PMID- 33752952 OWN - NLM STAT- MEDLINE DCOM- 20210524 LR - 20210524 IS - 1873-2518 (Electronic) IS - 0264-410X (Linking) VI - 39 IP - 16 DP - 2021 Apr 15 TI - Redesigning immunization supply chains: Results from three country analyses. PG - 2246-2254 LID - S0264-410X(21)00318-2 [pii] LID - 10.1016/j.vaccine.2021.03.037 [doi] AB - INTRODUCTION: Immunization supply chains (iSC) are essential for ensuring access to vaccines that prevent diseases. Guinea, Madagascar, and Niger initiated iSC system design efforts to conduct analysis of alternative supply chain scenarios to identify areas for improvement. METHODOLOGY: Key stakeholders from Ministries of Health and immunization programs identified bottlenecks in the current iSC and prioritized five general design scenarios to model in each country. Scenarios included aspects of integration, changing supply chain levels and delivery frequency, ignoring administrative boundaries, and direct delivery. Primary and secondary data were collected and cleaned. Analysis was completed using Supply Chain Guru (Madagascar and Niger) and AnyLogistix (Guinea) modeling software to build a virtual representation of the iSC physical components and operating policies. RESULTS: Modeling results were compared using both quantitative and qualitative criteria (total operating costs, cost per dose, cold chain capacity, risk of mishandling, logistics burden on healthcare workers, feasibility to implement, and equity). Using a Stop Light Analysis for user-friendly understanding of positive, negative or minimal impact on scenarios, cost savings were realized in most scenarios in Madagascar (except using autonomous aerial vehicles); proposed scenarios in Guinea increased costs or had minimal impact; in Niger, eliminating regional tiers reduced costs. Facility level cold chain was sufficient in all countries. Effect on qualitative indicators largely depended on the scenario and country context. DISCUSSION: Similarities in scenarios selected were seen across the three countries. Results suggest that efficiencies can be found through changes to the iSC design, but the benefits of each scenario must be considered in the country context. Results of the analysis do not provide "the right answer" but rather options and guidance which then must be grounded in the country context and used as evidence for decision making to ensure reliable availability of vaccines. CI - Copyright (c) 2021 Elsevier Ltd. All rights reserved. FAU - Prosser, Wendy AU - Prosser W AD - JSI. 2733 Crystal Drive, 4th floor, Arlington, VA, USA. Electronic address: wendy_prosser@jsi.com. FAU - Folorunso, Olamide AU - Folorunso O AD - UNICEF/Supply Division, UN City, Copenhagen, Denmark. Electronic address: ofolorunso@unicef.org. FAU - McCord, Joseph AU - McCord J AD - JSI. 2733 Crystal Drive, 4th floor, Arlington, VA, USA. Electronic address: joe_mccord@jsi.com. FAU - Roche, Gregory AU - Roche G AD - JSI. 2733 Crystal Drive, 4th floor, Arlington, VA, USA. Electronic address: gregory_roche@jsi.com. FAU - Tien, Marie AU - Tien M AD - JSI. 2733 Crystal Drive, 4th floor, Arlington, VA, USA. Electronic address: marie_tien@jsi.com. FAU - Hatch, Benjamin AU - Hatch B AD - JSI. 2733 Crystal Drive, 4th floor, Arlington, VA, USA. Electronic address: benjamin_hatch@jsi.com. FAU - Spisak, Cary AU - Spisak C AD - JSI. 2733 Crystal Drive, 4th floor, Arlington, VA, USA. Electronic address: cary_spisak@jsi.com. FAU - Genovese, Eleonora AU - Genovese E AD - UNICEF/Niger, Naimey, Niger. Electronic address: egenovese@unicef.org. FAU - Pare, Bibata AU - Pare B AD - UNICEF/Guinea, Conakry, Guinea. Electronic address: bpare@unicef.org. FAU - Donatien, Koffi AU - Donatien K AD - UNICEF/Madagascar, Antananarivo, Madagascar. Electronic address: kgdonatien@unicef.org. FAU - Ibrahim, Magdi AU - Ibrahim M AD - Gavi, the Vaccine Alliance, Chemin du Pommier 40, 1218 Le Grand-Saconnex, Switzerland. Electronic address: mibrahim@gavi.org. FAU - Abou-Charaf, Elias AU - Abou-Charaf E AD - Gavi, the Vaccine Alliance, Chemin du Pommier 40, 1218 Le Grand-Saconnex, Switzerland. Electronic address: eaboucharaf@gavi.org. FAU - Wright, Christopher AU - Wright C AD - Independent Consultant. FAU - Dubourg, Jean-Charles AU - Dubourg JC AD - Gavi, the Vaccine Alliance, Chemin du Pommier 40, 1218 Le Grand-Saconnex, Switzerland. Electronic address: jdubourg@gavi.org. LA - eng PT - Journal Article PT - Research Support, Non-U.S. Gov't DEP - 20210320 PL - Netherlands TA - Vaccine JT - Vaccine JID - 8406899 RN - 0 (Vaccines) SB - IM MH - Humans MH - *Immunization Programs MH - Madagascar MH - Niger MH - Vaccination MH - *Vaccines OTO - NOTNLM OT - Immunization OT - Modeling OT - Supply chain OT - System design OT - Vaccine COIS- Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper. EDAT- 2021/03/24 06:00 MHDA- 2021/05/25 06:00 CRDT- 2021/03/23 06:09 PHST- 2020/12/28 00:00 [received] PHST- 2021/03/07 00:00 [revised] PHST- 2021/03/08 00:00 [accepted] PHST- 2021/03/24 06:00 [pubmed] PHST- 2021/05/25 06:00 [medline] PHST- 2021/03/23 06:09 [entrez] AID - S0264-410X(21)00318-2 [pii] AID - 10.1016/j.vaccine.2021.03.037 [doi] PST - ppublish SO - Vaccine. 2021 Apr 15;39(16):2246-2254. doi: 10.1016/j.vaccine.2021.03.037. Epub 2021 Mar 20.