POST 00681E : VACCINE WASTAGE
Follow-up on Post 00620E and all postings on Vaccine Forecast
28 May 2004
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Ãœmit Kartoglu (mailto:
[email protected]) from WHO clarifies some points on
vaccine wastage in relation with the document he authored on the subject
and comments from the discussion on vaccine forecast.
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Being the author of the mentioned "monitoring vaccine wastage at country
level: Guidelines for programme managers (WHO/V&B/03.18)" I would like to
make the following comments on the discussion:
1. The above mentioned manual is not a job aid that gives prescribed action
points. It is designed in a way that discusses vaccine wastage in detail to
provide a comprehensive information on reasons and approaches to reduce or
eliminate it. It also explains simple and advanced vaccine wastage
calculations and proposes a sentinel site surveillance for monitoring of
vaccine wastage at the country level. Section 8 (pages 43 to 45) is the
summary that can be referred for easy reference. The manual brings the
following new points that were never considered before in wastage calculations:
- Vaccine wastage at store levels
- Concept of wastage in opened and unopened vials.
- Calculation of wastage factor as a multiplication factor of wastage rates
calculated both from the field and vaccine stores
- Analyzing vaccine wastage rates against immunization performance.
- Sentinel site vaccine wastage surveillance.
2. "Vaccine usage rate" has more positive spin compared to vaccine wastage.
In general "wastage" as a concept is not appreciated by many and especially
by politicians. It would be critical in many settings to speak with the
usage rates.
3. Of course, the easiest way to calculate vaccine wastage factor is
dividing the number of doses used by the number of doses administered. But
this formula does NOT take into account the number of doses wasted at the
storage facilities and during in-country transport. Experience shows that
vaccine wastage at storage facilities is high and should NOT be ignored.
In addition, calculating "number of doses used" is not an easy task if you
are receiving reports from each and every immunization facility in your
country. Number of doses used includes doses used for immunization and all
doses discarded or lost for any reason (including expiry, VVM indication,
cold chain failure, freezing, missing inventory or routine discard of open
vials of vaccine at the end of a session). To do this each immunization
point should report on their start balance, number of doses received and
end balance so number of doses used can be calculated easily (which is not
the case in many countries).
4. Oleg is right, if number of doses administered corresponds only to DTP3,
all doses given as DTP1 and DTP2 will be counted as "wasted". If all doses
given are not included in the formula, the country may end up ordering
unnecessarily high number of doses. This is clearly described in the above
mentioned manual (see page 16 footnote 11).
5. Unless wastage is studied in detail as described in the manual, measures
to reduce or eliminate it cannot be introduced. With the usual formulas as
indicated in previous postings, the country can only have a wastage factor
for the sake of inclusion in vaccine forecast. This vaccine wastage factor
will not be sufficient to decide what measures should be introduced to
reduce the wastage. The manual was prepared in order to assist countries to
reduce wastage.
Thanks and cheers,
Umit Kartoglu
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