by Steve Landry, Bill & Melinda Gates Foundation; Anne Schuchat, CDC; Xavier Tomsej, USAID; Thomas O'Connell, UNICEF; David Lee, Management Sciences for Health, and Jean-Marie Okwo-Bele, WHO In July 2010, Optimize convened workshops in Washington, DC and Seattle, WA, to engage a wide range of stakeholders in shaping a unified vision (http://www.who.int/immunization_delivery/systems_policy/optimize/en/) for the future of immunization technologies and logistics systems in low- and middle-income countries. During the workshops, participants reviewed the history and current state of developing-country immunization systems and shared their perspectives on the challenges facing current systems, the desired future state (i.e., by 2025) of these systems, and work streams required to reach the desired state. While the ultimate goal is clear—state–of-the-art supply chains must enable the right vaccines to be in the right place, at the right time, in the right quantities, in the right condition, and at the right cost—achieving that goal is a bit more complicated. As more vaccines become available in developing countries and place a larger financial and structural burden on immunization systems, it is becoming evident that the current supply chain systems are inadequate. With this in mind the Cold Chain and Logistics Task Force (under the leadership of the United Nations Children’s Fund [UNICEF]) has assembled a "think tank" to develop a shared vision for future supply system solutions and a space to discuss options and trade-offs of proposed technologies, policies, and procedures that can significantly impact the way vaccines are distributed. Think tank members include representatives from UNICEF Programme and Supply Division; John Snow, Inc.; US Centers for Disease Control and Prevention; Clinton Foundation; World Health Organization, the GAVI Alliance, Management Sciences for Health, and others. Optimize is acting as a temporary secretariat for this effort. In its current iteration the vision is organized around five tenets: 1. Vaccine products and their packaging are designed with characteristics that best suit the operational needs of countries. This includes quality and safety as well as specific product attributes such as vial size, labeling, and packaging. Inherent in this tenet is a desire to create sustainable mechanisms for collaboration and a dialogue with manufacturers. 2. Immunization supply systems are designed to maximize effectiveness and efficiency and are built around mechanisms that support continuous learning to improve system performance. This means that supply chain systems are streamlined and efficient, adaptable to varying volumes and quantities of vaccines, and demand driven based on accurate projections of need at the clinic level. 3. Immunization supply systems are part of an integrated health supply system that maximizes synergies and makes the most appropriate strategic links with the private sector. Inherent in this tenet is a need to evaluate synergies between multiple vertical delivery systems and outsource logistics components to private-sector operators as appropriate. 4. The environmental impact of energy, materials, and processes used in immunization supply systems from the international to the local-level is assessed and minimized. This may include moving some vaccines into a controlled-temperature chain outside of the usual system of refrigeration. It may also include the control of energy costs through technologies, vehicle choice, waste management, or distribution strategies that save energy or resources. 5. Data produced by effective, affordable, and sustainable information systems and technologies are used to inform and drive immunization supply systems. Ideally, all information system requirements for immunization are integrated and used for decision-making, and individual records are disaggregated and used to estimate demand. The vision will serve as a common platform behind which key partners at all levels (country, regional, and global) can unite. It will allow partners to identify gaps and orient their work in a direction that supports logistics and supply systems today, yet ensures that they are able to address the challenges of tomorrow as efficiently, effectively, and sustainably as possible. To participate in the visioning process, please contact: [firstname.lastname@example.org]Optimize[/email]
TechNet-21 - Forum
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