Impact of introducing the pneumococcal and rotavirus vaccines into the routine immunization program in Niger

Abstract

Objectives: We investigated whether introducing the rotavirus and pneumococcal vaccines, which are greatly needed in West Africa, would overwhelm existing supply chains (i.e., the series of steps required to get a vaccine from the manufacturers to the target population) in Niger.

Methods: As part of the Bill and Melinda Gates Foundation-funded Vaccine Modeling Initiative, we developed a computational model to determine the impact of introducing these new vaccines to Niger's Expanded Program on Immunization vaccine supply chain.

Results: Introducing either the rotavirus vaccine or the 7-valent pneumococcal conjugate vaccine could overwhelm available storage and transport refrigerator space, creating bottlenecks that would prevent the flow of vaccines down to the clinics. As a result, the availability of all World Health Organization Expanded Program on Immunization vaccines to patients might decrease from an average of 69% to 28.2% (range = 10%-51%). Addition of refrigerator and transport capacity could alleviate this bottleneck.

Conclusions: Our results suggest that the effects on the vaccine supply chain should be considered when introducing a new vaccine and that computational models can help assess evolving needs and prevent problems with vaccine delivery.

FIGURE 1—

Vaccine supply chain network in Niger. Note. IHC = integrated health center. The capacities (L) listed in parentheses are the ranges of available storage capacity across all locations within level. Sources. Data to construct the model came from interviews and meetings with in-country officials from the World Health Organization in Geneva, Switzerland, and Niger; UNICEF; the Niger National Geographic Institute; the Niger Ministry of Health; the Niger office of Expanded Program on Immunization; and from field observations.

FIGURE 2—

Extra storage capacity required at the regional, district, and integrated health center levels for (a) Expanded Program on Immunization baseline vaccines alone and for baseline vaccines plus (b) PCV-7, (c) 17.1 cm³ rotavirus and PCV-7, and (d) 259.8 cm³ rotavirus in Niger. Note. IHC = integrated health center; PCV-7 = 7-valent pneumococcal conjugate vaccine.

FIGURE 3—

Extra transport capacity required at the regional, district, and integrated health center levels for (a) Expanded Program on Immunization baseline vaccines alone and for baseline vaccines plus (b) PCV-7, (c) 17.1 cm³ rotavirus and PCV-7, and (d) 259.8 cm³ rotavirus in Niger. Note. IHC = integrated health center; PCV-7 = 7-valent pneumococcal conjugate vaccine.

FIGURE 4—

Frequency histograms of supply ratios at the integrated health center level for (a) Expanded Program on Immunization baseline vaccines alone and for baseline vaccines plus (b) PCV-7, (c) 17.1 cm³ rotavirus and PCV-7, and (d) 259.8 cm³ rotavirus in Niger. Note. IHC = integrated health center; PCV-7 = 7-valent pneumococcal conjugate vaccine.