Evaluating supply chain management of cold storage for preventive child healthcare programmes: A comparative study from western India.

Introduction: Efficient cold chain and vaccine logistics management are made possible by the health system's processes, practices, and policies, which are evaluated by Effective Vaccine Management, a diagnostic tool. A significant number of urban Jabalpur children receive vaccinations from a government health facility.The aim of the study wasto Assessthe cold chain maintenance and vaccine management practices at urban government Cold Chain Points of Jabalpur district.Methods:A cross-sectional study was carried out at all of 13 urban government ColdChain Points across Jabalpur district. Globally validated World Health Organization -United Nations International Children's Emergency Fund Effective Vaccine Management tool was used for this study. Criteria wise and Consolidated Effective Vaccine Management scores were calculated as per World Health Organization guidelines. Results: All the urban service point stores or cold chain points scored more than the target 80% in two criteria: storage capacity and building. The consolidated criteria score of all the cold chain points in urban Jabalpur, criteria like maintenance, stock management, management information system, and supportive functions, were lagging behind the 80% mark. Low scores in maintenance, stock management, and management information system and supportive functions criteria are somehow a setback for all the preparationand hard work done towards optimal vaccine management and supply chain in the area. Conclusion: The overall performance of the urban cold chain points in Jabalpur district was far better as compared to the state-level effective vaccine management assessment done in Madhya Pradesh in 2011 and 2016. Planned preventive maintenance for buildings and equipment needs to be strengthened. Issues like Lack of information for stock management, need for periodic refresher trainings are to be emphasized.

UNICEF launched the mobile-based Effective Vaccine Management (EVM) system in Bihar in 2014 along with the state government to electronically capture information and identify gaps in the existing vaccine management system for appropriate action. This study accessed the implementation process of this initiative. Quantitative data related to vaccine supply chain management indicators were collected in November-December 2015 using factsheets and dashboards, representing the situation of the vaccine supply and cold chain management system at regular intervals since the launch. In-depth interviews were conducted with the program specialists to understand the initiative's genesis, its challenges and strengths. This initiative resulted in an increased cold chain space from 49% (July 2014) to 87% (September 2015), deployment of sufficient human resource; 38 cold chain technicians for regular maintenance of the machines and equipment, installation of necessary equipment, and upgradation of state and regional vaccine stores. In health facilities, district vaccine stores, and regional vaccine stores, marked improvements were observed in the overall EVM criteria indicators (82%, 84%, and 80% in September 2015, respectively, as against 51%, 46%, and 43% in July 2014, respectively) as well as EVM category indicators (83%, 84%, and 76% in September 2015, respectively, as compared to 54%, 53%, and 54% in July 2014, respectively). The EVM mobile initiative was successfully implemented and it complies with its objective of providing experienced guidance to the human resource responsible for vaccine cold chain management. The initiative is scalable and its sustainability depends on its thoughtful merger with the existing immunization ecosystem.

Pharmaceutical companies, upstream suppliers, associated logistics providers, health workers, regulatory agencies, public health experts and ultimately the medical practitioners and general public have been navigating an increasingly globalized vaccine supply chain; any disruption to the supply chain may cause cascading failure and have devastating consequences. The COVID-19 pandemic has already highlighted the lack of resilience in supply chains, as global networks fail from disruptions at single nodes and connections. As the race for a COVID-19 vaccine continues, the importance of not only an efficient supply chain but a resilient vaccine supply chain capable of reliable production and reaching target populations despite likely but currently unknown disruptions is imperative. Proactively applying resilience analytics to vaccine supply chain models will increase the probability that vaccination programs meet their goals. Without such a network in place for manufacture and distribution of the COVID-19 vaccine, even the most efficacious and safe vaccine will not prove viable. Through an overview of the existing vaccine and pharmaceutical supply chain publications focusing on resilience, as well as recent papers reporting modeling of resilience in supply chains across multiple fields, we find that models for supply chain resilience are few and most of them are focused on individual dimensions of resilience rather than on comprehensive strategy necessary for scaling up vaccine production and distribution in emergency settings. We find that COVID-19 resulted in a wave of interest to supply chain resilience, but publications from 2020 are narrow in focus and largely qualitative in nature; evidence-based models and measures are rare. Further, publications often focus exclusively on specific portions of the specific supply chain of interest, excluding associated supporting networks, such as transportation, social and command and control (C2) necessary for vaccine production and equitable distribution. This lack of network analysis is a major gap in the literature that needs to be bridged in order to create methods of real-time analysis and decision tools for the COVID-19 vaccine supply chain. We conclude that a comprehensive, quantitative approach to network resilience that encompasses the supply chain in the context of other social and physical networks is needed in order to address the emerging challenges of a large-scale COVID-19 vaccination program. We further find that the COVID-19 pandemic underscores the necessity of positioning supply chain resilience within a multi-network context and formally incorporating temporal dimensions into analysis through the NAS definition of resilience—plan, absorb, recover, adapt—to ensure essential needs are met across all dimensions of society. Modeling and analyzing vaccine supply chain resilience ensures that value is maintained should disruptions occur.KeywordsVaccine supply chain resilienceSupply chain resilienceVaccine supply chainPharmaceutical supply chainCOVID-19 supply chain

IntroductionEvidence suggests that immunization supply chains are becoming outdated and unable to deliver needed vaccines due to growing populations and new vaccine introductions. Redesigning a supply chain could result in meeting current demands. MethodsThe Ministries of Health in Benin in Mozambique recognized known barriers to the immunization supply chain and undertook a system redesign to address those barriers. Changes were made to introduce an informed push system while consolidating storage points, introducing transport loops, and increasing human resource capacity for distribution. Evaluations were completed in each country. ResultsEvaluation in each country indicated improved performance of the supply chain. The Effective Vaccine Management (EVM) assessment in Benin documented notable improvements in the distribution criteria of the tool, increasing from 40% to 100% at the district level. In Mozambique, results showed reduced stockouts at health facility level from 79% at baseline to less than 1% at endline. Coverage rates of DTP3 also increased from 68.9% to 92.8%. DiscussionBenin and Mozambique are undertaking system redesign in order to respond to constraints identified in the vaccine supply chain. Results and learnings show improvements in supply chain performance and make a strong case for system redesign. These countries demonstrate the feasibility of system redesign for other countries considering how to address outdated supply chains.

Key lessons learned from the immunization supply chain of Malawi, an African country using EVM2.0

Background: Immunization helps save a life, protect serious illness, and improve quality of life. It is recognized as one of the most cost-effective public health interventions available around the globe. However, the success of this program is heavily dependent on strong immunization supply chain practices. Proper immunization supply chain management ensures availing potent and live vaccines to the community. Objective: To evaluate the application of effective vaccine management in health facilities of Wassit Governorate, Iraq. Subjects and Methods: It was a cross-sectional study involving a multistage sampling. A total of 45 health facilities sites were selected, as follows: one sub-national store (SN), six district store (LD), and thirty eight service point (SP) by using effective vaccine management (EVM) questionnaire, interview, reviewing the records, and observations for the agreed review period. Results: The overall scores of this assessment for all levels (SN, LD, and SP) of the supply chain 66.6% demonstrates a need for more improvement in most areas of the vaccine and supply management system as only two criteria (storage capacity E3 and vaccine management practices E8) exceeds the WHO recommended minimum score of 80%. Performance levels of one criteria (building, equipment E4) were about 72% storage temperature (E2), maintenance(E5) and stock management (E6) were between 61 and 68%, while the vaccine distribution (E7), and information management (E9) were notably very weak with performance in each category less than 60%. Conclusions: The national average percentage at all levels was below the WHO recommended minimum score of 80%. Recommendation: The future vaccine storage capacity must be recalculated and stored to enter any new vaccine, receive large quantities of the influenza vaccine, and replace vaccine refrigerators at the sector level with cold rooms to accommodate current and future increases.

Background The Effective Vaccine Management (EVM) initiative provides the platform needed to monitor and assess the vaccine supply chain system to identify strengths and weaknesses of the system at all levels to enhance the development of improvement plan to strengthen the system. This valuation was carried out in the Tolon District of the Northern Region, Ghana. Methods A descriptive valuation of vaccine management was carried out in six vaccine stores in the Tolon District of Northern Ghana. We employed World Health Organization (WHO) assessment tools and procedures which consisted of desk reviews and interviews of cold chain managers to assess vaccine management practices in the district. Five out of the nine global assessment criteria were assessed and a minimum target level required for all criteria to meet the WHO standard was 80%. Results None of the facilities assessed met the WHO benchmark of 80% for all but one criteria assessed. With regards to temperature control, the scores ranged from 42% at Kasuliyili CHPS Centre to 77% at the district store with an average district score of 60%. Stock management ranged between 11% at Wantugu Health Centre and 75% at Nyankpala Health Centre with district average score of 32%. Effective vaccine distribution scores ranged between 13% at Kasuliyili CHPS and 46% at Nyankpala Health Centre with an average district score of 27%. Only Nyankpala Health Centre had an acceptable score of 84% for vaccine management, whereas the lowest score for this indicator was 5% at Tolon Health Centre store with district average score of 53%. Information management and supportive functions scores ranged from 0% at Tolon Health Centre to 26% at the district store with the district average score of 16%. Nineteen (90.5%) of vaccine users had poor knowledge regarding temperature control and vaccine distribution. Conclusion Effective vaccine management knowledge and practices are poor at Tonlon district and calls for urgent and pragmatic approaches such as training and re-training of vaccine users at all levels.

Cold chain equipments (CCEs) at health facilities (HFs) are an essential part of the immunization supply chain (ISC). The CCEs in government HFs of Delhi were never assessed using the World Health Organization-United Nations Children's Fund (WHO-UNICEF) Effective Vaccine Management (EVM) tool except that of state vaccine store during National EVM assessment 2013. The objective of the study was to assess the CCEs and their management in government HFs using the WHO-UNICEF EVM tool in a district of Delhi. The assessment was done during December 2017-March 2018 in one randomly selected district of Delhi. Sample size and site selection were done using the WHO EVM site selection tool. A total of 29 HFs were assessed along with District Vaccine Store. Questions on CCEs in EVM tool 1.0.9 were used for data collection. Out of 56 electrical CCEs, 8.9% were nonfunctional, 48.2% were noncompliant with WHO standards, 5.4% were not chlorofluorocarbon free, 4.7% did not have temperature monitoring device, and 18.8% did not have stabilizer. Eighty-six percent of passive containers were compliant with the WHO standards. The storage capacity of electrical vaccine storage equipment was insufficient in 3.4%, passive container capacity in 65.5%, and ice packs preparation and storage capacity in 24.1% of HFs. There was no planned preventive maintenance of CCEs and no standard operating procedures for emergency event management. There was a shortage of vaccine storage, ice packs preparation and storage, and passive container capacity. Many CCEs used in ISC of assessed sites were noncompliant to the WHO standards. There was no PPM of CCEs and no guidelines for emergency event management.

To ensure immunization access, equity, and sustainability, vaccines must remain a top priority for governments across the globe.

The complexity of the supply chains and the uncertainties in the processes cause business to become more vulnerable in the face of disruptions. Pandemic situations such as COVID-19 cause sudden disruptions in supply chains, causing processes to be disrupted. Especially in multi-stakeholder supply chains, the importance of stakeholder communication, motivation, and regulations i.e. comes to the forefront in order to ensure the resilience of supply chains. As learned with the COVID-19 pandemic, vaccine supply chains are also one of the multi-stakeholder supply chains and are extremely vulnerable to disruptions. In COVID-19 times, the importance of vaccine supply chain management and the resilience in vaccine supply chains increased. To have more resilient vaccine supply chains, stakeholder engagement is an essential issue. Therefore, the Graph Theory Matrix Approach has been used to determine factors of stakeholder engagement in multi-stakeholder vaccine supply chains and to specify the relationships between the factors of project and stakeholder engagement in vaccine supply chains to increase resilience in disruption times. The aim of the study is to identify the factors of project and stakeholder engagement that are necessary to ensure the resilience of multi-stakeholder vaccine supply chains and not be affected by disruptions such as COVID-19 as it is today. As a result of the study, innovativeness of stakeholders is the most important factor of stakeholder engagement in vaccine supply chains.

Immunization programs are highly dependent on an effective and efficient supply chain system for storing, transporting, and distributing vaccines. This ensures that the right products are available in the right place, at the right time, and under the right conditions to provide efficient health services to the public. This study aims to evaluate the implementation of Effective Vaccine Management (EVM) in Central Java and identify its obstacles. This study used a quantitative method with a cross-sectional approach. A descriptive analysis of vaccine management was carried out in 35 regencies/cities in Central Java. The population comprised EVM programmers in Central Java selected using the total sampling technique. Data were collected using the World Health Organization (WHO) assessment tools and in-depth interviews with pharmacy departments or person in charge of immunization programs in each regency/city. The results showed that five of the 35 regencies/cities had an average score of 80% and above across nine assessment indicators, but no region met the WHO standards of 80% across all the criteria assessed. The overall EVM assessment revealed that 20% of the regencies/cities fell into the low category, 65.7% in the medium category, and 14.3% in the high category. Each region had different problems in fulfilling the nine criteria of EVM assessment, such as inadequate infrastructure, lack of periodic vaccine stock recording, absence of standard operating procedures, and insufficiently trained officers. Therefore, support is needed from the Central Java Provincial Government in providing support to the regions with regular monitoring and evaluation of the EVM implementation. Additionally, officers need to be trained regarding proper vaccine management.

Background: The success of immunization depends highly on the level of cold chain maintenance. For effective implementation and success of the Universal Immunisation Programme, proper maintenance of Cold Chain needs a great focus. In 2010, WHO and UNICEF launched the Effective Vaccine Management (EVM) initiative. EVM is a tool which assesses immunization supply chain logistics management. Objectives: To evaluate the performance of Immunization supply chain in cold chain points of Government Health Facilities (HF) of Jammu district Methodology: A facility based cross-sectional study was conducted in Jammu district of UT of J&K. The assessment was done during November 2021– October 2022 using WHO-UNICEF EVM assessment standalone questionnaire generated on EVM assessor app. Sample size and site selection were done using the WHO EVM site selection tool(v1.7-March 2014). A total of 31 HFs were assessed including Divisional Vaccine Store (SN) Results: None of the health facilities reached the WHO recommended overall score of >80%. The criterion scores showed that Facility infrastructure and equipment (E4) and waste management (E9) for District Vaccine Store (LD) was 83% & 86%. Vaccine management (E8) score for SN level & Government Hospital was 88% & 82%. Rest of the CCPs scored less than 80% for all the criteria(E2-E9). The scores of distribution of vaccines and dry goods (E7) were very low for Primary Health Centres (PHC) and Health & Wellness Centres (H&WC) i.e., 39% and 25%. The scores for all the categories(C1-C6) for various CCPs were below 80%. Management criteria scores for supportive supervision(M3) was 0% for all CCP except LD &PHC Conclusion: The overall performance of cold chain in Jammu district was below the recommended level. Supportive supervision, provision of safe disposal pits, power backup, micro plan, training of Cold Chain Handlers and provision of vaccine transportation facility can help in effective vaccine management

Background: The COVID-19 pandemic revealed vaccine supply chain (VSC) weaknesses and enabled post-pandemic analysis highlighting the growing importance of supply chain resilience. This study analyzes weaknesses and potentials for VSC resilience from an industry perspective. Insights from this study are aimed at supporting helping managers and policy-makers build a more resilient vaccine supply. Methods: A qualitative semi-structured interview study was conducted with 12 industry experts along the VSC. The interviews were assessed concerning the learnings from the pandemic in a two-step content analysis. Codes were assigned to key VSC concepts and variables and then linked to political, economic, social, technological, legal, and environmental (PESTLE) dimensions. The complex multi-stakeholder supply chain was visualized in a system overview, highlighting main actors, roles, constraints, and resilience. Results: The analysis resulted in 60 codes, categorized into the six PESTLE dimensions and three additional (sub)groups (mRNA, Supply chain resilience, and Solutions). The largest dimension was Economic, with 39 codes, including the Supply chain resilience subgroup. Twelve stakeholder groups were identified, with purchasers, manufacturers, suppliers, developers, and regulatory agencies being the most significant in emergency vaccine manufacturing situations. Conclusions: The system overview demonstrated the VSC as a complex network of actors with unaligned goals rather than a linear supply chain. This study shows that the VSC is characterized by uncertainty due to external factors, like the unpredictability of new emergencies, and internal factors like vaccine demand. The lack of transparency between industry stakeholders exacerbates VSC disruption. We conclude that infrastructures and management practices that enable increased transparency and collaboration between stakeholders hold the greatest potential for strengthening the VSC's resilience to future pandemics.

PurposeThe authors identify the critical bottlenecks that exist in the vaccine supply chain that are preventing a robust coronavirus disease (COVID) response. The authors posit that improved supply chain signals can result in improved handling and distribution of vaccines in a post-COVID world and identify recommendations for redesign of the vaccine supply chain as well as future research questions for scholars.Design/methodology/approachThe supply chain operating reference (SCOR) model is used as a framework to identify each of the major gaps that exist in the supply chain for the COVID vaccine. The critical bottlenecks and delays that exist within this supply chain are identified through this framework and validated through the ongoing research and interviews in the field.FindingsWhilst the vaccine supply chain for influenza is perfectly sized for development and distribution of this cyclical virus, the emergence of a new virus created a pandemic, which has exposed a number of critical shortages. The authors find that the design of the COVID vaccine supply chain suffers from a flawed structure. To date, less than 3% of the United States and global population has been fully vaccinated. The authors advocate a “back to front design”, beginning with demand planning for actual vaccinations and working backwards toward supply planning and distribution planning. These lessons may be helpful for capacity planning and supply chain strategy for future vaccinations as variants of the COVID vaccine emerge.Originality/valueThe authors provide a unique approach for viewing the current shortages that exist in the vaccine supply chain and offer suggestions for new variants of this supply chain for the future.

PurposeDespite rapid success in bringing SARS-CoV-2 vaccines to distribution by multiple pharmaceutical corporations, supply chain failures in production and distribution can plague pandemic recovery. This review analyzes and addresses gaps in modeling supply chain resilience in general and specifically for vaccines in order to guide researchers and practitioners alike to improve critical function of vaccine supply chains in the face of inevitable disruptions.Design/methodology/approachSystematic review of the literature on modeling supply chain resilience from 2007 to 2020 is analyzed in tandem with the vaccine supply chain manufacturing literature. These trends are then used to apply a novel matrix analysis to seven Securities and Exchange Commission (SEC) annual filings of pharmaceutical corporations involved in COVID-19 vaccine manufacture and distribution.FindingsPharmaceutical corporations favor efficiency as they navigate regulatory, economic and other threats to their vaccine supply chains, neglecting resilience – absorption, adaptation and recovery from inevitable and unexpected disruptions. However, explicitly applying resilience analytics to the vaccine supply chain and further leveraging emerging network science tools found in the academic literature, such as artificial intelligence (AI), stress tests and digital twins, will help supply chain managers to better quantify efficiency/resilience tradeoffs across all associated networks/domains and support optimal system performance post disruption.Originality/valueThis is the first review addressing resilience analytics in vaccine supply chains and subsequent extension to operational management through novel matrix analyses of SEC Filings. The authors provide analyses and recommendations that facilitate resilience quantification capabilities for vaccine supply chain managers, regulatory agencies and corporate stakeholders and are especially relevant for pandemic response, including application to the SARS-CoV-2 vaccines.