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  2. Supply chain and logistics
  3. Saturday, 03 May 2008

POST 01261E: STRENGTHENING THE VACCINE SUPPLY CHAIN
3 MAY 2008

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Rowan Wagner writes about managing an efficient vaccine supply chain.
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Recently I received a request for information about logistic training material aimed at vaccine supply chains and have given it a thought - and shared the request. However, upon reflection, there is a lot of material targeted for the commercial sector in supply chain and demand chain management but not necessarily about vaccine chain management - there is cold chain management but not necessarily vaccine chain management (from a systems point of view)

There are many similarities of a vaccine supply chain to supply chain management of any commercial supply chain: a) need for information in terms of potential demand, monitoring/security – prevention of theft or spoilage and actual receipt of product, b) transport of the product from source of manufacture to end client, c) and end-user usage/satisfaction (which provides a feedback mechanism for quality improvement and efficiency building that reduces costs and builds customer base).


KEY ELEMENTS:
Epidemiological and demographical survey – to determine demand and priority of need
Procurement – tendering process for effective use of limited monetary resources and transparency in the procurement of vaccines and support equipment especially in terms of safety and quality assurance
Manufacturing /onsite storage – to include specificities of unique storage requirements of the vaccine and of the support equipment
Transportation – to one or several points
Intermediate storage – centralized and point of delivery
Actual immunization (use of product)
Feedback - in terms of coverage and adverse affects and other quality control factors
Disposal of hazardous waste (in the case of many manufactures they have a reverse supply chain to recover key product elements that can be recycled or are mandated to by governments to as means of public safety)
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So in simple terms, like commercial supply chains, vaccine supply chains need: effective management information systems and logistics support to achieve an overall goal of getting an important product connected to a client. Unlike commercial products, the individual benefit of the product may or not be realized and in addition others may gain positive benefits in terms of their own health (making it a public good) and often the end individual client often does not have the resources to provide economic viability of the product if it was a commercial venture especially when you factor in logistic costs in getting the product/service to the client/customer.

This is why in general, governments under the auspicious role of “public safety/health” “own” or like to control elements of public health systems to include supply chains (in the name of safety and/or specialized skills only possessed by the system). However, governments tend to be bureaucratic in nature (as can large corporations) and often create barriers (duplication, poor communication systems, etc…;) to essential information flow that results in waste of often very limited and valuable resources (money, human capital and time). This is counterintuitive to effective supply chain management that relies heavily on quality data/information to achieve efficiency and meet client expectations (in order to develop a lifelong customer relationship that enhances long-term profits).

Secondly, governments tend not to update the logistic support systems (the second critical component to an effective supply management system) especially in terms of vehicle fleets due to numerous reasons to include the cost of replacement parts and vehicles which are not often planned into the governmental budget and internal battles between governmental agencies that often leave public health and education at the bottom of the resource priority list., or do not effectively outsource logistics as the push/pull of cost savings and development of an effective customer relationship are not present.

And thirdly, the situation of the clients in terms of access and understanding of their own need (demand) for the immunization services places a challenge in terms of delivery of the product and service which adds to the costs in terms of communication and delivery logistically.

Given the similarities and differences any program looking at to improve vaccine supply chain management through training and/or programs projects should contain the following fundamental elements:
Understanding how demand is determined (epidemiological and demographic data) and the role of surveillance systems in providing decision making data in a timely manner. And how to create demand – critical to reduce wastage and to increase support for sustainability in terms of political/financial (government spending, tax collection, fee for service, etc…;)
Fundamentals of procurement (vaccines, immunizations support equipment and transport) and procurement systems contracts, information systems and outsourcing of maintenance and repair services - to include strengths and weakness of various options.
Transport and storage of vaccines and immunization associated equipment to include quality assurance and safety as point of ultimate delivery
Medical wastage disposal - a key long term public health risk when not done effectively.
Sustainability –like management information is embedded in each of the other elements.
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These elements have been addressed by many different organizations but often fragmentally such as:

WHO – IBV training aimed at health care workers in data collection (population epidemiological survey), safe injection practices, vaccine monitoring, medical waste handling and disposal.

WB – basics of health economics, which includes procurement and sustainability

UNICEF – procurement and communication (aimed a political and demand creation) Communication Handbook for Polio Eradication and Regular EPI – an effective resource

JSI – DELIVER – fundamentals of logistics and supply management

CDC – development of epidemiological data collection systems (EPI-Info), immunization campaign planning (CDC Synergy), vaccine safety to include low cost disposal for low resource countries – in partnership with WHO

PATH – cold chain management, new technology in immunization programs


Though these training programs contain information and learning outcomes that could develop key performance needed in an effective vaccine supply chain management they are often aimed at and attended by clinicians and are often restricted to looking at clinical issues: Whereas supply change management encompass MIS and management skills.

Areas that should be included beyond the key elements:

Management Tools:

Ø Critical decision making and systems analysis as immunization is part of health system and require decisions that have opportunity costs and gain both in the short and long terms, especially in making decisions on medium and long term life equipment and resources needed to sustain the equipment

Ø Effective communication – good supply chain management requires the right data at the right time to the right person. As supply chains can extend across the globe understanding how to communicate effectively and clearly across cultures is important.

Ø Human Resources – understanding how to design roles, recruit, select, and maintain/motivate human capital to ensure the vaccine supply chain system meets the needs of all key stakeholders and is sustainable. This means understanding how to best fit someone into a position who may not be a health professional or to design an effective system that lower level health personal who may not have a higher secondary or tertiary education can function effectively in. In terms of motivate and maintain this includes understanding reward systems, tools to gage employee satisfaction and tool that improve motivation: “Because without people the system does not work.”

Ø Entrepreneurship – especially skills that deal with solution generation and actualization

Material that addresses these issues can be found from organizations such as:

Management Sciences for Health (MSH)
Abt Associates Zdraft Plus – health care reform project
American International Health Alliance
MIDEGO (a global health care consulting firm)
MEDA
And many others…who work in capacity development of communities and organizations across the NGO spectrum

All the pieces of the puzzle, are there (with many extra as well); the question lies in:, “how do we all work together overcoming organizational/institutional silos; lack of political will and growing disbelief of the effectiveness and safeness of vaccines by the general public to build the big picture (and what does the picture look like) we are all working towards?” – Especially in terms of a better vaccine supply chain – to achieve health for all.

Inputs welcome

Rowan Wagner ([email=%5browanwagner@yahoo.com%5d]%5browanwagner@yahoo.com%5d[/email])
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A Supply Chain Fix for Flu

Influenza causes some 35,000 deaths and 100 million lost working days annually in the
United States, yet a vaccine to fight the illness is often in short supply when the flu season is at its peak. Supply chain issues have not been part of the debate until now. A study carried out by Yadav, and David Williams has identified a number of ways to make the vaccine supply chain more efficient. Here are some of the findings.
http://ctl.mit.edu/index.pl?id=4702

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