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[DATE][SPEAKERS NAMES]

The 6th Global Health Supply Chain Summit

November 18 -20, 2013Addis Ababa, Ethiopia

 

HERMES Computational Simulation Modeling to Improve Vaccine Supply Chain Operations in Two

West African Countries: Niger and Benin Bryan A. Norman

HERMES Team

Tina-Marie Assi, PhDFormer Co-Coordinator

Rachel B. Slayton, PhDFormer Co-Coordinator

Shawn T. Brown, PhDTechnical Lead

Joel S. Welling, PhDDeveloper

Bruce Y. Lee, MD, MBAScientific Lead

Bryan A. Norman, PhDIndustrial Engineering

Jayant Rajgopal, PhDIndustrial Engineering

Diana L. Connor, MPHCo-Coordinator

Sheng-I Chen, PhDIndustrial Engineering

Angela R. Wateska, MPHCo-Coordinator

Brigid E. Cakouros, MPHSenior Analyst

Yu-Ting Weng, MSDeveloper

Michelle M. Schmitz,BAAnalyst

Jim Leonard

Developer

Leila A. Haidari, BSAnalyst

Leslie E. Mueller, BSAnalyst

Erin G. Claypool, PhD Industrial Engineering

Proma Paul, MHSSenior Analyst

Veena Karir, PharmD, MSSenior Analyst

Roslyn J. Phillips, MPHSenior Analyst

• HERMES Overview• Examples of In-Country

Work• Sample studies• Summary and

Discussion

Overview

For more information visit- http://hermes.psc.edu

Air and Space Travel and Exploration

Transportation

Natural Resource and Energy Exploration

Finance and Investment

Sports

Military/Defense

Modeling Is Widely Used

For more information visit- http://hermes.psc.edu

HERMES Vision

For more information visit- http://hermes.psc.edu

HERMES can address…

• Impact of introducing new technology – e.g., vaccines, storage, and monitoring

• Characteristics of vaccines and other technologies– e.g., vaccine vial size, vaccine thermostability, cold device

capacity• Configuration and operations of the supply chain

– e.g., storage, shipping frequency, personnel, ordering policy• Effects of differing conditions/circumstances

– e.g., power outages, delays, inclement weather, limited access• Investment or allocation of resources

– e.g., adding refrigerators vs. increasing transport frequency• Optimizing vaccine delivery

– e.g., minimize cost, cost per outcome, maximize immunizations

Discrete Event Simulation

For more information visit- http://hermes.psc.edu

Service Delivery Location

Steps to Model Supply Chains

• Identify purpose of simulation

– Questions to address

– Perspective of user

• Determine level of detail required in the simulation model

– Less detail to address general, simpler questions

– More detail to address more complex questions

For more information visit- http://hermes.psc.edu

Steps to Model Supply Chains

• Gather and input supply chain data into HERMES

– Evaluate the data that is available.

– Less data less detailed simulation model

– More data more detailed simulation model

• Decision maker can directly run HERMES on any laptop computer

For more information visit- http://hermes.psc.edu

HERMES GUI

• Simplifies

– Data input

– Running models

– Evaluating different scenarios

– Identifying bottlenecks

• Seeking Beta testers for the HERMES GUI for early 2014

For more information visit- http://hermes.psc.edu

• HERMES Overview• Examples of In-

Country Work• Sample studies• Summary and

Discussion

Overview

For more information visit- http://hermes.psc.edu

Examples of In-Country Work

For more information visit- http://hermes.psc.edu

• HERMES Overview• Examples of In-Country

Work• Sample studies• Summary and

Discussion

Overview

For more information visit- http://hermes.psc.edu

Niger Supply Chain

1 Month42 District Stores (Chest Refrigerators and Freezers)

Serum Institute Sanofi Aventis

Regional Store

600+ Clinics (Small Refrigerators and/or Freezers)600+ Clinics

Regional Store

1 Mon

th

Regional Store

Regional Store

Regional Store

Regional Store

Regional Store

Central Store

For more information visit- http://hermes.psc.edu

Vaccine Availability

Vaccine Availability (%) Vaccine Availability (%)

Vaccine Availability (%) Vaccine Availability (%)

For more information visit- http://hermes.psc.edu

Truck Capacity Utilization

10-dose measles vaccine vial size5-dose measles vaccine vial size2-dose measles vaccine vial size1-dose measles vaccine vial size

10-dose measles vaccine vial size5-dose measles vaccine vial size2-dose measles vaccine vial size1-dose measles vaccine vial size

Storage Capacity Utilization

Measles Vaccine Vial Size Scenario 10 doses per vial 5 doses per vial 2 doses per vial 1 doses per vial

100% Target Population SizeBacille-Calmette-Guerin Tuberculosis (BCG)

79% 79% 78% 76%

Diptheria-tetanus-pertussis-hepatitis B-Haemophilus influenza type B (DTP-HepB-Hib)

84% 84% 82% 80%

Measles 90% 87% 86% 80%Oral polio (OPV) 80% 80% 78% 76%Tetanus toxoid (TT) 84% 84% 83% 80%Yellow fever (YF) 79% 79% 78% 76%80% Target Population SizeBCG 84% 85% 85% 84%DTP-HepB-Hib 86% 86% 86% 84%Measles 94% 92% 89% 84%OPV 80% 80% 80% 79%TT 86% 86% 86% 84%YF 84% 85% 85% 84%60% Target Population SizeBCG 81% 81% 81% 80%DTP-HepB-Hib 91% 91% 91% 89%Measles 93% 91% 91% 90%OPV 82% 82% 82% 82%TT 90% 90% 90% 89%YF 81% 81% 81% 80%

Vaccine Availability by Vaccine

Cost per Dose by Arrival Rate

Optimal Vial Size

Benin: The Problem

• The Benin supply chain may not be effectively getting vaccines to the population.– At least 15% of children in Benin are not receiving

full vaccinations (as measured by estimated DTP3 coverage).1

– Impending new vaccine introduction (e.g., rotavirus vaccine) may exacerbate this problem.

• The Benin vaccine supply chain may also cost more to operate than it should (not completely efficient).

1 http://www.who.int/immunization_monitoring/data/ben.pdf - 2011 Government and WHO-UNICEF estimate.

For more information visit- http://hermes.psc.edu

Benin: Objectives

• Evaluate the current Benin vaccine supply chain:– Identify vulnerabilities (bottlenecks)– Calculate operating costs (storage, transport, labor, and

building)

• Assess Benin vaccine supply chain’s ability to handle new vaccine introduction.

• Identify an alternate, more efficient vaccine supply chain design.

• Establish a blueprint for redesign.

• Build a business case to change the system.

• Determine if costs could be lowered and coverage increased from the current system.

Approach: HERMES Modeling Each Scenario

Data on Benin Vaccine Supply Chain• 2010 Cold Chain Equipment Management (CCEM) assessment• Pilot 2012 EVM+HERMES • 2008 Comprehensive Multiyear Plan (cMYP)•Personal communications with Benin Ministry of Health (MoH), WHO, UNICEF, Project OPTIMIZE, and other key stakeholders

Measure Operating Costs

Make Additions to Relieve Bottlenecks

Run Simulation

Measure Vaccine Availability

Detailed Simulation Model of the Benin Vaccine Supply Chain

Run Simulation

Measure Operating CostsMeasure Vaccine Availability

Measure Capital Expenditure

For more information visit- http://hermes.psc.edu

Current System: Not Completely Effective or Efficient

Vaccine availability: 93% (71% after rotavirus introduction)Total annual operating costs: $1,113,954 ($1,117,494 after rotavirus introduction)

Logistics cost per dose: $0.23 ($0.26 after rotavirus introduction)

* Current Bottlenecks: Storage at National Store and transport between all levels

Which Redesign is the Best Option?

Capital Expenditures Required to Achieve Each Design Alternative that will Accommodate

Rotavirus Introduction

ZS + Truck Loops: Lowest Capital Expenditures and Operating Costs

ZS + Truck Loops: Lowest Logistics Cost per Dose Administered

ZS+Truck Loops: Over Half a Million USD in Cost Savings after 5 Years

Synergy of Two Changes Creates Savings

• Zone Sanitaire plus 4 x 4 Truck Loops at Lowest Level is clear choice.

Lower capital expenditures

Lower operating costs

After four years over half-million in cost savings

• Combination of Zone Sanitaire and Truck Loops leads to a synergistic effect.

Conclusions

For more information visit- http://hermes.psc.edu

• HERMES Overview• Examples of In-Country

Work• Sample studies• Summary and

Discussion

Overview

For more information visit- http://hermes.psc.edu

Summary and Discussion

• HERMES can rapidly create a simulation model of any supply chain

• Serve as a virtual laboratory to help a wide variety of vaccine decision makers answer any number of questions

• Already implemented in multiple countries

For more information visit- http://hermes.psc.edu

Looking To The Future

• Over the next ten years most GAVI countries are expanding their vaccines – MenAfriVac®, Rotavirus, PCV-13, others

• Many new vaccines are relatively large– Even more burden on the vaccine cold chain

• Higher coverage rate targets for current and new vaccines

• Cost effective distribution is critical to achieve coverage targets

For more information visit- http://hermes.psc.edu

Acknowledgements

• Funded by the Bill and Melinda Gates Foundation and the U.S. National Institutes of Health

• Valued collaborators include: World Health Organization (WHO), UNICEF, PATH, Agencie de Medecine Preventive (AMP)

For more information visit- http://hermes.psc.edu

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