Nowadays, the global health policy has given due emphasis for preventive interventions to combat common preventable diseases. To realize such cost effective interventions, immunization is the most rewarding approach in improving quality of life, protecting serious illness and averting multitudes of childhood deaths. Nevertheless, for vaccines to be effective, there needs to be a strong and reliable vaccine and cold chain management practices from the point of origin to end users. Due to the peculiar nature of vaccines, immunization supply chain management remains challenging and dynamic. The issue becomes more palpable in the case of developing countries like Ethiopia. This book therefore, provides an insight for supply chain practitioners to understand the common challenges on immunization supply chain practices particularly, vaccine handling, storage and distribution at different supply chain levels.