Cold chain challenged by new vaccines:

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

4th Annual Global Immunization Meeting New-York,
17 - 19 February 2009 S. Kone WHO/IVB/EPI Osman
David Mansoor UNICEF Patrick Lydon - WHO/IVB/EPI
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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

UCI
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Current anticipated vaccines volumes per child
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National vaccine store capacity, by region
5/9 countries
2/6 countries
4/6 countries
3/8 countries
TVPentaPCV (100 cm3/child)
32/35 countries
4/6 countries
Source Country cold chain data are from GAVI
applications, EVSM assessment reports, Stock
Management Tools
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Upgrading cold chain takes Time!

• Assessing the need ? 3 months
• Central intermediate ? 1-2 months
• Intermediate service ? 2-3 months
• Preparing ordering ? 6-9 months
• Receiving and installation ? 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

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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

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Efforts to address challenge

• 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

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What is the EVM ?

• 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

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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

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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?
• 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!

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Analysis of EVSMs

• 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

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Value of Re-assessments

• 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)
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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

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Thank you !
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