The importance of vaccine supply chains to everyone in the vaccine world

Leveraging Resource Centers for Strengthening Immunization Supply Chain

The efficacy of immunization programs is critically dependent on robust supply chain management, a complex challenge exacerbated by expanding program scopes and evolving vaccine technologies. This comprehensive review underscores the pivotal role of Resource Centers in fortifying the immunization supply chain, presenting a paradigm shift toward enhanced national and global health outcomes. Through a detailed examination of their key activities, the article elucidates how these centers catalyze improvements across various facets of supply chain management - from the integration of suitable technology technologies and specialized training programs to the development of sustainable models and advocacy for policy prioritization. This further explores the multifaceted challenges these centers confront, including funding constraints, capacity building, and infrastructural gaps, alongside the burgeoning opportunities presented by new vaccine introductions, donor interest in health system strengthening, and the potential for broadened scope beyond immunization. By weaving together examples of existing centers worldwide, the review highlights their contributions towards optimizing vaccine logistics, enhancing data management, and ultimately achieving Sustainable Development Goal 3. The insights provided offer valuable guidance for planning and sustaining resource centers, positioning them as indispensable allies in the global pursuit of universal immunization coverage.

Access to DTP-Based Combination Vaccines in Asia-Pacific Countries between 2019 and 2022

The Asia-Pacific countries are highly diverse in health and economic conditions that may impact vaccine access and uptake. Our study aimed to characterize patterns of health access to DTP-based combination vaccines in 10 countries from 2019 to 2022 using the IQVIA-MIDAS database. The availability, affordability, and accessibility were compared across countries by national health and economic performance indicators using Spearman's rank correlation coefficient. Our findings showed that the three aspects of access to DTP-based vaccines varied substantially in the Asia-Pacific region, with higher levels in countries with better health and economic performance. Affected by the COVID-19 pandemic, vaccine accessibility fluctuates significantly in lower-income countries, with DTP coverage rates falling by more than 14% in the Philippines and Indonesia between 2019 and 2021. For availability and affordability, Singapore and Malaysia from high-income groups were largely affected, which may be related to health expenditure as a percentage of gross domestic product (Coefficient = 0.39, p = 0.03). Our study indicates that greater attention needs to be paid to national health expenditure and routine immunization services to improve vaccine disparities and increase the robustness and resilience of the vaccine supply chain during public health emergencies.

Modeling a closed-loop vaccine supply chain with transshipments to minimize wastage and threats to the public: a system dynamics approach

Purpose

This study aims to focus on building a conceptual closed-loop vaccine supply chain (CLVSC) to decrease vaccine wastage and counterfeit/fake vaccines.

Design/methodology/approach

Through a focused literature review, the framework for the CLVSC is described, and the system dynamics (SD) research methodology is used to build a causal loop diagram (CLD) of the proposed model.

Findings

In the battle against COVID-19, waste management systems have become overwhelmed, which has created negative environmental and extremely hazardous societal impacts. A key contributing factor is unused vaccine doses, shown as a source for counterfeit/fake vaccines. The findings identify a CLVSC design and transshipment operations to decrease vaccine wastage and the potential for vaccine theft.

Research limitations/implications

This study contributes to establishing a pandemic-specific VSC structure. The proposed model informs the current COVID-19 pandemic as well as potential future pandemics.

Social implications

A large part of the negative impact of counterfeit/fake vaccines is on human well-being, and this can be avoided with proper CLVSC.

Originality/value

This study develops a novel overarching SD CLD by integrating the epidemic model of disease transmission, VSC and closed-loop structure. This study enhances the policymakers’ understanding of the importance of vaccine waste collection, proper handling and threats to the public, which are born through illicit activities that rely on stolen vaccine doses.

Impact of Improper Storage of ChAdOx1-S (AstraZeneca) Vaccine on Its Efficacy and Safety

Background: In May 2021, there was an incident regarding giving patients AstraZeneca vaccines stored improperly. They were stored at room temperature (21 degrees centigrade) for 18 h, 12 h longer than the producer recommends. Aim of the study: The paper aims to contribute to the body of knowledge concerning the efficacy and safety of the ChAdOx1-S (AstraZeneca) vaccine concerning the requirements for cold supply chain specification. Patients and methods: Improperly stored vaccines were given to 44 patients, and 39 of them decided to take part in the study. The Control group consisted of 56 people vaccinated on the same days by the same medical teams, using properly stored medicines. Results: The concentration of anti-S1 SARS-CoV-2 Spike protein IgG antibodies did not differ significantly between the groups. Examined group median 70 kU/L (20;100). Control group median 66 kU/L (32.75;100), p = 0.751. We did not observe any COVID-19 infections in either the control or examined group for half a year after the incident. People from each group reported that local and systemic adverse events occurred directly after the first and second doses. In the control group, one case of spontaneously subsiding face edema and joint pain was observed. There were no severe or fatal adverse events. There were no significant differences between the groups, besides the fatigue, after the second dose. Conclusion: AstraZeneca vaccine ChAdOx1-S stored at 21 degrees centigrade for 18 h before vaccination has the same safety profile (p < 0.05) and the same efficacy (p < 0.05) as the vaccines stored in conditions recommended by the producer.

Vaccine cold chain management and cold storage technology to address the challenges of vaccination programs

The outbreaks of infectious diseases that spread across countries have generally existed for centuries. An example is the occurrence of the COVID-19 pandemic in 2020, which led to the loss of lives and economic depreciation. One of the essential ways of handling the spread of viruses is the discovery and administration of vaccines. However, the major challenges of vaccination programs are associated with the vaccine cold chain management and cold storage facilities. This paper discusses how vaccine cold chain management and cold storage technology can address the challenges of vaccination programs. Specifically, it examines different systems for preserving vaccines in either liquid or frozen form to help ensure that they are not damaged during distribution from manufacturing facilities. Furthermore, A vaccine is likely to provide very low efficacy when it is not properly stored. According to preliminary studies, the inability to store vaccine properly is partly due to the incompetency of many stakeholders, especially in technical matters. The novelty of this study is to thoroughly explore cold storage technology for a faster and more comprehensive vaccine distribution hence it is expected to be one of the reference and inspiration for stakeholders.

Modeling a sustainable vaccine supply chain for a healthcare system

This study develops a vaccine supply chain (VSC) to ensure sustainable distribution during a global crisis in a developing economy. In this study, a multi-objective mixed-integer programming (MIP) model is formulated to develop the VSC, ensuring the entire network's economic performance. This is achieved by minimizing the overall cost of vaccine distribution and ensuring environmental and social sustainability by minimizing greenhouse gas (GHG) emissions and maximizing job opportunities in the entire network. The shelf-life of vaccines and the uncertainty associated with demand and supply chain (SC) parameters are also considered in this study to ensure the robustness of the model. To solve the model, two recently developed metaheuristics-namely, the multi-objective social engineering optimizer (MOSEO) and multi-objective feasibility enhanced particle swarm optimization (MOFEPSO) methods-are used, and their results are compared. Further, the Technique for Order Preference by Similarity to Ideal Solution (TOPSIS) model has been integrated into the optimization model to determine the best solution from a set of non-dominated solutions (NDSs) that prioritize environmental sustainability. The results are analyzed in the context of the Bangladeshi coronavirus disease (COVID-19) vaccine distribution systems. Numerical illustrations reveal that the MOSEO-TOPSIS model performs substantially better in designing the network than the MOFEPSO-TOPSIS model. Furthermore, the solution from MOSEO results in achieving better environmental sustainability than MOFEPSO with the same resources. Results also reflect that the proposed MOSEO-TOPSIS can help policymakers establish a VSC during a global crisis with enhanced economic, environmental, and social sustainability within the healthcare system.

A two-stage decision-support approach for improving sustainable last-mile cold chain logistics operations of COVID-19 vaccines

The COVID-19 pandemic has become a global health and humanitarian crisis that catastrophically affects many industries. To control the disease spread and restore normal lives, mass vaccination is considered the most effective way. However, the sustainable last-mile cold chain logistics operations of COVID-19 vaccines is a complex short-term planning problem that faces many practical challenges, e.g., low-temperature storage and transportation, supply uncertainty at the early stage, etc. To tackle these challenges, a two-stage decision-support approach is proposed in this paper, which integrates both route optimization and advanced simulation to improve the sustainable performance of last-mile vaccine cold chain logistics operations. Through a real-world case study in Norway during December 2020 and March 2021, the analytical results revealed that the logistics network structure, fleet size, and the composition of heterogeneous vehicles might yield significant impacts on the service level, transportation cost, and CO2 emissions of last-mile vaccine cold chain logistics operations.

Improving management of vaccine supply chains: A multi-methods evaluation of vSTEP in Zambia

BACKGROUND

Equipping supply chain professionals at all levels of the health care systems with essential leadership and management skills is essential to achieving global immunization targets. Numerous and diverse professional development initiatives have been established to support vaccine supply chain managers in Gavi-eligible countries. However, COVID-19 catalyzed rapid innovation in approaches to support leadership development in times of rapid change, and systematic evaluation of these approaches can inform future workforce development strategies to ensure resilient health systems. Therefore, we sought to evaluate outcomes and short-term impact of the fully virtual Strategic Training Executive Program 2.0 (vSTEP 2.0) program in Zambia on participant engagement, skill development, and application of new skills to improve supply chain performance.

METHODS

We used a multi-method design to describe the outcomes and short-term impact of vSTEP 2.0 at three levels: (1) delegate response to the training experience (including participation, completion, and satisfaction); (2) delegate change in leadership skill (including achievement of learning objectives and change in competencies); and (3) application of new skills to impact supply chain performance.

RESULTS

The program achieved high levels of engagement and an 83% graduation rate despite the length and rigor of the program. High satisfaction was evidenced by positive feedback from delegates on the quality and relevance of the program, especially in the context of COVID response (100% would "definitely" recommend). Delegates demonstrated significant growth in all domains of leadership competencies and applied their learnings to address a complex challenge in supply chain performance in their home organization.

DISCUSSION

These findings demonstrate a strong appetite for leadership development support among vaccine supply chain professionals, especially in times of rapid change such as during the COVID response. These results also demonstrate the feasibility and impact of a fully virtual model for leadership development, with implications well beyond the COVID-19 pandemic.

Optimization methods for large-scale vaccine supply chains: a rapid review

Global vaccine revenues are projected at $59.2 billion, yet large-scale vaccine distribution remains challenging for many diseases in countries around the world. Poor management of the vaccine supply chain can lead to a disease outbreak, or at worst, a pandemic. Fortunately, a large number of those challenges, such as decision-making for optimal allocation of resources, vaccination strategy, inventory management, among others, can be improved through optimization approaches. This work aims to understand how optimization has been applied to vaccine supply chain and logistics. To achieve this, we conducted a rapid review and searched for peer-reviewed journal articles, published between 2009 and March 2020, in four scientific databases. The search resulted in 345 articles, of which 25 unique studies met our inclusion criteria. Our analysis focused on the identification of article characteristics such as research objectives, vaccine supply chain stage addressed, the optimization method used, whether outbreak scenarios were considered, among others. Approximately 64% of the studies dealt with vaccination strategy, and the remainder dealt with logistics and inventory management. Only one addressed market competition (4%). There were 14 different types of optimization methods used, but control theory, linear programming, mathematical model and mixed integer programming were the most common (12% each). Uncertainties were considered in the models of 44% of the studies. One resulting observation was the lack of studies using optimization for vaccine inventory management and logistics. The results provide an understanding of how optimization models have been used to address challenges in large-scale vaccine supply chains.

The Importance of Nanocarrier Design and Composition for an Efficient Nanoparticle-Mediated Transdermal Vaccination

The World Health Organization estimates that the pandemic caused by the SARS-CoV-2 virus claimed more than 3 million lives in 2020 alone. This situation has highlighted the importance of vaccination programs and the urgency of working on new technologies that allow an efficient, safe, and effective immunization. From this perspective, nanomedicine has provided novel tools for the design of the new generation of vaccines. Among the challenges of the new vaccine generations is the search for alternative routes of antigen delivery due to costs, risks, need for trained personnel, and low acceptance in the population associated with the parenteral route. Along these lines, transdermal immunization has been raised as a promising alternative for antigen delivery and vaccination based on a large absorption surface and an abundance of immune system cells. These features contribute to a high barrier capacity and high immunological efficiency for transdermal immunization. However, the stratum corneum barrier constitutes a significant challenge for generating new pharmaceutical forms for transdermal antigen delivery. This review addresses the biological bases for transdermal immunomodulation and the technological advances in the field of nanomedicine, from the passage of antigens facilitated by devices to cross the stratum corneum, to the design of nanosystems, with an emphasis on the importance of design and composition towards the new generation of needle-free nanometric transdermal systems.

Challenges to COVID-19 vaccine supply chain: Implications for sustainable development goals

The COVID-19 outbreak has demonstrated the diverse challenges that supply chains face to significant disruptions. Vaccine supply chains are no exception. Therefore, it is elemental that challenges to the COVID-19 vaccine supply chain (VSC) are identified and prioritized to pave the way out of this pandemic. This study combines the decision-making trial and evaluation laboratory (DEMATEL) method with intuitionistic fuzzy sets (IFS) to explore the key challenges of the COVID-19 VSC. The IFS theory tackles the uncertainty of key challenges while DEMATEL addresses the interlaced causal relationships among crucial challenges to the COVID-19 VSC. This work identifies 15 challenges and reveals that 'Limited number of vaccine manufacturing companies', 'Inappropriate coordination with local organizations', 'Lack of vaccine monitoring bodies', 'Difficulties in monitoring and controlling vaccine temperature', and 'Vaccination cost and lack of financial support for vaccine purchase' are the most critical challenges. The causal interactions along with mutual relationships among these challenges are also scrutinized, and implications for sustainable development goals (SDGs) are drawn. The results offer practical guidelines for stakeholders and government policy makers around the world to develop an improved VSC for the COVID-19 virus.

A simulation-based analysis for effective distribution of COVID-19 vaccines: A case study in Norway

Since December 2020, the vaccines from several manufacturers, e.g., Pfizer/BioNTech, Moderna, etc., have been approved for mass vaccination to control the COVID-19 pandemic, which has caused more than 100 million infections and 2.4 million deaths. These vaccines are produced and transported in large quantities to suffice the needs of several countries. Before arriving at the end-users, the vaccines need to be stored at extremely low temperatures and distributed through reliable cold chain logistics networks. Thus, the timely and cost-effective distribution of COVID-19 vaccines via cold chain logistics has become a complex operational challenge. In this paper, we develop a simulation-based approach combining both route optimization and dynamic simulation to improve the logistics performance for COVID-19 vaccine distribution. A state-of-the-art simulation package called anyLogistix is used to perform a real-world case study in Norway. With the data of periodic vaccine demands, customer and warehouse locations, vehicle-related costs and emissions, and expected service levels, implications are obtained based on the analysis of several scenarios. Our experimental results reveal that the service level, cost-effectiveness, environmental performance, and equity of a cold chain vaccine logistics system can be significantly influenced by the fleet size, the fleet composition, the type of vehicle used, and the route optimization. Thus, these factors need to be holistically considered in the planning of an effective COVID-19 vaccine distribution system.

A fuzzy multi-criteria framework to identify barriers and enablers of the next-generation vaccine supply chain

Purpose

Due to the introduction of new vaccines in the child immunization program and inefficient vaccine supply chain (VSC), the universal immunization program (UIP), India is struggling to provide a full schedule of vaccination to the targeted children. In this paper, the authors investigate the critical factors for improving the performance of the existing VSC system by implementing the next-generation vaccine supply chain (NGVSC) in India.

Design/methodology/approach

The authors design a fuzzy multi-criteria framework using a fuzzy analytical hierarchical process (FAHP) and fuzzy multi-objective optimization on the basis of ratio analysis (FMOORA) to identify and analyze the critical barriers and enablers for the implementation of NGVSC. Further, the authors carry out a numerical simulation to validate the model.

Findings

The outcome of the analysis contends that demand forecasting is the topmost supply chain barrier and sustainable financing is the most important/critical enabler to facilitate the implementation of the NGVSC. In addition, the simulation reveals that the results of the study are reliable.

Social implications

The findings of the study can be useful for the child immunization policymakers of India and other developing countries to design appropriate strategies for improving existing VSC performance by implementing the NGVSC.

Originality/value

To the best of the authors’ knowledge, the study is the first empirical study to propose the improvement of VSC performance by designing the NGVSC.

Optimal planning of the COVID-19 vaccine supply chain

This work presents a novel framework to simultaneously address the optimal planning of COVID-19 vaccine supply chains and the optimal planning of daily vaccinations in the available vaccination centres. A new mixed integer linear programming (MILP) model is developed to generate optimal decisions regarding the transferred quantities between locations, the inventory profiles of central hubs and vaccination centres and the daily vaccination plans in the vaccination centres of the supply chain network. Specific COVID-19 characteristics, such as special cold storage technologies, limited shelf-life of mRNA vaccines in refrigerated conditions and demanding vaccination targets under extreme time pressure, are aptly modelled. The goal of the model is the minimization of total costs, including storage and transportation costs, costs related to fleet and staff requirements, as well as, indirect costs imposed by wasted doses. A two-step decomposition strategy based on a divide-and-conquer and an aggregation approach is proposed for the solution of large-scale problems. The applicability and efficiency of the proposed optimization-based framework is illustrated on a study case that simulates the Greek nationwide vaccination program. Finally, a rolling horizon technique is employed to reactively deal with possible disturbances in the vaccination plans. The proposed mathematical framework facilitates the decision-making process in COVID-19 vaccine supply chains into minimizing the underlying costs and the number of doses lost. As a result, the efficiency of the distribution network is improved, thus assisting the mass vaccination campaigns against COVID-19.

Should countries switch to using five- or ten-dose rotavirus vaccines now that they are available?

Introduction:

Single-dose rotavirus vaccines, which are used by a majority of countries, are some of the largest-sized vaccines in immunization programs, and have been shown to constrain supply chains and cause bottlenecks. Efforts have been made to reduce the size of the single-dose vaccines; however, with two-dose, five-dose and ten-dose options available, the question then is whether using multi-dose instead of single-dose rotavirus vaccines will improve vaccine availability.

Methods:

We used HERMES-generated simulation models of the vaccine supply chains of the Republic of Benin, Mozambique, and Bihar, a state in India, to evaluate the operational and economic impact of implementing each of the nine different rotavirus vaccine presentations.

Results:

Among single-dose rotavirus vaccines, using Rotarix RV1 MMP (multi-monodose presentation) led to the highest rotavirus vaccine availability (49–80%) and total vaccine availability (56–79%), and decreased total costs per dose administered ($0.02-$0.10) compared to using any other single-dose rotavirus vaccine. Using two-dose ROTASIIL decreased rotavirus vaccine availability by 3–6% across each supply chain compared to Rotarix RV1 MMP, the smallest single-dose vaccine. Using a five-dose rotavirus vaccine improved rotavirus vaccine availability (52–92%) and total vaccine availability (60–85%) compared to single-dose and two-dose vaccines. Further, using the ten-dose vaccine led to the highest rotavirus vaccine availability compared to all other rotavirus vaccines in both Benin and Bihar.

Conclusion:

Our results show that countries that implement five-dose or ten-dose rotavirus vaccines consistently reduce cold chain constraints and achieve higher rotavirus and total vaccine availability compared to using either single-dose or two-dose rotavirus vaccines.

Determinants of Incomplete Vaccination Among Children Aged 12 to 23 Months in Gindhir District, Southeastern Ethiopia: Unmatched Case-Control Study

Background

Incomplete vaccination can put children at greater risk of acquiring vaccine-preventable diseases. In Ethiopia, vaccination coverage against vaccine-preventable diseases is still a significant and persistent public health challenge. Thus, the aim of this study was to identify the determinants of incomplete childhood vaccination among children aged 12-23 months in Gindhir District, Southeast Ethiopia.

Methods

A community-based unmatched case-control design was employed among children aged 12-23 months from 1 to 28 February 2020. A total of 254 cases and 508 controls were included using the stratified random sampling technique. Cases included children aged 12-23 months who missed at least one dose of the routine vaccination, and controls were the children with complete vaccination with all required doses. Binary logistic regression analyses were used to identify the independent factors for children's incomplete vaccination status.

Results

Of all assessed determinants, maternal knowledge about vaccination (AOR=0.50, 95% CI: 0.31, 0.80), educational status (AOR=2.61, 95% CI: 1.19, 5.67), average monthly income (AOR=0.33, 95% CI: 0.15, 0.77), model family (AOR = 2.50, 95% CI: 1.51, 4.14), taking TT vaccine (AOR= 0.45 95% CI: 0.29, 0.78), number of under five children (AOR= 4.90 95% CI: 1.72, 13.93) and birth order (AOR= 6.33, 95% CI: 1.89, 14.87) were found to have statistically significant association with childhood incomplete vaccination.

Conclusion

In this study, the mother's education, model family, birth order, average monthly income, and knowledge were some of the independent determinants of incomplete childhood vaccination. Improving maternal knowledge, income, and educational status should be the expectable measure to reduce incomplete vaccination.

Bullwhip effect reduction map for COVID-19 vaccine supply chain

The growing COVID-19 virus pandemic outbreak causes an urgent need to produce its vaccine. Pharmaceutical companies would encounter a massive wave of unforeseen demand for the COVID-19 Vaccine after the vaccine production that could lead to a bullwhip effect in the COVID-19 Vaccine Supply Chain (CVSC). The main objective of this study is to design a cognitive map based on the influential factors on the Bullwhip Effect Reduction (BER) of CVSC. Hence, in the first step, the affecting factors on the BER of CVSC are identified and ranked based on their importance from the pharmaceutical experts using the AHP technique. In the second step, 13 out of 18 identified factors are considered for further analyzing and understanding their relationship by Fuzzy Cognitive Mapping (FCM) technique. Furthermore, three different forward scenarios and three backward scenarios are carefully constructed to find the optimal solution for BER on pharmaceutical organizations. The obtained results show that the flexibility factor is the starting point of the backward scenario, which reduces the bullwhip effect in CVSC. Beside, by improving the inventory management and reliability factor, it would be effectively possible to control the lead-time factor and consequently, overcome the bullwhip effect in CVSC.

Prioritizing the vaccine supply chain issues of developing countries using an integrated ISM-fuzzy ANP framework

Purpose

Delivering vaccines to the children who need them requires a supply chain that is efficient and effective. In most of the developing countries, however, the unknown and unresolved supply chain issues are causing inefficiencies in distributing vaccines. There is, therefore, a great need in such countries to recognize the issues that cause delays in vaccine delivery. With this purpose, the present study aims to identify and analyze the key issues in the supply chain of basic vaccines required to immunize children in developing countries.

Design/methodology/approach

Based on a field survey of three states of India, in-depth review of relevant literature and experts’ opinions, 25 key issues were recognized as factors of the vaccine supply chain (VSC) and categorized into five main domains. Using integrated interpretive structural modeling and fuzzy analytic network process approaches, the issues have been prioritized to determine their relative importance in the VSC. In addition, a sensitivity analysis has been performed to investigate the priority stability of the issues.

Findings

The results of the analysis show that among the five domains of VSC issues, the economic domain with a weight of 0.4262 is the most important domain, followed by the management (0.2672), operational (0.2222), environmental (0.0532) and social (0.0312).

Research limitations/implications

This study focuses on the prioritization of VSC issues; therefore, the results of the present study can provide direction to the decision-makers of immunization programs of developing countries in driving their efforts and resources on eliminating the most important obstacles to design successful vaccination programs.

Originality/value

To the authors’ knowledge, this paper is first to provide a direction to the decision-makers in identifying and managing important issues through the use of an analytical approach.

The livestock vaccine supply chain: Why it matters and how it can help eradicate peste des petits Ruminants, based on findings in Karamoja, Uganda

Understanding factors that hinder vaccination, including logistical and social constraints, is critical to finding the most effective approach for the global eradication of peste des petits ruminants (PPR). Vaccination projects should analyze the supply chain and take it into consideration when planning and creating a vaccination strategy. Adequate supply chain management of the PPR vaccine could lead to reduced cost, increased availability, and the construction of a data platform for other livestock vaccines. Integrating the supply chain of PPR vaccine with other veterinary or health commodities could reduce cost, as well as increase uptake. The use of a thermostable vaccine could potentially have a positive impact on the eradication of PPR in remote areas, such as the Karamoja subregion in Uganda, as it did with rinderpest across Sub Saharan Africa. In terms of vaccine delivery, the use of community animal health workers (CAHWs) could be beneficial in certain areas, such as the Karamoja subregion of Uganda, by alleviating supply chain constraints in the last-mile delivery, as well as increasing coverage and uptake. A gendered approach to livestock vaccines should also be considered, as decision-making power regarding livestock vaccination is gendered in many various contexts. The PPR eradication strategy-as well as other livestock vaccination programs-would be more effective and efficient if the supply chain management were considered as a key component in the process and efforts tailored, accordingly.

Modeling the economic impact of different vial-opening thresholds for measles-containing vaccines

INTRODUCTION

The lack of specific policies on how many children must be present at a vaccinating location before a healthcare worker can open a measles-containing vaccine (MCV) - i.e. the vial-opening threshold - has led to inconsistent practices, which can have wide-ranging systems effects.

METHODS

Using HERMES-generated simulation models of the routine immunization supply chains of Benin, Mozambique and Niger, we evaluated the impact of different vial-opening thresholds (none, 30% of doses must be used, 60%) and MCV presentations (10-dose, 5-dose) on each supply chain. We linked these outputs to a clinical- and economic-outcomes model which translated the change in vaccine availability to associated infections, medical costs, and DALYs. We calculated the economic impact of each policy from the health system perspective.

RESULTS

The vial-opening threshold that maximizes vaccine availability while minimizing costs varies between individual countries. In Benin (median session size = 5), implementing a 30% vial-opening threshold and tailoring distribution of 10-dose and 5-dose MCVs to clinics based on session size is the most cost-effective policy, preventing 671 DALYs ($471/DALY averted) compared to baseline (no threshold, 10-dose MCVs). In Niger (median MCV session size = 9), setting a 60% vial-opening threshold and tailoring MCV presentations is the most cost-effective policy, preventing 2897 DALYs ($16.05/ DALY averted). In Mozambique (median session size = 3), setting a 30% vial-opening threshold using 10-dose MCVs is the only beneficial policy compared to baseline, preventing 3081 DALYs ($85.98/DALY averted). Across all three countries, however, a 30% vial-opening threshold using 10-dose MCVs everywhere is the only MCV threshold that consistently benefits each system compared to baseline.

CONCLUSION

While the ideal vial-opening threshold policy for MCV varies by supply chain, implementing a 30% vial-opening threshold for 10-dose MCVs benefits each system by improving overall vaccine availability and reducing associated medical costs and DALYs compared to no threshold.

Two-way assessment of key performance indicators to vaccine supply chain system in India

Purpose

The purpose of this paper is to identify the key performance indicators (KPIs) of vaccine supply chain of Universal Immunization Program (UIP) India, and measure their impact on vaccine supply chain performance improvement, so that results of this study can help the decision makers manage the activity and effectiveness of their resources in order to improve vaccine delivery performance and child immunization coverage.

Design/methodology/approach

The 41 KPIs in terms of four dimension of the balanced scorecard (BSC), i.e. financial, customer, internal process and learning and growth have been identified and validated from the literature and expert’s opinions. Further, the impact of internal process and learning and growth performance indicators on the vaccine supply chain performance improvement have been evaluated using two-way assessment. The rankings obtained using two-way assessment are then compared to DEMATEL approach to validate the results.

Findings

The results from the analysis reveal that “Enhancement in employee work satisfaction” (LG3=10.08 percent), “Enhancement in professional vaccine supply chain managers and leaders” (LG2 = 6.70 percent) “Improvement in planning and coordination in the supply chain” (LG9 = 6.57 percent) are the three critical performance indicators having maximum impact on vaccine supply chain performance improvement. The decision makers should give priority to these performance indicators to improve delivery performance and immunization coverage.

Social implications

This study focuses on the improvement in vaccine delivery performance, therefore, analysis and findings can be useful to government immunization programs of India to other developing nations to improve child immunization coverage.

Originality/value

To our knowledge, this paper is first to attempt to provide a direction to improve immunization coverage through vaccine supply chain performance indicators.

Evaluating scenarios of locations and capacities for vaccine storage in Nigeria

Many developing countries still face the prevalence of preventable childhood diseases because their vaccine supply chain systems are inadequate by design or structure to meet the needs of their populations. Currently, Nigeria is evaluating options in the redesign of the country's vaccine supply chain. Using Nigeria as a case study, the objective is to evaluate different regional supply chain scenarios to identify the cost minimizing optimal hub locations and storage capacities for doses of different vaccines to achieve a 100% fill rate. First, we employ a shortest-path optimization routine to determine hub locations. Second, we develop a total cost minimizing routine based on stochastic optimization to determine the optimal capacities at the hubs. This model uses vaccine supply data between 2011 and 2014 provided by Nigeria's National Primary Health Care Development Agency (NPHCDA) on Tuberculosis, Polio, Yellow Fever, Tetanus Toxoid, and Hepatitis B. We find that a two-regional system with no central hub (NC2) cut costs by 23% to achieve a 100% fill rate when compared to optimizing the existing chain of six regions with a central hub (EC6). While the government's leading redesign alternative - no central three-hub system (Gov NC3) - reduces costs by 21% compared with the current EC6, it is more expensive than our NC2 system by 3%. In terms of capacity increases, optimizing the current system requires 42% more capacity than our NC2 system. Although the proposed Gov NC3 system requires the least increase in storage capacity, it requires the most distance to achieve a 100% coverage and about 15% more than our NC2. Overall, we find that improving the current system with a central hub and all its variants, even with optimal regional hub locations, require more storage capacities and are costlier than systems without a central hub. While this analysis prescribes the no central hub with two regions (NC2) as the least cost scenario, it is imperative to note that other configurations have benefits and comparative tradeoffs. Our approach and results offer some guidance for future vaccine supply chain redesigns in countries with similar layouts to Nigeria's.