vendredi 16 mai 2008
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POST 01266E: BROADENING THE USE OF THE VVM 16 MAY 2008 FOLLOW UP ON POST 01264E: ******************************************* Hans Everts responds to Joanie Robertson’s request for out-of-cold-chain vaccine distribution experiences and asks for a proactive approach to VVM. He says the need is to find the right balance between micro-planning and prescriptive policy. Theo Wirkas writes to say that he will be closely following the OCC experiences discussed on TechNet. Anil Varshney seeks information on vaccine holding capacities of WICs, DFs and ILRs of the different brands. ----------- Regarding VVM OCC experience, this is what I wrote in POST 01042E in January 2007: QUOTE: Referring to the comments by Subhash C Choudhury on India, I think the vaccinators made a wise decision. The advantage of the VVM is not only to passively monitor the cold chain, but at least if not more important, to actually find solutions to problems in operational campaign implementation, beyond simply stopping the vaccination. There is a lot of - undocumented - experience, in particular in the African Region in the use of VVM for polio campaigns: [list=1] use of non-PIS (PQS) quality vaccine carriers to conduct polio SIA; [/ol] [list=1] teams not returning to their base for renewal of ice after it has melted and therefore being able to continue vaccination; [/ol] [list=1] vaccine carriers with only 1 or 2 icepacks, rather than 4, in particular for urban teams; [/ol] [list=1] teams splitting up at markets and bus stations, while one member keeps the vaccine carrier and the other simply relies on the VVM; [/ol] [list=1] teams going to remote villages, beyond the cold life of the vaccine carrier; [/ol] [list=1] teams keeping the vaccine cool by other means, like digging a hole in the ground, keeping it in clay pots, etc. [/ol] All these experiences may not be useful or necessary everywhere, but so far Asian countries have taken a much more conservative attitude towards proactive use of VVM as an operational planning and implementation tool rather than as a mere monitoring tool. I have seen teams split up on markets taking advantage from the VVM in India, but that is considered an exception to be prevented, rather than the seed of a new operational approach. Applying VVM in a proactive way, including vaccine out of the cold chain, is a change in paradigm from the top-down classical cold chain. Progress is certainly not as much as I would have liked it to be, but I do believe that at least the mental paradigm change has taken place, even though it is only put into practice sporadically. When I did Out-of-Cold-Chain presentations late 20th and beginning 21st century, I risked my life, whereas now, people may still not implement it and be skeptical, but there is an openness that did not exist earlier. UNQUOTE Proactive use of VVM implies exploring the potential of the VVM on basis local conditions. As such, it can hardly be a national standard policy, except for transport and general guidance. It should be integrated in a micro planning approach like the one used for RED. The difficulty lies in finding the right balance between autonomous decision-making at a decentralized level and the need and sometimes even the preference for a central standard and prescriptive policy. Micro planning exercises in polio campaigns have shown that autonomous decentralized decision making can be extremely powerful and effective. Broadening the use of VVM continues to be one of the most exiting topics in vaccination policy, according to me. Hans Everts ([[email protected]][email protected][/email]) WHO Geneva Technical officer EPI +41 22 791 3683 ------ Dear Moderator, Joanie’s query concerning OCC is interesting. My country has not implemented OCC but there are possibilities. I would be closely following the subject. Thanks and all the best, Theo Wirkas (Mr.) ([[email protected]][email protected][/email]) EPI – Papua New Guinea ------ Dear Padmini I wanted to know the Vaccine holding capacities of WIC, ILRs and deep freezers of different make as I am unable to get the UNICEF PSQ catalogue. regards Anil Varshney ([[email protected]][email protected][/email]) Post generated using Mail2Forum (http://www.mail2forum.com)
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