Globally Resilient Supply Chains for Seasonal and Pandemic Influenza Vaccines (2022) / Chapter Skim
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4 Vaccine Distribution and Delivery
4 Vaccine Distribution and Delivery
Pages 95-130
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From page 95... ...
Given the annual need to update a seasonal influenza vaccine and the limited period of use, poorly managed logistics systems can disrupt vaccination campaigns and lead to inequitable vaccine distribution.
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For example, a vaccine that requires sub-zero cold chain temperatures (less than 0°C) along with various ancillary supplies will place greater stains on supply chains than a vaccine that can be stored at standard refrigeration temperatures (2°–8°C)
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Though no currently available influenza vaccines require ultra-cold supply chains, these barriers must be considered in the event that mRNA technology is someday used for influenza vaccines. There is a tradeoff between vaccine design and speed and the efficiency of distribution, delivery, and administration.
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Beyond vaccine quality and efficacy, there is a need to develop vaccines that account for global logistical constraints. To encourage innovation in influenza vaccine development to address these needs, WHO has developed preferred product characteristics1 for next generation influenza vaccines (WHO, 2017)
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They also advocate for "catch-up vaccinations" -- special efforts to roll out routine immunizations that have been disrupted due to the COVID-19 pandemic. These operational considerations acknowledge that communities with higher risk of vaccine-preventable disease outbreak, such as those experiencing low vaccine coverage, poverty, or displacement, should be prioritized for catch-up efforts (CDC, 2021d)
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. Vaccines, like all medicinal products, have an expiration date and shelf life that is determined by the manufacturer and approved by regulatory authorities (WHO Africa, 2021)
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During a pandemic when there is limited initial stability data for novel vaccines, and potentially even for well-accepted vaccines (i.e., strategic national stockpile) , QR codes are the best option for manufacturers to use that provide access to the latest data on vaccine stability, shelf life, and safety.
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Certain vaccines, such as the mRNA COVID-19 vaccines, can strain a country's vaccine distribution by increasing the need for cold chain maintenance, specific delivery devices, or repeated doses. As a result, researchers and vaccine manufacturers need to consider the effect of these issues on massscale distribution.
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The VIPS alliance is developing a single integrated framework to evaluate and prioritize vaccine product innovations and focus on needs of LMICs, in consultation with wider stakeholders, including end users from those countries. It is crucial to take stock of the current vaccine innovations implemented in response to COVID-19 vaccines and further support end-to-end vaccine innovations covering the entire product development to simplify logistics, improve equitable access, increase the acceptability and safety of immunization, allow vaccine interchangeability, and facilitate outreach during future pandemic preparedness and response.
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From page 104... ...
, but this type of projection does not provide the concrete guidance that can help manufacturers or those managing the supply chains for vaccine production to prepare for an upcoming influenza season or pandemic. Unlike childhood vaccines, whose demand is relatively simple for vaccine manufacturers to predict, seasonal influenza vaccine demand is more uncertain given the seasonality of influenza outbreaks, their changing nature from year to year, varying and uncertain vaccine uptake due to multiple factors, and vaccine spoilage and wastage.
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. These investigators assessed potential demand for seasonal influenza vaccine, and the results led them to identify the ways that immunization programs may be affected by availability gaps in supply linked to current vaccine production cycles and shelf life duration.
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Demand Generation Demand generation and demand forecasting are two distinct gaps affecting vaccine supply chains. Generating demand is a critical consideration that is often neglected.
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Low efficacy of the seasonal vaccine is a poor incentive to increase integration into immunization schedules. The committee distinguishes two factors that affect demand generation for seasonal influenza vaccines: a country's willingness to include seasonal influenza vaccines in its vaccination programs, and uptake by the public once a vaccine is in the program.
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Influenza vaccines remain underutilized because there are relatively few economic evaluations done on seasonal influenza vaccination, leading to poor understanding of the benefits of vaccination to guide decision makers (Newall et al., 2018)
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Getting influenza vaccines from manufacturers to recipients while maintaining the cold chain is a logistical challenge. Limited storage capacity and inefficient distribution and logistics systems have long been bottlenecks in the supply chain, particularly for LMICs (Zaffran et al., 2013)
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requires complex coordination of multiple agencies, receiving countries, manufacturers, and logistics providers. A pandemic context places strains on transport capacity that could affect flow of materials and products across the end-to-end supply chain.
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. However, given the near universal condemnation of these export restrictions, several organizations and authors have called for negotiations to reduce these exceptions to effectively address the next pandemic (Pauwelyn, 2020)
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. IN-COUNTRY STORAGE AND DISTRIBUTION The committee finds that the physical supply chain, from cold chain considerations to transport capacity, is already stressed in LMICs.
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Failure to address these dynamics may perpetuate low uptake of influenza vaccines into national vaccine schedules due to the high burden on local supply chains and competition for limited resources with other priority vaccines. Cold Chain Considerations The temperature instability of vaccines can emerge as a key challenge to distributing an approved vaccine for widespread use.
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. One of the challenges of distributing influenza vaccines in remote or rural communities in LMICs is the unavailability or unreliability of electricity to power refrigeration units.
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Lack of funding to deliver vaccines is a critical issue. Personnel, cold chain requirements, and transportation costs can all serve as added challenges to vaccine transportation funding, particularly in a pandemic scenario when a significant portion of the population is targeted for vac 4 COVAX is the acronym for COVID-19 Vaccines Global Access; see fn.
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The operational cost of getting influenza vaccines to people is significant, placing a high burden on some LMIC country budgets. Beyond standard transportation and distribution costs, human resource capacity for distribution and delivery is a major challenge.
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Different types of vaccination strategies (including clinic-based, mass vaccination sites, mobile sites) create different transport, logistics, and operational challenges.
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. Models of widespread use of patch technologies for some routine vaccinations revealed a significant decrease in vaccine wastage, although specific effects on the supply chain varied depending on context-specific cold chain capacities (Wedlock et al., 2019)
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In planning and monitoring a vaccination campaign, whether for seasonal or pandemic influenza, information systems need to be able to provide data on the uptake of vaccines, both by targeted population groups and by regions, as well as data that public health officials can use to monitor and evaluate the logistical chain that supplies vaccines where they are needed. Currently, "there is no global monitoring system for influenza vaccination coverage," making it difficult to match vaccine supply and demand (Palache et al., 2021, p.
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Based on this assessment, countries can develop and finance comprehensive improvement plans to strengthen immunization supply chains to help ensure that vaccines are available, that vaccines remain potent, and that resources are efficiently used. This tool also assesses information systems and supportive management functions involved in vaccine storage and distribution.
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Studies revealed that people were traveling across county lines in order to receive a COVID-19 vaccine. In addition, white populations were significantly more likely than other groups to have received a vaccine, and vaccine coverage varied significantly on a local level (Wainscott-Sargent, 2021)
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Immunization information systems for routine immunization are relevant to planning, delivery, and administration in supply chain logistics and procurement (delivery, cold chain monitoring)
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Tools need to be available to assist countries and global institutions with planning vaccination strategies, including selection of sites, supply and logistics, and operational setup of vaccination sites for efficiency. Tools are also needed to lower the cost of ownership for cold chain equipment, which serves as a bottleneck in vaccine transportation.
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2020. Abu Dhabi brings hope to global vaccine distribution.
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2020. Influenza vaccines market to rise at 7.7% CAGR till 2026; in creasing demand for effective flu vaccines to aid market expansion: Fortune business insights.
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2017. Equalizing access to pandemic influenza vaccines through optimal allocation to public health distribution points.
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2017. Data and product needs for influenza immunization programs in low- and middle-income countries: Rationale and main con clusions of the WHO preferred product characteristics for next-generation influenza vaccines.
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2019. The potential effects of introducing microneedle patch vaccines into routine vaccine supply chains.
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2017. WHO preferred product characteristics for next-generation influenza vaccines.
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