Cold chain challenged by new vaccines: How Effective Vaccine Management helps

Transcription

1 Cold chain challenged by new vaccines: How Effective Vaccine Management helps 4th A nnual G lobal Im m unization M eeting N ew - Y ork, February 09 S. K one W H O /IV B /E PI O sm an D avid M ansoor U N ICE F P atrick L ydon - W H O /IV B /E PI

2 Cold Chain & Logistics for EPI: Essential Health System Infrastructure 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 % coverage UCI Global African American Eastern Mediterranean European South East Asian Western Pacific

3 Current & anticipated vaccines volumes per child Todays' requirements TV + Penta_liq + PCV- Uniject + Rota New target for Pneumo & Rota Initial target for Pneumo & Rota TV + Penta + PCV-2- dose vial + Rota TV + Penta + PCV TV + Penta 41 Tradi Vax Traditional Vax dtp/hepb/hib combo PCV Rota Volumes, cm3

4 National vaccine store capacity, by region Gross cold-chain capacity of national vaccine store (cm3/child) TV+Penta+PCV+Rota (300 cm3/ 98 4/6 countries 135 (300 cm3/child) TV+Penta+PCV+Rota (150 cm3/ 4/6 countries 356 (150 cm3/child) 32/35 countries 2/6 countries EMR AFR AMR WPR EUR SEAR /8 countries TV+Penta+PCV (100 cm3/ TV+Penta 5/9 countries 497 (100 cm3/child) TV+Penta (61.0 cm3/child child) Source: Country cold chain data are from GAVI applications, EVSM assessment reports, Stock Management Tools

5 Upgrading cold chain takes Time! Assessing the need 3 months Central & intermediate 1-2 months Intermediate & service 2-3 months Preparing & ordering Receiving and installation 6-9 months 3-6 months It can take at least 12 months to upgrade needed cold chain capacity for new vaccines introduction And money: rough estimate $5-10 per birth

6 Increasing complexity of EPI operations 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

7 Efforts to address challenge Vaccine Presentation and Packaging Advisory Group (VPPAG): Input to future presentation development [see 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

8 What is the EVM? Effective Vaccine Store Management (EVSM) started in 02 and officially launched in 04 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

9 Why vaccine management? 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

10 The problem? No incentive for countries to undertake vaccine management assessments and re-assessment to improve their cold chain and logistics systems for vaccines Why? Yet 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 We are sending more and more vaccines and more costly vaccines into poor performing national cold chain and logistics systems!

11 Analysis of EVSMs 100 Certification [80%] Overall scores on the measure indicators below acceptable 80% best practice rate EVSM Score [0% - 100%] Vaccine Arrival Temp Control 61 Storage Capacity Build, Equip & Transp Maintenance Stock Control Distribution Lowest overall scores relate to Average Score (43) Minimum Score Vaccine arrival Storage capacity for vaccines and supplies Distribution and transportation of vaccines down the national supply chain Managing vaccine stocks

12 Value of Re-assessments In AFR (3) Distribution System Vaccine Arrival Temperature Control All countries that did an assessment and a reassessment improved on all vaccine management indicators Stock control Storage capacity In EMR (3) Equip Maintenance Distribution System Stock control Equip Maintenance Vaccine Arrival Build.Eqpt& Transport Temperature Control Storage capacity Build.Eqpt& Transport The process catalyzed Improvements in vaccine management practices National investment in cold chain and logistics systems The preparation for new vaccine introduction Re-Assessment Certification Baseline Assessment

13 Next steps for EVM 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 countries

14 Thank you! OPV Men conj Pneumo conj Cholera/ Typhoid Live JE mouse brain Measles Hib Lyo Rotavirus Rubella Rabies MMR Hep B IPV JE PHK DT/TT/Td Yellow Fever Hep A Hib Liq Cholera/ Typhoid Killed DTP DTaP + combos Influenza DTP-HepB Men PS Varicella Influenza BCG HPV