POST 00473E : VACCINE WASTAGE
Follow up on Posts 00311, 00316, 00320, 00324, 00345, 00349, 00404E and 00462E
11 July 2002
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Dr. Sobhan Sarkar (mailto:[log in to unmask]) from the Department of
Family Welfare of India and Mr. Elly Tumwine Rweizire
(mailto:[log in to unmask]) from EPI Uganda are both making a contribution
to the discussion on vaccine wastage
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The issue of vaccine wastage needs to be looked at on the basis of
micro-planning. Currently available vaccines are in multi-dose vials. Worst
is that of BCG which is 20 dose ampules or vial. In an outreach session
there may not be more than 3-4 children for BCG vaccination resulting in high
wastage rate. Each outreach session has to be given at least one vial of
each antigen or multiple vials and thus there would be high wastage. Say
for 12 doses of DPT we would need to issue 2 vials of 10 doses resulting in
wastage of 8 doses i.e. 4 doses per 10 doses. Therefore, before we take a
stand we need to look at the specific situation.
S. Sarkar
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TACKLING THE "MONSTER" VACCINE WASTAGE.
The burning question "how to reduce vaccine wastage?" is still relevant.
Tracking vaccine wastage is in its infancy stages in Uganda. The rates on
paper are still debatable. But we have started the process to get to actual
numbers.
I quite agree with Bob Davis that calculating vaccine wastage annually on a
national basis is a "post mortem" and too late to take corrective measures.
Unfortunately that's what many of us have done for a long time. The health
worker at unit level appreciates the need to track vaccine wastage where it
has been explained but there is still inadequate commitment to put the
results on paper. Some still believe it is a tool that will be used to
monitor their performance. (Would high vaccine wastage not be taken for not
doing a good job?).
The issues that I want bring forward are as follows:
· MDVP one of the most recently introduced concepts on management of
vaccine wastage, has now been reduced to OPV and TT (for us who used OPV,
TT, BCG, Measles and DPT), as we have gone into DPT-HepB+Hib with dry
freeze Hib and therefore DPT falls off.
· While it is true that the 2-dose vial should register a very small
vaccine wastage (5% as suggested), tackling reduction of Drop-Out Rate and
missed opportunities has warranted increased session frequency. This
tremendously reduces session size and chances of wasting one dose per
session cannot be ruled out. We are yet to establish what the actual
wastage will be for DPT-HepB+Hib. However it is still enormous for Measles
(10 dose vials) and BCG (20 dose vials).
It is still a long way to dream of running away from outreach session
strategy. This still accounts for more that 40% of expected coverage in our
country. This also does not favour MDVP under the circumstance where
guaranteeing non-contamination plays a main role. We have tried to move the
service delivery points closer to community. But the closer we move, the
more it appears that we are not near enough, resulting in a drop in coverage.
Thanks for the formulae for vaccine wastage. These will be helpful in our
tracking process.
Elly
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