TechNet-21 - Forum

This forum provides a place for members to ask questions, share experiences, coordinate activities, and discuss recent developments in immunization.
  1. John Lloyd
  2. Supply chain and logistics
  3. Monday, September 04 2017, 02:43 PM

Friends and Family of Immunization, I hope you will join me over the next six weeks before the TechNet Conference in Portugal to debate important futures for the vaccine supply chain. Each week, I will start a discussion on a topic and ask for your reactions. If you participate, you will also have the chance each week to respond to an online survey, just one or two questions, to express your agreement, interest or despair! The choice of topics is mine, not necessarily shared with any organization or individual. I chose them because they seem to respond to the changing needs of the vaccine cold chain and, collectively, they respond to most of the important challenges and opportunities that are on the horizon. They are:

  1. Merging vaccine and medicine distribution
  2. Advancing technologies of cooled-distribution
  3. Changing vaccines and their administration
  4. Introducing data-driven, remote oversight
  5. Addressing safety to maintain acceptance

At the end of these discussions, it may become clear whether collectively we are aligned towards this view of immunization futures or towards a different course. I will present the results of the survey in a summary posted before Technet. We expect to organize an event at the TechNet Conference to give a further chance to discuss these topics with other participants.

 

Topic one: Merging vaccine and medicine distribution

In the late 1970s, the vaccine supply chain was deliberately separated from other medical distribution systems. It was recognized at that time that vaccines occupied a small storage volume compared to that of medicines. Vaccines were different from medicines. They required special cooled handling procedures, a higher frequency of distribution and more timely arrival of fresh supplies.

 

Increased need for cooling of medicines

The volume of cooled medicines (+2/8C & +20/25C) is likely to be in the order of twenty times that of vaccines within the next few years. The demand for certain temperature products, such as insulin, is increasing and international standards (EU, US) have recently been established for handling all medicines. This is provoking extensive re-equipping of stores and re-mapping of transport. Ministries of Health are recognizing the economies of merging the distribution of vaccines with pharmaceuticals. WHO expressed the goal of integration in the Global Vaccine Action Plan 2011-2020 (GVAP) and many countries have already moved to integrate specific components of the supply chain.

The volume of cooled medicines (+2/8C & +20/25C) is likely to be in the order of twenty times that of vaccines within the next few years. The demand for certain temperature products, such as insulin, is increasing and international standards (EU, US) have recently been established for handling all medicines. This is provoking extensive re-equipping of stores and re-mapping of transport. Ministries of Health are recognizing the economies of merging the distribution of vaccines with pharmaceuticals. WHO expressed the goal of integration in the Global Vaccine Action Plan 2011-2020 (GVAP) and many countries have already moved to integrate specific components of the supply chain.

 

Rationalization of the distribution network

So many countries have now choosen to establish para-statal organizations that handle the distribution of vaccines, medicines and supplies. The process of integrating warehousing and distribution needs for medical products compels Ministries of Health to reconsider the network of intermediate stores linking districts with the central, national store. Instead of 40m3 ready-made, ‘plug-and-play’ cold rooms that are fitted into spare storage spaces, large-scale 5000m3 cold-room facilities are planned for large countries on the basis of efficient use of the road network and optimizing storage sites.

Discussion point #1: Do the existing primary stores and transport infrastructure provide the most efficient network for future distribution of temperature-sensitive medicines and vaccines?

 

Vaccine volumes now require refrigerated vehicles

Cold boxes or vaccine packaging cooled by ice-packs are typically loaded onto trucks and used for most journeys between stores. Frozen ice-packs increase the risk of freezing in transport and a high level of compliance is needed to reduce the risk. The increased volume of vaccines to be transported is becoming unmanageable. Hundreds of packs are loaded into 25l insulated boxes that occupy six times the storage volume of vaccines to be transported and exceed the capacity of trucks.

 

Integrated transport by refrigerated vehicle

Refrigerated vehicles are efficient in the use of transportable volume per km. They require less re-packing time and staff resources and most already carry temperature-recording devices that will soon be merged with the monitoring equipment standardized for vaccine refrigerators. In addition, satellite-positioning systems in the trucks will enable LMIS systems to automatically track distribution timeliness and arrival at each delivery point on optimized road circuits.

Refrigerated vehicles will improve the timeliness of the delivery system and will raise the standard of vaccine handling. Refrigerated vehicles are the mode of choice for store-to-store pharmaceutical distribution and will replace passive cooling at central and intermediate stores. Icepack freezing will still remain an important option at the level of service delivery.

Discussion point #2: When planning transport for store-to-store delivery of vaccine, do country managers evaluate the costs and benefits of sharing refrigerated vehicles and integrating with supply of temperature controlled medicines?

 

Please click this link to complete a short questionnaire:

https://www.surveymonkey.com/r/3F6K5TL

I will return the analysis to you at the end of this week and the results will be posted before TECHNET for all five topics. Thank you!

 

References
  1. https://www.technet-21.org/en/forums/discussions/vaccine-supply-chain-futures-2-6-advancing-technologies-and-techniques-of-distribution
John Lloyd Accepted Answer

Vaccine Supply Chain Futures 2/6 : Advancing technologies of cooled-distribution

What are the advances in technology and technique that are available now or in the near future and that are likely to be critical success factors for the vaccine supply chain? In this, second topic on ‘futures’ of the vaccine chain I am proposing four important advances:

  • Distribution of supplies in today’s world is achieved by pre-planned, regular, timely delivery from higher level to lower level stores. Quality and efficiency will never be achieved by ad-hoc collection of vaccines;
  • Rates of vaccine consumption and utilization at the point of administration and in real-time can and should drive vaccine requirements forecasting at all levels. Data transmission technology to implement this is becoming available everywhere:
  • Accidental freezing of vaccines that remains as a persistent problem particularly during immunization outreach and campaigns can be eliminated by new cooling technologies;
  • Innovative refrigerator options powered by solar or grid and that share the same energy buffer to achieve continuous, high quality cooling will merge in a single, universal product to replace yesterday’s complex procurement choices.

These four sub-topics are discussed in the attached file. As for Topic 2, I invite you to click on this link to complete just 5 multiple option questions ?

https://www.surveymonkey.com/r/GTC82DX

I will return the analysis to you at the end of this week and the results will be posted before TECHNET for all five topics.

Thank you! 

Attachments (1)
  1. more than a month ago
  2. Supply chain and logistics
  3. # 1
John Lloyd Accepted Answer

Topic 1 : Merging Medicine and Vaccine Supply Chains: Summary of discussion and results of SurveyMonkey Q1-Q4

________________________________________________

Although response to this Topic was light (n=10), there was strong support for countries to evaluate thoroughly the benefits versus the costs of progressively merging the use of vehicles and refrigerated and controlled temperature stores for vaccines and medicines. This does not necessarily imply that control over the distribution process has to be removed from immunization and vaccine managers who often resist the change. If the vehicle and cold room resources are managed by the merged distribution para-statal, computers can be used by immunization managers to schedule and oversee the quality of handling and timeliness of deliveries. The benefits of specific aspects of the merge appear to be convincing enough to include in strategic planning of vaccine distribution in every country.

PLEASE OPEN ATTACHED FILE FOR FULL REPORT !

Attachments (1)
  1. more than a month ago
  2. Supply chain and logistics
  3. # 2
James Cheyne Accepted Answer

Hello,

Thank you for this challenging challenge!

For me, sharing vaccine deliveries with, for example oxytocin and other temperature-sensitive pharmaceuticals, is a bit of a 'no brainer'.  Of course they should be integrated.  

Can you imagine DHL, FedEx or UPS using a different van to deliver different products to the same address: parcels are delivered by this van and letters are delivered by a different van?

The issue is how to do share deliveries in practice between the multiple departments in the MoH who need supplied delivered.  The private delivery companies charge their customers a fee, who want their parcels or letter delivered, based on weight or volume so that the owner of the vehicle covers their costs - fuel, vehicle maintenance, drivers' salary, profit, etc. 

This is not rocket science.  Has anyone seen common deliveries supporting several departments in a Ministry?   For example, the malaria, HIV, MCH and EPI departments with each paying for a share of a single van or truck to make a round of deliveries.      And if so, what worked well and what needed fixing after the system was introduced?  Or is there another way that works well in the public sector?

We learn from our successes; but we learn more from our failures.

P.S. There are dozens of free trip-planning applications that will work out the most efficient route for each journey that may be different each time depending on what’s in the van and to where the individual items need to be delivered.

 

  1. more than a month ago
  2. Supply chain and logistics
  3. # 3


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