Friends and Family of Immunization, I hope you will join me over the next six weeks before the TechNet Conference in Portugal to debate important futures for the vaccine supply chain. Each week, I will start a discussion on a topic and ask for your reactions. If you participate, you will also have the chance each week to respond to an online survey, just one or two questions, to express your agreement, interest or despair! The choice of topics is mine, not necessarily shared with any organization or individual. I chose them because they seem to respond to the changing needs of the vaccine cold chain and, collectively, they respond to most of the important challenges and opportunities that are on the horizon. They are:
- Merging vaccine and medicine distribution
- Advancing technologies of cooled-distribution
- Changing vaccines and their administration
- Introducing data-driven, remote oversight
- Addressing safety to maintain acceptance
At the end of these discussions, it may become clear whether collectively we are aligned towards this view of immunization futures or towards a different course. I will present the results of the survey in a summary posted before Technet. We expect to organize an event at the TechNet Conference to give a further chance to discuss these topics with other participants.
Topic one: Merging vaccine and medicine distribution
In the late 1970s, the vaccine supply chain was deliberately separated from other medical distribution systems. It was recognized at that time that vaccines occupied a small storage volume compared to that of medicines. Vaccines were different from medicines. They required special cooled handling procedures, a higher frequency of distribution and more timely arrival of fresh supplies.
Increased need for cooling of medicines
The volume of cooled medicines (+2/8C & +20/25C) is likely to be in the order of twenty times that of vaccines within the next few years. The demand for certain temperature products, such as insulin, is increasing and international standards (EU, US) have recently been established for handling all medicines. This is provoking extensive re-equipping of stores and re-mapping of transport. Ministries of Health are recognizing the economies of merging the distribution of vaccines with pharmaceuticals. WHO expressed the goal of integration in the Global Vaccine Action Plan 2011-2020 (GVAP) and many countries have already moved to integrate specific components of the supply chain.
The volume of cooled medicines (+2/8C & +20/25C) is likely to be in the order of twenty times that of vaccines within the next few years. The demand for certain temperature products, such as insulin, is increasing and international standards (EU, US) have recently been established for handling all medicines. This is provoking extensive re-equipping of stores and re-mapping of transport. Ministries of Health are recognizing the economies of merging the distribution of vaccines with pharmaceuticals. WHO expressed the goal of integration in the Global Vaccine Action Plan 2011-2020 (GVAP) and many countries have already moved to integrate specific components of the supply chain.
Rationalization of the distribution network
So many countries have now choosen to establish para-statal organizations that handle the distribution of vaccines, medicines and supplies. The process of integrating warehousing and distribution needs for medical products compels Ministries of Health to reconsider the network of intermediate stores linking districts with the central, national store. Instead of 40m3 ready-made, ‘plug-and-play’ cold rooms that are fitted into spare storage spaces, large-scale 5000m3 cold-room facilities are planned for large countries on the basis of efficient use of the road network and optimizing storage sites.
Discussion point #1: Do the existing primary stores and transport infrastructure provide the most efficient network for future distribution of temperature-sensitive medicines and vaccines?
Vaccine volumes now require refrigerated vehicles
Cold boxes or vaccine packaging cooled by ice-packs are typically loaded onto trucks and used for most journeys between stores. Frozen ice-packs increase the risk of freezing in transport and a high level of compliance is needed to reduce the risk. The increased volume of vaccines to be transported is becoming unmanageable. Hundreds of packs are loaded into 25l insulated boxes that occupy six times the storage volume of vaccines to be transported and exceed the capacity of trucks.
Integrated transport by refrigerated vehicle
Refrigerated vehicles are efficient in the use of transportable volume per km. They require less re-packing time and staff resources and most already carry temperature-recording devices that will soon be merged with the monitoring equipment standardized for vaccine refrigerators. In addition, satellite-positioning systems in the trucks will enable LMIS systems to automatically track distribution timeliness and arrival at each delivery point on optimized road circuits.
Refrigerated vehicles will improve the timeliness of the delivery system and will raise the standard of vaccine handling. Refrigerated vehicles are the mode of choice for store-to-store pharmaceutical distribution and will replace passive cooling at central and intermediate stores. Icepack freezing will still remain an important option at the level of service delivery.
Discussion point #2: When planning transport for store-to-store delivery of vaccine, do country managers evaluate the costs and benefits of sharing refrigerated vehicles and integrating with supply of temperature controlled medicines?
Please click this link to complete a short questionnaire:
https://www.surveymonkey.com/r/3F6K5TL
I will return the analysis to you at the end of this week and the results will be posted before TECHNET for all five topics. Thank you!
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