insulated containers and 370 temperature data loggers in 13 regions of Ukraine. These efforts will ensure vaccines remain effective despite ongoing challenges, safeguarding the health of Ukraine’s population even in the face of adversity. Additionally, USAID SAFEMed is implementing a last-mile logistics pilot to develop optimal models for vaccine distribution and sustainable financial mechanisms for the vaccine supply chain system.