While immunization partners involved in supporting vaccine supply chain (WHO, UNICEF’s CCL and Project Optimize ...) are collaborating and building on each others’ experiences, there are several pertinent questions to the field yet to be addressed:
1. Questions related to standby generators:
Although the EVM assessment tool pays lip service to standby generators, it does not go into details and does not examine the size (power generated) and its adequacy. In addition program managers and immunization specialist are completely dependent on electricians to determine the size of the generators in order to replace the old one or to purchase new ones. Simple tools can be developed to enable immunization program managers and vaccine store staff to estimate the electrical load and to determine generator sizes and therefore give them power to negotiate and make informed decisions.
2. Questions related to cold rooms versus refrigerators:
Is there any clear line for determining when to opt for a number of refrigerators over one cold room? There must be a relationship between capital and running cost of cold rooms versus refrigerators. This question is particularly relevant during the planning stages of a new store or planning for expansion of the existing stores. At what volume of vaccines is a cold room(s) justified? There are many technical and economic issues involved in this decision and they may change in different situations - What are the pros and cons? It is now time for empowering program managers to make informed decisions and enable them to negotiate with equipment providers. The other question to be addressed is the efficient number of walk-in cold rooms for an estimated volume of vaccines. Do we install one large walk-in cold room or do we go for a certain number of smaller cold rooms to sum-up to the same volume of the large cold room?
3. Questions related to the proportion of cold chain equipment from those tested and standardized and those locally purchased:
We know that large countries like China, the Philippines, Egypt, Iran, etc purchase their cold chain equipment from local markets. We also know that cold chain equipment provided by UNICEF, GAVI and WHO are usually from tested and pre-qualified equipment. However, the information unavailable to us is the proportion of locally made and pre-qualified cold chain equipment used for vaccination programs. Even a rough estimate can help developing guidelines for those programs purchasing equipment from local markets to select the best available option. It is quite necessary for the program managers to be informed on how to select the most suitable refrigerators from a variety of available domestic ones? This will apply to all other cold chain equipment.
4. Questions related to number of programs where vaccine storage, distribution and handling are integrated with other pharmaceuticals and medical supplies:
Do we know how many countries or programs are storing and particularly distributing vaccines with other medical supplies? Are these programs successful? What are the challenges involved in integrating the vaccine supply chain with other medical supplies? It was important to note that Project Optimize looked at the possibility of involving private sector in vaccine storage and distribution in South Africa and Thailand but did not look at the question of integration of vaccine with other medical supplies in the context of government run supply chain.
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