In early 1974, smallpox outbreaks were appearing in areas of India that had been smallpox-free for months. After a week of plotting the epidemic with pushpins on hand-drawn maps, a pattern emerged. Each outbreak began with a working-age young man who had returned home to his village. These cases were “importations.” The young men had come from—or traveled through—the bordering state of Bihar. Cases were originating in Tatanagar, the company town of the corporate behemoth, Tata Companies. Tatanagar, a city in the state of Bihar, had no centralized government, and no public health structure in place.

One of the most challenging things for vaccinations is reaching those who live “at the end of the road”—those who are geographically isolated due to distance or living in hard to access regions. A well-functioning delivery system is one that reaches the patient at the point-of-care. Such a system is essential for adequate access to and availability of vaccines. But, while across Africa, governments and donors are investing billions of dollars to strengthen health systems and make affordable medicines available, government supply chains often struggle to get medicines and supplies through the last mile to the health facilities and to the people who need them most.