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Doses per vaccine vial container: An understated and underestimated driver of performance that needs more evidence

Monday, 3rd of April 2017

Abstract below; full text is at http://www.sciencedirect.com/science/article/pii/S0264410X16311379

Vaccine, Volume 35, Issue 17, 19 April 2017, Pages 2272–2278

Doses per vaccine vial container: An understated and underestimated driver of performance that needs more evidence ☆

Alexis Heatona, , ,

Kirstin Krudwiga,

Tina Lorensonb,

Craig Burgessa,

Andrew Cunninghama,

Robert Steinglassa

a JSI Research & Training Institute, Inc., United States

b Bill & Melinda Gates Foundation, United States

Available online 3 February 2017

Abstract

The widespread use of multidose vaccine containers in low and middle income countries’ immunization programs is assumed to have multiple benefits and efficiencies for health systems, yet the broader impacts on immunization coverage, costs, and safety are not well understood. To document what is known on this topic, how it has been studied, and confirm the gaps in evidence that allow us to assess the complex system interactions, the authors undertook a review of published literature that explored the relationship between doses per container and immunization systems. The relationships examined in this study are organized within a systems framework consisting of operational costs, timely coverage, safety, product costs/wastage, and policy/correct use, with the idea that a change in dose per container affects all of them, and the optimal solution will depend on what is prioritized and used to measure performance.

Studies on this topic are limited and largely rely on modeling to assess the relationship between doses per container and other aspects of immunization systems. Very few studies attempt to look at how a change in doses per container affects vaccination coverage rates and other systems components simultaneously. This article summarizes the published knowledge on this topic to date and suggests areas of current and future research to ultimately improve decision making around vaccine doses per container and increase understanding of how this decision relates to other program goals.