Concept note on ‘scaling up the delivery of ITM in Tanzania through
facilitation of ITM delivery value chain’
Lead agency: ILRI
Partners: GALVmed; existing ITM distributors, DVS, other partners to be identified during
proposal development
Summary: East Coast Fever (ECF) is the most important infectious disease facing cattle
keepers in Tanzania and the region. In order to address this challenge, Tanzanian authorities
have since 2003 adopted the Infection and Treatment Method (ITM) vaccine against ECF. To
date, an estimated 1 million heads of cattle have been vaccinated with the 2 recognized
distributors delivering 150,000 doses per year. However, the total vaccinated cattle accounts
for less than 5% of the total cattle population, leaving a huge gap that could be bridged by
scaling up the delivery of ITM. This would reduce ECF-related losses by an estimated
US$129.5 million, and benefit about 1.7 million cattle keepers. Expansion of ITM delivery has
so far been restricted by limited capacity of existing distribution channels. Working with the
Tanzanian government, GALVmed and the existing ITM distributors, this project aims at
increasing the availability of ITM by identifying, training, certifying and equipping vaccinators
and linking them to village level networks and organizations through appropriate business
models. Besides facilitating the delivery of the vaccine and reaching 350,000 heads of cattle
in 2 years, the project will also assess the relative effectiveness and efficiency of at least 2
envisaged delivery mechanisms.
Rationale for upscaling ECF Vaccine
East Coast Fever (ECF) is a tick-borne disease caused by a protozoan parasite Theileria parva
that is transmitted by the tick Rhipicephalus appendiculatus. The disease presents critical
constraints to cattle production in East, Central and Southern Africa (Dolan 1999). Overall,
losses due to ECF are estimated at US$54.5 million, US$4.41 million and US$0.1 million in the
smallholder dairy sectors in Kenya, Tanzania and Malawi, respectively. However, losses in the
traditional cattle sector (pastoral systems & smallholders keeping local breeds), are more
pronounced in Tanzania – estimated at US$129.5 million (Minjauw and McLeod 2003). This is
in comparison to losses amounting to US$34.1 million and US$2.5 million in the traditional
sector for Kenya and Malawi respectively. It is also estimated that ECF is responsible for: over
43% of annual cattle deaths reported in Tanzania (Kambarage, 1995; Mtei and Msami,
1995); economic losses amounting to over US$ 35 million in cattle mortality and; over US$ 6
million in lost milk production in (McLeod and Kristjanson, 1999). More recent surveys continue
to rank ECF as the most important cattle disease (ILRI 2013).
In pastoralist systems, ECF is believed to be the main cause of calf mortality rates of between
40-80% (Babo Martins et al., 2010). ECF is also a threat in more intensive mixed dairy
systems with cross-bred cattle, where it is mainly managed through tick control measures.
Animals are treated with acaricides in up to half-weekly intervals. However, whenever these
control measures fail, prevalence rates of 45% and case fatality rates of 68% have been
recorded (Kivaria and Noordhuizen, 2010). Besides these risks, an acaricide-based approach
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to ECF control implies considerable costs and negative environmental effects, calling into
question the efficacy of this approach (Kivaria, 2007). Due to the ECF risks and the associated
cost of controlling the disease, many smallholders across East Africa are often reluctant to
adopt improved breeds of cattle (Mukhebi and Perry, 1992).
In an attempt to find a more cost effective control of ECF, an alternative approach, the
infection and treatment method (ITM), was developed more than 30 years ago. Scientists from
the East African Veterinary Research Organisation (now the Kenya Agricultural and Livestock
Research Organisation), in collaboration with international partners first reported the
immunisation potential of infecting and simultaneously treating cattle against ECF in the mid70s (Radley et al 1975)). However, due to characteristics of the approach (animals are
infected with live parasites of varying genetic identities), distribution constraints (the vaccine
requires liquid nitrogen storage), treatment costs (animals are treated with a long-acting dose
of specific antibiotics contributing to total vaccination costs of USD 8-12) and post-vaccination
reactions (depending on vaccine and treatment doses some vaccinated animals show severe
ECF infection symptoms), the approach did not experience large-scale uptake during the first
two decades. In 1997 and 2008, ILRI was mandated by the FAO and AU-IBAR respectively to
produce commercial size batches of the vaccine stabilate through an improved methodology
to enhance the safety and efficacy of the vaccine. Since then, adoption has improved
considerably and the vaccine has been registered in Tanzania, Kenya and Malawi and is
licensed for use by the Director of Veterinary Services in Uganda while awaiting registration.
Delivery has been led by the private sector in Kenya, Tanzania and Malawi enabling over 1
million animals, mostly from pastoral communities in Tanzania to be vaccinated by 2014 (ILRI,
2014a).
Contrary to initial focus on the improved breeds in the smallholder dairy systems when the
technology was envisioned, it has since become apparent that the biggest actual losses to ECF
in Tanzania occur in the traditional sector. This is exemplified by the rapid adoption of the
ECF vaccine in the pastoralist areas. Indeed, more than 80% of the vaccination against ECF in
Tanzania has been in the pastoral sector. However, although mortality is much lower in the
smallholder dairy sector, farmers spend much more on acaricides and curative drugs,
underscoring the importance of ECF even in the smallholder dairy sector. Moreover, since allyear zero-grazing systems are rare in this region, nearly all cattle are exposed to the risk of
contracting ECF. Additionally, the seasonal distribution of infection risk is also closely related
to vector dynamics that in turn are often determined by vegetation and rain-fall patterns
(Gachohi et al., 2011; Lynen et al., 2006).
In terms of milk consumption, Tanzania ranks lowest in East Africa with a capita consumption of
42 litres. However, with increasing incomes and changing dietary habits demand for milk is
increasing. Thus, the dairy sector is growing and intensifying and with this comes the increasing
attention on cattle health. A study on adult cross-bred dairy cattle in Tanzania has shown ITM
to also be effective in this production system (Lynen et al., 2012). The results show that farmers
quickly reduced the frequency of tick control activities (weekly dipping or spraying regimes
are common) without detrimental animal health effects, which corresponds with
recommendations from research findings (Kivaria et al., 2007). The resulting reduction in
production costs proved to be the main direct benefit.
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Maximizing returns to ECF vaccination therefore calls for a focus on both systems – deepening
the progress so far achieved in the pastoralist systems while closing the wider vaccination gap
that exists in the smallholder dairy sector.
Current delivery approach and its challenges
In Tanzania, the current distribution channel for the ECF vaccine is composed of 2 private
distributors at the national level who import the vaccine from the manufacturer. Each
distributor has a network of vaccinators some of whom act as agents for downstream
distribution of the vaccine. The agent-vaccinators are either linked to some other trained
vaccinators or they deal directly with cattle keepers. However, the current vaccine delivery
system is fraught with many challenges that have stifled widespread uptake of the vaccine by
cattle keepers. Among these challenges is the limited coverage of existing number of
vaccinators. First, the current number of vaccinators are far too few for a vast country with the
population of cattle the size of Tanzania. Moreover, some trained vaccinators do not have the
necessary kits to transport vaccines to the field once they have sourced them from the agents.
Neither do they have access to suitable financing schemes that can help them acquire the
kits. As a result, there is plenty of unused capacity among the current crop of trained
vaccinators. Consequently, even cattle keepers with a desire to adopt the technology may not
be reached by the few trained vaccinators.
Secondly, the cold chains for storage of the vaccine that are maintained and serviced by
distributors and networks of their agents only go as far as major urban centers and their
environs. This restricts cattle keepers in remote areas from accessing the ECF vaccine.
Besides lack of necessary equipment, most vaccinators lack additional and supportive
training on business practice. The current mode of training is restricted to technical aspects
with limited or no focus on business skills. Yet there exists a large scope to inject business
approaches into vaccination services that can substantially enhance the reach and uptake of
the vaccine.
Finally, the level of awareness about the ECF vaccine among both cattle keepers and some
government technical personnel is also limited if not lacking. Due to either misinformation by
competing products or misperception about the vaccine and its impact, some cattle keepers
fear that they may lose their animals after vaccination. Besides, in large areas of the country
especially in the agro-pastoral areas cattle keepers are unaware of the existence of an ECF
vaccine. Considerable efforts should therefore target improving delivery in order to access
more than just a fraction of the potential market.
Availability of vaccine
On request by regional authorities including AU-IBAR, ILRI produced slightly over 1million
doses of the ECF stabilate in 2008. By the end of 2013 almost all the vaccine had been
bought by distributors across the region but with the bulk going to Tanzania. Under a
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commercialization process facilitated by GALVmed, ILRI transfered the vaccine production
technology to the Centre for Ticks and Tick-borne Diseases (CTTBD), an AU-IBAR supported
institution, for future vaccine production. With financial support from BMGF through GALVmed
and technical support from ILRI, CTTBD embarked on production of a commercial batch of the
vaccine stabilate. This batch, of at least 250,000 doses, is expected to be in the market by
the end of 2014. It was also recently reported at a regional stakeholder workshop on ITM
that plans are at an advanced stage to produce additional 1million doses of the stabilate by
2016.
The current annual ECF vaccine usage in the region stands at about 150,000 doses but
demand has been rising. Once the batch from CTTBD is available towards the end of the
year plus any doses that distributors across the region might still have in stock, a doubling of
demand in 2015 could be accommodated. However, going forward careful monitoring of
progress on the production of the next batch of stabilate by CTTBD would be needed to
ensure adequate supply in 2016 and beyond if the project succeeds in significantly increasing
adoption.
Commercialization plans – the business model
In order to enhance uptake of ECF vaccine we propose expansion of distribution networks via
linkages of various grass-root level institutions (e.g., a cooperative, qualified input dealer, etc.)
to existing distributors’ networks. In order to ensure viable delivery of vaccine to end users, we
propose equipping and increasing business orientation of vaccinators and bundling of services
at the service provider and distributor-agent level.
Expanding distribution networks
In order to expand the distribution networks we will work with distributors to identify grassroot institutions to act as additional agents or provide infrastructure for storage of the vaccine.
This will enhance access to vaccine for existing but idle vaccinators in remote locations, while
also opening doors for more vaccinators to be trained and recruited into the network, where
they do not exist currently. The expansion approach can take various institutional forms.
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Cooperatives, producer organizations (POs), dairy marketing hubs or other collective
action institutions. Some cooperatives and POs have refrigeration facilities that can
provide the basis for establishing vaccine storage - making them potential agents for
distribution of the vaccine. While the existing chilling facility will cater for refrigeration of
the vaccine diluent, the PO’s will need to acquire a liquid nitrogen tank for storage of the
vaccine itself. In some cases, the PO may be willing and able to purchase equipment.
Where possible this option will be explored. Otherwise, established POs deficient of funds
for such an investment will be linked to financing scheme to facilitate acquisition of the cold
chain. We will work with the distributors to identify such institutions and support them
accordingly. In some cases, the PO and the distributor can be co-funded to jointly establish
the cold chain infrastructure with the distributor acting as a guarantor. If this approach is
taken, the trained vaccinator(s) will be the custodian of the vaccine stored at the chilling
plant.
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Alternatively, input dealerships run by qualified animal health personnel will be identified
and supported through appropriate financing to acquire the cold chain infrastructure. Such
dealership would then be recruited into the distributor networks.
Train, equip and link vaccinators to groups of farmers
Additional to existing vaccinators, we will work with the distributors and relevant government
departments to train more vaccinators who will then be equipped with the necessary kits and
linked to cattle keepers through appropriate institutional arrangements.
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First, a standardized course on safe and efficient delivery of ITM vaccine that is
recognized and certified by DVS will be established. Currently in Tanzania, the course is
organized by the distributors, which means that the trained vaccinators are ‘tied’ to a
particular distributor. Harmonizing the training will standardize ECF vaccination practice
and forestall some unethical behaviors that expose the vaccine to unnecessary disrepute,
which impacts negatively on uptake. The course will be developed in collaboration with the
distributors and all stakeholders in the livestock health sectors and suitable institutions will
then be identified to offer this training.
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Second, suitable candidates with animal health qualification will be identified, trained and
certified as vaccinators. Priority will be given to animal health practitioners in the field to
take advantage of the networks that have been developed through these service
providers. Besides technical training, we will work with the distributors to develop
appropriate business training for all vaccinators that are part of their distribution networks
to enhance the business orientation of respective vaccinators. We expect to achieve
substantial buy in from distributors since it is in their business interest that their vaccinators
deliver the vaccine to more end users.
Where necessary, trained vaccinators will be linked to suitable financing for the sake of
acquiring equipment and start up supplies. To ensure sustainability of the approach, the
project will not contribute financially to the purchase of the equipment. Instead, financing
will be provided by an external agency and channeled through the vaccine distributors.
Loans provided to vaccinators will then be recovered every time vaccinators make
purchases of vaccines from distributors. One distributor (Ronheam International) has
successfully implemented a vaccinator equipping program based on a credit scheme.
Working with our business development partners, we will then facilitate the emergence of
contractual agreement between trained vaccinators and the PO and/or hubs, both in the
Southern highlands, Tanga and Morogoro regions where ILRI and its partners are working
to transform the dairy value chain and increase household income through the hub
approach. The hub approach allows for economies of scale not only in milk but also for
inputs and services. The approach ensures a sufficiently large market for the trained
vaccinators (in comparison with them working with scattered households) and decrease the
cost of delivering the vaccine, both by decreasing costs of storage as well as making it
easier to get the required number of animals to be vaccinated.
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Bundling of services
In order to spread the overhead costs and thus make the vaccine delivery more affordable to
end users, we will explore possibilities of using AI delivery infrastructure in order to take
advantage of existing cold chain infrastructure. Similarly, we will work with existing
distribution agencies and explore possibilities of integrating AI delivery into their business
portfolios. In particular:
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All grass-root institutions that are recruited into the distribution networks to act as agents
(cooperatives, hubs, agro-vets etc.) will be encouraged to bundle vaccine and semen
storage, as a way of spreading the overhead costs. Where infrastructure for delivery of
AI already exists in some set-ups (cooperatives etc.), such facilities will be considered for
recruitment as grass-root institutions to be upgraded for delivery of ECF vaccine.
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Additionally, given the relatively low demand for the vaccine in some production systems,
trained vaccinators will be encouraged to bundle services as a way of expanding their
businesses and making the vaccination service more viable. In this regard and where
necessary, the vaccinators will additionally be trained on provision of AI services to help
expand their business portfolios so as to cover for any business shortfall that may arise
from limited vaccine business.
Sensitization and awareness creation
To address lack of awareness among cattle keepers, we will work with GALVmed to organize
various field exhibitions and farmer to farmer sensitization approaches. We will also mount
several media campaigns through newspaper, magazines, radio and television. Taking
cognizance of the role of government in enhancing adoption of technologies, we will also
organize technical trainings and awareness forum for the relevant government officials. During
these forums the relevant government officials will be sensitized on their regulatory and
oversight role in enhancing the uptake of the ECF vaccine.
Through the suggested upscaling initiatives we hope to vaccinate 230,000 cattle in the first
year and another 120,000 in the second year. These projections are, however, contingent
upon projected availability of the next batch of vaccine – 250,000 dosses to be released for
the entire region by November this year and approximately 1 million dosses by 2016.
Institutional collaboration and partnership
The proposed project is in line with the on-going collaborative work by GALVmed, ILRI and
other partners aimed at establishing a sustainable commercial basis for supply and
distribution of ECF-ITM in East, Central and Southern Africa. This collaborative initiative will
see the sale of 2.5 million dosses to livestock keepers by June 2017. Besides enhancing
technical capacity within CTTBD for vaccine production, the on-going work also aims at
developing businesses around vaccine delivery and embedding of marketing skills at various
levels of the vaccine supply chain. The proposed work in Tanzania will therefore provide an
excellent opportunity to focus on specific elements of the vaccine supply chain and develop
practices and processes that facilitate increased adoption of ITM-ECF elsewhere in the region.
These lessons would particularly be useful even as GALVmed together with other national and
regional partners plan to intensify the ECF-ITM activities in Uganda and Kenya.
In collaboration with GALVmed and other regulatory authorities and manufacturer, we will
also explore possibilities of expanding into new territories through the establishment of
additional distributors. GALVmed have previously facilitated the registration of the vaccine
and undertaken sensitization campaigns to increase awareness of the vaccine. Furthermore,
we will also work with current distributors to expand their networks of vaccinators and to train
and equip trained vaccinators – borrowing a lot from experiences of existing distributors.
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At country level, the proposed approach takes cognizance of existing plans and approaches
by various partners in the livestock sector and seeks to work with them to expand or adapt the
current approaches, whichever is appropriate. First, our proposed scaling up is in line with the
plans of the Ministry of livestock development that focusses on improving animal healthcare.
We also adapt the hub innovation approach that is currently being piloted by ILRI in
collaboration with our partners - Heifer Project Tanzania (HPT) and Faida Mali. At the heart
of the hub approach is an interlinked product and input and/or service market, where cattle
keepers can access inputs and services on the account of products they deliver to buyers.
Under this tri-partite agreement, the buyer checks off the cost of services and/or inputs
received by the cattle keeper (from input/service providers) from the proceeds of the milk
delivered to a buyer. The system is sustained by equipping service providers with business
skills to do business with cattle keepers/groups of cattle keepers.
Finally, linking to our existing platforms, at national level through the Dairy Development
Forum (see http://livestockfish.cgiar.org/2013/08/09/ddf2/ ) and at local level through
innovations platforms promoted by ILRI and partners in Tanga and Morogoro among others,
we propose to upscale the ECF vaccine in Tanga and Morogoro – up North and in Southern
Highlands These areas have both smallholder dairy and pastoralist production systems and
provide platforms for comparing different vaccine delivery approaches.
Research design
Vaccinated herds will be monitored closely to assess the impact of vaccination on calf
mortality, morbidity and productivity. Diseases incidence, cause-specific mortality, growth
rates and other productive parameters will be measured in immunized and non-immunized
herds. This work is important as most studies assessing the impact of ECF have considered the
reduction in mortality only. Of particular interest will be to compare the impact of vaccination
in indigenous breeds with crossbred breeds to provide evidence to farmers whether ECF
vaccination can indeed protect their valued investment against death and lead to increased
productivity in their herds. The results could be used in sensitization campaigns to provide a
powerful incentive for livestock owners to adopt the vaccine.
Additionally, we will evaluate the various ‘last mile’ delivery mechanisms, by comparing the
effectiveness and efficiency of delivering ITM through
1. Trained vaccinators operating on their own
2. Trained vaccinators attached to a PO or a hub (either directly employed by the PO or
linked through contractual arrangement whereby the vaccinator is paid by the PO that
collect milk from the cattle keepers)
3. Any other delivery mechanism that may arise. Indicators to be collected include:
average number of vaccinations done per month; turnover per year; profits per year;
etc.
For the project as a whole, a Returns on Investment analysis will be conducted, with returns
including those at household level (decrease in mortality and morbidity; decrease in tick
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control costs; possibly increase in uptake of cross bred cattle); as well as at other points along
the value chain (trained vaccinators and distributors).
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