Vaccination: Rattling the Supply Chain: The Introduction of New Vaccines, Combined with a Push to Expand Immunization Globally to Reach Every Child, Is Straining Vaccine Supply Chains to the Limit. New Thinking on the Way Vaccines Are Delivered Is Needed

By Humphreys, Gary | Bulletin of the World Health Organization, May 2011 | Go to article overview

Vaccination: Rattling the Supply Chain: The Introduction of New Vaccines, Combined with a Push to Expand Immunization Globally to Reach Every Child, Is Straining Vaccine Supply Chains to the Limit. New Thinking on the Way Vaccines Are Delivered Is Needed


Humphreys, Gary, Bulletin of the World Health Organization


The first decade of this century was perhaps the most productive in the history of vaccine development, seeing the release of a plethora of new life-saving vaccines for rotavirus diarrhoea, types of meningitis and pneumonia, and for human papilloma-virus (HPV) infections that cause cervical cancer. "We are in a very different situation now compared to 10 years ago;' says Dr Osman Mansoor at the United Nations Children's Fund (UNICEF) in New York. Mansoor, who is UNICEF's senior health adviser for the Expanded Programme on Immunization and New Vaccines, notes that more vaccines are in the pipeline. In fact more than 80 vaccines are in the late stages of clinical testing, and 30 of them are designed to protect against major diseases including dengue and malaria.

At the same time, the global vaccine market is booming: since 2000, global revenue from the sale of vaccines has almost tripled reaching more than US$17 billion by mid-2008. While most of this expansion is accounted for by sales of new and more costly vaccines in industrialized countries, more vaccines are also reaching developing countries due to the efforts of the GAVI Alliance (formerly the Global Alliance for Vaccines and Immunization), a public-private partnership established in 2000 to increase immunization in poor countries.

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The World Health Organization (WHO) and UNICEF estimate that just over 80% of the world's children now have access to immunization, as measured by coverage of the third dose of DTP (diphtheria, tetanus and pertussis) vaccine, while an increasing number also have access to powerful new vaccines. "In the past, countries relied on a package of vaccines against six diseases" says Project Optimize Coordinator Modibo Dicko, referring to WHO's Expanded Programme on Immunization, which was launched in 1974. "Now some countries are doubling the number of vaccines they offer."

As encouraging as all this seems, the scaling up of immunization programmes and the introduction of new vaccines is putting an unprecedented strain on delivery systems that have not changed in decades. James Cheyne, a supply-chain consultant, who started his career in vaccine logistics in Burma (now Myanmar) in 1977, is in a good position to judge those systems since he has had a hand in designing several himself.

Cheyne cites the unnecessary layering of distribution networks as one of his main concerns. "Typically there is a central store that supplies the regional stores, which then feed the provincial stores and district stores that in turn supply the local health centres," he says, pointing out that while this layering made sense 30 years ago, because the lines of communication were weak, these days low-cost telecommunications technology has changed things. "You don't need a store for each administrative level anymore because we have cell phones and the person from the health centre can call the central store directly; Cheyne says.

Making better use of that kind of technology is a core aspect of the work being done by Project Optimize, a collaboration between WHO and PATH (formerly the Program for Appropriate Technology in Health), a nongovernmental organization.

For Michel Zaffran, the director of Project Optimize, information technology is key in combating one of the biggest problems faced by vaccine distribution systems--overstock in supply. On the face of it the idea that immunization programmes are hampered by too much vaccine seems paradoxical. But, in fact, the overstocking of vaccines increases cold storage costs and generates waste (when vaccines are lost, damaged or not used before their expiry date, and when not all vials in a multi-dose vial get used).

"We want to have as little buffer stock as possible, but still we want to have enough vaccine to vaccinate the children," Zaffran says, arguing that this means putting in place information systems and technologies that give managers a real-time picture of how much stock they have throughout a country and whether the quantities meet the requirements of their immunization strategy. …

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