title: Removing the regional level from the Niger vaccine supply chain.
abstract: OBJECTIVE
  Since many of the world's vaccine supply chains contain multiple levels, the question remains of whether removing a level could bring efficiencies.
  
  
  METHODS
  We utilized HERMES to generate a detailed discrete-event simulation model of Niger's vaccine supply chain and compared the current four-tier (central, regional, district, and integrated health center levels) with a modified three-tier structure (removing the regional level). Different scenarios explored various accompanying shipping policies and frequencies.
  
  
  RESULTS
  Removing the regional level and implementing a collection-based shipping policy from the district stores increases vaccine availability from a mean of 70-100% when districts could collect vaccines at least weekly. Alternatively, implementing a delivery-based shipping policy from the central store monthly in three-route and eight-route scenarios only increases vaccine availability to 87%. Restricting central-to district vaccine shipments to a quarterly schedule for three-route and eight-route scenarios reduces vaccine availability to 49%. The collection-based shipping policy from district stores reduces supply chain logistics cost per dose administered from US$0.14 at baseline to US$0.13 after removing the regional level.
  
  
  CONCLUSIONS
  Removing the regional level from Niger's vaccine supply chain can substantially improve vaccine availability as long as certain concomitant adjustments to shipping policies and frequencies are implemented.
authors.affiliation: Public Health Computational and Operations Research (PHICOR), University of Pittsburgh, Pittsburgh, PA, United States.
authors.forename: Tina-Marie
authors.initials: TM
authors.lastname: Assi
authors.forename: Shawn T
authors.initials: ST
authors.lastname: Brown
authors.forename: Souleymane
authors.initials: S
authors.lastname: Kone
authors.forename: Bryan A
authors.initials: BA
authors.lastname: Norman
authors.forename: Ali
authors.initials: A
authors.lastname: Djibo
authors.forename: Diana L
authors.initials: DL
authors.lastname: Connor
authors.forename: Angela R
authors.initials: AR
authors.lastname: Wateska
authors.forename: Jayant
authors.initials: J
authors.lastname: Rajgopal
authors.forename: Rachel B
authors.initials: RB
authors.lastname: Slayton
authors.forename: Bruce Y
authors.initials: BY
authors.lastname: Lee
mesh_terms: D006801:Humans; D017146:Models, Organizational; D008962:Models, Theoretical; D009548:Niger; D012984:Software; D014612:Vaccines / Q000600:supply & distribution*
chemical_list: D014612:Vaccines