The Pan American Health Organization (PAHO), which I am honored to lead during the 2020–2021 biennium, has successfully achieved a series of initiatives to address the COVID-19 pandemic and health in the Americas.

The purchasing sector during the 2020–2021 biennium saw PAHO's procurement value reach U$ 2.8 billion – an increase of 41% – having seen sustainable growth in recent years. However, the Procurement and Supply Management Department (PRO) of the Organization took on great challenges during this biennium to provide high-quality services to Member States through technical cooperation in the purchase of goods and services for health. Of note was the successful COVAX Initiative, whereby PAHO both purchased COVID-19 vaccines for Member States and facilitated logistics for COVID-19 vaccine donations.

In addition, PRO is leading the digital transformation, implementing software for the purchase of vaccines and medicines, mitigating risks through working together with Member States, and providing specialized technical assistance for the purchase of goods and services. The work by PRO was recognized through its shortlisting for three best practices at the World Procurement Awards 2022: Supplier Collaboration & Innovation Award; Procurement Team; and Digital Impact Award. PAHO won the Digital Impact Award.

Our objective is to offer excellent technical assistance to Member States, providing timely and efficient delivery of goods and services. Therefore, I am very pleased to present the Biennial Report of Procurement and Supply Management 2020–2021.

PAHO is the second-largest buyer of medicines and vaccines and the seventh in value of purchases within the United Nations System, so the impact on the purchase of goods and services in the Organization is extremely important.

Purchasing in the established timeframe can make a difference for the population in the Americas. Purchasing implies teamwork with technical units, PAHO country offices, Ministries of Health of the Member States, and suppliers.

This is made possible through a coordinated effort among all these partners to achieve the objectives of the Organization. For example, we can coordinate initiatives with suppliers to improve demand and supply visibility, improve time and access to market, and standardization of product presentation/labeling.

Our objective is to ensure that the provision of goods and services for health by the Organization remains efficient and effective, and is completed in the shortest possible time. The operational excellence that has been achieved in project implementation has allowed for effective streamlining of processes using technology, in coordination with our partners.

On behalf of The Procurement and Supply Management Team (PRO) of the Pan American Health Organization (PAHO), I am pleased and honored to present the Biennial Report of Procurement and Supply Management 2020–2021. This report highlights the strength and relevance of the procurement function on supporting governments in the Americas to protect and enhance people’s health, by improving access to quality essential health products across the Region, responding to emergencies, and improving and equipping primary health care facilities.

This biennium has been of great relevance for the procurement function, because of the challenges that COVID-19 posed, in terms of seeking access to key supplies that protect, detect, treat, and prevent this virus in millions of people in our region, while we keep supporting our countries on accessing all other health technologies for the routine health programs. The procurement team at headquarters and in our countries not only showed an enormous commitment to our organization and our countries, but also turned challenges into opportunities by adopting modern technologies, increasing our market intelligence, and implementing innovative procurement tools, while strengthening our collaboration with our countries, technical teams, and suppliers.

The pandemic highlighted the relevance of collaborative procurement with global partners, looking for unique solutions for unique problems. As one of procurement partners of COVAX, we celebrate being part of this historical moment for public health and procurement, as being part of the largest multilateral international agreement since the Paris Climate agreement with over 190 participating economies. The logistic component saw us leveraging our expertise on this aspect (managing +3000 shipments of health supplies to the Region every year) and maintaining very close communication with governments to mobilize doses as quickly and safely as possible. Our team was proud to have coordinated and managed the first delivery of US donated doses in the world through COVAX to Honduras, providing 1.5 million doses of Moderna vaccine to help protect 15% of its population, when these were the most needed.

The COVID-19 pandemic validated the vision we started constructing as a team several years ago, whereby we looked to shift from being merely “doers” to becoming “thinkers”; moving from “tactical” to “strategic”; and moving from the requisition and purchase order perception of procurement as “back office” and position ourselves as “solution providers”.

This Biennial Report of Procurement and Supply Management 2020–2021 thus summarizes our actions for procurement in the Region and highlight the work of our procurement practitioners working as a team and committed to support the delivery of our technical cooperation to save and enhance the lives of millions of people in the Americas and ensure that we don’t leave anyone behind.

During the 2020–2021 biennium the COVID-19 pandemic took hold throughout the world including the Americas. The pandemic considerably affected the logistics issue and presented challenges that had to be faced as an organization. One of the main challenges faced was the closure of airports and therefore the closure of shipments of vaccines and medicines. To solve these new obstacles, the Procurement and Supply Management Department (PRO) had to implement immediate measures such as coordination with suppliers, coordination with PAHO Member States, and immediate actions as a team that allowed shipments to be sent to supply vaccines and pharmaceuticals.

The 2020–2021 biennium witnessed a total of 6,017 shipments of vaccines and medicines at a rate of 8 daily shipments. In the current biennium we have implemented a review of the technology for the shipments. Previous to the pandemic, communication with suppliers and ministries of health (MoHs) of Member States was done by email, spending around four days to facilitate the information and shipping documents between suppliers and countries.

Now this situation changed with the implementation of two robotic process automation (RPA) systems – Mia and Max – whereby the communication with our suppliers and MoH is immediate and 24/7 – the first in the whole Organization. Max creates the Advanced Shipment Notice and also applies Object Character Recognition (OCR) technology to extract data from thousands of shipping documents. Mia creates the draft of purchase orders of vaccines and pharmaceuticals.

These systems work 24/7 helping to respond to the COVID-19 pandemic and regular procurement of vaccines and pharmaceuticals. Technology continues to change organizations at a rapid pace. Humans working side by side with such technology is no longer something out of science-fiction, but a reality since the beginning of 2021.

In 2021, the Pan American Health Organization (PAHO) and the United Nations Children's Fund (UNICEF) strengthened their partnership to procure and transport life-saving vaccines to low- and middle-income countries on behalf of COVAX.

The COVAX Facility is the only global initiative aiming to ensure countries have fair and equitable access to COVID-19 vaccines – no matter their wealth or whereabouts. It is also the largest vaccine supply operation ever undertaken. PAHO and UNICEF are co-leading procurement efforts on behalf of the COVAX Facility, with PAHO responsible for participating economies in Latin America and the Caribbean.

UNICEF at global level, and PAHO in the Region of the Americas, worked together to ensure quality-assured COVID-19 vaccines were procured and delivered to countries without delays as soon as vaccines were available. This meant high-risk and vulnerable groups – including frontline health care workers – could be protected from infection, helping to prevent severe illness, save lives and keep health systems running. PAHO delivered 92 million COVID-19 vaccines to 33 countries by the end of 2021 in the Region of The Americas.

As soon as vaccines touched down at airports, PAHO and UNICEF supported governments to roll out their vaccination campaigns, including in difficult-to-reach areas such as mountain villages, Pacific islands, and the Amazon basin. This work, on behalf of COVAX, was built on the back of UNICEF and PAHO’s joint vaccine tender launched in late 2020 and the longstanding partnership between both agencies.

Who are the mysterious Mia and Max? And how have they managed to facilitate so perfectly the sale and distribution of vaccines?

If there is anything that the Pan American Health Organization (PAHO) can be proud of over the past two years, it’s of their two first digital collaborators: Mia and Max. Together they were able to do part of the team’s habitual works in record time. For example, over the last two years, shipments of COVID-19 vaccines – 120 million in total, have happened daily, while at the same time navigating countless intricate, complex, and long voyages.

This massive task would not have been possible without the help of this dynamic duo, who work 24 hours a day, seven days a week. But how? Who are they and how do they manage this? The truth is that these prodigious individuals are robots. No, really! This is a cutting-edge initiative from PAHO that has flipped the digital transformation on its head. Mia oversees purchasing orders, while Max runs logistics, managing shipping documents and all requirements for providers as well as for the countries’ shipment recipients.

Thanks to these two, the speed, efficiency, and punctuality of the process has been exceptional. Amid a pandemic applying intense pressure, urgency and demand for COVID-19 vaccines and treatments, PAHO’s Procurement and Supply Management Department (PRO) had no alternative but to find a fast and efficient workforce to manage the volume of operations and orders they were receiving daily with the same team, now in charge of higher added value tasks such as finding solutions, identifying risks, finding alternatives, etc.

With 12–14-hour workdays, weekends, and holidays, they were barely able to reach their goals. Then came Mia and Max, the greatest gift, the biggest help, and the best news for the Organization, its providers, and the Ministries of Health in the Region they serve. This great initiative by PAHO has been one of the decisive features of the past two critical years. Welcome, Mia and Max! We hope you are the first of many.

Buying a correctly outfitted ambulance has always been a challenge. Notably, these are not ordinary ambulances. Some must be capable of accessing remote areas and withstand rough terrain; others need to be equipped to handle critical patients or newborn babies, or even women giving birth in regions without hospitals. The wave of COVID-19 patients over the past two years also means that ambulances must not only be able to reach patients and provide services quickly, but must also be equipped with biosafety measures to protect service providers.

Purchasing these vehicles has turned into a remarkable experience for the Procurement and Supply Management Department (PRO) to the extent that they decided to travel to different countries, along with the technical team, to visit a series of ambulance providers to learn everything they could about them: how they differ and what each one can do; what configuration does each need for different situations; what is the purpose of each one; what specifications work best in each scenario; etc.

PRO wanted to find the best. As if this wasn't enough, the department also visited different emergency centers to understand the exact process, from dispatch and deciding which ambulance to send, to the treatment received upon arrival on the scene, to admission at a hospital – all possible scenarios were considered. With all this newfound knowledge in hand, a technical sheet was created listing the strict requirements for each model of ambulance (basic, rural, advanced, etc.).

Despite the restrictions created by the pandemic, PRO has managed to ship 126 ambulances since 2020, meeting these high standards. One hundred have gone to the Dominican Republic, twenty five to Honduras, and one to Suriname. In areas where hospitals are not equipped to treat COVID-19, these ambulances, acquired and distributed through PRO and capable of transporting critical patients while maintaining biosecurity, have been key to transporting patients to specialized medical centers that could save their lives, especially in cases where they have been rescued from rural areas.

The 2020–2021 biennium was one of many challenges for the Pan American Health Organization (PAHO) to ensure access to health in the Region. The lives of hundreds of thousands of people in the Americas and Caribbean depended on their ability to quickly receive shipments of necessary medical supplies to combat COVID-19. The series of challenges and obstacles they faced was seemingly endless.

First, it was necessary to find effective means to diagnose COVID-19. Once diagnostic tests were on the market, the Procurement and Supply Management Department (PRO) had to determine which had been approved by the various regulatory agencies (the FDA in the United States; Health Canada in Canada; EMA in Europe; etc.), as well as find providers that could also work with these institutions.

Vaccines, once approved, became the next challenge. Where to find shots that had already been approved, when there were barely enough to go around? Which were the best providers, offering the lowest cost and the fastest delivery, notwithstanding the fact that many factories and manufacturers were closed or only operating part time? Part of the challenge was also guaranteeing product availability and extensive inventory. Moreover, it was necessary to have a reliable alternative should a provider run out of stock.

Shipping vaccines was yet another logistics nightmare, with ports and airports closed, flights cancelled or reduced to a minimum, and with companies also limiting operations. In addition, vaccines need special refrigeration to maintain viability – ensuring shipments met these requirements was in itself a formidable challenge.

Still, none of this stopped the efforts made by the PRO team, which against all odds and with an indomitable spirit of solidarity and passion for their job, worked 10-12 hours daily, seven days a week, and secured US$ 2.8 billion worth of goods to continue saving lives through a once in a generation public health crisis.

Having hospitals and medical centers either nearby or easily accessible is the norm for many without realizing that it is, in reality, a luxury. Nevertheless, the COVID-19 pandemic that has dominated attention globally for the past two years has highlighted the sad truth that many places in the Caribbean, for example, lack adequate numbers of hospitals. In instances where they do have them, they are ill-equipped, located in high-risk areas, run-down due to adverse climate conditions, and often only offer basic services.

Once again, the Pan American Health Organization (PAHO) has taken the lead on addressing this issue, and has joined forces with the Foreign, Commonwealth & Development Office of the United Kingdom (FCDO), to implement an exceptional program ‘Smart Hospitals’ founded by PAHO. The initiative aims to modernize hospitals in the Region with the latest technology, as well as structural reinforcements that will withstand extreme weather, natural disasters, and sudden crises; improve their operational capacity; and also be eco-friendly.

In September 2021, the Pan American Health Organization (PAHO) gave Dr. Frank Anthony, Health Minister of Guyana, the keys to Lethem Regional Hospital, which serves the country's Region 9 and its surrounding areas, including patients coming from Brazil. This new hospital center is an incredible advancement for public health in the nation. Dr. Lisa Adams-Uthman, a radiologist at the hospital, stated that thanks to the newly installed ultrasound machine, she can detect high-risk pregnancies, saving the lives of countless mothers and babies. Meanwhile, Dr. Olivia Vaz, a radiologist at the same hospital, also stated that thanks to these advancements provided by PRO, they are now capable of doing two emergency surgeries a day, as well as multiple elective surgeries; before, they could only do one of each daily.

Despite restrictions and obstacles, PAHO was able to inaugurate 39 Smart Hospitals in the Region over the past two years: six in Belize, eleven in Jamaica, three in Dominica, four in Saint Lucia, six in Saint Vincent and the Grenadines, four in Granada and five in Guyana. The struggle for PAHO to improve access to health in the Region continues unabated, slowly making the world a better place.