Influenza vaccine supply chain

The Influenza Vaccine Supply Chain: Structure, Risk, and Coordination

By David George Williams

Deaths In England From All Causes

Deaths In England From Influenza

The Cost Per Year In The U.S.

•  $12 to $15 Billion Direct and Indirect Costs •  35,000 deaths, 90% Elderly •  100 Million Days of Work Lost •  40 Million Days of School Lost

Aventis Pasteur’s Fluzone®

Distribution Problems?

The Chicken Eggs

The Cold Chain

Other Problems

•  Order Gaming – Duplicate, Inflated Orders

•  Opportunistic Vending – The worst example 2000 shortage:

•  11 days, 3 transactions, price from $23 to $147

– Fax and email spam distorts supply visibility

Manufacturer

Distributor

Health Care Provider

Vaccine Recipients

And General Public

Insurance Company

Money,Information

Information

Money,Information

Information

The US Flu Vaccine

Supply Chain

The Timeline

PRE-SEASON FLU SEASON

MANUFACTURING CAPACITY

ALLOCATED

BOOKING PERIOD

PRE-BOOKING REGULAR BOOKING

KEY ISSUE: FORECASTING AND PLANNING

KEY ISSUE: DISTRIBUTION AND REALLOCATION

PRODUCTION BEGINS

Manufacturer Health Care Provider

RISK BORNE: WITH PRE-BOOKING:

• DEMAND UNCERTAINTYWITH REGULAR BOOKING:

• YIELD UNCERTAINTY

RISK BORNE: WITH PRE-BOOKING:

• YIELD UNCERTAINTYWITH REGULAR BOOKING:• DEMAND UNCERTAINTY

Money,Information

The Risks

The Root Problems

ALLOCATED

BOOKING PERIOD

PRODUCTION BEGINS

Third Strain Identification

Shipments Go Out

EGG BASED PRODUCTION PROCESS TIME

The Root Problems

ALLOCATED

BOOKING PERIOD

PRODUCTION BEGINS

Shipments Go Out

NO SLACK IN THE SYSTEM FOR DISTRIBUTION LEAD TIME BUFFERING OR STAGGERED PRODUCTION

The Root Problems

ALLOCATED

BOOKING PERIOD

PRODUCTION BEGINS

Shipments Go Out

NO SLACK IN THE SYSTEM FOR DISTRIBUTION LEAD TIME BUFFERING OR STAGGERED PRODUCTION UNCERTAIN

DEMAND

Coordination

Manufacturer

Distributor

Vaccine Recipients

And General Public

Money,Information

SometimesMoney

Information

Insurance Company

Information

Coordination

Manufacturer

Distributor

Vaccine Recipients

And General Public

Money,Information

SometimesMoney

Information

BUYBACK VALUE

PREREQUISITE REPORT

Insurance Company

Coordination

Manufacturer

Distributor

Vaccine Recipients

And General Public

Money,Information

SometimesMoney

Information

BUYBACK VALUE

PREREQUISITE REPORT

THE E-HUB: A

VIRTUAL MARKET PLACE

Insurance Company

Coordination

Manufacturer

Distributor

Vaccine Recipients

And General Public

Money,Information

SometimesMoney

Information

INSURER BUYBACK:«INCREASE VACCINE

SALVAGE VALUE AT THE HEALTH CARE PROVIDER

BUYBACK VALUE

PREREQUISITE REPORT

THE E-HUB ALLOWS FOR TRANSPARENT

ORDERING AND REALLOCATIVE EFFICIENCY

FORECASTS BASED ON PRE-BOOKED, EXACT AND HONEST ORDERS

ALLLOW FOR BETTER CAPACITY ALLOCATION AND STABLE

DEMAND PLANNING

THE E-HUB: A

VIRTUAL MARKET PLACE

INCREASED INCENTIVE TO FORECAST

WHEN BUYBACK IS RESTRICTED

Insurance Company

Acknowledgements

•  Jennifer Alfisi of the Health Industry Distributors Association (HIDA) •  Catherine Fuller MD •  Google: the most important human invention after the printing press

•  Brian Greenberg MD

•  Jay Grossman DDS •  Janet Heinrich of the United States Government Accountability Office (US GAO) •  Leonard Kruimer of the Crucell Corporation in the Netherlands

•  Jeanne Santoli of the Center for Disease Control (CDC) •  Jeffrey Wasson MD •  Dr. Prashant Yadav

Influenza vaccine supply chain

Documents

Cytomegalovirus-Infected Individuals H1N1 Influenza Vaccine

Influenza and influenza immunisation in Australia · • Influenza vaccines • Vaccine coverage • Influenza vaccine effectiveness ... enzoonotic in Chinese poultry, occasional

Gsk influenza virus vaccine

Influenza Vaccine STN BL 125254 Package insertlabeling.seqirus.com/PI/US/Afluria/EN/Afluria...Influenza Vaccine STN BL 125254 5 unclear. If influenza vaccine does pose a risk, it is

WHO activities on influenza vaccine research

Health Care Workers and Influenza Vaccine - Michigan...Trivalent Inactivated (Killed) Influenza Vaccine. Live Attenuated Influenza Vaccine This virus can grow in the nose and throat,

Influenza and Influenza Vaccine

Influenza Vaccine Effectiveness in Preventing Severe

SANOFI PASTEUR INFLUENZA VACCINE PRESENTATIONS 2018 … · Vaccine Code Because there are many CPT®a codes that describe influenza vaccine, accurate coding for influenza vaccine

Universal Influenza Vaccine Development · 2016. 3. 23. · Universal Influenza Vaccine Development 2016 Global Vaccine and Immunization Research Forum (GVIRF) 15 – 17 March 2016

Seasonal influenza vaccine policy and utilization: A ... · Seasonal influenza vaccine policy and utilization: A global perspective Joachim Hombach Initiative for Vaccine Research

Quadrivalent influenza vaccine developments · Selection of influenza B strain for vaccine From Belshe, Vaccine 2010;285:D45–53. Influenza Predominant lineage Mismatch season of

· anidulafungin, influenza H1N1 vaccine, influenza H5N1 vaccines, influenza seasonal vaccine, methoxy polyethylene glycol-epoetin beta, vaccinia smallpox vaccine Full text with

Review of New Vaccine Platforms and Influenza Vaccine Pipeline · Review of New Vaccine Platforms and Influenza Vaccine Pipeline Rick A. Bright, PhD Influenza Division Biomedical

Influenza vaccine

2009 H1N1 Influenza Vaccine

Influenza Vaccine Manufacturing - RTI · 4. Influenza Vaccine Manufacturing 101 4.1 Influenza Vaccine Manufacturing Process Two types of influenza vaccine are licensed for use in

Influenza Vaccine-201202 Recommendation

Informal meeting of WHO, influenza vaccine …...2 Vaccines for pandemic influenza Informal meeting of WHO, influenza vaccine manufacturers, national licensing agencies, and government

IND Influenza Vaccine: Shortage Program