Vaccine management systems with a focus on cold chain management and delivery of immunization services in low- and middle-income countries: A scoping review

Objective: The main objective of this scoping review is to examine the characteristics of vaccine management and delivery systems with a specific focus on cold chain management used for routine immunization in the LMICs, along with factors influencing these systems, challenges faced and the extent of digitization implemented. Methods: A comprehensive literature search was conducted using PubMed, Scopus, Cochrane Library, and Google Scholar for studies published between 2010 and February 2025. Our study selection, data charting, and synthesis followed methodological frameworks outlined by the Joanna Briggs Institute and PRISMA guidelines for Scoping Review. Result: Outof 2451 identified studies, 16 eligible studies were included. The findings revealed diverse vaccine management system designs, including centralized and decentralized architecture, interoperable integrated models, and provisions for online and offline accessibility. Core features of these systems included longitudinal health records, automated inventory monitoring, and beneficiary engagement features including digital health cards. Implementation was influenced by global initiatives, project management teams and their capability, and challenges related to digitization. Factors impacting vaccine delivery included immunization sessions, stock management systems, distribution weaknesss, suboptimal practices, training gaps, and documentation. Digital transformations varied across countries, with Vietnam, Tanzania, and Zambia adopting electronic immunization registries, while India implemented the Electronic Vaccine Intelligence Network. The implementation of these digital logistics management information systems significantly improved vaccine management by reducing wastage, enhancing record-keeping, and optimizing supply chain efficiency. Conclusion: To our knowledge, this scoping review is the first to provide empirical evidence on vaccine management and delivery systems and digitization in immunization in the LMICs. This review concludes that LMICs have been adapting various systems including electronic system, digitization, decentralisation of vaccine delivery, stock monitoring, individual tracking to improve immunization. Across countries, some have made notable progress, while others are at their initial stage of implementation. However, this review suggests further studies on integrated vaccine management systems and their impact for inter-country comparison.