Re-designing the Mozambique vaccine supply chain to improve access to vaccines

Abstract

Introduction Populations and routine childhood vaccine regimens have changed substantially since supply chains were designed in the 1980s, and introducing new vaccines during the “Decade of Vaccine” may exacerbate existing bottlenecks, further inhibiting the flow of all vaccines. Methods Working with the Mozambique Ministry of Health, our team implemented a new process that integrated HERMES computational simulation modeling and on-the-ground implementers to evaluate and improve the Mozambique vaccine supply chain using a system-re-design that integrated new supply chain structures, information technology, equipment, personnel, and policies. Results The alternative system design raised vaccine availability (from 66% to 93% in Gaza; from 76% to 84% in Cabo Delgado) and reduced the logistics cost per dose administered (from $0.53 to $0.32 in Gaza; from $0.38 to $0.24 in Cabo Delgado) as compared to the multi-tiered system under the current EPI. The alternative system also produced higher availability at lower costs after new vaccine introductions. Since reviewing scenarios modeling deliveries every two months in the north of Gaza, the provincial directorate has decided to pilot this approach diverging from decades of policies dictating monthly deliveries. Discussion Re-design improved not only supply chain efficacy but also efficiency, important since resources to deliver vaccines are limited. The Mozambique experience and process can serve as a model for other countries during the Decade of Vaccines. For the Decade of Vaccines, getting vaccines at affordable prices to the market is not enough. Vaccines must reach the population to be successful.

Economic impact of thermostable vaccines

“…Of course, the impact may vary depending on the severity of constraints in a supply chain and the burden of disease in the population. However, as previous studies have shown, many lower- and middle-income counties suffer from significant bottlenecks[1–3, 11, 12], while the burden of major vaccine-preventable disease remains high[13]. …”

How coping can hide larger systems problems: the routine immunisation supply chain in Bihar, India

“…As described in previous publications,7 9 10 13–16 Highly Extensible Resource for Modelling Event-Driven Supply Chains (HERMES) is a software platform developed by the HERMES logistics team that allows users to generate detailed discrete event simulation models of any vaccine supply chain. Each supply chain model contains a virtual representation of all storage facilities and devices (including buildings, refrigerators and freezers), vehicles and routes (including vehicle types, travel frequency and travel distance), human resources (including logisticians, drivers and vaccinators), vaccines, supply chain policies and associated costs for each component.…”

“…As our previous studies demonstrated, the design of most low-income and middle-income countries’ routine immunisation systems took place around four decades ago 5–8. Despite changes in external circumstances (eg, substantial population growth) and the introduction of new technology (eg, vaccine introductions), there have been relatively few re-design efforts until recently 5 9 10. This raises the possibility that significant coping could be occurring.…”

Dual-chamber injection device for measles-rubella vaccine: The potential impact of introducing varying sizes of the devices in 3 countries

“…Our team used three previously developed stochastic, discrete-event vaccine supply chain simulation models of Benin [16] , [17] , [18] , Bihar [19] and Mozambique [20] . These models were developed using the Highly Extensible Resource for Modeling Supply Chains (HERMES) software and virtually represent all of the storage facilities, refrigerators and freezers, shipping routes, vehicles, personnel, and vaccines in each supply chain.…”