The value of tailoring vial sizes to populations and locations

Patrick T Wedlock, Elizabeth A. Mitgang, Leila A. Haidari, Wendy Prosser, Shawn T. Brown, Kirstin Krudwig, Sheryl Siegmund, Jay V. DePasse, Jennifer Bakal, Jim Leonard, Joel Welling, Robert Steinglass, Frances Dien Mwansa, Guissimon Phiri, Bruce Lee

Research output: Contribution to journalArticle

Abstract

Background: Frequently, a country will procure a single vaccine vial size, but the question remains whether tailoring the use of different size vaccine vial presentations based on populations or location characteristics within a single country could provide additional benefits, such as reducing open vial wastage (OVW) or reducing missed vaccination opportunities. Methods: Using the Highly Extensible Resource for Modeling Supply Chains (HERMES) software, we built a simulation model of the Zambia routine vaccine supply chain. At baseline, we distributed 10-dose Measles-Rubella (MR) vials to all locations, and then distributed 5-dose and 1-dose MR vials to (1) all locations, (2) rural districts, (3) rural health facilities, (4) outreach sites, and (5) locations with average MR session sizes <5 and <10 children. We ran sensitivity on each scenario using MR vial opening thresholds of 0% and 50%, i.e. a healthcare worker opens an MR vaccine for any number of children (0%) or if at least half will be used (50%). Results: Replacing 10-dose MR with 5-dose MR vials everywhere led to the largest reduction in MR OVW, saving 573,892 doses (103,161 doses with the 50% vial opening threshold) and improving MR availability by 1% (9%). This scenario, however, increased cold chain utilization and led to a 1% decrease in availability of other vaccines. Tailoring 5-dose MR vials to rural health facilities or based on average session size reduced cold transport constraints, increased total vaccine availability (+1%) and reduced total cost per dose administered (−$0.01) compared to baseline. Conclusions: In Zambia, tailoring 5-dose MR vials to rural health facilities or by average session size results in the highest total vaccine availability compared to all other scenarios (regardless of OVT policy) by reducing open vial wastage without increasing cold chain utilization.

Original languageEnglish (US)
JournalVaccine
DOIs
StateAccepted/In press - Jan 1 2018

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Rubella
Measles
Population Density
vaccines
rural health
dosage
Vaccines
Rural Health
Health Facilities
Zambia
Refrigeration
supply chain
Rubella Vaccine
Measles Vaccine
outreach
administered dose
health care workers
simulation models
vaccination
Vaccination

Keywords

  • Measles-rubella
  • Supply chain logistics
  • Tailoring
  • Vial size

ASJC Scopus subject areas

  • Molecular Medicine
  • Immunology and Microbiology(all)
  • veterinary(all)
  • Public Health, Environmental and Occupational Health
  • Infectious Diseases

Cite this

Wedlock, P. T., Mitgang, E. A., Haidari, L. A., Prosser, W., Brown, S. T., Krudwig, K., ... Lee, B. (Accepted/In press). The value of tailoring vial sizes to populations and locations. Vaccine. https://doi.org/10.1016/j.vaccine.2018.12.010

The value of tailoring vial sizes to populations and locations. / Wedlock, Patrick T; Mitgang, Elizabeth A.; Haidari, Leila A.; Prosser, Wendy; Brown, Shawn T.; Krudwig, Kirstin; Siegmund, Sheryl; DePasse, Jay V.; Bakal, Jennifer; Leonard, Jim; Welling, Joel; Steinglass, Robert; Mwansa, Frances Dien; Phiri, Guissimon; Lee, Bruce.

In: Vaccine, 01.01.2018.

Research output: Contribution to journalArticle

Wedlock, PT, Mitgang, EA, Haidari, LA, Prosser, W, Brown, ST, Krudwig, K, Siegmund, S, DePasse, JV, Bakal, J, Leonard, J, Welling, J, Steinglass, R, Mwansa, FD, Phiri, G & Lee, B 2018, 'The value of tailoring vial sizes to populations and locations', Vaccine. https://doi.org/10.1016/j.vaccine.2018.12.010
Wedlock, Patrick T ; Mitgang, Elizabeth A. ; Haidari, Leila A. ; Prosser, Wendy ; Brown, Shawn T. ; Krudwig, Kirstin ; Siegmund, Sheryl ; DePasse, Jay V. ; Bakal, Jennifer ; Leonard, Jim ; Welling, Joel ; Steinglass, Robert ; Mwansa, Frances Dien ; Phiri, Guissimon ; Lee, Bruce. / The value of tailoring vial sizes to populations and locations. In: Vaccine. 2018.
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abstract = "Background: Frequently, a country will procure a single vaccine vial size, but the question remains whether tailoring the use of different size vaccine vial presentations based on populations or location characteristics within a single country could provide additional benefits, such as reducing open vial wastage (OVW) or reducing missed vaccination opportunities. Methods: Using the Highly Extensible Resource for Modeling Supply Chains (HERMES) software, we built a simulation model of the Zambia routine vaccine supply chain. At baseline, we distributed 10-dose Measles-Rubella (MR) vials to all locations, and then distributed 5-dose and 1-dose MR vials to (1) all locations, (2) rural districts, (3) rural health facilities, (4) outreach sites, and (5) locations with average MR session sizes <5 and <10 children. We ran sensitivity on each scenario using MR vial opening thresholds of 0{\%} and 50{\%}, i.e. a healthcare worker opens an MR vaccine for any number of children (0{\%}) or if at least half will be used (50{\%}). Results: Replacing 10-dose MR with 5-dose MR vials everywhere led to the largest reduction in MR OVW, saving 573,892 doses (103,161 doses with the 50{\%} vial opening threshold) and improving MR availability by 1{\%} (9{\%}). This scenario, however, increased cold chain utilization and led to a 1{\%} decrease in availability of other vaccines. Tailoring 5-dose MR vials to rural health facilities or based on average session size reduced cold transport constraints, increased total vaccine availability (+1{\%}) and reduced total cost per dose administered (−$0.01) compared to baseline. Conclusions: In Zambia, tailoring 5-dose MR vials to rural health facilities or by average session size results in the highest total vaccine availability compared to all other scenarios (regardless of OVT policy) by reducing open vial wastage without increasing cold chain utilization.",
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AU - Haidari, Leila A.

AU - Prosser, Wendy

AU - Brown, Shawn T.

AU - Krudwig, Kirstin

AU - Siegmund, Sheryl

AU - DePasse, Jay V.

AU - Bakal, Jennifer

AU - Leonard, Jim

AU - Welling, Joel

AU - Steinglass, Robert

AU - Mwansa, Frances Dien

AU - Phiri, Guissimon

AU - Lee, Bruce

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N2 - Background: Frequently, a country will procure a single vaccine vial size, but the question remains whether tailoring the use of different size vaccine vial presentations based on populations or location characteristics within a single country could provide additional benefits, such as reducing open vial wastage (OVW) or reducing missed vaccination opportunities. Methods: Using the Highly Extensible Resource for Modeling Supply Chains (HERMES) software, we built a simulation model of the Zambia routine vaccine supply chain. At baseline, we distributed 10-dose Measles-Rubella (MR) vials to all locations, and then distributed 5-dose and 1-dose MR vials to (1) all locations, (2) rural districts, (3) rural health facilities, (4) outreach sites, and (5) locations with average MR session sizes <5 and <10 children. We ran sensitivity on each scenario using MR vial opening thresholds of 0% and 50%, i.e. a healthcare worker opens an MR vaccine for any number of children (0%) or if at least half will be used (50%). Results: Replacing 10-dose MR with 5-dose MR vials everywhere led to the largest reduction in MR OVW, saving 573,892 doses (103,161 doses with the 50% vial opening threshold) and improving MR availability by 1% (9%). This scenario, however, increased cold chain utilization and led to a 1% decrease in availability of other vaccines. Tailoring 5-dose MR vials to rural health facilities or based on average session size reduced cold transport constraints, increased total vaccine availability (+1%) and reduced total cost per dose administered (−$0.01) compared to baseline. Conclusions: In Zambia, tailoring 5-dose MR vials to rural health facilities or by average session size results in the highest total vaccine availability compared to all other scenarios (regardless of OVT policy) by reducing open vial wastage without increasing cold chain utilization.

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