Vaccine vial monitor use, policy, and practices in four regionsby Julie Milstien, independent consultant While the benefits of using vaccine vial monitors (VVMs) in immunization programs are widely known, a recently completed study of VVM use and availability shows that their use is still not universal. [img width=927]http://www.technet21beta.org/components/com_agora/converter/uploads/attachments/vvm_image_729.jpg[/img] The vaccine vial monitor is a small sticker that adheres to the label or the cap of a vaccine vial. The inner square is made of heat-sensitive material that changes color as the vaccine is exposed to heat letting health workers know whether the vaccine can be safely used for immunization. By synthesizing information from a number of sources, the study estimated that approximately 82% of the doses used for routine immunization in the Eastern Mediterranean region come with VVMs. The figure is about 84% in the African region, 56% in the Southeast Asian region, and 30% among developing countries in the Western Pacific region. The availability of VVMs depends largely on how the vaccine is procured. Countries using the United Nations-based procurement system tend to have VVMs on all vaccines used for routine immunization programs. Countries that procure their own vaccines directly from manufacturers or use a mixed sourcing system are likely to have a mix of products, and if they use VVMs at all, are most likely to have them on the oral polio vaccine. Most countries that produce their own vaccines do not use VVMs. Notable exceptions are India and Indonesia; both countries require VVMs on all domestically produced vaccine. The report provides several recommendations to improve VVM availability including the following. Work with countries in the Eastern Mediterranean and Western Pacific regions to specify VVMs for all vaccines as part of their procurement requirements, whether the vaccine is being procured directly from external or domestic manufacturers or being sourced by other donors. Help countries that have specified VVMs as a requirement ensure that manufacturers include them.In cases where domestically manufactured vaccines are not prequalified by WHO, it may be necessary to convene a policy group to consider the implications of using VVMs on these vaccines including the type of VVM, oversight and enforcement issues, and financing concerns.The study also considered results of in-depth reviews of policies and practices in eight countries, revealing a range of opportunities for improving and maximizing the impact of VVM use on program performance. For example, few countries are successfully using the VVM as a management tool (e.g., using the VVMs to decide which vaccines to use first or monitoring VVM color changes at each level of the supply chain), training is not systematically available at all levels of the health system, and there is widespread confusion about how to use VVMs with the multidose vial policy. To improve correct VVM use, several recommendations were made, including the following: Display visual reminders of correct VVM use and the multidose vial policy at all places where vaccinations are given.Ensure training gaps, particularly among vaccinators, are addressed through systematic fixed-site training sessions or by supervision and on-the-job training.Use vaccine administration records to record the VVM stage on receipt at each level.Enhance supervision practices to ensure proper implementation of VVM practices such as recording the VVM stage, employing the multidose vial policy, prioritizing vaccines with VVMs that are starting to change color, correctly handling and discarding vaccines with VVMs that have reached their endpoint, and monitoring wastage.With increased availability and proper use, VVMs can become a springboard for improving vaccine management practices, improving documentation of vaccines at each stage, ensuring efficient use of vaccines, avoiding stockouts and loss that result from improper storage, and ensuring that every dose given has not been damaged by heat. For a copy of the report, please send an email to [email@example.com]firstname.lastname@example.org[/email]. We invite you to comment on or post a question relating to this article by clicking the “post reply” button on this page. You will have to log in or register; the process is very simple. Return to the Optimize newsletter.  VVM non-use in this region is heavily influenced by large countries that produce their vaccines domestically (e.g., China and Vietnam).
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