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  3. Thursday, 21 June 2012

IVAC held a 2-day roundtable meeting with about 40 experts and observers in Washington, DC on May 9th and 10th to review the available evidence and develop a framework for improving decision-making related to vaccine vial size, and understand the economics of vaccine choice.

Here is a list of presentation summaries and documents:

Primary Container Considerations for Prequalification
Andrew Meek, World Health Organization [ View PDF ]
Outlines mandatory, critical, and preferred vaccine characteristics concerning programmatic suitability for WHO prequalification. Addresses removal of preservative thiomersal, including lack of alternatives and consequences of removal on immunization programs. Also describes prequalification and future challenges for Synflorix 2-dose presentation.

Considerations for Primary Vaccine Containers. IFPMA Perspectives: What are the Issues?
Jules Millogo, International Federation of Pharmaceutical Manufacturers and Associations [ View PDF ]
Introduces IFPMA, a non-profit representing the research-based pharmaceutical industry worldwide. Discusses details of manufacturing, technical, financial, patient and practitioner considerations, and secondary packaging considerations. Concludes stating that parameters for primary container selection are complex and multiple, and patient and provider considerations drive decision-making.

Primary Vaccine Container Selection in Developing Countries Safety
Neal Halsey, Johns Hopkins Bloomberg School of Public Health [ View PDF]
Addresses surveillance systems for adverse events following immunization, vaccine presentations, preservatives, and contamination and needlesticks. Errors in vaccine administration occur everywhere, although no true rate data exist. Surveillance systems and staff training and supervision are also inadequate. Simpler vaccine administration methods reduce errors. Pre-filled single-use syringes are easiest and safest, but also expensive and bulky, and may not be practical. Contamination of multi-dose vials has resulted in outbreaks and deaths globally. Preservatives are effective but have several manufacturing and delivery vulnerabilities.

Primary Vaccine Container Selection Bangladesh Perspectives
Tajul Islam Abdul Bari, Ministry of Health Bangladesh [ View PDF ]
Covers Bangladesh’s vaccine schedule, delivery system, cold chain, multi-dose vial policy, vaccine wastage, and plans for new vaccine introduction. Bangladesh has no major administration safety problems, although cost, cold chain management, vaccine supply, and vaccine wastage are all important issues for the country.

Primary Vaccine Container Roundtable: Modeling
Bruce Y. Lee, University of Pittsburg [ View PDF ]
Presents the Vaccine Modeling Initiative’s HERMES, a computational tool to design, plan, and manage vaccine supply chains. Discusses impact of rotavirus and pneumococcal vaccine introduction in Niger and Thailand. Other important vaccine supply factors considered are cost, vial size, capacity utilization, and vaccine availability.

Cold Chain, Disposal Volumes, Current Status and Future Trends
S. Kone, WHO/IVB [ View PDF ] [ View PDF - Vaccine Presentations ]
This presentation provides an overview of major elements in immunization systems, along with information about the operations impact of vaccine characteristics such as price, presentation, and formulation. Data from the Democratic Republic of Congo and Chad demonstrate the challenges of vaccine volume changes and increased workload.

Considerations for Primary Container Decisions: DCVMN Perspective
Suresh S. Jadhav, Serum Institute of India / DCVMN [ View PDF ]
Introduces the DCVMN, an alliance of vaccine manufacturers from developing countries that aims to ensure a consistent supply of quality vaccines for developing countries. Presents manufacturers perspectives on cost, vial size, and preservatives. Discusses implications for transition from multi-dose vials to single-dose presentations.

Immunization Session Attendance, Vaccine Wastage and Coverage
Philippe Jaillard, Agence de Médecine Préventive [ View PDF ]
Presents a study conducted by AMP to measure session attendance and calculate wastage in urban and rural areas of Burkina Faso (2009). Main conclusions were: session organization differed by setting, successful strategies exist to limit wastage without reducing coverage, and vial size may be impact quality. Lists areas for further research.


For further questions on the roundtable or framework, please contact [email=lprivord@jhsph.edu]Lois Privor-DummLois Privor-Dumm[/email], Director of Alliances and Information at IVAC.



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