1. CLICK TO ADD TITLE [DATE][SPEAKERS NAMES] The 5th Global Health Supply Chain Summit November 14 -16, 2012 Kigali, Rwanda Optimizing the vaccine supply chains Modibo Dicko

2. What is Project Optimize? Five-year (2007-2012) collaboration between WHO and PATH, funded by the Bill & Melinda Gates Foundation Objective: To shape the future of technologies and logistic systems for vaccines in low- income and middle-income countries. Sanaipei Kisoso, WHO Mike Wang, PATH

3. Vaccines & Supplies Information A network of people, equipment and well established procedures Vaccine supply chain yesterday & today - 1 3 Simple, precise & rigid rules!

4. This system has served us very well for over 30 years! But it has now reached its limits! * Source: WHO. Guidelines on the international packaging and shipping of vaccines. 2002; WHO/V&B/01.05. ** Based on $7.50/dose for Rotarix and $0.155 per dose for polio and measles $635.50** $4,687.50** 625 doses of Rotavirus Vaccine District vaccine store, Brazil 4100 doses of Polio and Measles Vaccines Rural hospital storage, Mozambique 4100 doses of Polio and Measles Vaccines Rural hospital storage, Mozambique More volumes for new vaccines: Depending on packaging rota & pneumo vaccines require 45% to 113% more storage volume!

5. A changing environment: More, more, more More target populations: –Immunization & other programs are striving to reach new target groups with new strategies and new products. More parallel health supply chains: –An increasing number of interventions establish their own supply chains to ensure reliable access to quality products. More global interdependence: – Pandemic influenza, Avian Influenza, Meningococcal Meningitis, Yellow Fever, Polio, SARS… 5

6. A changing environment: Increased complexity 197519901995200020052010 PEI: GAVI 1 GAVI 2 GIVS Measles DoV? + Right Cost Co-Financing + Right Quantity + Right Place + Right Time 4 Rights 5 Rights UCI* Full 6 Rights** * UCI = Universal Childhood Immunization. PEI = Polio Eradication Initiative. GIVS = Global Immunization Vision & Strategies ** The right products in the right quantity, at the right place, in the right condition, at the right time, at the right cost 2 Rights: Right vaccines in Right conditions (everywhere, all the time, in abundant quantities as cost is low ) EPI

7. Underper- forming health programs and unachieved health goals Poor availability of health commodities at facilities, wasted resources Unqualified and disempowered staff managing public health supply chains Supply chains poorly managed and insufficiently resourced Source: Kevin Piltz, USAID/Washington, 2010 A changing environment: unqualified staff can no longer cope with requirements

8. By 2020, state-of-art supply systems enable the right vaccines to be at the right place, in the right quantities, at the right time, in the right condition, at the right cost.  Engage key partners- within immunization and across public health  Develop a joint vision and plan for the future Partners agree on 2020 vision and action plan  Implement specific interventions with countries (Albania, Guatemala, Senegal, Tunisia, Vietnam)  Model potential impact Evidence base created & lessons documented  Identify innovative technologies and practices for future supply systems  Promote an environment conducive to innovation Policies, guidelines and processes in place Project Optimize Vision & Objectives INNOVATEDEMONSTRATEFACILITATE

9. A Vision and 5 Tenets

10. Controlled temperature chain Product packaging Passive cooling Integration and moving warehouse Outsourcing Net-zero energy supply chain Temperature monitoring Immunization registries Capturing last mile data Modelling supply chains Project Optimize Activities at a glance Optimize techn. working groups Country collaboration projects Operational research Challenges to industry CCL Taskforce collaboration

11. Supply chain optimization – Senegal Horiz. integration: Integrated storage & distribu-tion from central to reg' level. Vertic. integration: From Reg'l Store directly to health posts using a moving warehouse. International / Manufacturers PNA National level PRA Regional level 5 Health Centres & 110 Health Posts Distribution Other drugs & health products Vaccines & heat sensitive drugs Distribution DPM Virtual Store National level Regional Virtual Store St Louis Region District Virtual Stores 5 Districts Moving Warehouse A B C Cold ChainAmbient Temp Chain Information Post-Integration Situation (Dakar & St Louis Region)

12. Supply chain optimization – Tunisia Integrated supply chain system from the national level down to regional levels. Solarized stores at regional and district levels Solar-powered “moving warehouse” delivery system.

13. Supply Chain Modelling & Costing Collaboration with the Vaccine Modelling Initiative (VMI), University of Pittsburg –Development of a simulation supply chain model to assess scenarios for Senegal. Excel-based model and data collection tools to support country demonstration projects ­ Comparing baseline and various scenario logistics costs (transport and cold chain). SC Cost components

14. Standard input deck MODELLING & COSTING Vaccine availability by scenario Total & unit costs by scenario Data on Supply Chain Structure, Storage Locations, Transport, Capacities, Personnel, etc. Supply chain function costs Supply chain performance metrics Supply chain performance metrics Discrete event simulation model of supply chain OPTIMIZE supply chain costing tool Cost Drivers Cost Drivers Total Costs Total Costs Unit Costs Unit Costs Economic Metrics Source: VMI (University of Pittsburg)

15. November 28, 2011 © 2011 Bill & Melinda Gates Foundation | 15 Vaccine Availability & Costs by Scenario Senegal (Constrained)

16. November 28, 2011 © 2011 Bill & Melinda Gates Foundation | 16 Vaccine Availability & Costs by Scenario Senegal (Unconstrained)

17. What next at country level: scaling up Development of a scale up strategy for successful innovations: ­ Using ExpandNet* methodology in Senegal and Tunisia Validation by MoH & funding to be sought (MoH & partners). * www.ExpandNet.netwww.ExpandNet.net Senegal & Tunisia Scaling – Up Strategy

18. What next at global level: linking with the Decade of Vaccines GVAP Ensure Optimize learning lives on: Action Plans developed for the 5 tenets of the global vision. Plans are online and available at: http://www.path.org/publications/files/TS_opt_action_plans.pdf These will be reformatted and published as a vision 2020 outputs companion document to the DoV Global Vaccine Action Plan (GVAP).

19. Nothing is impossible – never say never... and trust staff (Optimize Team – Albania)