The Immunization Data: Evidence for Action (IDEA) report and supporting materials are now available on the TechNet-21 website in English, Spanish and French. The IDEA report, A Realist Review of What Works to Improve Data Use for Immunization: Evidence from low-and middle-income countries, was written by PATH and the Pan American Health Organization (PAHO). It provides the immunization community with clear, proven strategies for improving the quality and use of immunization data. In addition, it outlines how funders, policymakers, and program implementers can incorporate these best practices to improve the efficacy of state, regional, and national immunization programs. The available materials include the full report, an executive summary, the review’s guiding Theory of Change, an evidence synthesis table and a summary of the five top findings. In addition, there is an Evidence Gap Map. For each primary intervention type identified in the IDEA literature review, the gap map visualizes all the pieces of evidence and promising strategies identified. The gap map illustrates where there is greater coverage of evidence and promising strategies as well as where there are gaps in evidence to help inform future research needs. To view the Evidence Gap Map and all the IDEA materials please visit: https://www.technet-21.org/en/topics/idea

Dear colleagues, In 2017, WHO, PATH, the Bill & Melinda Gates Foundation, UNICEF and Gavi launched the Vaccine Innovation Prioritisation Strategy (VIPS), with the aim to drive vaccine product innovation to better meet country needs and support Alliance goals on immunisation coverage and equity. Product innovation refers to completely new vaccine products or adaptations to existing products that provide measurable financial or programmatic benefits to low and middle income countries (LMICs), such as increased coverage and equity (e.g., by overcoming a ‘last mile’ barrier) or improved vaccine effectiveness. Through VIPS, the Alliance strives to understand countries’ needs to consider the financial and non-financial impact of innovations; develop common principles to measure the benefits of product innovations; and convene a platform to articulate a clear and aligned perspective on priority product innovations in development and communicate these priorities to provide greater clarity for manufacturers or partners to help inform investment decisions. At this stage of the VIPS process, we would like to ask for feedback through this survey on the relative importance of immunisation programme implementation challenges and barriers to improved coverage and equity and other pressing issues, from a country perspective. Your answers will inform VIPS assessments of vaccine product innovations in order to prioritise innovations that may be most valued in addressing country needs. This survey should take no more than 15 minutes to complete and will be available through the 30th September 2018 under one of the following links: English version - https://www.surveymonkey.com/r/BPMTGC9 French version - https://www.surveymonkey.com/r/LFH2DKQ Russian version - https://ru.surveymonkey.com/r/R3XMMMC Please feel free to forward the survey links to other stakeholders who may be interested. We apologise for the inconvenience if you have already received a link to this survey through another communication. We appreciate you making time to complete this questionnaire and look forward to continuing engagment with you on this important topic. If you have any questions, please feel free to contact Anna Osborne: aosborne@gavi.org Best regards, Debbie Kristensen on behalf of the VIPS Secretariat  

As countries increasingly implement and scale electronic immunization registries (EIRs), it will be critical that they exchange lessons and best practices. The BID Initiative, which is led by PATH, in partnership with the governments of Tanzania and Zambia, recently hosted delegates in Tanzania from PATH's Vietnam office and the country's Ministry of Health. Despite their different health contexts and challenges, Vietnam and Tanzania have much to learn from each other. In Vietnam, PATH’s pilot EIR, called ImmReg, was first developed and tested in 2012, before expanding into the National Immunization Information System (NIIS), which was launched in 2017. Last month’s visit was a chance to deepen this partnership and trade lessons about the challenges and successes of securing government buy-in and building health system capacity for EIRs. Check out several of the takeaways from the recent study visit in this blog post.  

WHO PQS is conducting a survey to learn from users of Remote Temperature Monitoring Devices (RTMDs) and inform the future of vaccine cold chain monitoring. Have you ever… Received a text, email or notifications from an RTMD? Interacted with RTMD hardware in the field, including responding to alarms? Setup RTMD hardware and/or software? Interacted with an online RTMD web portal? Conducted repairs or service on RTMDs? If so, we want YOU to help inform the future of RTMDs! Interested? Please send an email to dhabimana@path.org to receive the survey link!  Best wishes, Denise Habimana Vaccine Cold Chain Technologies Program Officer at PATH

We are happy to announce the latest version of the Total Cost of Ownership tool for cold chain equipment (v1.5) is now available to download and use. If you have been using an earlier version of the tool, please download the latest version from the link below.   Version 1.5 includes options to add Service Bundle quotes for CCEOP procurement which will overwrite installation cost assumptions.  Version 1.5 also features enhanced warranty comparisons that reflect the value of standard warranties from suppliers over time.  The latest version of the TCO tool contains PQS pre-qualified equipment as of May 2018. Please download the latest version (in English or French) for the most up to date products and pricing. http://www.path.org/publications/detail.php?i=2576  If you have any questions or would like any training/demos please email Matt Morio mmorio@path.org

A new PQS freeze protected vaccine carrier has been approved. The incorporation of this new carrier would solve a serious problem but at a considerable cost. PATH estimates that 2 million carriers would have to be replaced. Several years ago we had been working on a freeze protection method which incorporated water as a phase change barrier between the stored vaccines and the ice packs. This appears to be the same freeze protection mechanism incorporated in the PQS approved carrier. The water barrier in our freeze protection method was created by a water pack which would have the same height and width as a .6 liter pack however it would be much thinner, only about 5 mm thick. When the ice packs are loaded the barrier packs would be clipped against the frozen ice packs. In the carrier the barrier would sit between the stored vaccines and the cold ice packs. The barrier packs would be stored at room temperature. As a consequence of not having to replace the carrier this technique would be much less  costly to implement. Using water pack barriers also offers the flexibility of working with different sized carriers. In addition it would reduce the amount of plastic waste produced with replacement. Sun Frost did not go further with the commercialization of this technique because we did not have the funds for implementation at that time. We would be glad to consult with any company interested in implementing this technique. Larry Schlussler Phd Sun Frost

PATH’s Freeze-Safe innovation sets a new benchmark, helping protect vaccine potency, reducing health worker burden, and providing cost savings to health systems Seattle, February 7, 2018—This week, the first commercially available freeze-free vaccine carrier will begin introductory field trials in Nepal. This follows the World Health Organization (WHO) announcement that the Indian-made carrier using PATH’s “Freeze-Safe” reference design passed WHO Performance, Quality, and Safety (PQS) laboratory tests for User Independent Freeze Prevention, which prequalifies it for use in global immunization programs. This is the first low-cost carrier innovation available to address the widespread and long-standing problem of vaccines freezing in the cold chain during the “last mile” of outreach to infants and children.
[Read more]   Media inquiries: Global: Kate Davidson | media@path.org India: Anil Cherukupalli | acherukupalli@path.org

Electronic immunization registries (EIRs) and other immunization information systems can be powerful tools, but in order to achieve their long-term sustainability, countries and governments must understand the financial investment to develop, implement, and sustain such tools as the BID Initiative's EIRs in Tanzania and Zambia. This sort of costing information helps countries budget for and plan for expansion.  Learn more about BID's total cost of ownership (TCO) tool in this recent Q&A with our Senior Health Economist, or reference our TCO factsheet. We hope it will benefit other countries interested in implementing their own digital health initiatives.   Sincerely, The BID Initiative

We are happy to announce the latest version of the Total Cost of Ownership tool for cold chain equipment (v1.4) is now available to download and use. If you have been using an earlier version of the tool, please download the latest version from the link below.   Version 1.4 includes filters for CCEOP eligible equipment, as well as filters for refrigerator/freezer combination devices.  The latest version of the TCO tool contains PQS pre-qualified equipment as of May 2017. Please download the latest version (in English or French) for the most up to date products and pricing. http://www.path.org/publications/detail.php?i=2576  If you have any questions or would like any training/demos please email Matt Morio mmorio@path.org

To ensure that solar direct drive (SDD) appliances can keep vaccines at acceptable temperatures continuously, the installed photovoltaic array often produces excess power that is not used by the primary cooling load and this excess power generally goes unutilized. If this power is to be used, the primary SDD appliance load must be prioritized above any other load. WHO and other organizations have been working to define how this can be done safely and reliably. In support of WHO/PQS, PATH has recently posted results from lab testing of a couple of prototype devices intended to do just this. The Solar Electric Light Fund (SELF), organized and provided the prototypes and also carried out initial field tests on this energy harvesting control (EHC) technology. You can access the report here: http://www.path.org/publications/detail.php?i=2699 Additionally, the recently posted PQS specification and verification protocol are available on the WHO website: http://apps.who.int/immunization_standards/vaccine_quality/pqs_catalogue/catdocumentation.aspx?id_cat=36 I would be interested to know - what do people think of this approach with the intent to safely access excess power through EHCs? What do you think could be the most important uses for this power in remote health settings? Thank you, Steven P. Diesburg Product Development Engineer PATH, Seattle, WA, USA

Hi All, PATH Senegal Office had proceeded last year a field evaluation of Sure Chill’s long-term passive device for the use of cold storage of vaccines in Senegal and provides important feedback in terms of thermal performance, end-user inputs, and perceptions at the Ministry of Health of the potential impact of the device on vaccine storage and availability in Senegal. Please find the study report by clicking on the following link: http://www.path.org/publications/detail.php?i=2706 For more information, please contact Joanie Robertson: jrobertson@path.org or Abdoulaye Gueye: agueye@path.org PATH, bureau du Senegal a procédé l'année dernière à l'évaluation sur le terrain de l’appareil passif à long terme Sure Chill pour la conservation au froid des vaccins au Sénégal et fournit des commentaires importants en termes de performances thermiques, de contributions des utilisateurs finaux et de perceptions du Ministère de la Santé de l'impact potentiel de l'appareil sur la conservation et la disponibilité des vaccins au Sénégal. Merci de trouver le rapport de l'etude en cliquant sur le lien suivant: http://www.path.org/publications/detail.php?i=2706 Pour de plus amples informations, merci de contacter Joanie Robertson: jrobertson@path.org or Abdoulaye Gueye: agueye@path.org Best regards, Abdoulaye

Happy new year all, We are happy to announce that the latest version of the Total Cost of Ownership tool for cold chain equipment (v1.3) is now available to download and use. The latest version has a few minor changes to the presentation of data as well as the latest PQS pre-qualified equipment as of December 2016. Please download the latest version (in English or French) for the most up to date products and pricing. http://www.path.org/publications/detail.php?i=2576 If you have any questions or would like any training/demos please email Matt Morio mmorio@path.org

Dear TechNet Colleagues, PATH is seeking a Program Officer, Vaccine Cold Chain Technologies to join our Devices and Tools team in Geneva. I am hoping that you know a highly capable candidate for this role. Reporting to the PATH supply systems team leader in Seattle as well as the WHO PQS lead in Geneva, the Program Officer will contribute technical and project management expertise to WHO and the working group in efforts to improve the quality of cold chain equipment, assess equipment for prequalification, and monitor installed equipment post-prequalification. As you may know, PATH is an international organization that drives transformative innovation to save lives and improve health, especially among women and children www.path.org. I have included the job summary and a direct link to the posting: https://path.silkroad.com/epostings/index.cfm?fuseaction=app.jobinfo&id=23&jobid=302138&company_id=15780&version=1&source=ONLINE&JobOwner=1013211&level=levelid2&levelid2=96466&startflag=3 I would be thrilled if you would be open to referring someone. Please do not hesitate to reach me and/or our recruiter, Erika Herbst, at eherbst@path.org with questions. Thanks in advance for your consideration, Pat lennon

A well-functioning supply chain often goes unnoticed. People rarely talk about fully stocked shelves at the store or on-time delivery of a package. It’s the interruptions to the supply chain that get noticed. As they say, “the squeaky wheel gets the grease”. These days, immunization supply chains (iSC)—the network of staff, equipment, vehicles, and data needed to get vaccines safely from the manufacturer to the people who need them—are the “squeaky wheel” as the global health community seeks to close the immunization gap.
Addis Ababa, Ethiopia: First Ministerial Conference on Immunization in Africa
While gathering at the first-everMinisterial Conference on Immunization in Africa (MCIA)in Addis Ababa, Ethiopia earlier this year, supply chains formed an important part of the larger immunization conversation. TheAddis Declaration on Immunization,the official commitment signed by many African leaders at the conference, included objectives focused on addressing barriers to, and increasing effectiveness and efficiency of, vaccine delivery systems. In addition, ministers of health, parliamentarians, and other stakeholders attended a side session focused on immunization supply chains. During the session, the Ministers of Health from Mozambique, Ethiopia, Nigeria and Uganda, as well as EPI Managers from Benin and Senegal had the opportunity to share their experiences and lessons learned related to vaccine delivery. The conference was the first step in a series of country leader commitments and cross-country sharing for improving vaccine supply chains across the African continent.
Entebbe, Uganda: Eastern and Southern African Regional Meeting
In late August, logisticians and supply chain partners from 21 East and Southern African countries gathered in Entebbe, Uganda, at a meeting hosted by UNICEF to explore important supply chain topics and learn from one another. Participants from Malawi, Uganda, and Eritrea received awards as recognition of their efforts to champion supply chain improvements. Sessions structured around thefive fundamentals for next-generation supply chainsprovided deeper understanding on using data for decision-making, cold chain equipment, iSC human resource needs, and national logistics working groups. Participants learned more about the declaration stemming from MCIA and discussed strategies to build the case for increased investment and attention to supply chain issues. These local champions gained insights into how to advance their technical work by building on political commitments made by their leaders.
Amsterdam, Netherlands: Vaccine Congress: “No Products, No Programs: Why Vaccine Supply Chains Matter”
Shortly after the iSC discussion in Uganda, 10,000km away in Amsterdam, Netherlands, another high-level discussion on iSC took place at theVaccine Congress. Hosted by publisher Elsevier, the participants this time were not politicians, logisticians, or program implementers, but rather academic experts and scientists—an important constituency in this conversation. There, PATH organized a fireside chat on iSC. Panelists Raja Rao from the Bill & Melinda Gates Foundation and Heather Deehan from the UNICEF Supply Division engaged in a discussion moderated by Bruce Y. Lee from the Johns Hopkins Bloomberg School of Public Health. Seth Berkley, President and CEO of Gavi, the Vaccine Alliance, also joined by way ofvideo. The panel discussion entitled, “No Products, No Programs: Why Vaccine Supply Chains Matter,” engaged conference attendees on the linkages between iSC performance and programmatic success in low-and middle-income countries. This important discussion engaged scientists involved in vaccine development in the realities of vaccine delivery on the ground. It is critical that the issues communities face in safely delivering vaccines are taken into account early in the vaccine research and development process. In addition to having the people and processes in place to move vaccines to the furthest reaches of a country, it is crucial to have vaccines and related equipment that are able to sustain the journey.
“Synergies are needed for real impact to occur; it benefits everyone to establish a systems-wide approach that optimizes connections across the preclinical, clinical, post-licensure, introduction, and delivery continuum.” – Heather Deehan, UNICEF
From conversation to action
The rich conversations about iSC that are taking place around the world—among politicians, logisticians, and academics—and across the vaccine discovery to delivery continuum are very encouraging. However, actions speak louder than words. We look forward to African Union formally tabling the Addis Declaration on Immunization, and stakeholders following through on their commitments by taking up needed iSC innovations to ensure vaccines get to the children who need them.
Links for more information:
Ministerial Conference on Immunization in Africa:http://immunizationinafrica2016.org/
Addis Declaration on Immunization:http://immunizationinafrica2016.org/ministerial-declaration-english/
Watch global immunization leaders in Addis talk about the importance of iSC:https://youtu.be/t4h8tGCZz14
Vaccine Congress:http://www.vaccinecongress.com/
Watch remarks from Seth Berkley, President and CEO of Gavi, the Vaccine Alliance:https://youtu.be/fjPCm_cWMp8


http://www.technet-21.org/en/resources/technet-resource-library/

Hello all, Microarray patches (MAPs) are under development for delivering vaccine into the skin. The technology has exciting potential for application to immunization programs. PATH is looking for input from experts in low- and middle-income country immunization programs about the feasibility of MAPs to facilitate immunization, especially for novel delivery scenarios like self-administration of vaccine at home, as well as more traditional immunization settings in LMICs. We have created an online survey as a forum for collecting your feedback. We value your opinion on this topic. The survey will be open for one week and should take no more than 20 minutes: https://www.surveymonkey.com/r/vaccinepatch The results will inform dialogue with vaccine manufacturers and other stakeholders as we work to advance this exciting new method for vaccine delivery. I encourage you to share your opinion in the survey and to forward the link above to other colleagues, particularly those in LMIC immunization programs. I’m always happy to chat in person as well and have included my contact information below. I hope to hear from you. Best regards, Sarah     Sarah McGray Program Officer, Devices & Tools PATH Tel: 206.285.3500 Skype: smcgray Email: smcgray@path.org www.path.org

PATH has been collaborating with Vietnam National EPI to pilot the Digital Immunization Registry in one district in a Southern province under Optimize Project since 2012. In 2014, this system was expanded in all 164 Commune Health Centers in that province. It can help to reduce workload burden, increase data accuracy and more importantly increase on-time vaccination rates. This intervention has been awarded the Health Innovation Award, a partnership between GSK and Save the Children in 2015. PATH is working closely with Ministry of Health and the local biggest telecom company to integrate this system into national health information system and scale up nationwide. Please find more information via the link below
http://www.technet-21.org/en/resources/technet-resource-library/2742

Dose per Container Partnership (DPCP)
The issue: Multi-dose containers are used to offer lower prices, higher supply volumes, and minimize cold chain storage and distribution requirements. As new, more expensive, vaccines are introduced in multi-dose presentations, maximizing the use of every dose in a container increases in importance. HCWs need to be more strategic about when to open a container; diligent about how they care for open containers, and potentially more active with communication and community outreach to ensure optimal attendance and timely vaccination of every child. Thus, the number of doses per container (DCP) may also impact on health systems in terms of timely, safe and equitable vaccination coverage, supply and cold chain, wastage rates, cost and HCW behavior.
Immunization stakeholders need information and tools to assess which dose per container presentations are appropriate for a country’s specific context and priorities.
Initial 2015 response: With Bill & Melinda Gates Foundation (BMGF) funding, JSI Research & Training Institute, Inc. (JSI) helped identify evidence gaps by interviewing key stakeholders and analyzing existing research. An informal network of partners interested in advancing this work was created after a consultative meeting in July 2015.
Launch of the partnership: The Dose Per Container Partnership (DPCP) was launched in March 2016 as a project, funded by the BMGF and implemented by JSI in partnership with PATH, Agence de Médecine Préventive (AMP), Clinton Health Access Initiative (CHAI), HERMES modeling team and the International Vaccine Access Center (IVAC) / Johns Hopkins University. The DPCP aims to address the complexity of vaccine product and program decision-making to include DPC considerations. Understanding and assessing the trade-offs between cost and health impact allows better informed decisions about the impact of the dose per container selected.
DPCP objectives and work streams: The DPCP project will run from February 2016 – December 2017, guided by a Technical Advisory Group (TAG), and aims to achieve two objectives:
i) To gain a deeper understanding of the decision making processes, trade-offs, data
and tools used to assess DPC decisions at global and national levels in order to recommend process improvements;
ii) To provide guidance and tools including trade-offs to be considered by countries and facilitate
sharing of best practices for country level decision makers.
These will be implemented through three technical work streams:

A global cross-country review of current DPC-related decision making tools and processes;
Prospective research studies in two African countriesl will include data collection to improve modeling efforts, economic analysis and see the actual effect on the various systems variables; and
Synthesis of data supporting global level policy and country decisions.


Stakeholders: DPCP aims to inform, support and influence stakeholders at:
a) Global level, by providing evidence that fills critical gaps in knowledge, analysis, and policy. This includes ensuring that stakeholders will continue to be informed about sustainable decisions on DPC when considering vaccine products and program designs; and
b) Country level, by producing easy-to-use and -understand guides and tools to assess DPC tradeoffs, including cost and systems impact to inform vaccine product selection
Information about the DPCP will be made available through partners engaged with the project, the JSI website, announcements via the technet forum and various formal and informal opportunities where immunization practitioners meet globally, regionally or nationally.
http://jsi.com/JSIInternet/IntlHealth/project/display.cfm?ctid=na&cid=na&tid=40&id=22641

In cooperation with the Uganda Ministry of Health, PATH recently conducted a pilot study to document equipment failures in the Uganda National Expanded Programme on Immunization cold chain. Due to our use of purposeful sampling to locate a subset of failed cold chain equipment in Uganda, conclusions about predicted failures cannot be drawn from our study report. However, after learning of the failures, one manufacturer (B. Medical) has agreed to replace the equipment assessed. The full report can be accessed here: http://www.path.org/publications/detail.php?i=2586 Information from this report has also been added tothe Dulas VC65F revew here: http://www.technet-21.org/en/refrigerators-and-freezers/solar-battery-powered-refrigerators-and-or-refrigerator-freezers/dulas-solar-vc-65-2-e003-026

Earlier this month, the Dose Per Container Partnership (DPCP) project was launched. This Bill and Melinda Gates Foundation project is implemented by JSI and partners (PATH, Agence de Médecine Préventive (AMP), Clinton Health Access Initiative (CHAI), HERMES modelling team and the International Vaccine Access Center (IVAC) / Johns Hopkins University). The project will help identify evidence needed to support better-informed decision making related to the trade-offs between cost and health systems impact of vaccine doses per container (DPC). The project runs from February 2016 to December 2017 and has potential to influence country, regional and global equity and systems related policies, and have impact on supply and demand sides of various DPC options with three main deliverables: i) A global review of current decision making tools and processes related to DPC; ii) Prospective research studies in Tanzania and Senegal, including data collection to improve modeling efforts and economic analysis of this topic; and iii) Synthesis of data and harmonization of tools supporting global level policy and country decisions. Attached is an overview of the project and more details are available at http://jsi.com/JSIInternet/IntlHealth/project/display.cfm?ctid=na&cid=na&tid=40&id=22641

Dear TechNet Colleagues,   I would like to share with you a report on our latest cold chain maintenance investigation in Mozambique: "Why Fridges Fail Part 2: RTM Data for Maintenance". We are beginning to document how remote temperature monitoring data and dashboards can be used by maintenance technicians to significantly improve cold chain performance. This assessment follows up on the randomized control trial conducted in 2014-2015 with Village Reach, PATH, and the Ministry of Health in Mozambique which aimed to evaluate the impact of remote temperature monitoring (RTM) on vaccine cold chain equipment performance at the health facility level. That study showed that RTM with SMS alerts increased fridge uptime and reduced freezing (See Appendix I of the report for more details.)

However, even some fridges in the RTM intervention group had chronic problems and failed to achieve 95% uptime.

We launched this follow-up investigation to answer the question: Can maintenance + RTM lead to 95% uptime?

We were very happy to work with Soren Spanner, a global cold chain expert with decades of experience. Soren traveled to Mozambique from September 24 until October 14, 2015. He used ColdTrace data to identify 27 fridges that were failing and worked with the Ministry of Health maintenance technician to visit or remotely diagnose and fix as many fridges as possible. Soren remained active in fridge fixes, phone calls and follow-ups through the end of November.

Perhaps the most interesting finding was that distinct patterns in the RTM data (which we call “temperature data signatures”) can be used to remotely diagnose problems and enable remote fixes via phone calls to nurses in clinics. For the improperly adjusted fridges in this investigation, thermostat adjustments increased uptime by 30%. Today, the MOH technician continues to use the dashboard data to diagnose problems, call clinics to address the issues, and verify fixes by monitoring subsequent temperature data. We also learned that, without access to key spare parts/tools, even an expert technician cannot get all fridges to 95%: flat batteries on solar fridges were one such problem that Soren did not have the resources to fix. With RTM data, however, those responsible for cold chain maintenance can identify which fridges need help and determine where to focus resources.

This report features all causes of fridge failure that the Technicians encountered, several key screenshots from the ColdTrace web dashboard, and critical recommendations for how to procure for and improve cold chain maintenance capacity at every level of the health system moving forward. We hope you’ll find these results approachable and easy to understand. I would greatly appreciate your feedback on the report and I hope we can start a discussion here on how temperature monitoring data could improve maintenance. Thank you. Regards,
Shahrzad

Hi all, I just wrote a blog on PATH's DefeatDD.org called "Getting to 'Mars' with immunization delivery," which I thought might be of interest! I really enjoyed the recent blockbuster movie,The Martian. Andas a vaccine advocate supporting PATH's advocacy for stronger immunization supply chains project, I drewa parallel between the coordination, planning, and logistics that it would take for NASA to get humans to Mars (as portrayed in the movie) and the coordination, planning, and logistics that it takes to deliver lifesaving vaccines to every community around the world. If we want to reach our "Mars" of reaching every child, everywhere with vaccines, we need to focus on supply chain workers (or "astronauts"), high-tech cold chain equipment (spaceships), and data for decision-making (control centers). Hope you enjoy. :) -Laura   Laura Edison, MPH Scientific Communications Associate Vaccine Access and Delivery, PATH

On day 4 of the TechNet Conference, I facilitated a roundtable discussion on what it takes to generate political will for supply chain improvements. At each table, participants shared their experiences generating political will and discussed in detail what it took to achieve meaningful change. Below are their observations, grouped into like categories. I am sharing this to remind TechNet subscribers of all the ways in which they can influence political will for supply chain improvements. I also encourage subscribers to share experiences of communicating the importance of supply chain to non-technical decision makers within the Ministry of Health, Finance, Planning, or other. How have you been successful? How have you been unsuccessful? What can we learn from these experiences? Seek global buy-in and funding for the issue Global buy-in and funding can be critical for implementing something in a country Collect local evidence and credible indicators of problem Create new evidence to “change the story” about the issue Bring in different content experts to validate and contribute to the evidence so its not just one-sided Keep the momentum going (advocacy is a long process) Find ways to amplify the evidence and have many different people sharing it This process takes a lot of time. To maintain the focus, share small milestones and “wins” along the way. Give frequent updates on progress. Document government and partner commitments so you can hold them accountable later. Cultivate champions and key influencers--speak their language Transform leaders from forces of resistance to the heros—show them the difference they can make and give them credit Map key influencers at MOH and understand who influences the influencers. Learn what interests your key influencers, what their priorities are, what their background is, and what skills they have Speak their language—translate your message into something they care about, consider their point of view Be ready to educate and sensitize people to your issue and explain it in a way that makes sense to them. Seek perspectives from ALL parties affected by an intervention (e.g., district managers, health workers, patients) to anticipate and address confusion and possible resistance. Seek government ownership even if it takes longer Cultivate 1:1 relationships. A lot of political support must be cultivated this way. Acceptable solutions Be clear and specific about the changes you want to see Be aware of context Understand the decision-making system, when are decisions made (e.g., what time of year are budgets decided), what committees and individuals are in charge of making decisions, who they report to and when they meet. Target the right person and at the right time Partnerships Look for ways to lead in collaboration. Focus people on solving a problem together to get stronger buy-in and leadership. Please add to this thread to describe any insights that I did not capture, but you felt were important. Thanks!

VaxTrak in Vietnam VaxTrak helps health workers keep track of vaccine stock. In 2011, the Vietnamese National Expanded Programme on Immunization introduced VaxTrak in the provinces of Phu Tho, Quang Tri, and Ben Tre. This short video shows how VaxTrak works and examines the impact it has had. [youtube]zbYuN9OXV4c[/youtube] Logistimo in South Sudan Logistimo is a cloud-based logistics management information system that can help immunization health workers keep track of vaccine stock. In May 2012, the Government of South Sudan deployed Logistimo in the national store, the ten state stores, and all six counties of Central Equatoria State. This short video shows how Logistimo works and examines its impact. [youtube]Sr7rCnpLWyM&list=PLYNXI1NRQQ-AFEa6PaFxPplrvyZvChKwX[/youtube] Immunization Information Systems (IIS) in Albania In 2011, the Albanian Institute of Public Health deployed IIS in the northern Albanian district of Shkoder to record child immunizations and manage stock. This short video shows how it works and examines the impact it has had in Albania. [youtube]dczmp7JsIr4&list=PLYNXI1NRQQ-AFEa6PaFxPplrvyZvChKwX[/youtube] ImmReg in Vietnam ImmReg is a digital immunization registry that uses mobile phones to track children due for vaccination and record their vaccinations. In 2011, the Vietnamese National Expanded Programme on Immunization introduced ImmReg in the district of Mo Cay Nam in Ben Tre province. This short video shows how ImmReg works and examines its impact. [youtube]59gGuyFHle0&list=PLYNXI1NRQQ-AFEa6PaFxPplrvyZvChKwX[/youtube]

Building on the energy and excitement around this week’s International Rotavirus Symposium in Bangkok, Thailand, PATH is pleased to announce the launch of its new rotavirus vaccine access and delivery website and rotavirus advocacy and communications toolkit – two essential resources to help accelerate the financially sustainable introduction and implementation of rotavirus vaccines around the world. Check these resources out at http://sites.path.org/rotavirusvaccine/, and please feel free to share this link with others. PATH’s new website contains rotavirus advocacy and communication tools and technical rotavirus information including: • rotavirus disease burden • rotavirus vaccine efficacy and impact • PATH’s work in rotavirus (GAVI AVI TAC, RVP, new rotavirus vaccine development) • country introduction maps (global and GAVI-eligible countries) and an interactive country introduction spreadsheet • links to RotaFlash (latest edition and archives) and a sign-up page • an advocacy and communication toolkit (fact sheets, key messages, FAQ, PPT slide sets for country introduction maps and rotavirus vaccine impact tables) • other resources on rotavirus and diarrheal disease (from GAVI, WHO, DeafeatDD, ROTA Council etc.) • links to partner websites We hope you find these new rotavirus resources useful and informative. Please send your feedback on current content and ideas for future content to PATH [email= rotavirusvaccine@path.org.] rotavirusvaccine@path.org[/email].

Dear Sir,Based on the PATH report, we must immediately demand from DCGI office or GOI for use of IPV through Intradermal Route as well, otherwise people would be cheated as they have been with Rabies vaccine. Though I disagree with the report on one point that is a device is required for effective delivery of vaccine as this can be done with needle and syringe as well in India as we are doing with BCG/ ARV. also I disagree with the report that the needle syringe method would cost more, especially the costs calculated for disposal of waste are not appropriate. What, important is the delivery of vaccine through intradermal method. Read the report... In this report, results are presented from an economic model that calculates the costs involved in delivering IPV vaccine in Indian immunization clinics according to the first three strategies listed above. The model analyzed the costs associated with four delivery devices: disposable needle and syringe, disposable-syringe jet injectors (DSJI), an ID adapter (which controls the depth and angle of the ID injection), or a syringe-mounted hollow microneedle (MN). Clinical trials have shown that IDD of reduced doses (delivering 20% of the volume of a standard dose) can be sufficiently immunogenic. The results of the economic analysis suggest that IDD of IPV using needle and syringe, DSJI, or ID adapter could result in cost savings of up to 71%–73% per immunized infant compared with delivery of the standard dose via the usual intramuscular (IM) route using needle and syringe. Combining IPV with adjuvant so that only 10% of the original antigen content was needed, whilst still using the IM route, had the potential to save 82% to 83% of the immunization costs, depending upon the delivery device used. An aim of this strategy is to reduce the amount of vaccine antigen required to induce a protective immune response by intradermal (ID) delivery of fractional or reduced doses, i.e., administering a smaller volume of the existing formulation. If this could be achieved for IPV, it would have the potential to stretch the manufacturing capacity of existing IPV facilities and also to reduce the manufacturing cost per dose. Some logistics costs might also be reduced as it is possible that a lower-volume dose would require less space in the cold chain during distribution and storage.Intradermal delivery (IDD) of fractional doses has been investigated for a number of vaccines, most notably rabies, influenza, and hepatitis B.* Three studies of IDD of fractional doses of IPV have been published: * Reviewed in Intradermal Delivery of Vaccines. A review of the literature and the potential for development for use in low- and middle-income countries. PATH, August 2009. http://www.path.org/files/TS_opt_idd_review.pdf.IDD of reduced doses (20% of the standard volume and therefore 20% of the standard antigen content) induced striking antibody responses in adults and children who had previously been immunized.[14] No IM comparator arm was included in this trial. A schedule of two ID doses (20% of the standard dose) in nonimmune subjects resulted in a seroconversion index of 82% which was described as being comparable to an index of 91% seen in a previous study following two IM doses.[15] Nirmal et al.[16] reported that two or three 0.1 ml doses ID were equivalent in terms of seroconversion to two 0.5 ml doses of IPV delivered IM in a previous study. The overall seroconversion rates to all three poliovirus types were 85.5% and 89.0% following two or three ID doses, respectively. Seroconversion was seen in all infants (following either two or three ID doses) who did not have maternal antibodies present in prevaccination sera.[16] More recently, two GPEI-sponsored trials used the Biojector 2000® disposable syringe jet injector (DSJI) device to deliver a 20% dose ID compared with full-dose IM.5 Two different immunization schedules were tested, one in each of the two countries (Oman and Cuba) selected to run the study, and vaccines from two different suppliers were used. Thanks, Dr. Omesh Kumar BhartiM.B.B.S.,D.H.M.,M.A.E.(Epidemiology)Directorate of Health Safety and Regulation, SHIMLA, Himachal Pradesh, India.+91-9418120302[email=bhartiomesh@yahoo.com]bhartiomesh@yahoo.com[/email]; [email]bhartiomesh@gmail.com[/email]

Thanks Julian. It really helped. I stress so much on anti freezing the H1N1 vaccine during my country wide lectures that I needed to be sure of my claims. Frankly it would have been better for a H1N1 vccine without VVM to be freeze resistant, as opertaionally it is much easier for vaccinators in countries like ours to keep a vaccine close to ice and hence close to 0 or below than to keep it close to +2-+8C. Thanks again Best regards

The Advanced Immunization Management (AIM) e-Learning website recently launched a new module to help decision-making on rotavirus vaccine introduction. The module provides comprehensive information from basic disease characteristics through immunization session planning; this interactive online tool is primarily aimed at immunization program managers but will also be useful for country program officers, medical providers, public health educators, and public health managers. Developed by PATH and partners, the AIM e-Learning site also features modules on: Group A meningococcal conjugate vaccine (also available in French), hepatitis B vaccine (also in French and Russian) immunization financing (also in French, Russian and Bahasa Indonesia), and an Excel tutorial (also in French). An updated module on Japanese encephalitis vaccine and a new module on strategic planning for measles control are forthcoming. The rotavirus AIM module is online at http://aim.path.org/en/vaccines/rota/index.html and is also available on CD upon request to [email=info@aim.path.org]info at aim.path.org[/email]. The AIM homepage address is aim.path.org

by Joanie Robertson, Technical Officer, PATH

In March 2009, six companies submitted designs to PATH in response to its Battery-Free Solar Refrigerator Challenge. Product designs that meet desired specifications will receive financial assistance to cover the cost of third-party testing required for consideration under the World Health Organization's Product Quality and Service (PQS) process.

The purpose of the Battery-Free Solar Refrigerator Challenge is to encourage the development of new products in the solar refrigeration category for use in developing-country immunization programs. Solar-powered refrigerators are an attractive alternative to gas- and kerosene-powered absorption devices: they are environmentally sound, provide an alternative to grid electricity where it is unreliable, and can be produced affordably. However, most existing solar refrigerator products are inadequately designed to meet the needs of developing-country immunization programs. The main issues relate to the lack of or inappropriate replacements for exhausted batteries, inappropriate system sizing, and poor installation work.

The Battery-Free Solar Refrigerator Challenge is designed to help address the first of those issues. By providing clear specifications to known solar refrigerator manufacturers and helping facilitate the PQS testing and submission process, Optimize hopes to reduce some of the market barriers and spur innovation and growth in this important refrigeration category.