Thank you for sharing your VaCRO model. By creation of this tool, you obviously have an appreciation for the complexities immunization programs face with respect to multi-dose vials. VaCRO presents an interesting approach to preserving stock for future demand; however, it has the potential to perpetuate turning away children and caregivers who may have traveled far distances for their scheduled vaccination session.
Turning children away can increase the time and cost associated with community outreach to ensure children return, can place children at risk of receiving delayed vaccination or cause them to miss receiving the vaccine all together. Or, worse, turning a child away may cause caregivers such frustration that they may refuse future vaccinations. For a bit more background, attached is a presentation from Robert Steinglass (JSI), Oct 2014 DCVMN:
http://www.dcvmn.org/IMG/pdf/steinglass_jsi_29th_oct_2014_delhi.pdf, a short vignette from a mother in Nigeria:
http://allafrica.com/stories/201206040675.html, as well as link to the recent Technet post
http://www.ghanaweb.com/GhanaHomePage/health/Vaccine-hesitancy-challenge-for-immunization-programmes-376381.
WHO and UNICEF work closely with countries and manufacturers to balance supply and demand, accommodating for wastage. Your team may benefit from engaging with
Paul Colrain (see his
TechNet Conference 2015 presentation) who is working with WHO to develop a simple model to improve stock management and planning based on a facility’s mean session size. Instead of setting limits to the number of individuals vaccinated per session, it seeks to identify the best vaccine presentation (number of doses per container), frequency of sessions, and buffer stock to ensure sufficient supply is in place to accommodate all children who may show on a specific immunization day.
The global community continues to encourage the generation of data and analytics to improve management of multi-dose vials, especially for lyophilized vaccines which must be discarded 6 hours after reconstitution. We also seek input from countries regarding preferred vaccine presentations (number of doses per container). We are optimistic in the near future that countries will have access to lower dose vial options and may be open to using these presentations in specific settings to mitigate wastage and maximize coverage.
Tina
Kristina Lorenson, MPH, MBA
Program Officer, Vaccine Market Dynamics
Global Development Program
[email protected]
Bill & Melinda Gates Foundation