Cold chains, interrupted

Emvolio - A battery operated portable refrigerator preserves biochemical and haematological integrity of biological samples in preclinical studies

Background: Emvolio is a non-medical device, indigenously developed portable refrigeration for maintaining the internal temperature 2-8˚C. The Indian Patent Office has granted patent for applications such as preservation and transport of medicines, vaccines, food, beverages, dairy etc. Further, use of Emvolio can be utilized in transport and store biologicals to preserve their biochemical and cellular integrity.  The objective of this study was to evaluate the biochemical and haematological integrity of biological samples such as rat blood, serum and liver. Methods: The steady temperature was maintained inside the Emvolio, and it was compared to that of thermocol and polypropylene boxes aided with frozen gel packs. The blood and liver samples were isolated from Wistar rats and kept in Emvolio, thermocol and polypropylene boxes for 10 hrs, and the temperature was monitored. The blood parameters, namely red blood cells (RBC), white blood cells (WBC), platelets, haematocrit, haemoglobin, mean corpuscular volume (MCV), mean corpuscular haemoglobin concentration (MCHC) and red cell distribution width (RDW), serum parameters like alanine transaminase, alkaline phosphatase, total protein, albumin, creatine kinase, blood urea nitrogen and liver parameters like superoxide dismutase (SOD), glutathione (GSH), catalase were estimated and compared. Results: Emvolio maintained a constant inner temperature range of 2-8˚C, whereas a significant temperature variation was seen in thermocol and polypropylene boxes. There was no significant deviation in the parameters tested when samples were kept in Emvolio for six hours compared to the zero hour readings. In contrast, there was a significant deviation among the parameters for the samples kept in thermocol and polypropylene boxes for six hours compared to zero hour parameters. Conclusions: Emvolio maintained constant temperature and preserved the biological integrity of rat blood, serum and liver. Thus, Emvolio can be efficiently used as a biological sample carrier, especially in preclinical studies.

Inundative, Dry-Powder, Inhaled Measles Vaccination to Prevent Deaths of Young Children in War-torn Regions

Children living in war-torn and geographically remote regions often die from measles due to undervaccination. Protective community immunity could be safely improved through the comprehensive use of small, inexpensive, easy-to-use, dry-powder aerosolized measles vaccination inhalers. Influential local community members could be engaged to provide risk counseling and inform their peers of measles risks to inspire vaccine uptake. Vaccination by inhaled live attenuated measles vaccine has been shown to be safe and protective among several million research subjects and omits (1) needles, syringes, glass vials, and specialized disposal systems; (2) deadly vaccine reconstitution errors; (3) cold chain technology to protect temperature-sensitive vaccine; (4) vaccine wastage associated with suboptimal use of multidose vials; (5) trained vaccinators; (6) food, housing, and transportation costs associated with centralized vaccination campaigns; and (7) risk of violence to vaccinators and associated staff. All elements for inhaler-based measles vaccination are readily available. Dry-powder measles vaccine inhalers can be assembled and distributed to save lives.

Use of delivery drones for humanitarian operations: analysis of adoption barriers among logistics service providers from the technology acceptance model perspective

Delivery drones are yet to be adopted as a systematic delivery system for humanitarian operations but have the potential to substantially increase the efficiency and effectiveness of future delivery options. Thus, we analyse the impact of factors affecting the adoption of delivery drones by logistics service providers for humanitarian operations. A conceptual model of potential barriers to adoption and development is created using the Technology Acceptance Model theory involving security, perceived usefulness, perceived ease of use and attitude as factors that affect the intention to use. We validate the model using empirical data collected from 103 respondents by the 10 leading logistics firms located in China between May and August 2016. through a survey to examine factors currently affecting the intention/non-intention to adopt delivery drones. The results show that ease of use and addressing key security considerations about the drone, the delivery package and the recipient are crucial for adopting the technology as a specialized delivery option for logistics service providers. This is the first study of its kind and contributes to understanding the operational, supply chain and behavioural factors in the adoption of drones by logistics services providers for humanitarian operations.

Enhancing the environmental sustainability of emergency humanitarian medical cold chains with renewable energy sources

Purpose

Emergency humanitarian medical cold chains (HMCCs) depend heavily on their supporting energy services due to end-to-end temperature requirements in volatile disaster situations. Most energy sources powering emergency HMCCs are fossil-based due to well established processes, regardless of their environmental impact. In response to the recent energy crisis and climate change, a solution to tackle this issue relies on renewable energy sources (RES), whose use has increased to promote climate resilient development. Nevertheless, RESs’ capacity to replace conventional energy services in emergency HMCCs remains poorly understood. This study aims to investigate opportunities for, and barriers to, increasing the use of RESs in emergency HMCCs, thereby enhancing their environmental sustainability.

Design/methodology/approach

Based on a review of academic and practice literature, interviews with expert practitioners on emergency HMCCs and sustainable energy, and case study examples, this research aimed to analytically generalise the phenomenon by investigating opportunities for, and barriers to, increasing the use of RESs in emergency HMCCs. The phenomenon is illustrated in a novel framework of typical HMCC, that forms a contextual basis for future research.

Findings

A conceptual framework of typical emergency HMCC shows energy-consuming sections where RES can best be increased. This research is put forth in four propositions to manage the opportunities and barriers of the transition.

Originality/value

This research is, to the best of the author’s knowledge, the first attempt to operationalise sustainability by linking energy with HMCCs’ logistical activities in complex emergency settings. The cross-findings from literature, example cases and interviews together demonstrate the need to increase the use of RES in HMCCs, and how to do it.

An optimization framework for COVID-19 vaccine allocation and inventory management: A case study

As the novel coronavirus pandemic wreaked havoc globally, governments have implemented massive vaccination programs to tackle it. However, since the pandemic's emergence moves beyond the second year, some issues have stymied vaccination programs, including vaccine hesitancy, vaccine distribution inequality, new strains of the virus, and a possibility that the virus enters a stage of a requirement for cyclical vaccination. These challenges highlight the need for an appropriate mass COVID-19 vaccination program. Therefore, we attempt to address this problem by developing a bi-objective integrated vaccine allocation and inventory management framework. The goal is to minimize the system costs while maximizing the vaccination service level. Several important factors, such as multiple types of vaccines, the vaccines' perishability concept, demand uncertainty, and motivational strategy, have been addressed using dynamic planning. Besides that, the model development mechanism is carried out to be compatible and applicable to the current general vaccination program policies, forcing few strategic changes. Then, a case study concerning the vaccination program of the city of Mashhad in Iran is applied to the model. The results demonstrated significant advantages in total cost, vaccine shortage, and wastage compared to the current policy. Finally, the Lagrangian relaxation method is implemented on the model to strengthen further its capacity to handle larger-scale problems.

Sporozoite immunization: innovative translational science to support the fight against malaria

INTRODUCTION

Malaria, a devastating febrile illness caused by protozoan parasites, sickened 247,000,000 people in 2021 and killed 619,000, mostly children and pregnant women in sub-Saharan Africa. A highly effective vaccine is urgently needed, especially for Plasmodium falciparum (Pf), the deadliest human malaria parasite.

AREAS COVERED

Sporozoites (SPZ), the parasite stage transmitted by Anopheles mosquitoes to humans, are the only vaccine immunogen achieving >90% efficacy against Pf infection. This review describes >30 clinical trials of PfSPZ vaccines in the U.S.A., Europe, Africa, and Asia, based on first-hand knowledge of the trials and PubMed searches of 'sporozoites,' 'malaria,' and 'vaccines.'

EXPERT OPINION

First generation (radiation-attenuated) PfSPZ vaccines are safe, well tolerated, 80-100% efficacious against homologous controlled human malaria infection (CHMI) and provide 18-19 months protection without boosting in Africa. Second generation chemo-attenuated PfSPZ are more potent, 100% efficacious against stringent heterologous (variant strain) CHMI, but require a co-administered drug, raising safety concerns. Third generation, late liver stage-arresting, replication competent (LARC), genetically-attenuated PfSPZ are expected to be both safe and highly efficacious. Overall, PfSPZ vaccines meet safety, tolerability, and efficacy requirements for protecting pregnant women and travelers exposed to Pf in Africa, with licensure for these populations possible within 5 years. Protecting children and mass vaccination programs to block transmission and eliminate malaria are long-term objectives.

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.

Food Quality, Drug Safety, and Increasing Public Health Measures in Supply Chain Management

Over the last decade, there has been an increased interest in public health measures concerning food quality and drug safety in supply chains and logistics operations. Against this backdrop, this study systematically reviewed the extant literature to identify gaps in studying food quality and drug safety, the proposed solutions to these issues, and potential future research directions. This study utilized content analysis. The objectives of the review were to (1) identify the factors affecting food quality and possible solutions to improve results, (2) analyze the factors that affect drug safety and identify ways to mitigate them through proper management; and (3) establish integrated supply chains for food and drugs by implementing modern technologies, followed by one another to ensure a multi-layered cross-verification cascade and resource management at the different phases to ensure quality, safety, and sustainability for the benefit of public health. This review investigated and identified the most recent trends and technologies used for successfully integrated supply chains that can guarantee food quality and drug safety. Using appropriate keywords, 298 articles were identified, and 205 were shortlisted for the analysis. All analysis and conclusions are based on the available literature. The outcomes of this paper identify new research directions in public health and supply chain management.

The status of refrigeration solutions for last mile vaccine delivery in low-income settings

Recommendations for storage of most vaccines imply a continuous exposure to a temperature range between 0 °C and 10 °C, from the production to the administration to beneficiaries. According to the World Health Organization, more than 50% of vaccines are wasted around the world. Discontinuities of the cold chain in low-income settings where electricity is scarce contributes to this wastage. Recently, several advances have been made in cooling technologies to store and transport vaccines. This paper presents an overview of refrigeration technologies based on scientific publications, industry white papers and other grey literature. With a focus on vaccine transport, we briefly describe each refrigeration method, its best performing available devices as well as the outstanding research challenges in order to further improve its performance.

Dextran Mass Ratio Controls Particle Drying Dynamics in a Thermally Stable Dry Powder Vaccine for Pulmonary Delivery

PURPOSE

Thermally stable, spray dried vaccines targeting respiratory diseases are promising candidates for pulmonary delivery, requiring careful excipient formulation to effectively encapsulate and protect labile biologics. This study investigates the impact of dextran mass ratio and molecular weight on activity retention, thermal stability and aerosol behaviour of a labile adenoviral vector (AdHu5) encapsulated within a spray dried mannitol-dextran blend.

METHODS

Comparing formulations using 40 kDa or 500 kDa dextran at mass ratios of 1:3 and 3:1 mannitol to dextran, in vitro quantification of activity losses and powder flowability was used to assess suitability for inhalation.

RESULTS

Incorporating mannitol in a 1:3 ratio with 500 kDa dextran reduced viral titre processing losses below 0.5 log and displayed strong thermal stability under accelerated aging conditions. Moisture absorption and agglomeration was higher in dextran-rich formulations, but under low humidity the 1:3 ratio with 500 kDa dextran powder had the lowest mass median aerodynamic diameter (4.4 µm) and 84% emitted dose from an intratracheal dosator, indicating strong aerosol performance.

CONCLUSIONS

Overall, dextran-rich formulations increased viscosity during drying which slowed self-diffusion and favorably hindered viral partitioning at the particle surface. Reducing mannitol content also minimized AdHu5 exclusion from crystalline regions that can force the vector to air-solid interfaces where deactivation occurs. Although increased dextran molecular weight improved activity retention at the 1:3 ratio, it was less influential than the ratio parameter. Improving encapsulation ultimately allows inhalable vaccines to be prepared at higher potency, requiring less powder mass per inhaled dose and higher delivery efficiency.

An alternative vaccine prioritization approach in response to COVID-19 pandemic

Purpose

The purpose of this study is to evaluate the impact of food access and other vulnerability measures on the COVID-19 progression to inform the public health decision-makers while setting priority rules for vaccine schedules.

Design/methodology/approach

In this paper, the authors used the Supplemental Nutrition Assistance Program (SNAP) data combined with the Centers for Disease Control and Prevention (CDC)’s social vulnerability score variables and diabetes and obesity prevalence in a set of models to assess the associations with the COVID-19 prevalence and case-fatality rates in the United States (US) counties. Using the case prevalence estimates provided by these models, the authors developed a COVID-19 vulnerability score. The COVID-19 vulnerability score prioritization is then compared with the pro-rata approach commonly used for vaccine distribution.

Findings

The study found that the population proportion residing in a food desert is positively correlated with the COVID-19 prevalence. Similarly, the population proportion registered to SNAP is positively correlated with the COVID-19 prevalence. The findings demonstrate that commonly used pro-rata vaccine allocation can overlook vulnerable communities, which can eventually create disease hot-spots.

Practical implications

The proposed methodology provides a rapid and effective vaccine prioritization scoring. However, this scoring can also be considered for other humanitarian programs such as food aid and rapid test distribution in response to the current and future pandemics.

Originality/value

Humanitarian logistics domain predominantly relies on equity measures, where each jurisdiction receives resources proportional to their population. This study provides a tool to rapidly identify and prioritize vulnerable communities while determining vaccination schedules.

HumOSCM for pandemic response

Purpose

Humanitarian organizations have faced the unprecedented consequences of the coronavirus disease 2019 (COVID-19) pandemic. In this article, the authors therefore discuss how epidemics and pandemics, specifically Ebola and COVID-19, have affected humanitarian operations and supply chain management (HumOSCM), and how HumOSCM has contributed to preparedness for and response to epidemics and pandemics. The authors present lessons learned from responses to Ebola and COVID-19.

Design/methodology/approach

For this study, the authors review the scholarly HumOSCM literature, use documentary evidence from practitioner literature and apply a theory synthesis approach to derive recommendations on how HumOSCM could strengthen future responses to epidemics and pandemics.

Findings

The conceptualizations highlight the importance of strengthening collaboration, capability and capacity for the response to epidemics and pandemics. Furthermore, the components that can enhance the degree of collaboration, and hence, response formation, are discussed.

Research limitations/implications

As a non-empirical article, it suffers from the limitations of conceptual research. Hence, empirical testing of the proposed framework is recommended. The framework and propositions can serve as a basis for future studies.

Practical implications

The conceptual framework can help humanitarian organizations and other actors in the humanitarian sector to better understand how to prepare for future responses to epidemics and pandemics, in particular by considering the components that enhance the degree of collaboration, as well as through capability development and capacity building.

Originality/value

This article begins a discussion of how HumOSCM should evolve to better respond to future epidemics and pandemics.

Stability Modelling of mRNA Vaccine Quality Based on Temperature Monitoring throughout the Distribution Chain

The vaccine distribution chains in several low- and middle-income countries are not adequate to facilitate the rapid delivery of high volumes of thermosensitive COVID-19 mRNA vaccines at the required low and ultra-low temperatures. COVID-19 mRNA vaccines are currently distributed along with temperature monitoring devices to track and identify deviations from predefined conditions throughout the distribution chain. These temperature readings can feed into computational models to quantify mRNA vaccine critical quality attributes (CQAs) and the remaining vaccine shelf life more accurately. Here, a kinetic modelling approach is proposed to quantify the stability-related CQAs and the remaining shelf life of mRNA vaccines. The CQA and shelf-life values can be computed based on the conditions under which the vaccines have been distributed from the manufacturing facilities via the distribution network to the vaccination centres. This approach helps to quantify the degree to which temperature excursions impact vaccine quality and can also reduce vaccine wastage. In addition, vaccine stock management can be improved due to the information obtained on the remaining shelf life of mRNA vaccines. This model-based quantification of mRNA vaccine quality and remaining shelf life can improve the deployment of COVID-19 mRNA vaccines to low- and middle-income countries.

Restoring Immunization Services Provided by the Vaccines for Children Program in Puerto Rico After Hurricanes Irma and Maria, 2017-2019

CONTEXT

In September 2017, Hurricanes Irma and Maria impacted Puerto Rico, causing significant disruption of immunization services and vaccine losses due to widespread infrastructure and electrical grid damage and resulting cold chain failures.

OBJECTIVE

To describe posthurricane efforts undertaken to restore and strengthen immunization services provided by Puerto Rico's federally funded Vaccines for Children (VFC) Program, a network of clinics that provide vaccines to eligible children.

DESIGN

Historical records were reviewed to characterize Puerto Rico's prehurricane immunization system. Site visits to assess VFC clinic posthurricane operational status were conducted by the Puerto Rico Department of Health, working with the Centers for Disease Control and Prevention and other partners. Infrastructure repair and acquisition of backup generators, temperature data loggers, and replacement vaccines were carried out to restore operations.

RESULTS

Prior to the hurricanes, 224 VFC clinics throughout the island provided immunizations. An initial assessment 10 days after Hurricane Maria showed that only 11 (5%) of the clinics were operational. Reasons included ongoing power outages; difficulties in obtaining generator fuel; equipment or facility damage; and damaged vaccines. The VFC clinics were restored incrementally; 123 (55%) were operational by December 2017, 193 (86%) by May 2018, and 204 (91%) by May 2019. Long-term recovery activities are underway and focus on strengthening Puerto Rico's immunization system to withstand future disasters, including improving backup power systems.

CONCLUSION

Through coordinated efforts of the Puerto Rico Department of Health, the Centers for Disease Control and Prevention, and other partners, the operational status of VFC clinics posthurricanes was assessed and operations restored. Emergency plans for vaccine storage and handling, which called for alternative vaccine storage locations and backup generators, were inadequate to address disasters of the magnitude of Hurricanes Irma and Maria; such plans need to consider the possibility of large-scale disasters that result in long-term power outages.

Modelling the relative benefits of using the measles vaccine outside cold chain for outbreak response

INTRODUCTION

Rapid outbreak response vaccination is a strategy for measles control and elimination. Measles vaccines must be stored and transported within a specified temperature range, but this can present significant challenges when targeting remote populations. Measles vaccine licensure for delivery outside cold chain (OCC) could provide more vaccine transport/storage space without ice packs, and a solution to shorten response times. However, due to vaccine safety and wastage considerations, the OCC strategy will require other operational changes, potentially including the use of 1-dose (monodose) instead of 10-dose vials, requiring larger transport/storage equipment currently achieved with 10-dose vials. These trade-offs require quantitative comparisons of vaccine delivery options to evaluate their relative benefits.

METHODS

We developed a modelling framework combining elements of the vaccine supply chain - cold chain, vial, team, and transport equipment types - with a measles transmission dynamics model to compare vaccine delivery options. We compared 10 strategies resulting from combinations of the vaccine supply elements and grouped into three main classes: OCC, partial cold chain (PCC), and full cold chain (FCC). For each strategy, we explored a campaign with 20 teams sequentially targeting 5 locations with 100,000 individuals each. We characterised the time needed to freeze ice packs and complete the campaign (campaign duration), vaccination coverage, and cases averted, assuming a fixed pre-deployment delay before campaign commencement. We performed sensitivity analyses of the pre-deployment delay, population sizes, and two team allocation schemes.

RESULTS

The OCC, PCC, and FCC strategies achieve campaign durations of 50, 51, and 52 days, respectively. Nine of the ten strategies can achieve a vaccination coverage of 80%, and OCC averts the most cases.

DISCUSSION

The OCC strategy, therefore, presents improved operational and epidemiological outcomes relative to current practice and the other options considered.

A light-touch routing optimization tool (RoOT) for vaccine and medical supply distribution in Mozambique

Planning vaccine distribution in rural and urban poor communities is challenging, due in part to inadequate vehicles, limited cold storage, road availability, and weather conditions. The University of Washington and VillageReach jointly developed and tested a user-friendly, Excel spreadsheet based optimization tool for routing and scheduling to efficiently distribute vaccines and other medical commodities to health centers across Mozambique. This paper describes the tool and the process used to define the problem and obtain feedback from users during the development. The distribution and routing tool, named route optimization tool (RoOT), uses an indexing algorithm to optimize the routes under constrained resources. Numerical results are presented using five datasets, three realistic and two artificial datasets. RoOT can be used in routine or emergency situations, and may be easily adapted to include other products, regions, or logistic problems.

Analyzing the operational barriers of government-supported healthcare supply chain

Purpose

The purpose of this study is to develop a methodology for the identification, categorization and prioritization of operational government-supported healthcare supply chain barriers (GHSCBs).

Design/methodology/approach

This study develops a theoretical background for identifying and segregating relevant GHSCBs and proposes a 5W2H (a Toyota production system) with fuzzy DEcision MAking Trial and Evaluation Laboratory (DEMATEL) embedded approach to quantify the causal–effect relationships among the identified operational GHSCBs.

Findings

Seven GHSCBs (i.e. uncertainty of demand management, lack of continuous improvement and learning, lack of deadline management, lack of social audit, warehousing equipment unavailability, human resource shortage and inadequate top level monitoring) were identified as significant cause group where the government, top management and decision-makers of government-supported healthcare supply chain (GHSC) have to put efforts.

Research limitations/implications

The results obtained are specific to the GHSC of Indian perspective, which could be extended to global context. However, the proposed approach can be a base and provide a platform to understand and analyze the interactions among GHSCBs.

Practical implications

The proposed methodology will show the appropriate areas for allocating efforts and resources to mitigate the impact of GHSCBs for successful implementation of healthcare supply chain.

Originality/value

According to best of the authors' knowledge, this is the first study of operational barrier for GHSC in India in specific. The use of 5W2H embedded fuzzy DEMATEL approach for the development and analysis of the theoretical framework of Indian GHSCBs is unique in barrier literature.

Thermostabilization of viruses via complex coacervation

Widespread vaccine coverage for viral diseases could save the lives of millions of people each year. For viral vaccines to be effective, they must be transported and stored in a narrow temperature range of 2-8 °C. If temperatures are not maintained, the vaccine may lose its potency and would no longer be effective in fighting disease; this is called the cold storage problem. Finding a way to thermally stabilize a virus and end the need to transport and store vaccines at refrigeration temperatures will increase access to life-saving vaccines. We explore the use of polymer-rich complex coacervates to stabilize viruses. We have developed a method of encapsulating virus particles in liquid complex coacervates that relies on the electrostatic interaction of viruses with polypeptides. In particular, we tested the incorporation of two model viruses; a non-enveloped porcine parvovirus (PPV) and an enveloped bovine viral diarrhea virus (BVDV) into coacervates formed from poly(lysine) and poly(glutamate). We identified optimal conditions (i.e., the relative amount of the two polypeptides) for virus encapsulation, and trends in this composition matched differences in the isoelectric point of the two viruses. Furthermore, we were able to achieve a ∼103-104-fold concentration of virus into the coacervate phase, such that the level of virus remaining in the bulk solution approached our limit of detection. Lastly, we demonstrated a significant enhancement of the stability of non-enveloped PPV during an accelerated aging study at 60 °C over the course of a week. Our results suggest the potential for using coacervation to aid in the purification and formulation of both enveloped and non-enveloped viruses, and that coacervate-based formulations could help limit the need for cold storage throughout the transportation and storage of vaccines based on non-enveloped viruses.

Healthcare commodities for emergencies in Africa: review of logistics models, suggested model and research agenda

Purpose

Enormous numbers of people suffer from the effects of disasters and humanitarian crises in Africa, including medical and healthcare emergencies. International response to the 2014–2016 Ebola pandemic in West Africa and COVID 19 pandemic vividly demonstrates the need for efficient and effective logistics and supply chain systems in bringing succor to impacted and vulnerable communities. This paper critically reviews the academic literature on logistics models for sourcing, delivery and distribution of medical and healthcare products for humanitarian emergencies in Africa from 1990 to 2018. The paper suggests areas for further research and proposes an effective logistics model useful for international and national humanitarian organizations as well as public health authorities in Africa and developing areas.

Design/methodology/approach

The viewpoint paper draws upon a structured comprehensive and critical review of the academic literature on logistics and supply chain management and a qualitative analysis of the literature in 13 leading academic databases covering over 5,550 articles.

Findings

The paper finds significant gaps in the body of logistics and supply chain management research on practical deployable logistics models for sourcing, delivery, and distribution of medical and healthcare products for humanitarian emergencies. The paper suggests a model worthy of consideration by humanitarian and disaster response stakeholders as well as public health authorities in developing countries.

Research limitations/implications

This is a critical literature review paper based on a comprehensive literature research and analysis for the period from 1990 to 2018 from which a viewpoint is formed.

Social implications

This paper advocates for further research on appropriate models of logistics for the sourcing, delivery and distribution of medical and healthcare products to enhance the basic human rights and dignity of vulnerable people in developing countries.

Originality/value

The paper contributes directly to policy on logistics, humanitarian aid, disaster management, public health and health security policy in the developing world including Africa.

Enhancing service delivery in humanitarian relief chains: the role of relational capital

Purpose

The study examined the influence of relational capital on inter-cluster coordination and service delivery of humanitarian organisations; the mediating and moderating role of inter-cluster coordination on the relationship between relational capital and service delivery.

Design/methodology/approach

Data was collected from 60 humanitarian organisations. Potential respondents were five officers from each humanitarian organisation involved in delivering humanitarian assistance. Respondents from the different organisations were selected using purposive sampling. The SPSS software, SMART PLS and CB-SEM software were used to obtain results on the influence of relational capital on inter-cluster coordination and service delivery in humanitarian organisations; and the mediating and moderating role of inter-cluster coordination on the relationship between relational capital and service delivery.

Findings

Findings indicated that relational capital influences inter-cluster coordination and service delivery in humanitarian relief chains; inter-cluster coordination partially mediates the relationship between relational capital and service delivery in humanitarian relief chains; and no interactive effect was found when the moderation effect of inter-cluster coordination on the relationship between relational capital and service delivery in humanitarian organisations was examined.

Research limitations/implications

The study was mainly focused on humanitarian organisations excluding beneficiaries and the logistics suppliers. The research has implications to decision-makers in government and humanitarian organisations concerned with providing relief aid to beneficiaries.

Originality/value

The influence of relational capital on inter-cluster coordination and service delivery in humanitarian relief chains; the mediating role and moderating role of inter-cluster coordination on the relationship between relational capital and service in humanitarian relief chains are aspects that have not been given significant attention empirically.

Using Data to Keep Vaccines Cold in Kenya: Remote Temperature Monitoring with Data Review Teams for Vaccine Management

Using technology to make data visible to stakeholders and giving those stakeholders a framework for analyzing that data for decision making improves cold chain management of vaccines in Kenya.

Background:

Global vaccination coverage rates have remained around 85% for the past several years. Increasing immunization coverage rates requires an effective cold chain to maintain vaccine potency. Remote temperature monitoring (RTM) technology for vaccine refrigerators has shown promise for improving the ability of supply systems to maintain optimal temperature conditions to ensure potent vaccines reach the end users.

Methods:

A pilot study of RTM technology and data use teams was implemented in 36 study sites in Kenya. Data were collected at baseline and endline points over a 3-month baseline and 7-month implementation period. Data included 44 qualitative interviews, process logs, meeting minutes from data use team meetings, and quantitative temperature and power data from the RTM devices.

Results:

The ability of cold chain equipment to maintain World Health Organization-recommended temperatures in study sites improved markedly between the baseline and implementation periods, resulting in an improvement in total time spent in the correct range from 83.9% in the baseline period to 90.9% in the intervention period and an improvement in time spent in the too cold range from 6.5% to 1.5%. Friedman tests revealed that differences in time spent in the correct range and time spent in the too cold range during the course of the study were statistically significant (P<.001 and P=.04, respectively). Qualitative and quantitative data suggest that this improvement was due to a combination of improved responsiveness to temperature excursions at the facility level, resulting from SMS alarms for temperature excursion periods, and improved ability at the management level to recognize and address recurring problems.

Conclusion:

The combination of using RTM technology with a structured data review process by a management team is a promising approach for improving cold chain outcomes. Future research examining the added value of each of the technological and behavioral components separately is needed.

Gaming as a research method in humanitarian logistics

Purpose

The purpose of this paper is to present a methodology for research through game design and discuss how simulation games can be used to bridge the gap between operational exercises and simulation or analytical modelling and to provide guidelines on how simulation games can be designed for different research purposes in the context of humanitarian logistics.

Design/methodology/approach

This paper combines a literature review on gaming as a research method with an analysis of requirements for humanitarian logistics research methods. Starting from this theoretical framework, the authors develop a design thinking approach that highlights how games can be used for different research purposes. To illustrate the approach, the authors develop two different game set-ups that are of increasing fidelity and complexity. Finally, the authors discuss the results of the evaluation of both approaches, reflect on the design choices and provide recommendations for research and practice.

Findings

Gaming is a suitable research method to explore and analyse behaviour and decisions in emergent settings that require team work and collaborative problem solving. Especially when safety and security concerns may hinder access and experimentation on site, gaming can offer a realistic and engaging quasi-experimental environment. The aspects of engagement and realism also make gaming a suitable tool to combine training and research.

Originality/value

Although the use of games has attracted some attention in commercial supply chain management and crisis response, there is no systematic overview of gaming as a research method in humanitarian logistics. This paper is set to make a headway in addressing this gap by proposing a concrete approach to design games for humanitarian logistics research.

Multi-level facility location-allocation problem for post-disaster humanitarian relief distribution

Purpose

Previously use of drones as a relief distribution vehicle was studied in several studies where required number of drones and the best locations for the relief centers were investigated. The maximum travel distance of drones without a need to recharge is limited by their endurance. Recharge stations can be used to extend the coverage area of the drones. The purpose of this paper is to find the best topology for both relief centers and recharge stations to cover a large-scale area with minimum and feasible incurred costs and waiting times.

Design/methodology/approach

A multi-level facility location problem (FLP) is utilized to find the optimum number of relief centers and refuel stations and their locations. It is supposed that the demand occurs according to Poisson distribution. The allocation of the demand is based on nearest neighborhood method. A hybrid genetic algorithm is proposed to solve the model. The performance of the algorithm is examined through a case study.

Findings

The proposed method delivers increased efficiency and responsiveness of the humanitarian relief system. The coverage area of the drones is extended by refuel stations, total costs of the system are reduced and the time to respond an emergency, which is an important factor in survival rate, is significantly decreased.

Originality/value

This study proposes a multi-level FLP to simultaneously account for recharge stations, relief centers and the number of required drones to cover all the demand for relief in a post-disaster period.

Knowledge and Perceptions of Adverse Events Following Immunization among Healthcare Professionals in Africa: A Case Study from Ghana

The spontaneous reporting of suspected adverse events following immunization (AEFI) by healthcare professionals (HCPs) is vital in monitoring post-licensure vaccine safety. The main objective of this study was to assess the knowledge and perceptions of AEFIs among healthcare professionals (HCPs) in Africa, using the situation in Ghana as a case study. The study was of a cross-sectional quantitative design, and was carried out from 1 July 2017 to 31 December 2017 with doctors, pharmacists, and nurses as the study participants. A 28-item paper-based questionnaire, delivered by hand to study participants, was the data collection tool in the study. The study was conducted in 4 hospitals after ethical approval was granted. The desired sample size was 686; however, 453 consented to partake in the study. Data were analyzed using SPSS (software version 22, IBM, Armonk, NY, USA), and chi-square and binary logistic regression tests were used for tests of association between HCPs’ characteristics and their knowledge and perceptions. Detailed knowledge of AEFIs was ascertained with a set of 9 questions, with 8 or 9 correctly answered questions signifying high knowledge, 5 to 7 correctly answered questions signifying moderate knowledge, and below 5 correctly answered questions signifying low knowledge. A set of 10 questions also ascertained HCPs’ positive and negative perceptions of AEFI. Results revealed that knowledge of AEFIs was high in 49 (10.8%) participants, moderate in 213 (47.0%) participants, and low in 191 (42.2%) participants. There was no statistically significant correlation between AEFI knowledge and professions. The highest negative perception was the lack of desire to learn more about how to diagnose, report, investigate, and manage AEFI, whereas the lowest was the lack of belief that surveillance improves public trust in immunization programs. There was a general awareness of AEFIs among HCPs in this study. However, negative perceptions and the lack of highly knowledgeable HCPs regarding AEFIs were possible setbacks to AEFI diagnosis, management, prevention, and reporting. More training and sensitization of HCPs on AEFIs and vaccine safety will be beneficial in improving the situation. Future research should focus on assessing the training materials and methodology used in informing HCPs about AEFIs and vaccine safety.