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

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

4. $635.50** $4,687.50** 4100 doses of Polio and Measles Vaccines Rural hospital storage, Mozambique 625 dosesof Rotavirus VaccineDistrict vaccine store, Brazil This system has served us very well for over 30 years! But it has now reached its limits! More volumes for new vaccines: Depending on packaging rota & pneumovaccines require 45% to 113% more storage volume! * 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

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. + Right Cost + Right Quantity + Right Place + Right Time Co-Financing A changing environment: Increased complexity DoV? GAVI 2 GIVS Full 6 Rights** GAVI 1 5 Rights Measles 4 Rights PEI: 2 Rights: Right vaccines in Right conditions(everywhere, all the time, in abundant quantities as cost is low) EPI UCI* 1975 1990 1995 2000 2005 2010 * 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

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

8. INNOVATE DEMONSTRATE FACILITATE • Identify innovative technologies and practices for future supply systems • Promote an environment conducive to innovation • Implement specific interventions with countries (Albania, Guatemala, Senegal, Tunisia, Vietnam) • Model potential impact • Engage key partners- within immunization and across public health • Develop a joint vision and plan for the future Evidence base created & lessons documented Partners agree on 2020 vision and action plan Policies, guidelines and processes in place 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. Project Optimize Vision & Objectives

9. A Vision and 5 Tenets

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

11. International / Manufacturers Other drugs Vaccines & heat & health sensitive drugs products A PNA DPM Virtual Store National level National level Distribution B Regional Virtual Store PRA Regional level St Louis Region C Distribution District Virtual Stores 5 Districts Moving Warehouse 5 Health Centres & 110 Health Posts 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. Cold Chain Ambient 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 SC Cost components • Excel-based model and data collection tools to support country demonstration projects • Comparing baseline and various scenario logistics costs (transport and cold chain). • Collaboration with the Vaccine Modelling Initiative (VMI), University of Pittsburg • Development of a simulation supply chain model to assess scenarios for Senegal.

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

15. Vaccine Availability & Costs by Scenario Senegal (Constrained)

16. Vaccine Availability & Costs by Scenario Senegal (Unconstrained)

17. Whatnextat country level: scaling up Senegal & Tunisia Scaling – Up Strategy • Development of a scale up strategy for successful innovations: • UsingExpandNet* methodologyin Senegal and Tunisia • Validation by MoH & funding to besought (MoH & partners). * www.ExpandNet.net

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) Thank you!