Docstoc

Vaccines and Supply Chains

Document Sample
Vaccines and Supply Chains Powered By Docstoc
					                                                        Vaccines and
                                                       supply chains
                                 Keeping ahead of evolving
                                               challenges

Michel Zaffran
WHO/IVB



  1|   Global Immunization Meeting, Geneva, 1- 3 February 2010
The "Cold Chain"
has served us well




                     -Simple
                     -Precise
                     -Standardized
         A changing environment

                                       In the pipeline
                                          Deng    Malari
                                  TB
1: Introducing new                         ue       a

and underutilized
vaccines                          Menin
                             JE         Coming soon
                                   gA



                     Hib/P    Pneu Available now
Rota   Hep B   HPV             mo
                     enta
           A changing environment
  2: Reaching more –
  new strategies and target groups




Infants at birth Adolescent School aged TT   Unreached
  with Hep B girls with HPV    boosters      populations
       A changing environment

3: Linking with
other health
interventions



                  Health systems need to deliver
                  many more health products,
                  including heat sensitive ones, to
                  growing numbers of people
         A changing environment




4: Global interdependence
    Rapid vaccine deployment (e.g., Pandemic
     influenza)
                                                             New challenge
 Newer vaccines are more bulky and more costly
     35.00
                                                                                                       HPV ?
         Vaccine price (US$) per course



                                          25.00
                                                                                                             Rota
                                                                                                       PCV
                                                        Bubble size indicates volume per full
                                                        course of each vaccine
                                          15.00

                                                                                                       Penta

                                           5.00              DTP                   OPV          MenA
                                                  BCG
                                                                    YF
                                                                                                       JE
                                                                           Meas
                                          -5.00                                                 HepB
                                              1920                                    1970                          2020

                                                     Estimated year of licensure
Sources:UNICEF Vaccine projection and PAHO Revolving Fund Vaccine Prices, 2009, AMC price for PCV; Volume includes wastage .
            Case study:
Pneumo vaccine introduction in Turkey
  Primary storage capacity 2005: 2600 m3




Freezer rooms: 300 m3 and 200 m3
                                               cold

 cold          cold
 580 m3        400 m3
                                                   1 rental cold room
  Primary vaccine stores                                1100 m3
            55.9 cm3 per dose: prefilled syringe
              Case study:
  Pneumo vaccine introduction in Turkey
Primary storage capacity 2008: 11,400 m3




  Freezer rooms: 300 m3 and 200 m3

                                                 cold
                                                 cold
   cold          cold
   580 m3        400 m3
    Primary vaccine stores                           9 rental cold rooms
                                                     1100 m3 each
              55.9 cm3 per dose: prefilled syringe
               Case study:
   Pneumo vaccine introduction in Turkey
Capacity needed if more suitable presentation

                                                  cold




   Freezer rooms: 300 m3 and 200 m3

                                                  cold
                                                  cold
    cold          cold
    580 m3        400 m3
     Primary vaccine stores                        2 rental cold rooms
                                                      1100 m3 each
                4.8 cm3 per dose: two-dose vial
                           Average EVSM
                             Score (%)

                                                                   100




                           20
                                30
                                     40
                                          50
                                               60
                                                    70
                                                         80
                                                              90




                      10

                  0
Vaccine Arrival



  Temperature
      Control


      Storage
      capacity

      Building,
  Equipment &
    Transport
                                                                                   New challenge




  Equipment
 Maintenance


 Stock control
                                                                         Vaccine management far from optimal




   Distribution
       System
                         Average EVSM
                           Score (%)

                                                                 100




                         20
                              30
                                   40
                                        50
                                             60
                                                  70
                                                       80
                                                            90




                    10

                0
Vaccine Arrival


   Temperature
       Control


    Storage
    capacity

       Building,
   Equipment &
     Transport
                                                                                  New challenge




   Equipment
  Maintenance


Stock control
                                                                       Vaccine management far from optimal




 Distribution
   System
                                              New Challenge
       Status of central cold chain capacity


                                  Severe Gap
                              Insufficient for both     Adequate
                                 PCV and Rota           Capacity
                                      24%           Sufficient for both
                                                      PCV and Rota
                                                           37%
                                   Moderate Gap
                                  Sufficient for only
                                   one new vaccine
                                         39%




13 |   Global Immunization Meeting, Geneva, 1- 3 February 2010
                                                    Challenge
       Problems at district/peripheral levels
 Insufficient capacity
 Unreliable, or no electricity
 Challenges with existing
   technology
       – freezing vaccine
       – maintenance and fuel cost of
     absorption refrigerators
   – inadequate temperature
     monitoring
 Vaccine ordering based on
 target population

14 |   Global Immunization Meeting, Geneva, 1- 3 February 2010
                New Challenge
Existing supply chains are reaching their limits




                                                                         Manufacturer

                                                                                        Manufacturer
Inefficiencies




                                                                              1

                                                                                             2
• Too many steps
       Airport                                                           Port of Entry
• Deliveries not demand driven
       National                                                          Primary Store

• Information systems not designed to handle forecasting and
       Sub-national 1                     Intermediate
                                                                        (National Level)
                                                                                                               Intermediate

stock management complexities                 Store                                                                Store




Redundancies
       Sub-national 2      District
                           Storage
                                            District
                                            Storage
                                                             District
                                                             Storage
                                                                                                   District
                                                                                                   Storage
                                                                                                                 District
                                                                                                                 Storage
                                                                                                                                  District
                                                                                                                                  Storage




• Parallel public-sector supply chains : campaigns, ARVs, ACTs,
TB treatments, condoms, diagnostics ...)
       Sub-national 3
                        Health Centres                    Health Centres                      Health Centres                   Health Centres

• Parallel private sector supply chains
                                         Health Centres                                                       Health Centres


                                          Service Delivery                                                     Service Delivery
                 Challenge
     Adequate and appropriate personnel
 Logistics profession not recognized, with no attractive
  career path

 Lack of dedicated /recognized educational structure

 High rate of turnover

 Insufficient opportunities for training

 Partners have too few fulltime staff dealing with logistics
  and vaccine management

 Limited coordination between MoH and partners
Addressing the challenges

A few concrete next steps
       1. Optimize product presentation
                                 
                          Single-dose or low-dose
                          presentations
    What you can do:    Small volumes per dose
                        Vaccine Vial Monitors
    Donors/Partners/Industry
                        Environmental impact
    • Support VPPAG as a forum to develop Preferred Product Profiles
    • Give preference to products that meet preferred presentations

    Countries
      • Select products most suitable for the programme
      • If needed, delay introduction to get suitable product and to
      prepare for introduction
      • Send feedback on
Initial Rotavirus vaccine possible improvements of products
 Lyophilized, No VVMs
      presentations                2nd generation
  Full course: 330 cm3           rotavirus vaccine,          Latest rotavirus
                                        liquid                    vaccine
                               Full course: 170.6 cm 3      Full course: 34 cm3
2. Improve Vaccine Management Systems

      Effective vaccine
       management tool: EVM
       What you can do:
   Countries
  Focus: :
       • EVM assessment prior to new vaccine
        – Best practice according
       introduction criteria
           to 9 global
       •–Secure levels of resources for corrective
           At all national the
       measures (national,
           system
           subnational and service
       Partners/Donors :
           delivery)
       • Sponsor participants in EVM training
                                                    Sophie Newland/PATH
       • Sponsor countries´ assessments and corrective
       measures
19 |   Global Immunization Meeting, Geneva, 1- 3 February 2010
 3. Improve point of use Vaccine Management

    Discard vaccines possibly damaged by heat
   Reduce discards during cool chain breaks
    What you can do:
   Identify cool chain problems              U. Kartoglu/WHO

    Countries :
   Manage vaccine stocks
    • Request VVMs for all vaccines procured directly
      Ensure freezing
   •PreventVVMs training is part of all health workers
   training
     Facilitate outreach
       • Extend requirement for VVMs to all imported
       vaccines (private sector)
       Partners/donors :
       • Request that VVMs be always specified for the
20 |
       procurement Geneva, 1-finance
       Global Immunization Meeting,
                                    you 3 February 2010
                 4. Optimize supply systems
                                 2008                                   In 2009




                                                             Manufacturer
                                                             Manufacturer
                                                                        Port of Entry
                              Port of Entry




                                                                  2
                                                                  1
What can be done :
                                                                         Primary Store
                             Primary Store
• Plan today for tomorrow´s needs
      Airport
                                 (MoH)
                                                                 Port of Entry
                                                                          (Parastatal)
      National                                               Primary Store
Explore options                12 Regional
                                    Intermediate
                                                               (National
                                                                 Level)               Intermediate
      Sub-national 1
• Streamline the supply chain    Stores Store                                             Store


      o skip unnecessary levels
                          District      District      District            District       District       District
      Sub-national 2
                76 Provincial
                          Storage       Storage       Storage             Storage        Storage        Storage
      o introduce distribution based deliveries
                    Stores


• Consider outsourcing (parastatal agency, private sector)
      Sub-national 3               Hospitals
                District with
• Look for synergiesStores other health programmes
                       Health Centres              Health Centres       Health Centres              Health Centres



                                     Health Centres                                  Health Centres
                                                                    13,000 Health Centres
                         13,000 Health Centres
                                      Service Delivery                               Service Delivery
5. Strengthen Peripheral levels

• Order vaccines based on
consumption
• Implement chilled-water
packs where possible
• Use ILRs if >8hrs/24hrs
                                  C. Nelson/PATH
electricity and assess battery-
free solar (Solarchill)
• Introduce Fridge-tags with
training
                                        Unicef
A New technology
SolarChill – battery free

Pros
 Removes main weakness : the
  battery
 Low running costs
 Easy to install
 Good user satisfaction
Cons
 Not yet prequalified (PQS)
 High capital and installation cost
 Small capacity of current model
  (20L)
A New technology
Fridge-Tag to monitor temperatures

 Record of last 30 days
    temperatures
 Freeze and Heat ALARM
 approx US$20




Pros                                                             Cons
• Record of past month                                           • Cost
• Alarms at relevant                                             • Limited life: battery not
   temperatures                                                    replaceable
• No training needed for                                         • What to do when fails?
   thermometer function                                          • Hands-on training needed for all
                                                                   other features

24 |   Global Immunization Meeting, Geneva, 1- 3 February 2010
Coordinating Efforts
The Cold Chain and Logistics Taskforce (CCL)

"Strengthen capacity of NIPs to ensure every individual can benefit from
vaccines of assured quality delivered in the right amount at the right time
through efficient logistics, proper vaccine management, and a well-functioning
cold chain system"


 Subgroups
                                                   Advocacy Audiences
 • Guidance
                        Greater coordination       • Internal for each agency
 • Monitoring             & commitment             • Donors
 • Advocacy
                                                   • Developing Countries
 • Integration

  Cross-cutting theme: Human Resources and Capacity Building
www.technet21.org | www.path.org | www.who.int


Global Immunization Meeting, Geneva, 1- 3 February 2010

				
DOCUMENT INFO
Shared By:
Categories:
Tags:
Stats:
views:11
posted:7/4/2012
language:English
pages:26