POST 00607E : VACCINE WASTAGE

POST 00607E : VACCINE WASTAGE 27 September 2003 _____________________________________ Arantxa Colchero Aragones (mailto:[log in to unmask]) is asking a question about wastage rates and Ümit Kartoglu (mailto:[log in to unmask]) from WHO discusses the issue. _____________________________ Do you have information on vaccine wastage rates for 10, 20 and 50 doses per vial? Thanks _______________________________________ Vaccine wastage depends on many factors (that are also interlinked). The factors that affect vaccine wastage in a given country can be classified as follows: 1. Factors related to vaccine and syringe (vial size, dead space in syringes). 2. Factors related to immunization policy (coordination of donor efforts, procurement practices, VVM in tender documents, MDVP, temperature monitoring, communication and supervision). 3. Factors related to logistics (stock control, availability of alternative cold chain, quality and management of cold chain, vaccine distribution and transport, VVMs, temperature monitoring, communication and supervision). 4. Factors related to immunization practice (MDVP, reconstitution practices, cold chain failures, session size, contamination). Since many of these factors depend on the management performance of the system, it is not possible to expect similar rates in countries unless situation in both countries are the same/similar. Since many years, organizations have advocated some rates that could be used in annual vaccine need estimations as vaccine wastage rates. Some of these figures are taken as "standard" vaccine wastage rates. Standard means "acceptable". However, "acceptability" of a rate totally depends on the situation. Therefore, it is not possible to advocate for a universally acceptable vaccine wastage level. Acceptable wastage levels vary between programmes in the light of experience and the analysis of local situations. For example, remote services have to open more vials per child than urban services, and as a result higher wastage rates are expected in rural areas. Similarly, in locations where a great majority of the population can only be reached through outreach services, higher wastage rates are expected. A study of DTP and HepB vaccine wastage was conducted in the Lao People’s Democratic Republic in 2001. Villages were grouped according to their distance from a fixed immunization site. Wastage rates were lower in villages that immunization teams could reach on foot or by bicycle or canoe and from which they could return to base the same day than in locations where the teams had to stay overnight. In the Lao People’s Democratic Republic, around 38% of the population live in remote areas, corresponding to 53% of villages. It was concluded that higher immunization coverage could only be achieved if higher wastage rates were accepted. Vaccine wastage rates are NOT usually plotted against immunization coverage rates. They are evaluated in isolation, making it impossible to see whether they should be considered high, low or reasonable. For example, a DTP wastage rate of 40% may be considered high in a country with 50% immunization coverage but acceptable in a country where more than half the population can only be reached through outreach activities. It is also important to know the type of vaccine wastage. A high wastage rate attributable to opening a multidose vial for a small session size in order to avoid missed opportunities is more acceptable than wastage attributable to freezing or expiry. However, it should be noted that higher vaccine wastage is expected with freeze-dried vaccines since they must be discarded within six hours of opening, whereas liquid vaccines can be used in subsequent sessions for up to 4 weeks. The multifactorial relationship between vaccine wastage rate and immunization coverage is the KEY to deciding whether wastage is really high. Both should be analyzed over a period of time rather than at a given point in time in order to reveal trends. Announcing so called "standard" rates or rates for using in "estimations" result in countries using these figures rather than monitoring and calculating their own wastage rates. It is extremely important that countries monitor their OWN wastage on a routine/monthly basis and use their figures in annual vaccine requirement calculations. ______________________________________________________________________________ Visit the TECHNET21 Website at http://www.technet21.org You will find instructions to subscribe, a direct access to archives, links to reference documents and other features. ______________________________________________________________________________ To UNSUBSCRIBE, send a message to : mailto:[log in to unmask] Leave the subject area BLANK In the message body, write unsubscribe TECHNET21E ______________________________________________________________________________ The World Health Organization and UNICEF support TechNet21. The TechNet21 e-Forum is a communication/information tool for generation of ideas on how to improve immunization services. It is moderated by Claude Letarte and is hosted in cooperation with the Centre de coopération internationale en santé et développement, Québec, Canada (http://www.ccisd.org) ______________________________________________________________________________