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Vaccine stockouts around the world: Are essential vaccines always available when needed?

Friday, 31st of March 2017

Excerpt below; full text is at http://www.sciencedirect.com/science/article/pii/S0264410X17300452

Vaccine

Volume 35, Issue 17, 19 April 2017, Pages 2121–2126

 

Vaccine stockouts around the world: Are essential vaccines always available when needed? ^☆

• Patrick Lydon^a, , , 
• Benjamin Schreiber^b, 
• Aurelia Gasca^c, 
• Laure Dumolard^a, 
• Daniela Urfer^a, 
• Kamel Senouci^a
• ^a World Health Organization, Expanded Programme on Immunization, Geneva, Switzerland
• ^b UNICEF Programme Division, New York, USA
• ^c UNICEF Supply Division, Copenhagen, Denmark

Available online 30 March 2017

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http://dx.doi.org/10.1016/j.vaccine.2016.12.071

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Under a Creative Commons license

  Open Access

Abstract

Introduction 

As countries rise to the challenge of implementing the priorities of this “Decade of Vaccine” and their commitments delineated in the Global Vaccine Action Plan (GVAP), many continue to face important challenges of securing a continuous supply of essential vaccine for their national immunization programme. This study provides evidence on the incidence of vaccine stockouts in countries, their root causes and their potential impact on service delivery.

Methods

Vaccine stockout indicators collected from the WHO-UNICEF Joint Reporting Form (JRF) and UNICEF´s Vaccine Forecasting Tool were analysed for the years covering the first half of the GVAP (2011 to 2015) and using 2010 as the baseline year. While the JRF collects annual information on national and subnational stockouts by vaccine, the UNICEF Vaccine Forecasting Tool has the advantage of requesting UNICEF procuring countries to report on the reasons underpinning any stockouts.

Results

Every year on average, one in every three WHO Member States experiences at least one stockout of at least one vaccine for at least one month. The incidence is most pronounced in Sub-Saharan Africa where 38% of countries in this area of the world report national-level stockouts. The vaccines most affected are DTP containing vaccines (often combined with HepB and Hib) and BCG. They account for respectively 43% and 31% of stockout events reported. While national level vaccine stockouts occur in countries of all income groups, middle income countries are the most affected. In 80% of cases, national level stockouts were due to reasons internal to countries. More specifically, 39% of stockouts were attributable to government funding delays, 23% were caused by delays in the procurement processes, and poor forecasting and stock management at country level accounted for an additional 18%. When a national level stockout of vaccines occurs, there is an 89% chance that a subnational stockout will occur at district level. More concerning is that if a district level stockout occurs, this will lead to an interruption of vaccination services in 96% of cases.

Discussion

There continues to be important challenges of ensuring a continuous availability of essential vaccines. The global community, together with countries, urgently need to design effective interventions aimed at reducing the frequency and mitigating the impact of stockouts.

1. Introduction

One of the cornerstones of an effective national immunization programme is for its supply chain to ensure a continuous and uninterrupted availability of essential vaccines up to the point of vaccination. If vaccine availability is interrupted for any reason, missed opportunities to vaccinate will occur and populations run the risk of not being protected against deadly preventable diseases. Unfortunately, recent evidence has shed light on the fact that vaccine supply chain systems have gradually outgrown their ability to ensure uninterrupted availability of vaccine and to manage this current Decade of Vaccine priorities and commitments as delineated in the Global Vaccine Action Plan (GVAP 2011–2020) [1]; [2]; [3] ;  [4]. As part of the GVAP monitoring and accountability framework, a global vaccine availability indicator is being monitored yearly with an overarching objective of a 2/3 reduction goals in the number of countries with national level vaccine stockouts by 2020 [5] ;  [6].

In this study we present the findings from an in-depth analysis of the GVAP vaccine stockout indicator in 194 WHO Member States. The metric of vaccine availability used is the incidence and duration of vaccine stockouts reviewed for the years covering the first half of the GVAP (2011–2015) together with a 2010 baseline reference year. These indicators, while imperfect, are proxy measures of a stressed vaccine supply chain and indicative of systems unable to ensure that essential vaccines are available when needed. Disruptions in vaccine availability, places national immunization programme at risk of not reaching their own targets and goals of protecting their populations from vaccine preventable diseases. The findings from this research will contribute to the limited evidence on trends and performance of vaccine supply chain systems worldwide and serve as a first step towards understanding the root causes of vaccine stockouts. We hope that awareness of the challenges will be raised in order for the global community, together with countries, to design effective interventions aimed at reducing the frequency and mitigating the impact of stockouts.