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Article: System redesign of the immunization supply chain: Experiences from Benin and Mozambique

Prosser, Wendy / Bruce Y. Lee / Emmanuelle Assy / Graça Matsinhe / Mawutondji Dekoun / Philippe Jaillard / Shawn T. Brown

Vaccine. 2017 Apr. 19, v. 35, no. 17

2017

Abstract: Evidence suggests that immunization supply chains are becoming outdated and unable to deliver needed vaccines due to growing populations and new vaccine introductions.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.The Ministries of ... ...

Abstract	Evidence suggests that immunization supply chains are becoming outdated and unable to deliver needed vaccines due to growing populations and new vaccine introductions.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.The 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.Evaluation 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%.Benin 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 These countries demonstrate the feasibility of system redesign for other countries considering how to address outdated supply chains.
Keywords	immunization ; supply chain ; vaccines ; Benin ; Mozambique
Language	English
Dates of publication	2017-0419
Size	p. 2162-2166.
Publishing place	Elsevier Ltd
Document type	Article
ZDB-ID	605674-x
ISSN	1873-2518 ; 0264-410X
ISSN (online)	1873-2518
ISSN	0264-410X
DOI	10.1016/j.vaccine.2016.09.073
Database	NAL-Catalogue (AGRICOLA)

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Article: When are solar refrigerators less costly than on-grid refrigerators: A simulation modeling study

Haidari, Leila A / Bruce Y. Lee / Diana L. Connor / Marie Spiker / Patrick Wedlock / Shawn T. Brown

Vaccine. 2017 Apr. 19, v. 35, no. 17

2017

Abstract: Gavi recommends solar refrigerators for vaccine storage in areas with less than eight hours of electricity per day, and WHO guidelines are more conservative. The question remains: Can solar refrigerators provide value where electrical outages are less ... ...

Abstract	Gavi recommends solar refrigerators for vaccine storage in areas with less than eight hours of electricity per day, and WHO guidelines are more conservative. The question remains: Can solar refrigerators provide value where electrical outages are less frequent?Using a HERMES-generated computational model of the Mozambique routine immunization supply chain, we simulated the use of solar versus electric mains-powered refrigerators (hereafter referred to as “electric refrigerators”) at different locations in the supply chain under various circumstances.At their current price premium, the annual cost of each solar refrigerator is 132% more than each electric refrigerator at the district level and 241% more at health facilities. Solar refrigerators provided savings over electric refrigerators when one-day electrical outages occurred more than five times per year at either the district level or the health facilities, even when the electric refrigerator holdover time exceeded the duration of the outage. Two-day outages occurring more than three times per year at the district level or more than twice per year at the health facilities also caused solar refrigerators to be cost saving. Lowering the annual cost of a solar refrigerator to 75% more than an electric refrigerator allowed solar refrigerators to be cost saving at either level when one-day outages occurred more than once per year, or when two-day outages occurred more than once per year at the district level or even once per year at the health facilities.Our study supports WHO and Gavi guidelines. In fact, solar refrigerators may provide savings in total cost per dose administered over electrical refrigerators when electrical outages are less frequent. Our study identified the frequency and duration at which electrical outages need to occur for solar refrigerators to provide savings in total cost per dose administered over electric refrigerators at different solar refrigerator prices.
Keywords	cost effectiveness ; electricity ; guidelines ; immunization ; prices ; refrigerators ; simulation models ; supply chain ; vaccines ; World Health Organization ; Mozambique
Language	English
Dates of publication	2017-0419
Size	p. 2224-2228.
Publishing place	Elsevier Ltd
Document type	Article
ZDB-ID	605674-x
ISSN	1873-2518 ; 0264-410X
ISSN (online)	1873-2518
ISSN	0264-410X
DOI	10.1016/j.vaccine.2016.11.103
Database	NAL-Catalogue (AGRICOLA)

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Article ; Online: How coping can hide larger systems problems

Bruce Y Lee / Patrick T Wedlock / Elizabeth A Mitgang / Sarah N Cox / Leila A Haidari / Manoja K Das / Srihari Dutta / Bhrigu Kapuria / Shawn T Brown

BMJ Global Health, Vol 4, Iss

the routine immunisation supply chain in Bihar, India

2019 Volume 5

Abstract: IntroductionCoping occurs when health system personnel must make additional, often undocumented efforts to compensate for existing system and management deficiencies. While such efforts may be done with good intentions, few studies evaluate the broader ... ...

Abstract	IntroductionCoping occurs when health system personnel must make additional, often undocumented efforts to compensate for existing system and management deficiencies. While such efforts may be done with good intentions, few studies evaluate the broader impact of coping.MethodsWe developed a computational simulation model of Bihar, India’s routine immunisation supply chain where coping (ie, making additional vaccine shipments above stated policy) occurs. We simulated the impact of coping by allowing extra trips to occur as needed up to one time per day and then limiting coping to two times per week and three times per month before completely eliminating coping.ResultsCoping as needed resulted in 3754 extra vaccine shipments over stated policy resulting in 56% total vaccine availability and INR 2.52 logistics cost per dose administered. Limiting vaccine shipments to two times per week reduced shipments by 1224 trips, resulting in a 7% vaccine availability decrease to 49% and an 8% logistics cost per dose administered increase to INR 2.73. Limiting shipments to three times per month reduced vaccine shipments by 2635 trips, which decreased vaccine availability by 19% to 37% and increased logistics costs per dose administered by 34% to INR 3.38. Completely eliminating coping further reduced shipments by 1119 trips, decreasing total vaccine availability an additional 24% to 13% and increasing logistics cost per dose administered by 169% to INR 9.08.ConclusionOur results show how coping can hide major system design deficiencies and how restricting coping can improve problem diagnosis and potentially lead to enhanced system design.
Keywords	Medicine (General) ; R5-920 ; Infectious and parasitic diseases ; RC109-216
Language	English
Publishing date	2019-09-01T00:00:00Z
Publisher	BMJ Publishing Group
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article: Cost-effectiveness and public health impact of alternative influenza vaccination strategies in high-risk adults

Raviotta, Jonathan M / Kenneth J. Smith / Jay DePasse / Shawn T. Brown / Eunha Shim / Mary Patricia Nowalk / Angela Wateska / Glenson S. France / Richard K. Zimmerman

Vaccine. 2017,

2017

Abstract: High-dose trivalent inactivated influenza vaccine (HD-IIV3) or recombinant trivalent influenza vaccine (RIV) may increase influenza vaccine effectiveness (VE) in adults with conditions that place them at high risk for influenza complications. This ... ...

Abstract	High-dose trivalent inactivated influenza vaccine (HD-IIV3) or recombinant trivalent influenza vaccine (RIV) may increase influenza vaccine effectiveness (VE) in adults with conditions that place them at high risk for influenza complications. This analysis models the public health impact and cost-effectiveness (CE) of these vaccines for 50â64year-olds.Markov model CE analysis compared 5 strategies in 50â64year-olds: no vaccination; only standard-dose IIV3 offered (SD-IIV3 only), only quadrivalent influenza vaccine offered (SD-IIV4 only); high-risk patients receiving HD-IIV3, others receiving SD-IIV3 (HD-IIV3 & SD-IIV3); and high-risk patients receiving HD-IIV3, others receiving SD-IIV4 (HD-IIV3 & SD-IIV4). In a secondary analysis, RIV replaced HD-IIV3. Parameters were obtained from U.S. databases, the medical literature and extrapolations from VE estimates. Effectiveness was measured as 3%/year discounted quality adjusted life year (QALY) losses avoided.The least expensive strategy was SD-IIV3 only, with total costs of $99.84/person. The SD-IIV4 only strategy cost an additional $0.91/person, or $37,700/QALY gained. The HD-IIV3 & SD-IIV4 strategy cost $1.06 more than SD-IIV4 only, or $71,500/QALY gained. No vaccination and HD-IIV3 & SD-IIV3 strategies were dominated. Results were sensitive to influenza incidence, vaccine cost, standard-dose VE in the entire population and high-dose VE in high-risk patients. The CE of RIV for high-risk patients was dependent on as yet unknown parameter values.Based on available data, using high-dose influenza vaccine or RIV in middle-aged, high-risk patients may be an economically favorable vaccination strategy with public health benefits. Clinical trials of these vaccines in this population may be warranted.
Keywords	adults ; clinical trials ; cost effectiveness ; databases ; influenza ; influenza vaccination ; influenza vaccines ; models ; patients ; public health ; quality-adjusted life year ; risk ; United States
Language	English
Size	p. .
Publishing place	Elsevier Ltd
Document type	Article
Note	Pre-press version
ZDB-ID	605674-x
ISSN	1873-2518 ; 0264-410X
ISSN (online)	1873-2518
ISSN	0264-410X
DOI	10.1016/j.vaccine.2017.07.069
Database	NAL-Catalogue (AGRICOLA)

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Article: Modular vaccine packaging increases packing efficiency

Norman, Bryan A / Bruce Y. Lee / Jayant Rajgopal / Jung Lim / Katrin Gorham / Leila Haidari / Shawn T. Brown

Vaccine. 2015 June 17, v. 33, no. 27

2015

Abstract: Within a typical vaccine supply chain, vaccines are packaged into individual cylindrical vials (each containing one or more doses) that are bundled together in rectangular “inner packs” for transport via even larger groupings such as cold boxes and ... ...

Abstract	Within a typical vaccine supply chain, vaccines are packaged into individual cylindrical vials (each containing one or more doses) that are bundled together in rectangular “inner packs” for transport via even larger groupings such as cold boxes and vaccine carriers. The variability of vaccine inner pack and vial size may hinder efficient vaccine distribution because it constrains packing of cold boxes and vaccine carriers to quantities that are often inappropriate or suboptimal in the context of country-specific vaccination guidelines.We developed in Microsoft Excel (Microsoft Corp., Redmond, WA) a spreadsheet model that evaluated the impact of different packing schemes for the Benin routine regimen plus the introduction of the Rotarix vaccine. Specifically, we used the model to compare the current packing scheme to that of a proposed modular packing scheme.Conventional packing of a Dometic RCW25 that aims to maximize fully-immunized children (FICs) results in 123 FICs and a packing efficiency of 81.93% compared to a maximum of 155 FICs and 94.1% efficiency for an alternative modular packaging system.Our analysis suggests that modular packaging systems could offer significant advantages over conventional vaccine packaging systems with respect to space efficiency and potential FICs, when they are stored in standard vaccine carrying devices. This allows for more vaccines to be stored within the same volume while also simplifying the procedures used by field workers to pack storage devices. Ultimately, modular packaging systems could be a simple way to help increase vaccine coverage worldwide.
Keywords	children ; cold ; models ; packaging ; supply chain ; vaccination ; vaccines ; Benin
Language	English
Dates of publication	2015-0617
Size	p. 3135-3141.
Publishing place	Elsevier Ltd
Document type	Article
ZDB-ID	605674-x
ISSN	1873-2518 ; 0264-410X
ISSN (online)	1873-2518
ISSN	0264-410X
DOI	10.1016/j.vaccine.2015.04.091
Database	NAL-Catalogue (AGRICOLA)

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Article: Does cost-effectiveness of influenza vaccine choice vary across the U.S.? An agent-based modeling study

DePasse, Jay V / Eunha Shim / Jonathan M. Raviotta / Kenneth J. Smith / Mary Patricia Nowalk / Richard K. Zimmerman / Shawn T. Brown

Vaccine. 2017 July 13, v. 35, no. 32

2017

Abstract: In a prior agent-based modeling study, offering a choice of influenza vaccine type was shown to be cost-effective when the simulated population represented the large, Washington DC metropolitan area. This study calculated the public health impact and ... ...

Abstract	In a prior agent-based modeling study, offering a choice of influenza vaccine type was shown to be cost-effective when the simulated population represented the large, Washington DC metropolitan area. This study calculated the public health impact and cost-effectiveness of the same four strategies: No Choice, Pediatric Choice, Adult Choice, or Choice for Both Age Groups in five United States (U.S.) counties selected to represent extremes in population age distribution.The choice offered was either inactivated influenza vaccine delivered intramuscularly with a needle (IIV-IM) or an age-appropriate needle-sparing vaccine, specifically, the nasal spray (LAIV) or intradermal (IIV-ID) delivery system. Using agent-based modeling, individuals were simulated as they interacted with others, and influenza was tracked as it spread through each population. Influenza vaccination coverage derived from Centers for Disease Control and Prevention (CDC) data, was increased by 6.5% (range 3.25%–11.25%) to reflect the effects of vaccine choice.Assuming moderate influenza infectivity, the number of averted cases was highest for the Choice for Both Age Groups in all five counties despite differing demographic profiles. In a cost-effectiveness analysis, Choice for Both Age Groups was the dominant strategy. Sensitivity analyses varying influenza infectivity, costs, and degrees of vaccine coverage increase due to choice, supported the base case findings.Offering a choice to receive a needle-sparing influenza vaccine has the potential to significantly reduce influenza disease burden and to be cost saving. Consistent findings across diverse populations confirmed these findings.
Keywords	adults ; burden of disease ; Centers for Disease Control and Prevention ; cost effectiveness ; influenza ; influenza vaccination ; influenza vaccines ; models ; nose ; pathogenicity ; public health ; District of Columbia
Language	English
Dates of publication	2017-0713
Size	p. 3974-3981.
Publishing place	Elsevier Ltd
Document type	Article
ZDB-ID	605674-x
ISSN	1873-2518 ; 0264-410X
ISSN (online)	1873-2518
ISSN	0264-410X
DOI	10.1016/j.vaccine.2017.05.093
Database	NAL-Catalogue (AGRICOLA)

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Article ; Online: A Quantitative EEG Toolbox for the MNI Neuroinformatics Ecosystem

Jorge Bosch-Bayard / Eduardo Aubert-Vazquez / Shawn T. Brown / Christine Rogers / Gregory Kiar / Tristan Glatard / Lalet Scaria / Lidice Galan-Garcia / Maria L. Bringas-Vega / Trinidad Virues-Alba / Armin Taheri / Samir Das / Cecile Madjar / Zia Mohaddes / Leigh MacIntyre / CHBMP / Alan C. Evans / Pedro A. Valdes-Sosa

Frontiers in Neuroinformatics, Vol

Normative SPM of EEG Source Spectra

2020 Volume 14

Abstract: The Tomographic Quantitative Electroencephalography (qEEGt) toolbox is integrated with the Montreal Neurological Institute (MNI) Neuroinformatics Ecosystem as a docker into the Canadian Brain Imaging Research Platform (CBRAIN). qEEGt produces age- ... ...

Abstract	The Tomographic Quantitative Electroencephalography (qEEGt) toolbox is integrated with the Montreal Neurological Institute (MNI) Neuroinformatics Ecosystem as a docker into the Canadian Brain Imaging Research Platform (CBRAIN). qEEGt produces age-corrected normative Statistical Parametric Maps of EEG log source spectra testing compliance to a normative database. This toolbox was developed at the Cuban Neuroscience Center as part of the first wave of the Cuban Human Brain Mapping Project (CHBMP) and has been validated and used in different health systems for several decades. Incorporation into the MNI ecosystem now provides CBRAIN registered users access to its full functionality and is accompanied by a public release of the source code on GitHub and Zenodo repositories. Among other features are the calculation of EEG scalp spectra, and the estimation of their source spectra using the Variable Resolution Electrical Tomography (VARETA) source imaging. Crucially, this is completed by the evaluation of z spectra by means of the built-in age regression equations obtained from the CHBMP database (ages 5–87) to provide normative Statistical Parametric Mapping of EEG log source spectra. Different scalp and source visualization tools are also provided for evaluation of individual subjects prior to further post-processing. Openly releasing this software in the CBRAIN platform will facilitate the use of standardized qEEGt methods in different research and clinical settings. An updated precis of the methods is provided in Appendix I as a reference for the toolbox. qEEGt/CBRAIN is the first installment of instruments developed by the neuroinformatic platform of the Cuba-Canada-China (CCC) project.
Keywords	Statistical Parametric Mapping ; qEEGt ; CBRAIN ; EEG tomography ; quantitative EEG ; open science ; Neurosciences. Biological psychiatry. Neuropsychiatry ; RC321-571
Subject code	020
Language	English
Publishing date	2020-08-01T00:00:00Z
Publisher	Frontiers Media S.A.
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Data and Tools Integration in the Canadian Open Neuroscience Platform

Jean-Baptiste Poline / Samir Das / Tristan Glatard / Cécile Madjar / Erin W. Dickie / Xavier Lecours / Thomas Beaudry / Natacha Beck / Brendan Behan / Shawn T. Brown / David Bujold / Michael Beauvais / Bryan Caron / Candice Czech / Moyez Dharsee / Mathieu Dugré / Ken Evans / Tom Gee / Giulia Ippoliti /

Gregory Kiar / Bartha Maria Knoppers / Tristan Kuehn / Diana Le / Derek Lo / Mandana Mazaheri / Dave MacFarlane / Naser Muja / Emmet A. O’Brien / Liam O’Callaghan / Santiago Paiva / Patrick Park / Darcy Quesnel / Henri Rabelais / Pierre Rioux / Mélanie Legault / Jennifer Tremblay-Mercier / David Rotenberg / Jessica Stone / Ted Strauss / Ksenia Zaytseva / Joey Zhou / Simon Duchesne / Ali R. Khan / Sean Hill / Alan C. Evans

Scientific Data, Vol 10, Iss 1, Pp 1-

2023 Volume 11

Abstract: Measurement(s) Digital Data Repository Technology Type(s) Digital Data ... ...

Abstract	Measurement(s) Digital Data Repository Technology Type(s) Digital Data Repository
Keywords	Science ; Q
Language	English
Publishing date	2023-04-01T00:00:00Z
Publisher	Nature Portfolio
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article: Re-designing the Mozambique vaccine supply chain to improve access to vaccines

Lee, Bruce Y / Amelia Dipuve / Balbina Khanlawia / Diana L. Connor / Hidayat Kassim / Leila A. Haidari / Ruth Bechtel / Shawn T. Brown / Wendy Prosser

Vaccine. 2016 Sept. 22, v. 34, no. 41

2016

Abstract: Populations and routine childhood vaccine regimens have changed substantially since supply chains were designed in the 1980s, and introducing new vaccines during the “Decade of Vaccine” may exacerbate existing bottlenecks, further inhibiting the flow of ... ...

Abstract	Populations and routine childhood vaccine regimens have changed substantially since supply chains were designed in the 1980s, and introducing new vaccines during the “Decade of Vaccine” may exacerbate existing bottlenecks, further inhibiting the flow of all vaccines.Working with the Mozambique Ministry of Health, our team implemented a new process that integrated HERMES computational simulation modeling and on-the-ground implementers to evaluate and improve the Mozambique vaccine supply chain using a system-re-design that integrated new supply chain structures, information technology, equipment, personnel, and policies.The alternative system design raised vaccine availability (from 66% to 93% in Gaza; from 76% to 84% in Cabo Delgado) and reduced the logistics cost per dose administered (from $0.53 to $0.32 in Gaza; from $0.38 to $0.24 in Cabo Delgado) as compared to the multi-tiered system under the current EPI. The alternative system also produced higher availability at lower costs after new vaccine introductions. Since reviewing scenarios modeling deliveries every two months in the north of Gaza, the provincial directorate has decided to pilot this approach diverging from decades of policies dictating monthly deliveries.Re-design improved not only supply chain efficacy but also efficiency, important since resources to deliver vaccines are limited. The Mozambique experience and process can serve as a model for other countries during the Decade of Vaccines. For the Decade of Vaccines, getting vaccines at affordable prices to the market is not enough. Vaccines must reach the population to be successful.
Keywords	administered dose ; childhood ; equipment ; governance ; human resources ; information technology ; issues and policy ; market prices ; simulation models ; supply chain ; systems engineering ; vaccines ; Mozambique
Language	English
Dates of publication	2016-0922
Size	p. 4998-5004.
Publishing place	Elsevier Ltd
Document type	Article
ZDB-ID	605674-x
ISSN	1873-2518 ; 0264-410X
ISSN (online)	1873-2518
ISSN	0264-410X
DOI	10.1016/j.vaccine.2016.08.036
Database	NAL-Catalogue (AGRICOLA)

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Article: The economic value of increasing geospatial access to tetanus toxoid immunization in Mozambique

Haidari, Leila A / Bruce Y. Lee / Dagna Constenla / Eli Zenkov / Gatien de Broucker / Marie Ferguson / Sachiko Ozawa / Samantha Clark / Shawn T. Brown

Vaccine. 2016 July 29, v. 34, no. 35

2016

Abstract: With tetanus being a leading cause of maternal and neonatal morbidity and mortality in low and middle income countries, ensuring that pregnant women have geographic access to tetanus toxoid (TT) immunization can be important. However, immunization ... ...

Abstract	With tetanus being a leading cause of maternal and neonatal morbidity and mortality in low and middle income countries, ensuring that pregnant women have geographic access to tetanus toxoid (TT) immunization can be important. However, immunization locations in many systems may not be placed to optimize access across the population. Issues of access must be addressed for vaccines such as TT to reach their full potential.To assess how TT immunization locations meet population demand in Mozambique, our team developed and utilized SIGMA (Strategic Integrated Geo-temporal Mapping Application) to quantify how many pregnant women are reachable by existing TT immunization locations, how many cannot access these locations, and the potential costs and disease burden of not covering geographically harder-to-reach populations. Sensitivity analyses covered a range of catchment area sizes to include realistic travel distances and to determine the area some locations would need to cover in order for the existing system to reach at least 99% of the target population.For 99% of the population to reach health centers, people would be required to travel up to 35km. Limiting this distance to 15km would result in 5450 (3033–7108) annual cases of neonatal tetanus that could be prevented by TT, 144,240 (79,878–192,866) DALYs, and $110,691,979 ($56,180,326–$159,516,629) in treatment costs and productivity losses. A catchment area radius of 5km would lead to 17,841 (9929–23,271) annual cases of neonatal tetanus that could be prevented by TT, resulting in 472,234 (261,517–631,432) DALYs and $362,399,320 ($183,931,229–$522,248,480) in treatment costs and productivity losses.TT immunization locations are not geographically accessible by a significant proportion of pregnant women, resulting in substantial healthcare and productivity costs that could potentially be averted by adding or reconfiguring TT immunization locations. The resulting cost savings of covering these harder to reach populations could help pay for establishing additional immunization locations.
Keywords	cost effectiveness ; disability-adjusted life year ; economic valuation ; health services ; immunization ; income ; morbidity ; mortality ; pregnant women ; tetanus ; toxoids ; travel ; vaccines ; Mozambique
Language	English
Dates of publication	2016-0729
Size	p. 4161-4165.
Publishing place	Elsevier Ltd
Document type	Article
ZDB-ID	605674-x
ISSN	1873-2518 ; 0264-410X
ISSN (online)	1873-2518
ISSN	0264-410X
DOI	10.1016/j.vaccine.2016.06.065
Database	NAL-Catalogue (AGRICOLA)

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