Health system cost of delivering routine vaccination in low- and lower-middle income countries: what is needed over the next decade?

Lydon, Patrick; Gandhi, Gian; Vandelaer, Jos; Okwo‐Bele, Jean‐Marie

doi:10.2471/blt.13.130146

Cited by 39 publications

(40 citation statements)

References 8 publications

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“…After entering a country, vaccine vials typically travel by road through two to four storage locations before arriving at clinics where health workers administer doses to patients [1]. Non-vaccine costs of routine immunization systems are expected to rise by 80% between 2010 and 2020, with more than one-third of these costs attributable to supply chain logistics [2]. Supply chain bottlenecks and inefficiencies can cause vaccines to spoil and valuable resources to be wasted before vaccines reach the people who need them, suggesting a need for innovative and lower cost methods for distribution.…”

Section: Introductionmentioning

confidence: 99%

The economic and operational value of using drones to transport vaccines

Haidari

Brown

Ferguson

et al. 2016

Vaccine

219

124

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Background Immunization programs in low and middle income countries (LMICs) face numerous challenges in getting life-saving vaccines to the people who need them. As unmanned aerial vehicle (UAV) technology has progressed in recent years, potential use cases for UAVs have proliferated due to their ability to traverse difficult terrains, reduce labor, and replace fleets of vehicles that require costly maintenance. Methods Using a HERMES-generated simulation model, we performed sensitivity analyses to assess the impact of using an unmanned aerial system (UAS) for routine vaccine distribution under a range of circumstances reflecting variations in geography, population, road conditions, and vaccine schedules. We also identified the UAV payload and UAS costs necessary for a UAS to be favorable over a traditional multi-tiered land transport system (TMLTS). Results Implementing the UAS in the baseline scenario improved vaccine availability (96% versus 94%) and produced logistics cost savings of $0.08 per dose administered as compared to the TMLTS. The UAS maintained cost savings in all sensitivity analyses, ranging from $0.05 to $0.21 per dose administered. The minimum UAV payloads necessary to achieve cost savings over the TMLTS, for the various vaccine schedules and UAS costs and lifetimes tested, were substantially smaller (up to 0.40 L) than the currently assumed UAV payload of 1.5 L. Similarly, the maximum UAS costs that could achieve savings over the TMLTS were greater than the currently assumed costs under realistic flight conditions. Conclusion Implementing a UAS could increase vaccine availability and decrease costs in a wide range of settings and circumstances if the drones are used frequently enough to overcome the capital costs of installing and maintaining the system. Our computational model showed that major drivers of costs savings from using UAS are road speed of traditional land vehicles, the number of people needing to be vaccinated, and the distance that needs to be traveled.

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Section: Introductionmentioning

confidence: 99%

The economic and operational value of using drones to transport vaccines

Haidari

Brown

Ferguson

et al. 2016

Vaccine

219

124

View full text Add to dashboard Cite

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“…Healthcare provider, waste disposal, vaccine transportation, cold-chain and vaccine wastage all contribute to the cost of vaccination [29, 30]. While vaccine manufacturers often sell vaccine at significantly reduced cost for use in developing countries, the logistical costs to vaccinate can remain a significant barrier.…”

Section: Barriers To Vaccination In Developing Countriesmentioning

confidence: 99%

Microneedle patches for vaccination in developing countries

Arya

Prausnitz

2016

Journal of Controlled Release

171

148

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Millions of people die of infectious diseases each year, mostly in developing countries, which could largely be prevented by the use of vaccines. While immunization rates have risen since the introduction of the Expanded Program on Immunization (EPI), there remain major challenges to more effective vaccination in developing countries. As a possible solution, microneedle patches containing an array of micron-sized needles on an adhesive backing have been developed to be used for vaccine delivery to the skin. These microneedle patches can be easily and painlessly applied by pressing against the skin and, in some designs, do not leave behind sharps waste. The patches are single-dose, do not require reconstitution, are easy to administer, have reduced size to simplify storage, transportation and waste disposal, and offer the possibility of improved vaccine immunogenicity, dose sparing and thermostability. This review summarizes vaccination challenges in developing countries and discusses advantages that microneedle patches offer for vaccination to address these challenges. We conclude that microneedle patches offer a powerful new technology that can enable more effective vaccination in developing countries.

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“…One study estimated that cold chain equipment and overhead costs would account for 23% of the $25.4 billion needed for non-vaccine immunization program costs for low-and lower-middle-income countries from 2011 to 2020. 29 Some vaccines may have thermostability that allows them to be managed outside the cold chain for limited periods of time. For example, a major reason for the successful MenAfri-Vac campaigns in Africa was the relaxation of the cold chain requirements in a number of countries for the last miles of delivery.…”

Section: Low-and Middle-income Countriesmentioning

confidence: 99%