To maintain purity, the vaccine plant environment is highly regulated and monitored: people, equipment, and materials are introduced into the facilities in a precisely controlled manner. These impose significant restrictions on vaccine flow logistics.
Two critical vaccine flow logistics requirements start in the plant and span the entire immunization process up to vaccination of the individual: (a) maintenance of vaccine purity and (b) maintenance of vaccine potency by keeping it within the prescribed temperature range. Vaccine manufacturing plants are highly capitalized, multimillion-dollar facilities that use sophisticated technology to mass-produce the billions of doses of vaccines used globally each year.
The formulation, manufacture, and packaging of vaccines are well described in Chapter 5 this chapter highlights key factors relevant to immunization logistics. The antigen package delivery system originates in the vaccine manufacturing plant. Each of the four points along the package delivery system has distinct logistical challenges. The final destination points for antigen package delivery are the APCs inside the IM, subcutaneous (SC), cutaneous, or mucosal tissues of the billions of people who will benefit from immunization.
The POCs are the millions of hospitals, clinics, health posts, and homes where a competent vaccinator, an informed and willing vaccinee, and a safe and effective vaccine can be brought together for vaccine administration. The distribution and storage points form the network of thousands of sites from vaccine plants through national, regional, and local centers tasked with safely storing and transporting vaccines to the POCs. The points of origin are the dozens of vaccine manufacturing plants where antigens are produced and, along with other components, formulated into vaccines, and where the vaccines are further packaged in multiple layers of containers for storage and distribution. The four key points in the antigen package delivery system are the point of origin, storage and distribution point, the point of care (POC), and the final destination point in the recipient. These new technologies have the potential to increase the capacity and efficiency of immunization programs and make immunization safer and more effective, affordable, accessible, and acceptable for everyone. It reviews new technologies in various stages of development that have the potential to eliminate or reduce restrictions to vaccine flow. This chapter briefly describes key restrictions to vaccine flow logistics in terms of complexity, cost, human resources requirements, distributability, and sources of errors in the immunization process. Managing vaccine flow around those obstacles is the day-to-day work of immunization programs, which often requires heroic effort. Reviewing immunization as a package delivery process and recognizing critical hurdles, bottlenecks, and barriers to vaccine flow is a first step toward making immunization programs more efficient and effective. Some advances will come in the form of better vaccine antigens however, significant potential also lies in improving the way vaccines are packaged and delivered.
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Continual sharpening of this public health tool is needed to achieve the full potential of immunization for improving health. Immunization is one of the most powerful tools for health, but many current vaccines are not affordable, accessible, and acceptable to everyone who needs them. This simple concept of delivering antigen packages from point to point can help elucidate the complex logistical challenges inherent in the preservation, packaging, storage, transportation, and administration of vaccines. In this sense, immunization programs are package delivery systems: they manage the flow of antigens, formulated in vaccines and packaged in different presentations, between the point of origin at the vaccine manufacturer and the point of consumption, inside antigen-presenting cells (APCs) of the vaccinee. Immunization can be described as the process of delivering carefully packaged antigen to the appropriate destination in a vaccine recipient to produce a desired immune response. New Technologies Needed to Reduce Immunization Logistics Hurdles