POST 00915E : VACCINE WASTAGE
Follow-up on Posts 00889E, 00894E, 00899E, 00906E and 00910E
22 April 2006
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This posting contains three contributions.
The first is from Bibata Pare (mailto:
[email protected]) from Burkina
Faso. The second is from Amir Ansari (mailto:
[email protected]) from
Tajikistan. They both comment on Sridharan’s suggestion of promoting the
use of Uniject®.
And the third is from Anil Varshney (mailto:
[email protected]) from
India, who discusses both Sridharan’s suggestion and Anthony’s
contribution in Post 00906E. He rightly raises the issue of storage space.
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Dear friends,
The idea suggested by Sridharan might be the best solution for reducing
vaccines wastages. It would be excellent indeed, if there could be on the
market single dose packaging, not only for HepB vaccine, but for all EPI
antigens!!!
The paradox however is that presently, many countries are making a lot of
efforts to contribute to financing their own vaccines! Some even managed
to become self-sufficient, with the exception of course for new vaccines!
At what costs then could firms offer "single dose" vaccines to countries
most of which are, let’s not forget, heavily indebted poor countries? If
we could only dream of it!!!
Instead UNICEF and WHO could help countries put in place good vaccine
management systems. WHO has already taken steps in that direction with the
implementation of vaccines management performance tools. Their use though
is seriously challenged by lack of training!
We could certainly reduce system- related wastages, which are undoubtedly
current in many countries and represent at least 70% of all vaccines
wastages!
Mrs. PARE Bibata
Logistics / Burkina Faso
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Dear Sridharan
Thanks for sharing this info. I believe in addition to addressing vaccine
wastage, Uniject® could improve and increase coverage of Hep-B birth dose
especially in countries where home delivery is high due to access and
utilization challenges.
Best regards,
Amir Ansari, MD
Health Section
UNICEF Tajikistan
-----------------------------
Hello,
The vaccine wastage in HBV in Nigeria was expected as the program
management did not look at the DTP 3 coverage which was very low so high
wastages in DTP 3. Hence there will be high wastage in HBV ; also no
efforts to reduce wastages in programme.
The wastage in program could also have been reduced by trainining in
logistics - procurement. When ordering for vaccines most national program
managers order for the 100% coverage, 1.33 as wastage factor and 25 % as
buffer at each storage space which adds to excess stocks losses and wastages.
The stock positions at various depot at PHC, district, regional stores is
hardly taken into account. Stocks at these stores plus national stores
should be considered as stocks in hand.
Further distribution from national to state to regional to districts to
PHCs is not based on population but on fixed number of boxes to be
supplied and not vials in case of DTP or other vaccines and the same logic
is followed for HBV.
I had undertaken the vaccine logistics study for Andhra Pradesh/PATH
program prior to introduction of HBV ( this was one of the most extensive
study). It will be a good exercise to see if there is improvement in
vaccine use / wastages in the same distritcs/ other distritcs after HBV
was introduced and training was imparted in these districts under PATH.
The outcome could be an useful learning for other countries and states.
I did advocate use of multi-dose vials instead of Uniject® after
calculating the additional volumes needed for storage at each level and
possible wastages already in place and comparing them for Uniject® and
multidose vials cost.
In the case of Nigeria as Chari says savings would have been possible.
This would have been achieved only if the Uniject® was purchased/procured
in at national level or purchased in yearly demand with very long
expiration say more than 2 years ideally 4 years to compensate for the
wastage, as wastage was more than 80%. The wastages with Uniject® could
be reduced if procurement was linked to monthly or quarterly/half-yearly
consumption reports which usually does not take place at national level as
is based on yearly demand generation given to UNICEF with time frame for
deliveries and no possibility of corrections and reductions based on
consumption or wastages. Futher no supplier will agree to reduce volumes
once order has been placed.
Wastages in Uniject® would be nil if only quantities as calculated based
on actual children immunized not equal to DTP vaccine dose. When a new
vaccine is introduced it will only be from the end of 2nd year that the
actual consumption pattern would be useful since process of procurement
for 2nd year starts 6 months after first year procurement has begun.
Regards,
Dr Anil Varshney
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