POST 00672E : VACCINE FORECAST

POST 00672E : VACCINE FORECAST Follow-up on Posts 00649E, 00662E and 00671E 11 May 2004 ________________________________ To pursue this discussion on vaccine forecast, follows an exchange between Oleg Benesh (mailto:[email protected]) from Moldova, Robert Steinglass (mailto:[email protected]) from the United-States (Project BASICS II) and Alasdair Wylie (mailto:[email protected]) from the UK. ________________________________ Dear Robert and Alasdair, I would like to share with you my concern that many programmes may have included already the vaccine wasted for drop-out in their current estimates of the vaccine wastage rate. It is an issue of calculation of the wastage rate (or factor). This may happen if the number of administered doses is defined based on the no. of children vaccinated with DTP3. Consequently all vaccine doses administered to children who receive the 1st and 2nd dose but not the 3d dose are accounted as "wasted" doses. Estimating vaccine needs based on the coverage with the 1st dose in such a case will inflate unnecessarily the estimated no. of doses. Alternatively, in order to have a proper estimate of the number of all administered doses there is a need to collect data on no. of children vaccinated with each dose (DTP1, DTP2, DTP3 etc). I am not sure all countries collect those data. May ask for yours comments on that? Regards, Oleg Benesh Medical Epidemiologist National Center of Preventive Medicine Republic of Moldova -------------------------------------------------- from Robert Steinglass: Oleg, hi! Thanks for your message. I think it would be important for someone (WHO?) to look into your statement that "many countries may have already included the vaccine wasted for drop-out in their current estimates of the vaccine wastage rate." It is becoming increasingly clear to me that some things that we have assumed for a long time (e.g., that calculation of wastage was a simple and straightforward matter that by now everyone already knew how to do) might have been mistaken! You discuss in your first paragragh "vaccine wasted for drop-out." I think that is a confusing concept. Unless things have changed, I believe that doses given to children who start but do not complete the series are not to be considered as vaccine wastage. True, it adds to the cost of fully protecting the population if a lot of vaccine is used to give first but not last doses, but it is not classically "wastage." If countries are calculating wastage that way, I would be concerned. I know WHO has a new module on vaccine wastage. I picked it up in Turkey and looked quickly through it. It seemed quite complicated in that it proposed many formula for determining different aspects of the wastage problem. If what you say is accurate, we may be introducing more complex approaches before the basics are standardized and understood. I agree with your second para: to collect wastage info you need to know numbers immunized with DTP1, 2, and 3. I believe that all countries have these consolidated data at national level. But it has not always been reported for each dose to higher regional and global levels. I still prefer the way that wastage was calculated in the NIS. As you know, the numerator was simply the number of doses "used" and the denominator was number of doses administered. This automatically generated a wastage factor which could then be used to estimate vaccine requirements. In other words, they skipped the step of coming up with a wastage rate. I enjoyed seeing you again in Turkey. All the best. Robert -------------------------------- from Alasdair Wylie: Dear Oleg I agree with all of Robert's points and would just add two. In order to check if there is the problem you suspect, as far as country applications to GAVI are concerned, the GAVI secretariat might wish to check (recheck) the vaccine requirement/wastage factor calculations used by a sample of countries from, say the last three rounds, perhaps with the assistance of WHO/UNICEF/other agency country based staff. If an intial miscalculation results in a country getting more vaccine than it actually needs (or for that matter, less) then the normal annual calculations which take into account expected end year stock balance should help to rectify things - but might not on its own guarantee completely solving the problem. All the best Alasdair -------------------------------- from Oleg Benesh, with Alasdair's comments inserted in bold: Dear Robert, Alasdair, Thank you a lot for yours points. I fully support that an administered dose can not be considered as a wasted one. There may be an additional issue there: whether an administered dose is considered only if given