Hi John:
Thanks for continuing the discussion post-TechNet. Vaccine Utilization rate (VUR) could be a good substitute for closed vial wastage (CVW) as a high-level indicator in systems that rely on simple reporting systems (paper in particular) at the last mile. The challenge with this is that it mixes closed and open vial wastage and prevents disaggregation. I certainly understand the disincentive for the HCW to report wastage.
However, as digital reporting systems penitrate to the last mile, and especially in situations where a vender managed inventory (VMI) system (aka "informed push" or delivery truck top-up system) is used, we can offer pre-dertermined reason codes for any reported CVW, which can mitigate the disincentive. In the VMI scenario, the data are gathered by the delivery person and not the HCW, removing the onous of self-reporting/self-incrimination of CVW at the HF.
We know that CVW has many potential causes, from poor (over) forecasting, to poor storage condidtions, to heat or freeze exposure during transport, to poor inventory management (FEFO). Enabling the HCW to report a reason for the wastage not only lifts some of the onous from the HCW, it also informs decisions about how to address the problem by getting to (or closer to) and addressing root causes of CVW. Also, it's really important to monitor CVW incidents and causes at intermediate storage levels and during transport, since that is indicative of a potentially much larger risk than CVW loss at HF level.
Finally, my preference is to keep CVW distnct from VUR in digital systems since we can then compare reported coverage at each HF with reported SKUs opened/used in order to derive and monitor true OVW on a facility-by-facility basis. This data could then inform optimization of container size for each antigen best suited to each HF's service delivery profile. As barcoding technology also gets adapted and extended to the last mile, all of this becomes not only possible, but essential for enabling iSCs to evolve to greater maturity.
I look forward to reading responses amd seeing where this discussion goes!