Cold chain (transport & storage) &
disposal volumes, current status &
future trends in cold chain?
Primary container size roundtable
Washington, 09 - 10 May 2012
S. Kone, WHO/IVB
Major Impact on the Immunization systems
• Storage & transport:
– Increasing volume of vaccines
delivering more vaccines
Trend of # doses delivered per child
• Work force:
– Increasing workload for handling
& delivering more vaccines
• Injection safety:
– Increasing risk of programmatic
errors in handling more vaccines
• Waste management:
– Increasing pressure on the
environment from more injection
waste
0
# injections
2
4
6
# doses
8 10 12 14 16 18 20
– Secondary packaging (primary container per box)
– Packed volume (cm3/dose)
– Packed with or without diluents (if any)
• Price ($/dose)
Price Presentation
• Formulation (liquid or lyophilized, mono/multi
components)
• Preservative (Yes/No)
• No. of doses required per target (contacts)
• Mode of administration (oral/injection/nasal)
• Storage conditions (temperature ranges, VVM)
• Presentation (prefilled, single/multi-dose vials)
• Packaging
Formulation
Vaccine characteristics
Implications on operations
Administration
Cold chaîn
Dry storage
Waste
Mode administration:
– Oral Vaccine:
low
low
--
– Injectable Vaccines:
high
high
high
high
– Liquid Vaccines:
low
high
moderate
moderate
– Recons. Vaccines:
high
low
high
high
– Pre-filled device:
low
high
low
low
– Single dose vials:
high
high
high
high
--
Formulations:
Presentations:
– Multi-dose vials:
moderate
moderate
moderate
moderate
NVI schedule & increasing disparities…
DTP-HepB-Hib (liquid)
• Type of VVM: all with VVM14
• MDVP: Keep & use for subsequent sessions
• Presentations:
–
–
–
–
–
1-dose vial in boxes of 50: 10.28cm3/dose
1-dose vial in boxes of 50: 13.14cm3/dose
1-dose vial in boxes of 50: 26.1cm3/dose
2-dose vial in boxes of 50: 13.1cm3/dose
10-dose vial in boxes of 50: 2.6cm3/dose
•
•
•
•
DTP-HepB+Hib (liquid+lyo)
Type of VVM: all with VVM14
MDVP: Keep cool & use/discard @ 6h?!
Presentations:
–
–
–
–
–
1-dose vial in boxes of 200: 39.2cm3/dose
1-dose vial in boxes of 216: 58.7cm3/dose
2-dose vial in boxes of 200: 19.6cm3/dose
10-dose vial in boxes of 144: 7.8cm3/dose
10-dose vial in boxes of 150: 5.1cm3/dose
Cold/dry storage & transport - measurement
Volume of waste generated - measurement
 Schedule 10-dose
penta
•
•
2.2 empty vials
8,8 seringues usagers
 Schedule 1-dose penta
•
•
4.9 empty vials
127% increase vs 10-d
 Schedule CAD penta
•
•
1.8 empty vials
18% decrease vs 10-d
DRC cc analysis, EPI review 2012
 Increased capacity & workload:
•
•
Form 6 WICR to 19 WICR
Same logistics team
DRC cc analysis, EPI review 2012

Schedule 10-dose penta
•
•
•

Schedule 1-dose penta
•
•
•

20 WICR
No addition cc required for
PCV expansion
Rota can be introduced w/o
additional cc expansion
65 WICR
Ongoing cc expansion for PCV
Rota !?
Schedule CAD penta
•
•
•
49 WICR
Cc adequate for PCV
Moderate cc for rota
DRC cc analysis, EPI review 2012
 Increased No. of batches
•
•
•
> 220 batches for 7 vaccines
Penta 1-dose - 63 WICR
PCV-13 1-dose – 53 batches
Source: WHO/IVB, Apr. 2010 (based on Chad data)
Volume-DTC-HepB-Hib
Volume-DTC
New vaccine introduction resulted in a 5-fold increase of the
workload at central level!
2010-03-01
2010-02-01
2010-01-01
2009-12-01
2009-11-01
2009-10-01
2009-09-01
2009-08-01
2009-07-01
2009-06-01
2009-05-01
2009-04-01
2009-03-01
2009-02-01
2009-01-01
2008-12-01
2008-11-01
DPT: 2 shipments
per year (2,500
litres per shipment)
2008-10-01
9,000
2008-09-01
10,000
2008-08-01
2008-07-01
2008-06-01
2008-05-01
2008-04-01
2008-03-01
2008-02-01
2008-01-01
2007-12-01
2007-11-01
2007-10-01
2007-09-01
2007-08-01
2007-07-01
2007-06-01
2007-05-01
7,000
2007-04-01
8,000
2007-03-01
2007-02-01
2007-01-01
Volume vaccin, litres
Increased workload… EPI Chad, 2010
11,000
Evolution volume DTC & Penta
Penta: 4 shipments
per year (6,000
litres per shipment)
6,000
5,000
4,000
3,000
2,000
1,000
-
500

450
400
350

first generation new vaccines presented
challenging formats:
•
PCV-7 in preffilled glass syringe
•
Rota lyo complex & bulky
Upstream efforts initiated (VPPAG, OPTIMIZE) for
preferred vaccine presentations
Rota
300
250
200
Pneumo
150
100
50
0
Penta
Trad Vax (bcg, opv, msl, dtp & tt)
19
80
19
82
19
84
19
86
19
88
19
90
19
92
19
94
19
96
19
98
20
00
20
02
20
04
20
06
20
08
20
10
20
12
20
14
20
16
20
18
20
20
Vaccine storage volumes, cm3/child
Challenge of increased Vaccine volumes
TV (bcg, opv, dtp, msl, tt)
dtp-hepB-Hib
Pneumo
Rota
500


450
400
350
300
250
200

Drastic reduction of packed volumes
Still, many countries facing challenges:
•
Weak infrastructures
•
Inefficient distribution systems
•
Poor stock monitoring and tracking
•
Insufficient vaccine wastage control
As consequence
•
Delayed introductions
•
Short-term/ad-hoc solutions based
on risky coping strategies
•
Sub-optimal use of the opportunities
150
Rota
100
Pneumo
50
0
Penta
Trad Vax (bcg, opv, msl, dtp & tt)
19
80
19
82
19
84
19
86
19
88
19
90
19
92
19
94
19
96
19
98
20
00
20
02
20
04
20
06
20
08
20
10
20
12
20
14
20
16
20
18
20
20
Vaccine storage volumes, cm3/child
Challenge of increased vaccine volumes
TV (bcg, opv, msl, tt)
dtp-hepB-Hib
Pneumo
Rota
Vaccination workforce
• Workload per team (use your experience)
– No. of injections / vaccinator / day (according to settings)
• Vaccination teams:
– No. of teams = target population / daily workload / days
• No. of personnel = staff per team x No. of teams
–
–
–
–
Crowd/flow control
Screening/Recording
Mixing vaccine
Administration of vaccine
Analysis of No. of service points available
Analysis of No. of service points available
Thank you