POST 00217 : FAST CHAIN + CC DOCUMENTS

Post0217 FAST CHAIN + CC DOCUMENTS 17 January 2000 CONTENTS 1. FAST CHAIN, TECHNET'99 DISCUSSSIONS AND A NEW DOCUMENT 2. COLD CHAIN DOCUMENTS POSTED TO WHO WEBSITE 1. FAST CHAIN, TECHNET'99 DISCUSSSIONS AND A NEW DOCUMENT Hans Everts, WHO/V&B, responds to the Technet'99 Sub-Group on the Fast Chain draft recommendations. [A version of which is posted below] Allan Bass, TECHNET Forum, comments on his understanding of the Fast Chain discussions discussions at the plenary session and raises some additional matters. [The reply from Hans will be posted tomorrow.] While we are all sorry that the oral polio vaccine crisis forced Hans, among others, to miss the Technet'99 consultations, we have the continuing opportunity to complete these important discussions on the TECHNET Forum. A new DRAFT document: "Making use of VVMs: Flexible Vaccine Management for NIDS, SNIDs, and Mop-ups is available for download. Got to the website: ftp://ftp.acithn.uq.edu.au/Technet/1-ClickHereForTECHNETfiles/Coldchain/ and click on the file: Fastchain-Jan2000.PDF or get the file by by email to: [[email protected]][email protected][/email] with the message: get technet Fastchain-Jan2000.PDF * Hans requests our early comments, before 31 January 2000, please! Action, comments and additions please: [[email protected]][email protected][/email] or use your reply button ___________________________________________________________________________ From: [[email protected]][email protected][/email] Date: Thu, 06 Jan 2000 17:32:49 +0100 To: Subject: Fast chain Apologies for not having been in Harare. The OPV crisis prevented me unfortunately from going. I have read the comments on the fast chain guideline and I must admit that I am a bit confused. First of all, because the people the text [of the Fast Chain document] was shared with in an earlier stage (John LLoyd, Modibo, Michel, Terry, Alaisdair, Robert Steinglass, Mikko) all proposed a number of changes, but were finally quite positive. This is rather different from the conclusion I read from the working group on the fast chain, which is: "The draft in its present form should not be taken any further". This is especially confusing, because a name for a revised version is proposed in the following point in the Technet draft report. Anyway, let me answer a number of comments I received previously and in the Technet report. I agree that ideally we should have a properly updated complete training guideline for VVMs. I also agree that if we would have such a guideline, the 'fast chain' module could be reduced to a few pages. However, in the field I am regularly confronted with a number of problems that require an immediate solution: 1) people who hardly know the VVM 2) people who know the VVM, but at the most use it as passive monitoring tool, rather than for active planning 3) countries that for NIDs continue to built cold chains, that are oversized or badly adapted to the routine 4) large proportions of populations that are still not reached with the cold chain as implicit or explicit excuse We have less than 1 year to eradicate polio. We need something right now for the countries. Perhaps it can be regretted that we move from the specific to the general rather than starting with a general guideline, followed by a targeted supplement. However, I believe that the only inconvenience is that we will eventually end up with 2 guidelines that will partly overlap. I do not think that is confusing and I think the inconvenience is worth the price for being able to print something next week, rather that by the end of 2000. I could add another argument. We have all encountered resistance in countries to improve their campaign planning, which is often too 'traditional', and through which large parts of the population are still missed. It will take considerable time to change long established 'dogma'. Is it not possible that by pushing the VVM use at this stage specifically for polio, it will become easier to introduce it at more general level? People are during polio NIDs directly confronted with the limitations of the cold chain and the VVM offers them a specific operational and very practical solution. Is it not possible that by providing a practical specific solution for a practical specific problem people will easier learn the general issue, that when we would ask them to study a general guideline and apply it to a specific problem? In particular, because we will only have VVMs on other vaccines in 1 or 2 years. I agree that a general guideline should be ready by then, but I do not think it is appropriate to teach people about VVM use for vaccines that are not yet equipped with them, and not provide them a practical solution for problems they are immediately confronted with. I agree that the 'fast chain' concept was confusing in the text and the title and that fast chain and VVM were mixed. I do not think the fast chain concept should be dropped completely, but I have disentangled it from the VVM. The added cold chain calculation was appreciated during several workshops, especially because it follows, or tries to follow, a logical step-by-step explanation, rather than an automatic spread sheet approach. I hope to create an understanding of the process after which people can make their spread sheets on basis of their specific conditions, but maybe I am wrong and naive there. I hope the attached version answers a number of concerns expressed by John, Terry, Alaisdair and Robert. Comments are welcome. I hope to send the document this month to the printer. Regards --- Subject: Re: Fast chain Author: Allan Bass Date: 7-Jan-2000 10:44 Dear Hans, First- My best wishes for the New Century! I hope that you had a good X-Mass/NYE. Yes, we very much missed you at Harare - large parts of the discussion were much poorer without you. We heard about the OPV shortage! Bad timing... And WHO announced that it is US$1,000,000,000 short for this year's polio eradication activities.... * My understanding from the plenary discussions was that fast chain should be seen in the context of all of our other Cold Chain Guidance, and that there was a desire to have easy to use planning tools/worksheets. I did not think it was negative - but - the concern over the effect of the targeted polio strategies on the sustainability of the routine PHC & EPI was evident. ** On other matters: You had planned to have the new PIS at the printers in December 1999. Is that done? I hope not - we did not discuss the need for mandatory low temperature protection - specifically 0'C cutouts. Soren Spanner has posted something on that last week. I join him in feeling that this is an urgent matter. regards, allan ___________________________________________________________________________ FACSIMILE WORLD HEALTH ORGANIZATION VACCTNES AND BIOLOGICALS CH - 1211 GENEVA 27 - SWITZERLAND Tel: 41(22) 791441.8791441.8 FACSIMILE: 41 (22) 7914193 FACSIMILE. 41 (22) 7910746 Internet address: [[email protected]][email protected][/email] --- Page 1 of 4 pages Date, 7 January 2000 From- Mr Hans Everts To: Mr Allan Bass University of Queensland, Medical School, Brisbane, QLD TEXT Dear Allan. As promised in my e-mail, these are the copies of the recommendations. Apparently there are several versions in circulation. I am not sure which is the final one. Regards Hans Everts --- DRAFT 7112199 Discussion of working group on "Fast Chain", lunch 7/12 (note: prepared before "VVM Update" presentation 8/12) The group feels that: 1 . First priority must be given to ensuring good understanding and use of VVMs for better and more flexible management of vaccine (at present, OPV) distribution for both NIDs and routine immunization. 2. Combining the "fast chain" concept with VVM guidelines for NIDs, as in the WHO/HQ draft 'Fast Chain for NIDS" paper, is not helpful and has caused confusion. . The draft, in its present form should not be taken further. 3. A suitable working title for a revised paper could be. 'Making good use of VVMS: Flexibility in managing vaccines for NIDs and routine immunization". It should provide concise guidance for managers/supervisors. 4.1 Based on field observations since the last Technet, attention (still) needs to be paid to training on VVMs, (including training of new staff as soon as they are posted), to management and supervision issues related to use of VVMs, to recording of VVM status on receipt and despatch of vaccine, and to evaluation of results of training. 5. Lessons learned from the introduction of OPV VVMs since 1996, in particular the apparent failure of "cascade" training in many places and the lack of attention to management issues, must be very carefully considered in planning the introduction of VVMs for other vaccines. 6. The development of a vial freezing indicator for DPT/adsorbed vaccines/HepB are a high priority, as are the actions related to Low Temperature Protected refrigerators discussed at Technet 98. 7. These (3,4,5,6) to be pursued as appropriate in Session 4 "VVM Update" discussion, during a further working group meeting lunchtime Wednesday 8/12, and during the subgroup F work on Thursday 9/12. group members: R. Hoseini WHO/SEAR0 M. Dicko WHO/AFRO A. Pbuyan UNICEF India S. Kone WHO Cote d'lvoire T. Hart IT Power India A. Wylie W1.10 Temp. Adviser S. Spanner WHOISEAR0 A. Battersby FBA G. Larsen WHON&BIATT E. Ogden USAID Washington ____________________________________*______________________________________ 2. COLD CHAIN DOCUMENTS POSTED TO WHO WEBSITE New and revised documents have been posted to the WHO V&B Document Centre website: http://www.who.int/gpv-documents/ Action, comments and additions please: [[email protected]][email protected][/email] or use your reply button ___________________________________________________________________________ Subject: cold chain documents posted Author: girardete at whohq6 Date: 22/12/1999 18:28 pls note/advise your front page focal point: 1. New documents posted on doc centre website: 1.1 Quality of the cold chain: WHO-UNICEF policy statement on the use of vaccine vial monitors in immunization services, WHO/V&B/99.18, in English and French 1.2 Safety of injections: WHO-UNICEF joint statement on the use of auto-disable syringes in immunization services, WHO/V&B/99.25, in English. This replaces the former version WHO/EPI/LHIS/97.04 Rev.1. 2. Document removed: Safety of injections: WHO-UNICEF policy statement for mass imm campaigns WHO EPI LHIS 97.04 Rev.l in English, French, Russian. These changes will be included in next monthly update of dox posted. libby ___________________________________________________________________________ Safety of injections: WHO-UNICEF joint statement on the use of auto-disable syringes in immunization services (WHO/V&B/99.25) Electronic copy available as of 22 Dec 1999 Hard copy available as of 20 Jan 2000. PDF 30 K Quality of the cold chain : WHO-UNICEF policy statement on the use of vaccine vial monitors in immunization services (WHO/V&B/99.18) Also available in French. English version: Electronic and hard copies available. French version: Electronic copy available as of 22 Dec 99; hard copy available as of 20 Jan 2000 French PDF 27 K Guidelines for surveillance of congenital rubella syndrome and rubella - field test version, May 1999 (WHO/V&B/99.22) Also available in French. Electronic copy available as of 21 Dec 1999 Hard copies available 10 Jan 2000 PDF 120 K Strategies, policies and practices for immunization of adolescents - A review (WHO/V&B/99.24) Electronic copy available as of 17 Dec 1999 Hard copies available 20 Jan 2000 PDF (212K) Translation: Revisió® ¤e documentos existentes sobre planificaci󮬊realizaciá® y evaluaciá® de estudios clí®©cos sobre vacunas (WHO/V&B/99.09) Electronic copy available as of 17 Dec 1999 Hard copies available 20 Jan 2000 PDF (96K) Translation: Reglamentació® ¤e vacunas: desarrollo en los organismos actuales de reglamentació® ¦armacéµ´ica (WHO/V&B/99.10) Electronic copy available as of 17 Dec 1999 Hard copies available 20 Jan 2000 PDF (93K) Study of donor inputs to vaccine production (WHO/V&B/99.21) Electronic copy available as of 14 Dec 1999 Hard copies available 14 Dec 1999 PDF 78 K Issues relating to the use of BCG in immunization programmes - a discussion document (WHO/V&B/99.23) Electronic copy available as of 14 Dec 1999 Hard copies available approx 10 Jan 2000 PDF 153 K Translation: Test de corr鬡tion entre la pastille de contr?du vaccin et l'activité ¤u vaccin (WHO/V&B/99.11) Electronic copy available as of 14 Dec 1999 Hard copies available approx 10 Jan 2000 PDF 46 K Polio News, Issue 4, June 1999 (Ordering code: WHO/EPI/PN/99.02) Electronic copy available as of 14 Dec 1999 Hard copies available June 1999 PDF 509 K Polio News, Issue 5, September 1999 (Ordering code: WHO/EPI/PN/99.03) Electronic copy available as of 14 Dec 1999 Hard copies available Sept 1999 PDF 274 K Measles Bulletin, Number 1 Electronic copy available as of 14 Dec 1999 Hard copies available Sept 1999 English : PDF 288 French: PDF 237 Translation: Distribution de vitamine A durant les joun饳 nationales de vaccination (WHO/EPI/GEN/98.06) Electronic copy available as of 14 Dec 1999 Hard copies available Oct 1999 PDF 225 K Informal consultation of experts on national regulation of vaccines (WHO/V&B/99.08) Electronic copy available as of 19 Aug 1999 Hard copies available approx 30 Aug 1999 PDF 74 K Review of existing documents on planning, performance and assessment of clinical studies on vaccines (WHO/V&B/99.09) Electronic copy available as of 19 Aug 1999 Hard copies available approx 30 Aug 1999 PDF 116 K Regulation of vaccines: building on existing drug regulatory authorities (WHO/V&B/99.10) Electronic copy available as of 19 Aug 1999 Hard copies available approx 30 Aug 1999 PDF 117 K Report of the First Meeting of Interested Partners to the Health Technology and Pharmaceuticals Cluster, Geneva, 16-19 March 1999 (WHO/V&B/99.16) Electronic copy available as of 19 Aug 1999 Hard copies available approx 30 Aug 1999 ____________________________________*________________________