The benefits of redesigning Benin's vaccine supply chain

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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“…Formulas for each cost component are detailed in a previous publication [7]. We measured the following indicators of supply chain performance:…”

Section: Resultsmentioning

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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“…Logistics costs included storage (storage equipment maintenance, energy, and amortization), transport (driver per diems and vehicle maintenance, fuel/electricity, and amortization), buildings (infrastructure overhead and amortization at storage and immunization locations), and labor (personnel wages for time dedicated to supply chain logistics) and are defined in detail in a previous publication [11]. …”

Section: Methodsmentioning

confidence: 99%

The economic and operational value of using drones to transport vaccines

Haidari

Brown

Ferguson

et al. 2016

Vaccine

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235

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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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“…Our team used our previously described HERMES (Highly Extensible Resource for Modeling Event-Driven Supply Chains) software to construct and run detailed discrete-event simulation models of the Expanded Program on Immunization (EPI) and Universal Immunization Program (UIP) supply chains (representing all vaccines, storage and immunization locations, storage devices, vehicles, ordering and shipping policies and processes, and associated costs) for the Republic of Benin[4, 5] (4 levels: 1 national store, 7 region/department stores, 80 communes, 763 health posts); the state of Bihar, India[5] (4 levels: 1 state store, 7 division stores, 13 of 38 district stores, 161 of 533 PHCs); and Niger[1, 3, 6, 7] (4 levels: 1 national store, 7 regional stores, 42 districts, 644 integrated health centers).…”

Section: Methodsmentioning

confidence: 99%

Economic impact of thermostable vaccines

Lee

Wedlock

Haidari

et al. 2017

Vaccine

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Background While our previous work has shown that replacing existing vaccines with thermostable vaccines can relieve bottlenecks in vaccine supply chains and thus increase vaccine availability, the question remains whether this benefit would outweigh the additional cost of thermostable formulations. Methods Using HERMES simulation models of the vaccine supply chains for the Republic of Benin, the state of Bihar (India), and Niger, we simulated replacing different existing vaccines with thermostable formulations and determined the resulting clinical and economic impact. Costs measured included the costs of vaccines, logistics, and disease outcomes averted. Results Replacing a particular vaccine with a thermostable version yielded cost savings in many cases even when charging a price premium (two or three times the current vaccine price). For example, replacing the current pentavalent vaccine with a thermostable version without increasing the vaccine price saved from $366 to $10,945 per 100 members of the vaccine’s target population. Doubling the vaccine price still resulted in cost savings that ranged from $300 to $10,706, and tripling the vaccine price resulted in cost savings from $234 to $10,468. As another example, a thermostable rotavirus vaccine (RV) at its current (year) price saved between $131 and $1,065. Doubling and tripling the thermostable rotavirus price resulted in cost savings ranging from $102 to $936 and $73 to $808, respectively. Switching to thermostable formulations was highly cost-effective or cost-effective in most scenarios explored. Conclusion Medical cost and productivity savings could outweigh even significant price premiums charged for thermostable formulations of vaccines, providing support for their use.

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The benefits of redesigning Benin's vaccine supply chain

Cited by 81 publications

References 15 publications

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

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

The economic and operational value of using drones to transport vaccines

Economic impact of thermostable vaccines

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