CLICK TO ADD TITLE

[DATE][SPEAKERS NAMES]

The 5th Global Health Supply Chain Summit

November 14 -16, 2012Kigali, Rwanda

 

Optimizing the vaccine supply chainsModibo Dicko

What is Project Optimize?

• Five-year (2007-2012) collaboration between WHO and PATH, funded by the Bill & Melinda Gates Foundation

• Objective: To shape the future of technologies and logistic systems for vaccines in low-income and middle-income countries.

Sana

ipei

  Kis

oso,

WH

O

Mik

e W

ang,

PAT

H

Vaccines & Supplies

Information

A network of people, equipment and well established procedures

Vaccine supply chain yesterday & today - 1

3

Simple, precise & rigid rules!

This system has served us very well for over 30 years! But it has now reached its limits!

* Source: WHO. Guidelines on the international packaging and shipping of vaccines. 2002; WHO/V&B/01.05. ** Based on $7.50/dose for Rotarix and $0.155 per dose for polio and measles

$635.50** $4,687.50**

625 doses of Rotavirus VaccineDistrict vaccine store, Brazil

4100 doses of Polio and Measles

Vaccines Rural hospital storage, Mozambique

More volumes for new vaccines: Depending on packaging rota & pneumo vaccines require 45% to 113% more storage volume!

A changing environment: More, more, more

• More target populations:– Immunization & other programs are striving to reach new

target groups with new strategies and new products.

• More parallel health supply chains:– An increasing number of interventions establish their own

supply chains to ensure reliable access to quality products.

• More global interdependence: – Pandemic influenza, Avian Influenza, Meningococcal

Meningitis, Yellow Fever, Polio, SARS…

5

A changing environment: Increased complexity

1975 1990 1995 2000 2005 2010

PEI:

GAVI 1

GAVI 2GIVS

Measles

DoV?+ Right Cost

Co-Financing

+ Right Quantity

+ Right Place + Right Time 4 Rights

5 Rights

UCI*

Full 6 Rights**

* UCI = Universal Childhood Immunization. PEI = Polio Eradication Initiative. GIVS = Global Immunization Vision & Strategies** The right products in the right quantity, at the right place, in the right condition, at the right time, at the right cost

2 Rights: Right vaccines in Right conditions (everywhere, all the time, in abundant quantities as cost is low)

EPI

Underper-forming health programs and unachieved health goals

Poor availability of health

commodities at facilities, wasted

resources

Unqualified and disempowered staff managing public health supply chains

Supply chains poorly

managed and insufficiently resourced

Source: Kevin Piltz, USAID/Washington, 2010

A changing environment: unqualified staff can no longer cope with requirements

By 2020, state-of-art supply systems enablethe right vaccines to be at the right place, in the right quantities,

at the right time, in the right condition, at the right cost.

Engage key partners- within immunization and across public health

Develop a joint vision and plan for the future

Partners agree on 2020 vision and action plan

Implement specific interventions with countries (Albania, Guatemala, Senegal, Tunisia, Vietnam)

Model potential impact

Evidence base created & lessons documented

Identify innovative technologies and practices for future supply systems

Promote an environment conducive to innovation

Policies, guidelines and processes in place

Project Optimize Vision & Objectives INNOVATE DEMONSTRATE FACILITATE

A Vision and 5 Tenets

Hum

an

reso

urce

s

Info

rmat

ion

syst

ems

Env

ironm

enta

l im

pact

Imm

uniz

atio

n su

pply

sy

stem

s

Vacc

ine

prod

ucts

an

d th

eir p

acka

ging2020 Vision

The five tenets of the vision

Controlled temperature chain

Product packaging

Passive cooling

Integration and moving warehouse

Outsourcing

Net-zero energy supply chain

Temperature monitoring

Immunization registries

Capturing last mile data

Modelling supply chains

Project Optimize Activities at a glance

• Optimize techn. working groups• Country collaboration projects• Operational research• Challenges to industry• CCL Taskforce collaboration

Supply chain optimization – Senegal

Horiz. integration:Integrated storage & distribu-tion from central to reg' level.

Vertic. integration:From Reg'l Store directly to health posts using a moving warehouse.

International / Manufacturers

PNA National level

PRA Regional level

5 Health Centres & 110 Health Posts

Distribution

Other drugs & health products

Vaccines & heat sensitive drugs

Distribution

DPM Virtual Store

National level

Regional Virtual Store

St Louis Region

District Virtual Stores

5 Districts Moving

Warehouse

A

B

C

Cold Chain Ambient Temp Chain Information

Post-Integration Situation (Dakar & St Louis Region)

Supply chain optimization – Tunisia

• Integrated supply chain system from the national level down to regional levels.

• Solarized stores at regional and district levels

• Solar-powered “moving warehouse” delivery system.

Central Medical Store (PCT)

Inter-regional PCT Stores*

Virtual Store (DSSB)

Regional Stores Consolidated*

District Stores*

Health Centres

Electric Vehicle

Solarised stores

Electric Vehicle

Networked and real time LMIS

Supply Chain Modelling & Costing

• Collaboration with the Vaccine Modelling Initiative (VMI), University of Pittsburg – Development of a simulation supply chain model to assess scenarios for

Senegal.

• Excel-based model and data collection tools to support country demonstration projects­ Comparing baseline and

various scenario logistics costs (transport and cold chain).

SC Cost components

Standard input deck

MODELLING & COSTING • Vaccine availability by scenario• Total & unit costs by scenario

Data on Supply Chain Structure,

Storage Locations, Transport, Capacities,

Personnel, etc.

Supply chain

function costs

Supply chain

performance metrics

Discrete event

simulation model of

supply chain

OPTIMIZE supply chain

costing tool

Cost Drivers

Total Costs

Unit Costs

Economic Metrics

Source: VMI (University of Pittsburg)

November 28, 2011 © 2011 Bill & Melinda Gates Foundation | 15

Vaccine Availability & Costs by Scenario Senegal (Constrained)

Baseline

Scenario 5: Old Supply chain with rented truck

Scenario 4: Region removed: Monthly

Scenario 3: PRA deliver to Districts in loops

Scenario 2: Moving Warehouse with buffer stocks

Scenario 1: Moving Warehouse

0% 20% 40% 60% 80% 100% 120%

29%

29%

78%

43%

36%

89%

89%

97%

97%

99%

99%

Vaccine Availability

Se-ries1

$- $0.10 $0.20 $0.30 $0.40 $0.50 $0.60

$0.54

$0.56

$0.45

$0.53

$0.53

$0.33

$0.31

$0.30

$0.29

$0.29

Logistics Cost per Dose

Current EPI

With Rota and PCV

November 28, 2011 © 2011 Bill & Melinda Gates Foundation | 1616

Scenario 3. Depot mobile du niveau régional au niveau du

district

Scenario 1: Depot mobile du niveau régional au niveau du

poste de sante

0% 20% 40% 60% 80% 100% 120%

100%

99%

43%

36%

97%

99%

Vaccine Availability

$-

$0.10

$0.20

$0.30

$0.40

$0.50

$0.60

$0.23

$0.20

$0.45

$0.53

$0.30

$0.29

Logistics Cost per Dose

Current EPIWith Rota and PCVWith Rota and PCV-unconstrained

Vaccine Availability & Costs by Scenario Senegal (Unconstrained)

What next at country level: scaling up

• Development of a scale up strategy for successful innovations:­Using ExpandNet*

methodology in Senegal and Tunisia

• Validation by MoH & funding to be sought (MoH & partners).

The InnovationUser

Organization(s)Resource

Team

ORGANIZATIONALPROCESS

COSTS/RESOURCE MOBILIZATION

MONITORING AND

EVALUATION

4 TYPES OF SCALING UP: Expansion – Institutionalization – Diversification - Spontaneous

Scaling-upStrategy

DISSEMINATIONAND ADVOCACY

The elements of scaling up

Strategicchoiceareas

* www.ExpandNet.net

Senegal & TunisiaScaling – Up Strategy

What next at global level: linking with the Decade of Vaccines GVAP

Ensure Optimize learning lives on:

• Action Plans developed for the 5 tenets of the global vision.

• Plans are online and available at:

http://www.path.org/publications/files/TS_opt_action_plans.pdf

• These will be reformatted and published as a vision 2020 outputs companion document to the DoV Global Vaccine Action Plan (GVAP).

Nothing is impossible – never say never ... and trust staff (Optimize Team – Albania)

Thank you!