@article{3eaa5036b429412bac1039a6febffa01,
title = "Removing the regional level from the Niger vaccine supply chain",
abstract = "Objective: Since many of the world's vaccine supply chains contain multiple levels, the question remains of whether removing a level could bring efficiencies. Methods: We utilized HERMES to generate a detailed discrete-event simulation model of Niger's vaccine supply chain and compared the current four-tier (central, regional, district, and integrated health center levels) with a modified three-tier structure (removing the regional level). Different scenarios explored various accompanying shipping policies and frequencies. Findings: Removing the regional level and implementing a collection-based shipping policy from the district stores increases vaccine availability from a mean of 70-100% when districts could collect vaccines at least weekly. Alternatively, implementing a delivery-based shipping policy from the central store monthly in three-route and eight-route scenarios only increases vaccine availability to 87%. Restricting central-to district vaccine shipments to a quarterly schedule for three-route and eight-route scenarios reduces vaccine availability to 49%. The collection-based shipping policy from district stores reduces supply chain logistics cost per dose administered from US$0.14 at baseline to US$0.13 after removing the regional level. Conclusion: Removing the regional level from Niger's vaccine supply chain can substantially improve vaccine availability as long as certain concomitant adjustments to shipping policies and frequencies are implemented.",
keywords = "Immunization, Niger, Vaccine delivery, Vaccine distribution, Vaccine supply chain",
author = "Assi, {Tina Marie} and Brown, {Shawn T.} and Souleymane Kone and Norman, {Bryan A.} and Ali Djibo and Connor, {Diana L.} and Wateska, {Angela R.} and Jayant Rajgopal and Slayton, {Rachel B.} and Lee, {Bruce Y.}",
note = "Funding Information: The HERMES and Logistics Modeling Team consists of (in alphabetical order): Tina-Marie Assi, PhD, Shawn T. Brown, PhD (Technical Lead), Brigid E. Cakouros, MPH, Sheng-I Chen, PhD, Diana L. Connor, MPH (Co-Coordinator), Erin G. Claypool, PhD, Leila A. Haidari, MPH, Veena Karir, PharmD, Bruce Y. Lee, MD, MBA (Scientific Lead), Jim Leonard, Leslie E. Mueller, MPH, Bryan A. Norman, PhD, Proma Paul, MHS, Jayant Rajgopal, PhD, Michelle M. Schmitz, BA, Rachel B. Slayton, PhD, Angela R. Wateska, MPH (Co-Coordinator), Joel S. Welling, PhD, and Yu-Ting Weng, MS. For further questions regarding HERMES, please contact B. Lee, MD MBA (BYL1@pitt.edu) or S. Brown, PhD (stbrown@psc.edu). This study was supported by the Bill and Melinda Gates Foundation and the National Institute of General Medical Sciences Models of Infectious Disease Agent Study (MIDAS). The funders had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; and preparation, review, or approval of the manuscript. We would also like to acknowledge the important contributions of the following individuals to our study: Carol Levin (PATH), Mercy Mvundura (PATH), Dr. Amadou Garba (Schistosomiasis Control Initiative), Dr. Tiekoura Coulibaly (EPI Officer, WHO Niger), Dr. Abdou M. Chitou (EPI Administrator, UNICEF Niger), and Mr. Harou Moussa (EPI Office, WHO Niger). For more information on HERMES, please visit: hermes.psc.edu.",
year = "2013",
month = jun,
day = "10",
doi = "10.1016/j.vaccine.2013.04.011",
language = "English",
volume = "31",
pages = "2828--2834",
journal = "Vaccine",
issn = "0264-410X",
number = "26",
}