Vaccine wastage rates

Vaccine wastage is an academic exercise unless we go in for mono dose vials/pre-filled syringes. I have seen countless instances of children being turned away unimmunised from immunisation clinics in 1990s just because enough chidren were not avaible to open a multidose vial. Even now, the immunisation gets delayed to aviod vaccine wastage. Whenever information on vaccine wastage is asked for, health workers feel threatned that they will be held acountable for opening a vial for say 3-4 children. In remote hamlets, we can't have more than 3 children in an outreach immunisation camp. Thus concern about vaccine wastage becomes a strong barrier to universal coverage and access. Vaccine wastage is not criminal- it is rather criminal to not vaccinate a single child who has turned up for immunisation.-- Dr RK Sood District AIDS Project Officer Kangra # 402 C ZH Dharamshala, District Kangra Himachal Pradesh, India Mobile: +91 9418064077 Telefax: +91 1892- 225559 [[email protected]][email protected][/email]

I suggest that we talk about Vaccine Usage. The number of vials used to immunize all the children. We had looked at this issue with respect to some areas of our district. It is obvious that big institutions and areas with high population and high birth rates use less vials. As density drops, distance increases or birth rates drop the use is lower and smaller dose forms are needed. Reach every child with good quality vaccine should be our main motto. Centralized and extremely uniform rules will not work well in areas with wide geographic and demographic differences. Prabir PS- my views are entirely personal and should not be attributed to anyone else Planning-Immunization-in-U-Dinajpur.xls

Dear Friends, The contradictions in having a policy of introducing newer vaccines like Pentavalent in India at a cost 10 times higher than basic vaccine available now and reducing vaccine wastage despite leaving some children unvaccinated by not opening multidose vial need to be addressed in a situation when we all know that the vaccine coverage in India have declined over the years and would keep

This debate of multi dose vial v/s single dose is unending as there are many associated issues like cold chain space and cost etc. One practical solution is use of multi-dose vials with good planning and proper supervision. Unfortunately both are often missing. In field where motivation and commitment is missing, excessive wastage will remain an issue. These are my personal views. With warm regards Dr Naresh Goel Chief Medical Officer, CGHSMinistry of Health and Family Welfare Government of India Let us work together for 100% immunization against all VPDs

Dear Friends, If India can afford the Hep B and HiB, we can definitely afford the monodose prefilled syringes. The added advantages of injection safety and no wastage, more than compensate for the cost. The commitment is most seen in Bihar, where work conditions are poor and ANMs don't get salary for months together, but still they carry on their work and don't go on strikes. In my research work in Himachal Pradesh (a hill state with sparse population density), I have found that child having returned unimmunised due to not enough children turning up at imm. camp was major factor responsible for delay in immunisation. Wastage is a non issue. The issue is making the essential life-saving 6 EPI vaccines accessible and available. The credibility of imm. camp is lost if I would be turned away as a client, due to no fault of mine that enough children are not there to open a vial. If we can afford this, there is no point in new vaccine introduction. Vaccine requirement has to worked out session-wise and not children-wise (especially in sparse population settings). Mathematical formula applcation without micro-level plans will give a wrong impression of wastage. -- Dr RK Sood, Epidemiologist District AIDS Project Officer Kangra # 402 C ZH Dharamshala, District Kangra Himachal Pradesh, India Mobile: +91 9418064077 Telefax: +91 1892- 225559 [email protected]