Most of the countries now have improved immunization coverages and reach more children with vaccination, but we still need to monitor the potency of vaccines that are given on top of the high coverages we have achieved in many countries. One of the biggest challenges when we talk about vaccine potency is the storage condition and to be more specific “the storage temperature”. Most of the vaccines are either heat or freeze sensitive and we need to monitor the storage temperatures more closely s...

AWAY WITH THE DOGMA! 1: “Monitoring Closed Vial Wastage”   This is the first Blog in a series to encourage vaccine supply chain planners to consider changes without being constrained by some, dogmatic operational policies of the Expanded Program on Immunization. Taking one issue at a time I shall explain its origin, why it is no longer helpful and suggest alternatives for us to debate.   So please, open the attached file and I look forward to your frank reactions!...

Three years after the freeze-free concept was reported at the September 2014 meeting of the WHO PQS Committee, the current expectation of availability remains ‘sometime next year’ and it appears that no product has passed the pre-qualification (E004/VC02-VP.1) testing yet. The current status of this product was presented at the last Technet Conference by WHO/PQS. During the resulting discussion, I noted five issues that seem to require attention: The outside dimensions and weight of the curr...

Dear viewers Short supply of vaciines requiring multiple doses is one of the causes of accentuating negeative dropout rate, making the indicator invalid for programme review. India introduced two fractional doses of 0.1mL intra-dermal IPV in the National Immunization Schedule (NIS) since April 2016 as an end game strategy of Polio Eradication. It is supplied as multi dose vial of 50 doses per vial [0.1mL per dose – 5mL vial] & 25 doses [0.1mL per dose – 2.5mL]. From the first experiences of t...

Dear viewers - sharing the following for needful Universally it is very well known that vaccination is one of the most cost effective public health programme from control to eradication of Vaccine Preventable diseases. Public sector is provided with proper cold chain equipments, periodic training blended with monitoring & supportive supervision. National Immunization Schedule (NIS) is expanding; included IPV, Rota, MR, JE and Pneumococcal is the next candidate vaccine. Vaccines of NIS have Vac...

Dear viewers - Please find the following and the attached illustration for a critical review and needful. Background: CCH Mrs Anitha Beth and Asst CCH Mr Mukesh could not believe when the author shared his observations that the “T” series vaccines were found in “Frozen” condition at the session site far off from the ILR point. Temperature record book never showed subzero recording on any day. CCH had to distribute vaccines to ~50 session sites on Thursdays and ~30 session sites on Saturdays. I...

Vaccines can tolerate temperatures above 8 deg C however temperatures below 0 deg C will freeze a vaccine and it will lose it’s efficacy. At temperatures above 8 deg C the life of a vaccine will be lowered but the exposure will not be catastrophic. For the most sensitive vaccine, VVM II, the life of the vaccine will decrease from 104 days to 99 days when exposed to 20 deg C conditions for one day. For a VVM7 vaccine exposed to the same one day temperature excursion the life of the vaccine will d...

Does anyone have experience with vaccine passive storage devices in the field? We are piloting the PQS pre-qualified Arktek device in three rural health centers. By design, the device maintains a temperature range between 0°C and 10°C which will not freeze the vaccines so should not pose any risk to the potency of the vaccines. We are seeing some unease from health workers and EPI managers, though, who are concerned that vaccines would be out of the 2°C – 8°C range and at risk of freezing, even ...

Knowing the problem of vaccines being frozen because of too cold ice-packs. What about freezers that does not get colder that minus 5'C...

For your reading pleasure (and viewing since there is a 1 minute video)...

Most ice-lined refrigerators in India are fully functional at 5 - 45 degrees Celsius (ie, they are able to maintain an internal temperature of 2-8 degrees Celsius when the external temperatures are between 5 and 45 degrees Celsius). Some states of India have an extremely cold climate during winters (for example, the areas of Jammu and Kashmir, Uttarakhand, Sikkim that are in the Himalayas) and so they are prone to high rates of vaccine freezing. I am sure this is a problem experienced by progra...

The WHO UNICEF immunization Supply Chain Hub (iSC Hub)has released a new temperature monitoring website hosted on TechNet-21. A stringent system for temperature surveillance is essential to maintain the quality of the vaccines in an effective Supply Chain. By preventing vaccine exposure to freezing or hot temperatures in the cold chain, a functioning temperature monitoring system helps ensuring vaccine potency, avoiding both wasting vaccine investments (notably through reducing closed vial wast...

Dose per Container Partnership (DPCP) The issue: Multi-dose containers are used to offer lower prices, higher supply volumes, and minimize cold chain storage and distribution requirements. As new, more expensive, vaccines are introduced in multi-dose presentations, maximizing the use of every dose in a container increases in importance. HCWs need to be more strategic about when to open a container; diligent about how they care for open containers, and potentially more active with communication ...

A recent article on vaccine wastage from the International Journal of Community Medicine and Public Health http://www.ijcmph.com/?mno=214575 Abstract Background: India released its first National Vaccine Policy in 2011. The country is presently developing new strategies to increase immunization coverage and reach more children with quality vaccine. High vaccine wastage increase vaccine demand and inflate overall program cost. Methods: This was records based descriptive study carried out at...

Immunization outreach services depend on a protective, affordable and efficient supply chain to benefit rather than obstruct outreach operations. Four potential cold-chain solutions are on offer but each has barriers to be negotiated or removed. The options are: Frozen water packs BUT we should switch to freeze-free vaccine carriers to avoid the risk of freezing: Vaccines certified for use in a ‘Controlled Temperature Chain’: PCM-filled packs used in all existing carriers and boxes prevent ...

Potency of vaccine at the time of administration to the beneficiaries is of utmost importance in preventing morbidity and mortality due to vaccine preventable diseases. Evolution of more and more vaccines against crippling and lethal diseases has made vaccination the most cost-effective and important strategy from control to eradication. Domestic refrigerators with horizontally opening vertical door is not recommended by WHO for keeping vaccines for certain reasons leading to excess“temperatu...

“Apps” (computer software applications) are being developed and used as tools to help manage the vaccines and medicines supply chain more and more. But are they directed at challenges that have persisted the longest and would have the greatest impact if resolved? Take, for example, the following two challenges; do you recognise them? Do you agree that they need to be addressed or do you believe that they have been addressed in your country (ies) and that other should be chosen? Challenge 1: ...

The budget impact of controlling wastage with smaller vials: A data driven model of session sizes in Bangladesh, India (Uttar Pradesh), Mozambique, and Uganda. W Yang, M Parisi, B Lahue, J Uddin, D Bishai - Vaccine, 2014 Link to full Article. http://www.sciencedirect.com/science/article/pii/S0264410X14013358 Highlights This model was the first of its kind to generate wastage rates as an output based on country-level micro data collected at different types of clinics in the field. A d...