TechNet-21 - Forum

This forum provides a place for members to ask questions, share experiences, coordinate activities, and discuss recent developments in immunization.
  1. Gian-Gabriel Garcia
  2. Service delivery
  3. Wednesday, 19 August 2015

Hello everyone,

My colleagues and I have been developing VaCRO: Vaccine Clinic Reconstitution Optimizer. VaCRO is an Excel based tool that helps clinicians minimize open vial waste while maximizing immunization coverage by using the mathematical models to determine cut-off times for which it is optimal to stop reconstituting vials so vaccines can be preserved for future demand within the current cycle. This approach allows vaccine clinics to improve their immunization coverage without incurring any monetary costs.
We are looking to obtain feedback from VaCRO’s potential users. Please visit:http://pitt.edu/~vacro/to download VaCRO.

Currently, VaCRO is only available for Windows users. I will be adding VaCRO to the Technet Resource Library soon.


Many thanks,

Gian Garcia

Jay Rajgopal Accepted Answer
We would like to thank both of the above individuals for their insights and their comments about VaCRO, and would like to clarify a couple of points. First, our model was motivated by the tremendous amount of vaccine wastage (reported as ranging from 20% to as much as 80% for some vaccines) and the resultant unplanned shortages that lead to fewer immunizations overall. Our mathematical model is actually set up not to minimize wastage, but to maximize expected coverage based on a probabilistic characterization of demand. Second, and more importantly, this is a planning tool meant to come up with guidelines and is most certainly not a mandate. We fully agree that the field worker should always have the right to override these guidelines if he/she sees fit to do so. That said, the argument could be made that if we use a single dose today and waste the remaining 19 doses in a 20-dose vial, it is quite possible that a week from today we would be out of vaccine and perhaps turn away three children who show up to be vaccinated! Clearly, the best way to obviate this is through careful demand planning and ensuring that there is always an adequate supply of vaccine before the next order cycle at the clinic (and there are models that are similar to the one used in VaCRO that can assess how much vaccine supply is needed to provide prescribed levels of coverage). But in a resource constrained environment this might not always be feasible, and our tool could help with “looking ahead” when making decisions on opening new vials. However, we agree that clinicians/ field workers with their specific knowledge of an individual situation are the ones who are best suited to make the final decision on whether to override the model recommendation or not. We also agree that more flexibility in manufactured vial sizes would go a long way in maximizing coverage and are also studying this issue. Over the last several years we have worked quite a bit with public health professionals, but as industrial engineers we are admittedly not familiar with all aspects of day-to-day practice in the field, and we sincerely appreciate feedback and suggestions from practitioners that would guide us in ensuring that our models and analyses are grounded in reality. Jay -- Jayant Rajgopal Professor of industrial Engineering University of Pittsburgh Pittsburgh, PA 115261
  1. more than a month ago
  2. Service delivery
  3. # 1
Logical Epid Accepted Answer
I completely agree with Kristina,... It's very important to manage vaccine wastage but not at cost of denying vaccination to any child. Most public health experts would agree that many a times its advocated to reconstitute a multi-dose vial even if single due beneficiary has turned up at session site. cost effectiveness in decreasing morbidity and mortality due to that particular disease is much much more than trying to save few doses of vaccine in such cases, particularly in resource poor settings and developing countries with high disease burden. Very much impressed with your critical analysis madam
  1. more than a month ago
  2. Service delivery
  3. # 2
Kristina Lorenson Accepted Answer
Thank you for sharing your VaCRO model. By creation of this tool, you obviously have an appreciation for the complexities immunization programs face with respect to multi-dose vials. VaCRO presents an interesting approach to preserving stock for future demand; however, it has the potential to perpetuate turning away children and caregivers who may have traveled far distances for their scheduled vaccination session. Turning children away can increase the time and cost associated with community outreach to ensure children return, can place children at risk of receiving delayed vaccination or cause them to miss receiving the vaccine all together. Or, worse, turning a child away may cause caregivers such frustration that they may refuse future vaccinations. For a bit more background, attached is a presentation from Robert Steinglass (JSI), Oct 2014 DCVMN: http://www.dcvmn.org/IMG/pdf/steinglass_jsi_29th_oct_2014_delhi.pdf, a short vignette from a mother in Nigeria: http://allafrica.com/stories/201206040675.html, as well as link to the recent Technet post http://www.ghanaweb.com/GhanaHomePage/health/Vaccine-hesitancy-challenge-for-immunization-programmes-376381. WHO and UNICEF work closely with countries and manufacturers to balance supply and demand, accommodating for wastage. Your team may benefit from engaging with Paul Colrain (see his TechNet Conference 2015 presentation) who is working with WHO to develop a simple model to improve stock management and planning based on a facility’s mean session size. Instead of setting limits to the number of individuals vaccinated per session, it seeks to identify the best vaccine presentation (number of doses per container), frequency of sessions, and buffer stock to ensure sufficient supply is in place to accommodate all children who may show on a specific immunization day. The global community continues to encourage the generation of data and analytics to improve management of multi-dose vials, especially for lyophilized vaccines which must be discarded 6 hours after reconstitution. We also seek input from countries regarding preferred vaccine presentations (number of doses per container). We are optimistic in the near future that countries will have access to lower dose vial options and may be open to using these presentations in specific settings to mitigate wastage and maximize coverage. Tina Kristina Lorenson, MPH, MBA Program Officer, Vaccine Market Dynamics Global Development Program tina.lorenson@gatesfoundation.org Bill & Melinda Gates Foundation
  1. more than a month ago
  2. Service delivery
  3. # 3


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