Customizing immunization clinic operations to minimize open vial waste

Many multi-dose vaccine vials must be used within hours of reconstitution; unused doses are discarded as “open vial waste.” Building on Mofrad et al. (2014), we evaluate operating strategies that maximize coverage by controlling open vial waste. We define novel metrics for determining thresholds on vaccination clinic operating hours and session frequency. We study the performance of optimal and heuristic policies in the presence of random vial yield. Cost analyses indicate significant potential savings. Because optimal strategies are context specific, we also develop a decision support tool (available online) to easily replicate the analysis for any problem setting.

[1]  V. Costigliola,et al.  Pandemic influenza preparedness: The critical role of the syringe , 2006, Vaccine.

[2]  Lisa M. Maillart,et al.  Dynamically optimizing the administration of vaccines from multi-dose vials , 2012 .

[3]  Martin L. Puterman,et al.  Markov Decision Processes: Discrete Stochastic Dynamic Programming , 1994 .

[4]  Sheng-I Chen,et al.  Replacing the measles ten-dose vaccine presentation with the single-dose presentation in Thailand. , 2011, Vaccine.

[5]  P. Drain,et al.  Introducing auto-disable syringes to the national immunization programme in Madagascar. , 2003, Bulletin of the World Health Organization.

[6]  N. Nundy,et al.  Incremental costs of introducing jet injection technology for delivery of routine childhood vaccinations: comparative analysis from Brazil, India, and South Africa. , 2011, Vaccine.

[7]  D. Bishai,et al.  The budget impact of controlling wastage with smaller vials: A data driven model of session sizes in Bangladesh, India (Uttar Pradesh),Mozambique, and Uganda. , 2014, Vaccine.

[8]  Divya Parmar,et al.  Impact of wastage on single and multi-dose vaccine vials: Implications for introducing pneumococcal vaccines in developing countries , 2010, Human vaccines.

[9]  Rubén A. Proaño,et al.  Determining the optimal vaccine vial size in developing countries: a Monte Carlo simulation approach , 2012, Health care management science.

[10]  Sheng-I Chen,et al.  Single versus multi-dose vaccine vials: an economic computational model. , 2010, Vaccine.

[11]  Shawn T. Brown,et al.  Impact of changing the measles vaccine vial size on Niger's vaccine supply chain: a computational model , 2011, BMC public health.