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Editorial Note
Issue 28 brings you an update on the latest efforts in improving the immunization logistics systems under Project OPTIMIZE. The contributions span the efforts at preparing a preferred product profile for HPV vaccines, a likely change in the vaccine storage temperature policy, a new pilot for a computerized national immunization registry and vaccine ordering system, a study of fee-based immunization services in Vietnam, and a new version of the Cold Chain Equipment Manager (CCEM) tool.
Ener Cagri Dinleyici has a question for the forum: How do you prioritize various groups when it comes to the H1N1 vaccine?
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Working in collaboration with the Vaccine Presentation and Packaging Advisory Group (VPPAG), representatives from the public health community have initiated a series of studies to guide presentation and packaging decisions for future iterations of human papillomavirus (HPV) vaccines destined for low-income countries. Presentation and packaging decisions, such as the number of doses per container, type of container, and recommended storage temperatures greatly impact the way vaccines are handled, the quantity of vaccine doses wasted, and the ability of health workers to get the vaccines to remote, low-resource settings. By influencing these decisions early in the development process, public health officials can make sure that the specific needs of developing countries are considered.
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It has long been known that certain vaccines are stable for long periods of time at temperatures outside the standard cold chain protocol of 2° to 8°C. However, until recently, there have been few reasons to consider changing the relatively simple, blanket policy that all vaccines need to be stored between 2° and 8°C. The only exceptions have been occasional “off-label” use of some vaccines for immunizing hard-to-reach populations, such as “out-of-cold-chain” use of hepatitis B vaccine birth dose; use of tetanus toxoid in pregnancy, just before delivery; and the use of oral polio vaccine with or without cool water packs during campaigns.
A change in the vaccine storage temperature policy is not easy. It requires a great deal of evidence gathering, licensing and regulatory changes, and careful consideration of the programmatic impact of the change for countries. Depending on the country, such a change may merit new equipment, training, and monitoring to ensure that the new policy is followed correctly and consistently for all applicable vaccines.
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In early 2009, the Albanian Institute for Public Health (IPH) asked Optimize, a WHO-PATH collaboration, to develop a strategy for a computerized national immunization registry and vaccine ordering system. Working with IPH and other large stakeholder groups, Optimize assessed the existing paper-based system this summer and developed a strategy for implementing a small-scale pilot under IPH management in one district (Skodra).
In Albania, health workers are expected to record vaccinations for children in their catchment area on five different paper records. In order to determine vaccine orders, these records are compiled at the end of each month into two different reports that are aggregated at the district and national levels. The existing system, while functional, places a tremendous administrative burden on health workers and does not provide enough detail about populations that could be falling through the system’s cracks.
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While most people in Vietnam receive traditional Expanded Programme on Immunization vaccines free from government-run clinics and health centers, many others elect to receive these and other immunizations for a fee from private- and public-medical providers. Understanding the extent and quality of these fee‑based services and the reasons families prefer them can help the government improve regulatory oversight of private providers and perhaps improve both public and private provision of immunization services by sharing information between them.
Working with the Vietnam National Institute for Hygiene and Epidemiology (NIHE), Optimize is launching a fee-based immunization services assessment to: (1) understand the extent of fee-based immunization service delivery practices and related vaccine supply practices; (2) document government policies, regulations, guidelines, and enforcement mechanisms related to fee-based immunization services; and (3) identify potential mechanisms and interventions to improve regulatory processes and capability on fee-based immunization services.
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Managing Cold Chain Equipment Is Getting Easier
by Sophie Newland, David Lubinski, and John Lloyd
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Introducing newer, bulkier vaccines into a national immunization schedule can be a tricky job for logisticians. Is there enough space? Is there enough equipment? Is it in the right location? Is the equipment functioning properly? All immunization programs depend on reliable and sufficient refrigeration equipment to cool vaccines during transport and storage. But managing that information can be a daunting task.
In an effort to help countries more accurately establish and maintain cold chain equipment inventories and forecast future equipment needs, PATH and the United Nations Children’s Fund (UNICEF) collaborated in 2008 to create a software tool called Cold Chain Equipment Manager (CCEM). CCEM is a free, fast, accurate and easy-to-use Microsoft Access-based package designed to help countries create a comprehensive inventory of cold chain equipment and forecast future cold chain equipment needs according to planned changes in vaccines, schedules, and the target population.
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According to your experience, what is the main target (and steps) population for H1N1 vaccine?
In my country (Turkey), first, healthcare professionals (this week) followed by school children (age definition not described yet).
For childhood population:
- you prefer to first vaccinate the high risk group (<2 years and children with chronic underlying conditions)?
- school-children (strongly associated with spread of infection)?
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  Photos Courtesy: PATH/Robin Biellik
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