Design New Approaches to Optimize Immunization Systems (Round 9)

Background:

Immunization is one of the world’s most cost-effective health interventions. However, each year approximately 25 million infants are not fully vaccinated, and at least 2.4 million children die from vaccine-preventable diseases.

Since immunization programs were launched in low- and middle-income countries worldwide in the mid-1970s, most countries have been using the same standard package of six vaccines—measles, tetanus, diphtheria, whooping cough (pertussis), tuberculosis, and polio—in their national immunization schedule. In the last decade, however, as the public health impact of vaccines has become increasingly clear, interest in and funding for new vaccine development and delivery has surged. Throughout the next decade, low- and middle-income countries will have opportunities to introduce many new lifesaving vaccines into their standard immunization programs—in some cases doubling the number of vaccines offered in their programs within ten years.

The cost of traditional vaccines such as measles, diphtheria-tetanus-pertussis, and polio is low – often between $0.10 USD to $0.25 USD per dose. Due to both the investments made to discover and develop them, and because some of them are complex to manufacture, the cost of newer vaccines is significantly higher, ranging from $1.00 USD up to $15.00 USD per dose.  These increasing costs are driving the need to modify vaccine presentations.

With the introduction of these new vaccines, countries are facing new challenges—both in delivering these vaccines and in ensuring immunization programs reach new target populations. In 2010, a quarter of a million doses of pentavalent vaccine, costing nearly $1M USD, expired in one country’s central store because the system charged with delivering these vaccines was not yet ready to manage it. Another country was forced to delay its plans to introduce new vaccines because adding the new vaccine into the immunization program required a nine-fold expansion of the national storage system. Hence, low- and middle-income countries must find new ways to improve the logistics of national immunization programs to address the increasing burden facing their supply systems.

Roadblock:

Some of the key challenges facing immunization logistics and supply systems in low- and-middle income countries are as follows: 

• New vaccines present multiple challenges to the immunization supply systems of low- and middle-income countries; some of new vaccines can occupy more cold chain space, may be more complex to prepare for administration, and may have a thermostability profile which is not suited to the challenging environment of low- and middle-income countries;
• Current immunization supply systems were designed many years ago. As a result, they are often inefficient and operate in complete isolation from the supply systems of other health interventions and/or from the private sector. Furthermore, there is no mechanism in place to continuously monitor the performance of these systems in order to guide necessary adjustments and improvements;
• Manufacturers and donors and to a certain extent countries themselves do not focus on the environmental impact of energy, materials, and processes used in the immunization supply system from the international to local levels;
• Current information systems designs do not incorporate advances in technology that could help guide immunization program managers to plan and execute program strategies, thus ensuring that adequate quantities of vaccines, in the right format, are available to meet demand;
• Current human resource policies do not guarantee that adequate numbers of competent, motivated, and empowered personnel are available at all levels to overcome existing and emerging immunization supply challenges within low- and middle-income countries;
• In spite of the success of immunization programs, one in five children still does not have access to basic vaccines.

What We’re Looking For:

This topic aims to generate novel approaches to optimizing the performance of immunization logistics and supply systems in low-resource settings. Applicants are encouraged to re-examine the systems trusted with delivering vaccines and design innovative solutions to optimize the performance of these systems, both today and in the future. We seek proposals that are responsive to the topic that are daring in premise and clearly different from the approaches currently under investigation or employed. The solutions submitted to this topic must be focused on the operational aspects of immunization systems in countries, and must have the potential to be scaled up or reproduced in multiple settings.

Proposals must provide a strong rationale for the work proposed, demonstrating a clear understanding of country context and needs, present a defined hypothesis, and an associated plan for how the idea would be tested or validated. Proposed ideas must ultimately be translatable to practical interventions accessible in resource-limited settings.

We encourage applicants to address one or more of these gap areas:

1. Vaccine Product Characteristics
   • Tools to enable countries, donors and procurement agencies to assess the systems costs and benefits of specific types of vaccine product presentations and formulations, rather than product price alone, in order to inform their vaccine purchase decisions and optimize their relevance to their immunization strategies;
   • Low-cost vial-level temperature indicators that display both cumulative exposure to heat as well as peak exposures;
   • Non-formulation means to prevent inadvertent vaccine freezing and/or to guarantee the sterility of opened multi-dose vials during storage and use.
2. Supply System Design >Innovative solutions that would allow health workers to easily transport increased quantity and volume of vaccines to reach remote or hard-to-reach areas,  i.e. reduce need for ice for outreach, create new options for long term passive storage, utilize alternate transportation sources for vaccine delivery, ways to cool reconstituted vaccine at the point of use without using frozen ice or cool water packs, etc.;
   • In-country pilot demonstrations of efficiency gains achieved through synergies between the supply systems of immunization programs and those of other health interventions or from the private sector;
   • Incorporating global location information software tools to optimize logistics, transport legs, delivery routes and reduce environmental impact of the programs.
3. Environmental Impact
   • Design a pilot that demonstrates how to cost effectively minimize environmental impact when making supply system design choices and/or selecting new technologies;
   • Pilot innovative and environmentally responsible technologies or approaches to the safe treatment of medical waste, especially syringe waste.
4. Information Systems
   • Demonstrate an innovative low-cost solution that would meet the basic logistics information needs for vaccine supply systems at the intermediate and lowest levels of a low-income country government’s supply chain. (Note: proposals that are based or rely solely on an SMS platform for sending reminders or communication will not be accepted);
   • Demonstrate the benefits of low-cost purpose-built devices (i.e. the point-of-sales equipment used in the for-profit world for barcode reading), for use in low-income settings to meet basic logistics management data requirements.
5. Human Resources
   • Develop innovative tools and approaches that empower national staff to improve the performance of their immunization supply system.
6. Vaccination Acceptance
   • Innovative, affordable and sustainable approaches to increase the understanding, reach and public acceptance of immunization;
   • Creative approaches to rapidly address misinformation and inaccuracies around immunization in low income settings.

We will not consider proposals for the following:

• Proposals that do not directly address at least one of the areas of interest described above;
• Proposals without a clearly-articulated objective or an objective that cannot be easily assessed for quality, efficiency and/or effectiveness;
• Preclinical or clinical research - proposals for vaccine administration or delivery devices; proposals aimed at improving vaccine stability or formulation; proposals involving animal models or human subjects in clinical trials;
• Approaches that represent incremental improvements to current activities or conventional solutions, i.e. proposals that are based or rely solely on an SMS platform for sending reminders or communication;
• Approaches that are not applicable in low- and middle-income country settings;
• New solutions that do not have the potential to be used widely or scaled-up;
• Proposals that do not describe or outline the innovation’s down-stream effects on the supply system;
• Proposals that can only be applied to individual manufacturers' products or specific product improvement initiatives.