Cold chain challenged by new Cold chain challenged by new vaccines: vaccines: How Effective Vaccine How Effective Vaccine Management helps Management helps 4th Annual Global Immunization Meeting 4th Annual Global Immunization Meeting 4th Annual Global Immunization Meeting 4th Annual Global Immunization Meeting 4th Annual Global Immunization Meeting 4th Annual Global Immunization Meeting 4th Annual Global Immunization Meeting 4th Annual Global Immunization Meeting New New New New New New New New - - - - - - York, 17 York, 17 York, 17 York, 17 York, 17 York, 17 York, 17 York, 17 - - - - - - 19 February 2009 19 February 2009 19 February 2009 19 February 2009 19 February 2009 19 February 2009 19 February 2009 19 February 2009 S. Kone S. Kone S. Kone S. Kone S. Kone S. Kone S. Kone S. Kone – – – – – – WHO/IVB/EPI WHO/IVB/EPI WHO/IVB/EPI WHO/IVB/EPI WHO/IVB/EPI WHO/IVB/EPI WHO/IVB/EPI WHO/IVB/EPI Osman Osman Osman Osman Osman Osman Osman Osman David Mansoor David Mansoor David Mansoor David Mansoor David Mansoor David Mansoor David Mansoor David Mansoor – – – – – – UNICEF UNICEF UNICEF UNICEF UNICEF UNICEF UNICEF UNICEF Patrick Lydon Patrick Lydon Patrick Lydon Patrick Lydon Patrick Lydon Patrick Lydon Patrick Lydon Patrick Lydon - - - - - - WHO/IVB/EPI WHO/IVB/EPI WHO/IVB/EPI WHO/IVB/EPI WHO/IVB/EPI WHO/IVB/EPI WHO/IVB/EPI WHO/IVB/EPI
Transcript
Cold chain challenged by new Cold chain challenged by new vaccines: vaccines:
How Effective Vaccine How Effective Vaccine Management helpsManagement helps
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� Established in 1980s
-Needs updating for new challenges
� Inadequate cold chain constraint for vaccine delivery
� Integrate vaccine logistics with other essential health commodities
� Demands from new vaccines
- Increased volume
- Value of vaccines
Cold Chain & Logistics for EPI: Essential Health System Infrastructure
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Global African American
Eastern Mediterranean European South East Asian
Western Pacific
UCI
Current & anticipated vaccines volumes per childCurrent & anticipated vaccines volumes per child
� New vaccine products with non standard characteristics emerging
– Challenging existing simple rules (MDVP, VVM)
– Waste disposal (increased qty & diversity)
– Service delivery strategies (expanded age groups)
� Increase the quantity & volume of safe injection supplies stored at ambient
– Need for adequate storage & bundled distribution to matched with vaccines
� Radical implication for training & supportive supervision: – Increasing complexity and costs of logistics will require serious
qualification improvement of logistics managers at all levels!
– Health workers training and supportive supervision…
Increasing complexity of EPI operationsIncreasing complexity of EPI operations
� Vaccine Presentation and Packaging Advisory Group (VPPAG): Input to future presentation development
[see http://sites.google.com/site/vppagp]
� Development of electronic tools
– For country decision-making, planning & implementation
• Vaccine volume calculator
• Stock management tool (Access and Excel Based)
• Equipment inventory tools (Access and Excel Based)
• Scenario analysis & Multiyear forecasting of needs
– For assessment & identification of gaps
Efforts to address challengeEfforts to address challenge
� Effective Vaccine Store Management (EVSM) started in 2002 and officially launched in 2004 by WHO and UNICEF
� National level assessment leading to certification
� Vaccine Management Assessments (VMA)
� Covers all levels and no certification
� Effective Vaccine Management (EVM) initiative
� Currently under development
� Combines best features of both EVSM and VMA
� National and sub-national levels
� Self-management tool - modular
What is the EVM ?What is the EVM ?
� The vaccine supply chain is the most critical element of an immunization system
� Poor vaccine management and supply chain practices and/or equipment failure can cause loss of large quantities of vaccine
� Financial loss can run to millions of dollars and children can miss being immunized
� Growing concern with new more costly and more bulky vaccines
Why vaccine management ?Why vaccine management ?
� No incentive for countries to undertake vaccine management assessments and re-assessment to improve their cold chain and logistics systems for vaccines
� Why?
� Not promoted enough by immunization partners
� WHO-UNICEF joint statement has been forgotten
� GAVI and IRC not enforcing this requirement
� Logistics and good supply chain management in low income
countries tends to be a second order priority
� Yet
� We are sending more and more vaccines and more costly vaccines into poor performing national cold chain and logistics systems!
The problem ?The problem ?
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Average Score (43)
Minimum Score
Certification [80%]
• Overall scores on the measure indicators below acceptable 80% best practice rate
• Lowest overall scores relate to
– Vaccine arrival
– Storage capacity for vaccines and supplies
– Distribution and transportation of vaccines down the national supply chain
– Managing vaccine stocks
Analysis of EVSMs Analysis of EVSMs
0
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Temperature Control
Storage capacity
Build.Eqpt& TransportEquip Maintenance
Stock control
Distribution System
Re-Assessment
Certification
Baseline Assessment
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100Vaccine Arrival
Temperature Control
Storage capacity
Build.Eqpt& TransportEquip Maintenance
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Distribution System
• All countries that did an assessment and a re-assessment improved on all vaccine management indicators
• The process catalyzed– Improvements in vaccine
management practices– National investment in cold
chain and logistics systems– The preparation for new
vaccine introduction
In AFR (3)
In EMR (3)
Value of ReValue of Re--assessmentsassessments
• Raise awareness of the value of EVM
– CCL Taskforce– Optimize (WHO-PATH) – Promote Strategy 6 of the GIVS
• Work with GAVI – To enforce the EVM requirement– To encourage countries to do
EVM assessments using the NUVI grant monies (~$10,000 per assessment)
• Provide – Updated and streamlined tools– more training– roster of consultants – timely technical assistance to
