Literature review: The vaccine supply chain

Vaccination is one of the most effective ways to prevent and/or control the outbreak of infectious diseases. This medical intervention also brings about many logistical questions. In the past years, the Operations Research/Operations Management community has shown a growing interest in the logistical aspects of vaccination. However, publications on vaccine logistics often focus on one specific logistical aspect. A broader framework is needed so that open research questions can be identified more easily and contributions are not overlooked.In this literature review, we combine the priorities of the World Health Organization for creating a flexible and robust vaccine supply chain with an Operations Research/Operations Management supply chain perspective. We propose a classification for the literature on vaccine logistics to structure this relatively new field, and identify promising research directions. We classify the literature into the following four components: (1) product, (2) production, (3) allocation, and (4) distribution. Within the supply chain classification, we analyze the decision problems for existing outbreaks versus sudden outbreaks and developing countries versus developed countries. We identify unique characteristics of the vaccine supply chain: high uncertainty in both supply and demand; misalignment of objectives and decentralized decision making between supplier, public health organization and end customer; complex political decisions concerning allocation and the crucial

Planning and implementing COVID-19 mass vaccination clinics

Purpose: The COVID-19 pandemic is an unprecedented global public health crisis. Mass vaccination with safe and effective vaccines to achieve herd immunity requires a whole-of-society approach. Primary care has played a key role in those countries that have succeeded in rapidly vaccinating a large proportion of their populations, particularly those most at risk. In this special report we synthesize existing guidelines and peer-reviewed studies to provide family physicians with practical guidance on planning and implementing COVID-19 mass immunization clinics. Methods: PubMed, Ovid, MEDLINE, Epub Ahead of Print, Embase and Google Scholar were used to search for relevant literature using keywords, including “COVID-19”, “mass vaccination”, “campaign”, “standard” and “best practice”. We also identified and analyzed national and international guidelines. Results: Forty-six relevant articles, reports and guidelines were identified and synthesized. Key considerations for COVID-19 mass vaccination clinics include establishing a leadership structure and key roles, identifying optional locations, clinic layout and workflow, day-to-day operations including infection prevention and control, and communication strategies. Ongoing data collection is required to evaluate and continuously improve mass vaccination efforts. Primary care can play a key role in organizing clinics and ensuring populations who have been made vulnerable by social and economic policies are being reached. Conclusions: Planning and implementing a successful COVID-19 mass vaccination campaign requires a number of key steps and considerations. As the COVID-19 vaccine rollout occurs in various countries, research will be required to identify key factors for success in different healthcare systems to inform future pandemic responses.http://deepblue.lib.umich.edu/bitstream/2027.42/167674/1/AFM-393-21_PP.pdfDescription of AFM-393-21_PP.pdf : Main ArticleSEL

Literature Review - the vaccine supply chain

Vaccination is one of the most effective ways to prevent the outbreak of an infectious disease. This medical intervention also brings about many logistical quest

Immunization Tour: Preparing for Mass Immunization through Pharmacy and Nursing Interprofessional Student-led Service-learning

Pharmacy and nursing students piloted a collaborative student initiative to administer mass influenza immunizations to a large university campus. Through the support of the School of Nursing, College of Pharmacy, and University Health Service this project later turned into a unique service-learning interprofessional one credit elective course promoting public health philosophy and principles, emergency preparedness strategies, clinical skills, and interprofessional team competencies centered around influenza immunizations. Including lessons learned, this article will describe the evolution of this innovative student-led project.   Type: Case Stud

Immunization Tour: Preparing for Mass Immunization through Pharmacy and Nursing Interprofessional Student-led Service-learning

Pharmacy and nursing students piloted a collaborative student initiative to administer mass influenza immunizations to a large university campus. Through the support of the School of Nursing, College of Pharmacy, and University Health Service this project later turned into a unique service-learning interprofessional one credit elective course promoting public health philosophy and principles, emergency preparedness strategies, clinical skills, and interprofessional team competencies centered around influenza immunizations. Including lessons learned, this article will describe the evolution of this innovative student-led project.   Type: Case Stud

Using RealOpt-POD© to determine staffing capabilities during an infectious disease emergency

In the event of an infectious disease emergency, the Allegheny County Health Department (ACHD) may have to open Points-of-Dispensing (PODs) in order to administer life-saving medical countermeasures to the public. Under Centers for Disease Control and Prevention guidelines, local public health agencies are expected to demonstrate their ability to dispense medication or vaccine to everyone in their identified population within 48 hours. ACHD has designated 50 schools as public PODs throughout the county. In the event that all sites are activated, ACHD would need to supplement its workforce in order to provide adequate staffing to meet this capability. ACHD used RealOpt-POD©, a software tool designed to assist public health agencies, to determine optimal resource allocation for PODs, aiding in predicting staffing shortages and establish limitations on dispensing throughput. The public health significance of this project is in planning for infectious disease emergencies. RealOpt-POD© was used to model an influenza outbreak requiring mass vaccination. Information about ACHD’s workforce, including licensures, was inputted into RealOpt-POD©. Data about 548 Medical Reserve Corps (MRC) members was also included to supplement the workforce. RealOpt-POD© took into account whether or not an individual was licensed to give a vaccine. The model estimated the maximum number of people that can be treated with the available workforce within 48 hours at 50 PODs. In addition, RealOpt-POD© projected the minimum number of personnel needed to vaccinate the entire county. With 50 open PODs, the minimum number of workers needed to vaccinate the Allegheny County population (1.2 million) within 48 hours is 3,514. Assuming that 10% of MRC volunteers would assist, an additional 3,110 workers are needed. 45% of these workers should be licensed to give a vaccine. The maximum number of citizens that can be treated without the additional workers is 71,112. With its workforce alone, ACHD will not be able to provide vaccinations to the entire county within 48 hours. These results demonstrate that recruiting medically-oriented individuals should be a priority for the MRC and the ACHD may have to look to alternative staffing pools to ensure the ability to operate all 50 sites

Implementation of the Vaccines for Children Program in A Midwest, Urban Clinic Dedicated to the Underserved Population

Background: Low immunization rates weaken herd immunity and endanger children. The Safety Net Health Clinic (SNHC) study site serves an underprivileged and refugee population with significantly lower than ideal coverage. Series completion disparities persisted after control for demographic, access-to-care, poverty and language effects (Varan et al, 2016). Objectives: SNHC implemented the Vaccines for Children (VFC) program in order to increase the vaccination rates among the underserved population. Methods: As an efficacy study, the project focused on three major areas in the VFC implementation – cost, staff preparedness and patient need. Cost was determined by utilizing electronic medical records (EMR) and budgets. The need and preparedness parts of study were correlational analyses using convenience sampling. Preparedness study required staff training for appropriate policies and procedures. Staff knowledge and readiness was assessed with focus group and objective surveys from pre and post training seminar. Finally the study addressed need with vaccination rates contrasted by vaccine specific series completion for age cohorts, not for individual patients. Vaccination series completion rates were determined by age cohorts and compared to pre-implementation rates with Chi-squared tests. Vaccine series completion rates were compared to state and national data. Desire for VFC was surveyed from patients. Results: The study found that there was indeed a need for VFC as well as a staff prepared to implement the program. The clinic’s preparation can be improved due to the issues with refrigeration. Conclusion: The VFC program is a good fit for SNHC and should increase vaccination rates. Data will be entered into the EMR as part of routine health care documentation and is retrievable in the EMR reporting function by vaccination type and date parameters to assess series completion rates. Implications: The VFC program implementation was approved. SNHC should explore offering pediatric care

Shades of gray in vaccine decision making: Understanding, exploring, and addressing the challenges of influenza vaccine hesitancy in Ontario community pharmacies

Background: Two-thirds of Canadian adults currently do not receive the annual influenza vaccine. Vaccine hesitancy (VH), the voluntary delay or refusal of vaccination services despite availability is a significant contributor to the poor uptake of several vaccines including the influenza vaccine. The overarching intent of this thesis was to gain a nuanced understanding of the community pharmacists’ experiences with influenza VH and explore means to best address it. Methods: This thesis is comprised of three studies. The first study was a quantitative descriptive analysis of an exploratory cross-sectional online survey of 885 pharmacists. This study aimed to provide an overview of pharmacists’ perceived knowledge, attitudes and practices pertaining to influenza VH. The second study was a qualitative interpretive analysis of in-depth semi-structured interviews with 22 pharmacists. An implementation science lens was then used to examine the results from the first two studies to guide the selection of a behavioural target and inform intervention design. Based on these findings, the third study included a cost-utility analysis of a novel remunerated community pharmacist consultation service on influenza vaccination for Ontario seniors from a provincial payer perspective. Results: Pharmacists’ self-reported knowledge of influenza vaccine and disease, their confidence and ability to identify and address influenza VH was generally high. Pharmacists’ engagement with patients on the influenza vaccine was found to be modulated by a complex and mutually reinforcing constellation of attitudes and behaviours which included: a binary (pro-vaccine or anti-vaccine) perception of patient vaccination decisions; a conflation of those expressing hesitancy with those that are anti-vaccine; and a passive approach to patient engagement. Despite possessing the requisite knowledge and skills, workflow barriers such as limited time, inadequate staffing, and poor remuneration were found to restrict optimal patient engagement on influenza vaccinations. Offering pharmacists a CAD $15 consultation fee to engage with seniors on the influenza vaccine was estimated to be both cost-effective and clinically effective. Conclusion: Facilitating optimal practice scope for pharmacists, and capitalizing the additional convenience and accessibility offered through the community pharmacy setting presents a promising means to address influenza VH. Conventional tools to aid health professionals in addressing influenza VH rely on augmenting the vaccine provider’s knowledge and skills; however, our analysis suggests that reorienting efforts to enhance the provider’s motivation and opportunity to engage with patients on influenza vaccine conversations are likely to be more effective in the community pharmacy setting