Primary Vaccine Container
Roundtable: Modeling
Bruce Y. Lee, MD, MBA
Associate Professor of Medicine, Epidemiology, and
Biomedical Informatics
University of Pittsburgh
HERMES Vision
Data on Supply
Chain Structure,
Storage Locations,
Transport,
Capacities,
Personnel, etc.
Standard
input deck
Create a freely available and userfriendly software tool for decision
makers to generate an interactive
simulation model of any supply chain
(= a virtual laboratory).
Supply
chain
function
costs
Economic
Metrics
Total
Costs
Discrete
event
simulation
model of
supply
chain
Supply
chain
performan
ce metrics
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OPTIMIZE
supply
chain
costing
tool
Unit
Costs
Cost
Drivers
HERMES Can Address…
•
•
•
•
•
•
Impact of introducing new technology
– e.g., vaccines, storage, and monitoring
Characteristics of vaccines and other technologies
– e.g., vaccine vial size, vaccine thermostability, cold device
capacity
Configuration and operations of the supply chain
– e.g., storage, shipping frequency, personnel, ordering policy
Effects of differing conditions/circumstances
– e.g., power outages, delays, inclement weather, limited access
Investment or allocation of resources
– e.g., adding refrigerators vs. increasing transport frequency
Optimizing vaccine delivery
– e.g., minimize cost, cost per outcome, maximize
immunizations
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Discrete Event
Simulation Model
Each Storage Facility
*
Transport
Higher
Level
Refrigerator
*
Refrigerator
*
Refrigerator
Freezer
Each vaccine vial
= entity
*
Next
Level 1
*
Next
Level 2
*
*
*
Next
Level 3
*
 Capacity
 Temperature
range
 Probability of
failure or delay
Each diluent vial
= entity
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Health Service Delivery
Location
An example of the possible
devices available at any
location
Refrigerator
Vaccine carrier
Higher
Level
Example
of
outputs
Health care worker:
1. opens vaccine
vial and
reconstitutes with
diluent (if
required)
2. administers
vaccine to client
Open vial wastage
= unused doses
in opened vials
Client arrival based on health
system or census/birth data
If the correct vaccine is…
Available =
successful
immunization
Medical Waste
5
vaccine
=
availability
Not available =
missed
immunization
opportunity
clients successfully immunized
all clients arriving
What do you need to model a
supply chain?
• Identify purpose of simulation
– Questions to address
– Perspective of user
• Determine detail of simulation model required
– Less detail to address general, simpler questions
– More detail to address more complex questions
• Gather and input supply chain data into
HERMES
– Less data  less detailed simulation model
– More data  more detailed simulation model
• Decision maker can directly run HERMES on
any laptop computer
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Niger Supply Chain
Serum Institute
Sanofi Aventis
Central
Store
Regional
Store
Regional
Store
Regional
Store
Regional
Store
1
Regional
Store
Month
Regional
Store
42 District Stores (Chest
Refrigerators and Freezers)
1 Month
Clinics and/or Freezers)
600+ Clinics (Small 600+
Refrigerators
http://smartabouthealth.net/diseases/2008/10/27/rotavirus-vaccine-helping-fight-contagious-disease-in-kids/
Regional
Store
Thailand Supply Chain
International
Manufacturers
Domestic
Manufacturers
National Site
(1 location)
Trang
Province
Regional Site
(1 location)
Levels of vaccine administration
District Sites (21)
Trang Provincial Site
(1 location)
District Health
Offices (8)
Intermediary (1)
8
Hospitals (9)
Municipal Health
Centers (3)
Patients
Sub-district Sites
(126)
Patients
Vaccine Availability
Vaccine Availability (%)
Vaccine Availability (%)
Vaccine Availability (%)
Vaccine Availability (%)
Vaccine Availability
Vaccine. 2010 Jul 19;28(32):592-300. Epub 2010 Jun 3. PMID: 20566395 [PubMed – indexed for MEDLINE
Cost per Dose by Arrival Rate
Optimal Vial Size
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Capacity Utilization Rates
Ten-dose Measles
vaccine
Transport space utilization
Regional to
Provincial (1 route)
Single-dose MMR
vaccine
Single-dose Measles
vaccine
4.3%
4.0%
37.6%
(range: 8.7%-117.2%)**
49.9%
(range: 24.0%-106.9%)*
33.5%
(range: 7.5%-111.1%)*
45.3%
(range: 23.5%-97.5%)
41.9%
35.0%
29.2%
33.7%
31.0%
2.2%
(range: 0.7%-4.5%)
0.9%
(range: 0.4%-1.6%)
2.8%
(range: 0.7% - 5.1%)
1.1%
(range: 0.6%-2.4%)
2.6%
(range: 0.7%-4.8%)
1.1%
(range: 0.6%-2.3%)
3.8%
Provincial to
30.9%
District
(range: 6.9%-105.5%)*
District to Sub42.7%
district
(range: 22.9%-85.4%)
Storage space utilization
Regional
28.2%
(1 site)
Provincial (1 site)
District
Sub-district
* Only one transport device would need to utilize more than 100% of the available space
** Only two transport devices would need to utilize more than 100% of the available space
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Vaccine Availability
Mean
Min
Max
District
94.40%
90.80%
98.90%
Sub-district
95.60%
86.20%
100.00%
District
92.40%
88.20%
98.70%
Sub-district
83.40%
72.70%
92.90%
District
91.90%
87.90%
98.50%
Sub-district
83.60%
73.40%
91.70%
Ten-dose measles
Single-dose MMR
Single-dose measles
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Truck Capacity Utilization
10-dose measles vaccine vial size
5-dose measles vaccine vial size
2-dose measles vaccine vial size
1-dose measles vaccine vial size
Storage Capacity Utilization
10-dose measles vaccine vial size
5-dose measles vaccine vial size
2-dose measles vaccine vial size
1-dose measles vaccine vial size
Vaccine Availability
Percentages
Measles Vaccine Vial Size Scenario
10 doses per vial
5 doses per vial
2 doses per vial
1 doses per vial
79%
79%
78%
76%
84%
84%
82%
80%
90%
80%
84%
79%
87%
80%
84%
79%
86%
78%
83%
78%
80%
76%
80%
76%
84%
86%
94%
80%
86%
84%
85%
86%
92%
80%
86%
85%
85%
86%
89%
80%
86%
85%
84%
84%
84%
79%
84%
84%
81%
91%
93%
82%
90%
81%
81%
91%
91%
82%
90%
81%
81%
91%
91%
82%
90%
81%
80%
89%
90%
82%
89%
80%
100% Target Population Size
Bacille-Calmette-Guerin Tuberculosis (BCG)
Diptheria-tetanus-pertussis-hepatitis BHaemophilus influenza type B
(DTP-HepB-Hib)
Measles
Oral polio (OPV)
Tetanus toxoid (TT)
Yellow fever (YF)
80% Target Population Size
BCG
DTP-HepB-Hib
Measles
OPV
TT
YF
60% Target Population Size
BCG
DTP-HepB-Hib
Measles
OPV
TT
YF
Summary and Discussion
• HERMES can rapidly create a
simulation model of any supply chain
• Serve as a virtual laboratory to help a
wide variety of vaccine decision makers
answer any number of questions
•EVM+HERMES: World Health
Organization (WHO), UNICEF, Bill and
Melinda Gates Foundation
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Vaccine Logistics Team
May 29, 2012
Tina-Marie Assi, PhD
Leila A. Haidari, BS
Michelle M. Schmitz, BA
Epidemiology
Epidemiology
Computational Modeling
Shawn T. Brown, PhD
Bruce Y. Lee, MD, MBA
Rachel B. Slayton, PhD
Computational Science
Epidemiology, Economics,
and Operations Research
Epidemiology
Donald S. Burke, MD
Jim Leonard
Angela R. Wateska, MPH
Infectious Diseases,
Computer Science
Epidemiology
Brigid E. Cakouros, BA
Leslie E. Mueller, BS
Joel S. Welling, PhD
Behavioral and Community Health
Sciences
Epidemiology
Computer Science
Sheng-I Chen, MS
Bryan A. Norman, PhD
Yu-Ting Weng, MS
Industrial Engineering
Industrial Engineering
Biostatistics
Erin G. Claypool, PhD
Jayant Rajgopal, PhD
Carol Levin, PhD
Industrial Engineering
Industrial Engineering
PATH, Optimize
Diana L. Connor, MPH
Proma Paul, MPH
Mercy Mvundura, PhD
Infectious Diseases and
Microbiology
Epidemiology
PATH, Optimize
© 2011 Bill & Melinda Gates Foundation
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Contact Information
Bruce Y. Lee, MD MBA
Associate Professor of Medicine, Epidemiology,
and Biomedical Informatics
University of Pittsburgh
200 Meyran Avenue, Suite 200
Pittsburgh, PA 15213
Email: [email protected]
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