Core Allocations for Cooperation Problems in Vaccination

Vaccination is a very effective measure to fight an outbreak of an infectious disease, but it often suffers from delayed deliveries and limited stockpiles. To use these limited doses of vaccine effectively, health agencies can decide to cooperate and share their doses. In this study, we analyze this type of cooperation. Typically cooperation leads to an increased total return, but cooperation is only plausible when this total return can be distributed in a stable way. This makes cooperation a delicate matter. Using cooperative game theory, we derive theoretical sufficient conditions under which cooperation is plausible (i.e., the core is non-empty) and we show that the doses of vaccine can be traded for a market price in those cases. We perform numerical analyses to generalize these findings and we derive analytical expressions for market prices that can be used in general for distributing the total return. Our results demonstrate that cooperation is most likely to be plausible in case of severe shortages and in case of sufficient supply, with possible mismatches between supply and demand. In those cases, trading doses of vaccine for a market price often results in a core allocation of the total return. We confirm these findings with a case study on the redistribution of influenza vaccines

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

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

Dose-optimal vaccine allocation over multiple populations

For a large number of infectious diseases, vaccination is the most effective way to prevent an epidemic. However, the vaccine stockpile is hardly ever sufficient to treat the entire population, which brings about the challenge of vaccine allocation. To aid decision makers facing this challenge, we provide insights into the structure of this problem. We first investigate the dependence of health benefit on the fraction of people that receive vaccination, where we define health benefit as the total number of people that escape infection. We start with the seminal SIR compartmental model. Using implicit function analysis, we prove the existence of a unique vaccination fraction that maxi- mizes the health benefit per dose of vaccine, and that the health benefit per dose of vaccine decreases monotonically when moving away from this fraction in either direc- tion. Surprisingly, this fraction does not coincide with the so-called critical vaccination coverage that has been advocated in literature. We extend these insights to other compartmental models such as the SEIR model. These results allow us to provide new insights into vaccine allocation to multiple non-interacting or weakly interacting populations. We explain the counter-intuitive switching behavior of optimal allocation. We show that allocations that maximize health benefits are rarely equitable, while equitable allocations may be significantly non-optimal

International Externalities in Pandemic Influenza Mitigation

A serious influenza pandemic could be devastating for the world. Ideally, such a pandemic could be contained, but this may be infeasible. One promising method for pandemic mitigation is to treat infectious individuals with antiviral pharmaceuticals. While most of the benefits from treatment accrue to the country in which treatment occurs, there are some positive spillovers: when one country treats more of its population this both reduces the attack rate in the other country and increases the marginal benefit from additional treatment in the other country. These externalities and complementarities may mean that self-interested rich countries should optimally pay for some AV treatment in poor countries. This dissertation demonstrates the presence of antiviral treatment externalities in simple epidemiological SIR models, and then in a descriptively realistic Global Epidemiological Model (GEM). This GEM simulates pandemic spread between cities through the international airline network, and between cities and rural areas through ground transport. Under the base case assumptions of moderate transmissibility of the flu, the distribution of antiviral stockpiles from rich countries to poor and lower middle income countries may indeed pay for itself: providing a stockpile equal to 1% of the population of poor countries will reduce cases in rich countries after 1 year by about 6.13 million cases at a cost of 4.62 doses per rich-country case avoided. Concentrating doses on the outbreak country is, however, even more cost-effective: in the base case it reduces the number of influenza cases by 4.76 million cases, at the cost of roughly 1.92 doses per case avoided. These results depend on the transmissibility of the flu strain, the efficacy of antivirals in reducing infection and on the proportion of infectious who can realistically be identified and treated

Game theory to enhance stock management of Personal Protective Equipment (PPE) during the COVID-19 outbreak

Since the outbreak of the COVID-19 pandemic, many healthcare facilities have suffered from shortages in medical resources, particularly in Personal Protective Equipment (PPE). In this paper, we propose a game-theoretic approach to schedule PPE orders among healthcare facilities. In this PPE game, each independent healthcare facility optimises its own storage utilisation in order to keep its PPE cost at a minimum. Such a model can reduce peak demand considerably when applied to a variable PPE consumption profile. Experiments conducted for NHS England regions using actual data confirm that the challenge of securing PPE supply during disasters such as COVID-19 can be eased if proper stock management procedures are adopted. These procedures can include early stockpiling, increasing storage capacities and implementing measures that can prolong the time period between successive infection waves, such as social distancing measures. Simulation results suggest that the provision of PPE dedicated storage space can be a viable solution to avoid straining PPE supply chains in case a second wave of COVID-19 infections occurs

Emergence of infectious diseases

From SARS to avian influenza, Ebola virus and MERS-CoV, infectious diseases have received increasing attention in recent decades from scientists, risk managers, the media and the general public. What explains the constant emergence of infectious diseases? What are the related challenges? In five chapters, experts from different scientific fields analyse the ecological, social, institutional and political dynamics associated with emerging infectious diseases. This book discusses how the concepts, scientific results and action plans of international or governmental organizations are constructed and coordinated. In clear straightforward language, this book explores the continuities and discontinuities that occur with emerging infectious diseases, both in terms of collective action and in our relationship to the biological world

Supply chain coordination and influenza vaccination

Thesis (Ph. D.)--Massachusetts Institute of Technology, Sloan School of Management, Operations Research Center, 2008.Includes bibliographical references (p. 125-129).Annual influenza outbreaks incur great expenses in both human and monetary terms, and billions of dollars are being allocated for influenza pandemic preparedness in an attempt to avert even greater potential losses. Vaccination is a primary weapon for fighting influenza outbreaks. The influenza vaccine supply chain has characteristics that resemble the Newsvendor problem, but possesses several characteristics that distinguish it from many other supply chains. Differences include a nonlinear value of sales (caused by the nonlinear health benefits of vaccination that are due to infection dynamics) and vaccine production yield issues. In this thesis we present two models in the interface of operations and supply chain management and public health policy. In the first model, we focus on a supply chain with a government and a manufacturer. We show that production risks, taken currently by the vaccine manufacturer, lead to an insufficient supply of vaccine. Several supply contracts that coordinate buyer (governmental public health service) and supplier (vaccine manufacturer) incentives in many other industrial supply chains can not fully coordinate the influenza vaccine supply chain. We design a variant of the cost sharing contract and show that it provides incentives to both parties so that the supply chain achieves global optimization and hence improves the supply of vaccines. In the second mode, we consider the influenza vaccine supply chain with multiple countries.(cont.) Each government purchases and administers vaccines in order to achieve an efficient cost-benefit tradeoff. Typically different countries have different economics sensitivities to public outcomes of infection and vaccination. It turns out that the initiating country, while having a significant role in the spread of the disease, does not receive enough vaccine stockpiles. Our model indicates that lack of coordination results in vaccine shortfalls in the most needed countries and vaccine excess in the regions where are not as effective, if the governments in the model act rationally. We show the role of contracts to modify monetary flows that purchase vaccination programs, and therefore modify infectious disease flows.by Hamed Mamani.Ph.D