Documentation of vaccine wastage in two different geographic contexts under the universal immunization program in India

Das, Manoj; Sood, Mangla; Tambe, Muralidhar; Sharma, Thakur Dutt; Parande, Malangori A.; Surwade, Jitendra; Salunkhe, Nandakumar Manikrao; Patil, Shital; Pawar, Bhagwan; Guleri, Rajesh; Kaushal, Chitra; Sindhu, Monica

doi:10.1186/s12889-020-08637-1

Cited by 12 publications

(15 citation statements)

References 13 publications

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“… The number of doses in each vial [ 99 ]: WHO calculated the wastage rates for a single dose, 2 or 5-dose, and 10 or 20-dose were 5%, 10%, and 25% if the opened vial can be stored and reused in later sessions [ 98 ]. This has also been partially verified by Indian situations [ 153 ]. The no-show behaviour of the population [ 154 ]: Although some residents signed up for vaccination, not all of them would show up to get vaccines due to multiple reasons.…”

Section: Lessons and Opportunities For Future Pandemicssupporting

confidence: 55%

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COVID-19 pandemics Stage II – Energy and environmental impacts of vaccination

Klemeš

Jiang

Fan

et al. 2021

Renewable and Sustainable Energy Reviews

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The COVID-19 pandemic developed the severest public health event in recent history. The first stage for defence has already been documented. This paper moves forward to contribute to the second stage for offensive by assessing the energy and environmental impacts related to vaccination. The vaccination campaign is a multidisciplinary topic incorporating policies, population behaviour, planning, manufacturing, materials supporting, cold-chain logistics and waste treatment. The vaccination for pandemic control in the current phase is prioritised over other decisions, including energy and environmental issues. This study documents that vaccination should be implemented in maximum sustainable ways. The energy and related emissions of a single vaccination are not massive; however, the vast numbers related to the worldwide production, logistics, disinfection, implementation and waste treatment are reaching significant figures. The preliminary assessment indicates that the energy is at the scale of ~1.08 × 10 10 kWh and related emissions of ~5.13 × 10 12 gCO 2eq when embedding for the envisaged 1.56 × 10 10 vaccine doses. The cold supply chain is estimated to constitute 69.8% of energy consumption of the vaccination life cycle, with an interval of 26–99% depending on haul distance. A sustainable supply chain model that responds to an emergency arrangement, considering equality as well, should be emphasised to mitigate vaccination's environmental footprint. This effort plays a critical role in preparing for future pandemics, both environmentally and socially. Research in exploring sustainable single-use or reusable materials is also suggested to be a part of the plans. Diversified options could offer higher flexibility in mitigating environmental footprint even during the emergency and minimise the potential impact of material disruption or dependency.

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Section: Lessons and Opportunities For Future Pandemicssupporting

confidence: 55%

Section: Lessons and Opportunities For Future Pandemicssupporting

confidence: 55%

COVID-19 pandemics Stage II – Energy and environmental impacts of vaccination

Klemeš

Jiang

Fan

et al. 2021

Renewable and Sustainable Energy Reviews

View full text Add to dashboard Cite

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“…This is similar to the findings from other studies. [ 15 19 ] This may be because of the fact that the lyophilized vaccines need to be discarded within 4 h after reconstitution. [ 7 ] But, however BCG and Measles both behaved differently, for BCG overall wastage was within permissible limits at District Level but not so at CHC and SC, whereas Measles had wastage within permissible limits at all service delivery points despite the fact that both being reconstituted vaccines and have to be discarded after 4 h. A similar finding that substantially higher wastage of lyophilized vaccines compared to liquid ones was observed in UNICEF study.…”

Section: Discussionmentioning

confidence: 99%

“…A study conducted between two locations of Kangra, Himachal Pradesh and Pune, Maharashtra showed that overall wastage rates for almost all vaccines were higher in Kangra district (BCG 37.1%, DPT 32.1%, Measles 32.2%, OPV 50.8%, TT 34.1% and pentavalent 18.4%) than that of Pune district (BCG 35.1%, DPT 25.4%, Measles 21.7%, OPV 14.3%, TT 23.1% and pentavalent 13.2%. [ 19 ]…”

Section: Discussionmentioning

confidence: 99%

Vaccine wastage at primary, secondary, and tertiary level of healthcare system—A study from Northern India

Oberoi

Mishra

Gupta

et al. 2021

Journal of Family Medicine and Primary Care

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Background: High vaccine wastage results in escalation of budget of immunization program. Objective: To analyze vaccine wastage at three levels of service delivery under public sector, such as at district level, community health Centre (CHC), and sub center (SC). Study Design: A retrospective cross-sectional record based study in a north Indian state. Materials and Methods: The record from January to June 2016 was taken from randomly selected 5 districts of the state at 3 levels; for number of doses of vaccine used and number of children vaccinated for BCG, OPV, Hepatitis B, Pentavalent, DPT, IPV, Measles, and TT (vaccines being given in state in the study year). A total of 67,550 vaccine doses in routine immunization were studied. Statistical analysis used: Data were presented in mean ± standard deviation. One-way ANOVA test was used to compare the means among three levels. Results: Vaccine wastage for Pentavalent was remarkably low (4.86% at district level, 8.35% at CHC and 11.50% at SC) in contrast to other similar 10 dose vials of vaccines like DPT, TT, Hep B. For both the lyophilized vaccines, interestingly BCG wastage was not only significant but over the permissible levels at 60.39%, whereas it is not so for measles. Result indicated that mean difference of the vaccine wastage among three levels was significant for the BCG, OPV, Hepatitis B, Pentavalent, and TT ( P < 0.05); while insignificant for the DPT, IPV, and Measles ( P > 0.05). Conclusions: Not all vaccine wastage is preventable, but pruning the corners where feasible and allowing where it is desirable should depend on prioritizing stakeholders at the receiving end.

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“…In Kangra the wastage rates for different types of vaccines were: BCG 37.1%, DPT 32.1%, Measles 32.2%, OPV 50.8%, TT 34.1% and pentavalent 18.4%. While in Pune district the reported rates for vaccines wastage were: BCG 35.1%, DPT 25.4%, Measles 21.7%, OPV 14.3%, TT 23.1% and pentavalent 13.2% [ 2 ]. To assess missed opportunities for vaccination, the vaccine wastage rates for different categories were assessed in Cambodia and the assessment had found in 100 randomly selected health facilities in 24 districts the wastage rate for single dose vaccine was 4% while for multiple dose vaccines it was as high as 60% [ 3 ].…”

mentioning

confidence: 99%

Visibility and Analytics Network (VAN) approach to improve immunization supply chain and management performance system in Pakistan

Altaf¹,

Siddiqui²,

Ashfaq³

et al. 2021

J Glob Health

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Background Pakistan has been experiencing several immunization related challenges. The supply chain management information system (MIS) is considered an important component of immunization services as it can improve visibility in key areas such as vaccine shortages or wastage. This study assessed the effectiveness of the Visibility and Analytics Network (VAN) approach in improving vaccine supply and availability of stocks by comparing the situation in intervention and non-intervention districts in Sindh province of Pakistan. Methods We utilized a quantitative and qualitative approach to collect data to assess the VAN approach in two districts of Sindh province in Pakistan. The data were collected between August and October 2017. VAN is a systematic monitoring system which measures the performance of vaccine supply chain management based on a set of indicators. We assessed storage facilities of the Expanded Programme on Immunization (EPI) in Sindh and interviewed personnel involved using a pre-tested data collection tool. We also conducted in depth interviews with senior management to assess performance of VAN, adoption mechanism and needs to scale up the VAN approach. Results We assessed 52 EPI facilities of Sindh province government. In the intervention district 83.3% managers were using MIS data for decision making related to vaccine supplies whereas in the non- intervention district no MIS based data were available. Ninety percent of stores were maintaining a stock registry and 100% supplies matched with requisitions in the intervention district compared to 40% and 35% in the non-intervention district for the same variables. Vaccine wastage was high in the non- intervention district (BCG 46.7% vs 33.9; OPV 13.5% vs 9.5%; pneumococcal 11.4% vs 7.4%). In-depth interview findings suggested that the VAN approach provided data guided monitoring in Pakistan for the first time. The approach also enabled district managers to make timely decisions. Conclusion The VAN approach improves vaccine supply chain management. It should be scaled up and implemented at national or sub national especially in countries struggling with vaccine supply chain management.

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Documentation of vaccine wastage in two different geographic contexts under the universal immunization program in India

Cited by 12 publications

References 13 publications

COVID-19 pandemics Stage II – Energy and environmental impacts of vaccination

COVID-19 pandemics Stage II – Energy and environmental impacts of vaccination

Vaccine wastage at primary, secondary, and tertiary level of healthcare system—A study from Northern India

Visibility and Analytics Network (VAN) approach to improve immunization supply chain and management performance system in Pakistan

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