1. CLICK TO ADD TITLE [DATE][SPEAKERS NAMES] The 6th Global Health Supply Chain Summit November 18 -20, 2013 Addis Ababa, Ethiopia HERMES Computational Simulation Modeling to Improve Vaccine Supply Chain Operations in Two West African Countries: Niger and Benin Bryan A. Norman

2. HERMES Team Tina-Marie Assi, PhD Former Co-Coordinator Rachel B. Slayton, PhD Former Co-Coordinator Shawn T. Brown, PhD Technical Lead Joel S. Welling, PhD Developer Bruce Y. Lee, MD, MBA Scientific Lead Bryan A. Norman, PhD Industrial Engineering Jayant Rajgopal, PhD Industrial Engineering Diana L. Connor, MPH Co-Coordinator Sheng-I Chen, PhD Industrial Engineering Angela R. Wateska, MPH Co-Coordinator Brigid E. Cakouros, MPH Senior Analyst Yu-Ting Weng, MS Developer Michelle M. Schmitz, BA Analyst Jim Leonard Developer Leila A. Haidari, BS Analyst Leslie E. Mueller, BS Analyst Erin G. Claypool, PhD Industrial Engineering Proma Paul, MHS Senior Analyst Veena Karir, PharmD, MS Senior Analyst Roslyn J. Phillips, MPH Senior Analyst

3. HERMES Overview Examples of In-Country Work Sample studies Summary and Discussion Overview For more information visit- http://hermes.psc.edu

4. Air and Space Travel and Exploration Transportation Natural Resource and Energy Exploration Finance and Investment Sports Military/Defense Modeling Is Widely Used For more information visit- http://hermes.psc.edu

5. HERMES Vision For more information visit- http://hermes.psc.edu

6. HERMES can address… Impact of introducing new technology –e.g., vaccines, storage, and monitoring Characteristics of vaccines and other technologies –e.g., vaccine vial size, vaccine thermostability, cold device capacity Configuration and operations of the supply chain –e.g., storage, shipping frequency, personnel, ordering policy Effects of differing conditions/circumstances –e.g., power outages, delays, inclement weather, limited access Investment or allocation of resources –e.g., adding refrigerators vs. increasing transport frequency Optimizing vaccine delivery –e.g., minimize cost, cost per outcome, maximize immunizations

7. Discrete Event Simulation For more information visit- http://hermes.psc.edu

8. Service Delivery Location

9. Steps to Model Supply Chains Identify purpose of simulation –Questions to address –Perspective of user Determine level of detail required in the simulation model –Less detail to address general, simpler questions –More detail to address more complex questions For more information visit- http://hermes.psc.edu

10. Steps to Model Supply Chains Gather and input supply chain data into HERMES –Evaluate the data that is available. –Less data less detailed simulation model –More data more detailed simulation model Decision maker can directly run HERMES on any laptop computer For more information visit- http://hermes.psc.edu

11. HERMES GUI Simplifies –Data input –Running models –Evaluating different scenarios –Identifying bottlenecks Seeking Beta testers for the HERMES GUI for early 2014 For more information visit- http://hermes.psc.edu

12. HERMES Overview Examples of In- Country Work Sample studies Summary and Discussion Overview For more information visit- http://hermes.psc.edu

13. Examples of In-Country Work For more information visit- http://hermes.psc.edu

14. HERMES Overview Examples of In-Country Work Sample studies Summary and Discussion Overview For more information visit- http://hermes.psc.edu

16. Niger Supply Chain 1 Month 42 District Stores (Chest Refrigerators and Freezers) Serum InstituteSanofi Aventis Regional Store 600+ Clinics (Small Refrigerators and/or Freezers) 600+ Clinics Regional Store 1 Mon th Regional Store Central Store For more information visit- http://hermes.psc.edu

17. Vaccine Availability Vaccine Availability (%)

18. For more information visit- http://hermes.psc.edu

19. Truck Capacity Utilization 10-dose measles vaccine vial size 5-dose measles vaccine vial size 2-dose measles vaccine vial size 1-dose measles vaccine vial size

20. 10-dose measles vaccine vial size 5-dose measles vaccine vial size 2-dose measles vaccine vial size 1-dose measles vaccine vial size Storage Capacity Utilization

21. Measles Vaccine Vial Size Scenario10 doses per vial5 doses per vial2 doses per vial1 doses per vial 100% Target Population Size Bacille-Calmette-Guerin Tuberculosis (BCG) 79% 78%76% Diptheria-tetanus-pertussis-hepatitis B- Haemophilus influenza type B (DTP-HepB-Hib) 84% 82%80% Measles 90%87%86%80% Oral polio (OPV) 80% 78%76% Tetanus toxoid (TT) 84% 83%80% Yellow fever (YF) 79% 78%76% 80% Target Population Size BCG 84%85% 84% DTP-HepB-Hib 86% 84% Measles 94%92%89%84% OPV 80% 79% TT 86% 84% YF 84%85% 84% 60% Target Population Size BCG 81% 80% DTP-HepB-Hib 91% 89% Measles 93%91% 90% OPV 82% TT 90% 89% YF 81% 80% Vaccine Availability by Vaccine

23. Cost per Dose by Arrival Rate

24. Optimal Vial Size

25. Benin: The Problem The Benin supply chain may not be effectively getting vaccines to the population. –At least 15% of children in Benin are not receiving full vaccinations (as measured by estimated DTP3 coverage). 1 –Impending new vaccine introduction (e.g., rotavirus vaccine) may exacerbate this problem. The Benin vaccine supply chain may also cost more to operate than it should (not completely efficient). 1 http://www.who.int/immunization_monitoring/data/ben.pdf - 2011 Government and WHO-UNICEF estimate.http://www.who.int/immunization_monitoring/data/ben.pdf For more information visit- http://hermes.psc.edu

26. Benin: Objectives Evaluate the current Benin vaccine supply chain: –Identify vulnerabilities (bottlenecks) –Calculate operating costs (storage, transport, labor, and building) Assess Benin vaccine supply chains ability to handle new vaccine introduction. Identify an alternate, more efficient vaccine supply chain design. Establish a blueprint for redesign. Build a business case to change the system. Determine if costs could be lowered and coverage increased from the current system.

27. Approach: HERMES Modeling Each Scenario Data on Benin Vaccine Supply Chain 2010 Cold Chain Equipment Management (CCEM) assessment Pilot 2012 EVM+HERMES 2008 Comprehensive Multiyear Plan (cMYP) Personal communications with Benin Ministry of Health (MoH), WHO, UNICEF, Project OPTIMIZE, and other key stakeholders Measure Operating Costs Make Additions to Relieve Bottlenecks Run Simulation Measure Vaccine Availability Detailed Simulation Model of the Benin Vaccine Supply Chain Run Simulation Measure Operating CostsMeasure Vaccine Availability Measure Capital Expenditure For more information visit- http://hermes.psc.edu

28. Current System: Not Completely Effective or Efficient Vaccine availability: 93% (71% after rotavirus introduction) Total annual operating costs: $1,113,954 ($1,117,494 after rotavirus introduction) Logistics cost per dose: $0.23 ($0.26 after rotavirus introduction) * Current Bottlenecks: Storage at National Store and transport between all levels

29. Which Redesign is the Best Option?

30. Capital Expenditures Required to Achieve Each Design Alternative that will Accommodate Rotavirus Introduction

31. ZS + Truck Loops: Lowest Capital Expenditures and Operating Costs

32. ZS + Truck Loops: Lowest Logistics Cost per Dose Administered

33. ZS+Truck Loops: Over Half a Million USD in Cost Savings after 5 Years

34. Synergy of Two Changes Creates Savings

35. Zone Sanitaire plus 4 x 4 Truck Loops at Lowest Level is clear choice. Lower capital expenditures Lower operating costs After four years over half-million in cost savings Combination of Zone Sanitaire and Truck Loops leads to a synergistic effect. Conclusions For more information visit- http://hermes.psc.edu

36. HERMES Overview Examples of In-Country Work Sample studies Summary and Discussion Overview For more information visit- http://hermes.psc.edu

37. Summary and Discussion HERMES can rapidly create a simulation model of any supply chain Serve as a virtual laboratory to help a wide variety of vaccine decision makers answer any number of questions Already implemented in multiple countries For more information visit- http://hermes.psc.edu

38. Looking To The Future Over the next ten years most GAVI countries are expanding their vaccines –MenAfriVac®, Rotavirus, PCV-13, others Many new vaccines are relatively large –Even more burden on the vaccine cold chain Higher coverage rate targets for current and new vaccines Cost effective distribution is critical to achieve coverage targets For more information visit- http://hermes.psc.edu

39. Acknowledgements Funded by the Bill and Melinda Gates Foundation and the U.S. National Institutes of Health Valued collaborators include: World Health Organization (WHO), UNICEF, PATH, Agencie de Medecine Preventive (AMP) For more information visit- http://hermes.psc.edu