Frequency of vaccine wastage causes

You are undertaking a very valuable study. Vaccine wastage rates can be HUGE - up to 80% in some cases - and any work to reduce this could have a big impact on immunization coverage - to say nothing about the reduced cost. In case you haven't already seen this, you could start your research on TechNet21. Back in October last year there was some correspondence on this topic: http://www.technet21.org/index.php/forum/technet21/vaccine-presentation-packaging-and-wastage/1919-vaccine-wastage.html You could start by contacting the people who responded to this post through TechNet21. Another source is PATH.org that has done many studies on vaccine freezing in the cold chain and were the first organization to document the huge potential loss of vaccine due to freezing. Best of luck. Please share your result with us as they emerge - the immunization world needs them!

This link should work: http://www.technet21.org/index.php/forum/technet21/vaccine-presentation-packaging-and-wastage/1919-vaccine-wastage.html

James and Christian, thank you for your responses! Christian--have you looked at the Vaccine (2002) paper "Frequency and causes of vaccine wastage" (http://www.ncbi.nlm.nih.gov/pubmed/11803076)? It is a bit dated with data coming from 1998 and 1999, but it is the only substantial one that I have found on vaccine wastage in the US. The paper includes temperature related concerns as well as a more comprehensive overview of wastage causes. Even if this particular paper is not helpful, you might look into more recent ones that have cited it. On another note, does anyone know how significant vial/packaging breakage or theft is in contributing to vaccine wastage? I haven't found much information on those two potential causes for wastage. As always, your feedback is greatly appreciated--keep them coming!

Carla, This is indeed an interesting topic. and the answer is not trivial. The problem is that closed vial wastage is hardly ever reported separately, because there is often an element of neglect or error involved, and people would rather not report on their errors. It thus becomes hard to determine what percentage of wastage would be caused by, say, vaccine expiry, VVM exposure or freezing. But in some cases, total wastage is available (as the difference between used vaccine and the reported number of administered doses). The question now is: what part of this total wastage is attributable to closed vial wastage versus open vial wastage. The latter is a more acceptable kind of wastage as it is not caused by a weak supply chain or weak vaccine management practices, but is a direct consequence of the presentation of a vaccine in multi dose vials. Maybe the answer to that question can be found by looking at differences in wastage rates between single dose vial vaccines and multi dose vial vaccines. A study by Parmar et al (http://www.ncbi.nlm.nih.gov/pubmed/20009517/) looked at reported wastage rates in 19 GAVI countries and found 5% median (total) wastage rate for single dose vials and 10% for 10-dose vials. The 10% is questionable, in my opinion, but the 5% may be reasonable estimate for closed-vial wastage? There are several caveats: - Administered doses may be over-reported, which would make actual wastage higher - The study only used the 19 countries that were able to report wastage, out of 72 GAVI countries. That may have introduced a bias as these countries may have better systems and management in the first place, - Some kinds of wastage (especially freezing) may go undetected, and end up being administered. All of these would push actual wastage rates up, so in conclusion, 5% closed-vial (avoidable) wastage may be a lower limit. Jan

The Association of Immunization Managers (AIM) conducted a study on characterization of vaccine waste resulting from storage failures, July through September 2009. Contact Helen Fox Fields at AIM [email protected]. The CDC is very interested in information on vaccine wastage at the provider level in order to make recommendations and provide better guidance on prevention. Please share your information with me.