Landscaping the structures of GAVI country vaccine supply chains and testing the effects of radical redesign

Lee, Bruce Y.; Connor, Diana L.; Wateska, Angela R.; Norman, Bryan A.; Rajgopal, Jayant; Cakouros, Brigid E.; Chen, Sheng I.; Claypool, Erin; Haidari, Leila A.; Karir, Veena; Leonard, Jim; Mueller, Leslie E.; Paul, Proma; Schmitz, Michelle; Welling, Joel; Weng, Yu Ting; Brown, Shawn T.

doi:10.1016/j.vaccine.2015.07.033

Cited by 35 publications

(31 citation statements)

References 13 publications

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“…This is partly due to a lack of coordination between the multiple supply chain levels that each have their own stockpiles. In the epidemiological literature, numerous studies have examined this coordination and the redesign of the supply chain (Assi et al, 2013;Brown et al, 2014;Lee et al, 2015a). However, this topic has not been considered yet within the OR/OM community.…”

Section: Discussionmentioning

confidence: 99%

“…Many of these studies use a similar approach in which a simulation model is developed for a specific country, for example, using HERMES software (highly extensible resource for modeling supply chains) (e.g., Haidari et al, 2013;Assi et al, 2012Assi et al, , 2013. A common conclusion is that removing levels can reduce supply chain costs and increase vaccine availability (e.g., Assi et al, 2013;Brown et al, 2014;Lee et al, 2015a).…”

Section: Accepted M Manuscriptmentioning

confidence: 99%

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Literature review: The vaccine supply chain

Duijzer

Jaarsveld

Dekker

2018

European Journal of Operational Research

182

146

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Vaccination is one of the most effective ways to prevent and/or control the outbreak of infectious diseases. This medical intervention also brings about many logistical questions. In the past years, the Operations Research/Operations Management community has shown a growing interest in the logistical aspects of vaccination. However, publications on vaccine logistics often focus on one specific logistical aspect. A broader framework is needed so that open research questions can be identified more easily and contributions are not overlooked. In this literature review, we combine the priorities of the World Health Organization for creating a flexible and robust vaccine supply chain with an Operations Research/Operations Management supply chain perspective. We propose a classification for the literature on vaccine logistics to structure this relatively new field, and identify promising research directions. We classify the literature into the following four components: (1) product, (2) production, (3) allocation, and (4) distribution. Within the supply chain classification, we analyze the decision problems for existing outbreaks versus sudden outbreaks and developing countries versus developed countries. We identify unique characteristics of the vaccine supply chain: high uncertainty in both supply and demand; misalignment of objectives and decentralized decision making between supplier, public health organization and end customer; complex political decisions concerning allocation and the crucial importance of deciding and acting in time.

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Section: Discussionmentioning

confidence: 99%

Section: Accepted M Manuscriptmentioning

confidence: 99%

Literature review: The vaccine supply chain

Duijzer

Jaarsveld

Dekker

2018

European Journal of Operational Research

182

146

View full text Add to dashboard Cite

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“…A HERMES-generated model tracks each vial as it moves through the system to be shipped, stored, and ultimately used or wasted. Previous publications describe HERMES in detail [6–10]. …”

Section: Methodsmentioning

confidence: 99%

Re-designing the Mozambique vaccine supply chain to improve access to vaccines

Lee

Haidari

Prosser

et al. 2016

Vaccine

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Introduction Populations and routine childhood vaccine regimens have changed substantially since supply chains were designed in the 1980s, and introducing new vaccines during the “Decade of Vaccine” may exacerbate existing bottlenecks, further inhibiting the flow of all vaccines. Methods Working with the Mozambique Ministry of Health, our team implemented a new process that integrated HERMES computational simulation modeling and on-the-ground implementers to evaluate and improve the Mozambique vaccine supply chain using a system-re-design that integrated new supply chain structures, information technology, equipment, personnel, and policies. Results The alternative system design raised vaccine availability (from 66% to 93% in Gaza; from 76% to 84% in Cabo Delgado) and reduced the logistics cost per dose administered (from $0.53 to $0.32 in Gaza; from $0.38 to $0.24 in Cabo Delgado) as compared to the multi-tiered system under the current EPI. The alternative system also produced higher availability at lower costs after new vaccine introductions. Since reviewing scenarios modeling deliveries every two months in the north of Gaza, the provincial directorate has decided to pilot this approach diverging from decades of policies dictating monthly deliveries. Discussion Re-design improved not only supply chain efficacy but also efficiency, important since resources to deliver vaccines are limited. The Mozambique experience and process can serve as a model for other countries during the Decade of Vaccines. For the Decade of Vaccines, getting vaccines at affordable prices to the market is not enough. Vaccines must reach the population to be successful.

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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].…”

Section: Introductionmentioning

confidence: 99%

The economic and operational value of using drones to transport vaccines

Haidari

Brown

Ferguson

et al. 2016

Vaccine

Self Cite

235

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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Landscaping the structures of GAVI country vaccine supply chains and testing the effects of radical redesign

Abstract: A standard four-tier design template may have been followed for most countries and raises the possibility that simpler and more tailored designs may be warranted.

Cited by 35 publications

References 13 publications

Literature review: The vaccine supply chain

Literature review: The vaccine supply chain

Re-designing the Mozambique vaccine supply chain to improve access to vaccines

The economic and operational value of using drones to transport vaccines

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