title: The benefits of redesigning Benin's vaccine supply chain.
abstract: BACKGROUND
  New vaccine introductions have put strains on vaccine supply chains around the world. While increasing storage and transportation may be the most straightforward options, it is also important to consider what financial and operational benefits can be incurred. In 2012, suboptimal vaccine coverage and impending vaccine introductions prompted the Republic of Benin's Ministry of Health (MOH) to explore ways to improve their vaccine supply chain.
  
  
  METHODS
  Working alongside the Beninese MOH, we utilized our computational model, HERMES, to explore the impact on cost and vaccine availability of three possible options: (1) consolidating the Commune level to a Health Zone level, (2) removing the Commune level completely, and (3) removing the Commune level and expanding to 12 Department Stores. We also analyzed the impact of adding shipping loops during delivery.
  
  
  RESULTS
  At baseline, new vaccine introductions without any changes to the current system increased the logistics cost per dose ($0.23 to $0.26) and dropped the vaccine availability to 71%. While implementing the Commune level removal scenario had the same capital costs as implementing the Health Zone scenario, the Health Zone scenario had lower operating costs. This increased to an overall cost savings of $504,255 when implementing shipping loops.
  
  
  CONCLUSIONS
  The best redesign option proved to be the synergistic approach of converting to the Health Zone design and using shipping loops (serving ten Health Posts/loop). While a transition to either redesign or only adding shipping loops was beneficial, implementing a redesign option and shipping loops can yield both lower capital expenditures and operating costs.
authors.affiliation: Pittsburgh Supercomputing Center (PSC), Pittsburgh, PA, USA.
authors.forename: Shawn T
authors.initials: ST
authors.lastname: Brown
authors.affiliation: UNICEF, New York, NY, USA.
authors.forename: Benjamin
authors.initials: B
authors.lastname: Schreiber
authors.affiliation: Public Health Computational and Operations Research (PHICOR), Baltimore, MD, USA.
authors.forename: Brigid E
authors.initials: BE
authors.lastname: Cakouros
authors.affiliation: Public Health Computational and Operations Research (PHICOR), Baltimore, MD, USA.
authors.forename: Angela R
authors.initials: AR
authors.lastname: Wateska
authors.affiliation: Agence de Médicine Préventive (AMP), Paris, France; Agence de Médicine Préventive (AMP), Cotonou, Benin.
authors.forename: Hamadou M
authors.initials: HM
authors.lastname: Dicko
authors.affiliation: Public Health Computational and Operations Research (PHICOR), Baltimore, MD, USA.
authors.forename: Diana L
authors.initials: DL
authors.lastname: Connor
authors.affiliation: Agence de Médicine Préventive (AMP), Paris, France; Agence de Médicine Préventive (AMP), Cotonou, Benin.
authors.forename: Philippe
authors.initials: P
authors.lastname: Jaillard
authors.affiliation: PATH, Seattle, WA, USA.
authors.forename: Mercy
authors.initials: M
authors.lastname: Mvundura
authors.affiliation: University of Pittsburgh, Pittsburgh, PA, USA.
authors.forename: Bryan A
authors.initials: BA
authors.lastname: Norman
authors.affiliation: University of Washington, Seattle, WA, USA.
authors.forename: Carol
authors.initials: C
authors.lastname: Levin
authors.affiliation: University of Pittsburgh, Pittsburgh, PA, USA.
authors.forename: Jayant
authors.initials: J
authors.lastname: Rajgopal
authors.affiliation: Agence de Médicine Préventive (AMP), Paris, France; Agence de Médicine Préventive (AMP), Cotonou, Benin.
authors.forename: Mélanie
authors.initials: M
authors.lastname: Avella
authors.affiliation: Agence de Médicine Préventive (AMP), Paris, France; Agence de Médicine Préventive (AMP), Cotonou, Benin.
authors.forename: Caroline
authors.initials: C
authors.lastname: Lebrun
authors.affiliation: University of Pittsburgh, Pittsburgh, PA, USA.
authors.forename: Erin
authors.initials: E
authors.lastname: Claypool
authors.affiliation: University of Pittsburgh, Pittsburgh, PA, USA.
authors.forename: Proma
authors.initials: P
authors.lastname: Paul
authors.affiliation: Public Health Computational and Operations Research (PHICOR), Baltimore, MD, USA; Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA. Electronic address: bruceleemdmba@gmail.com.
authors.forename: Bruce Y
authors.initials: BY
authors.lastname: Lee
mesh_terms: D001541:Benin; D003198:Computer Simulation; D003365:Costs and Cost Analysis; D003695:Delivery of Health Care / Q000191:economics; D004356:Drug Storage / Q000191:economics; D017589:Immunization Programs / Q000191:economics* / Q000458:organization & administration*; D014186:Transportation / Q000191:economics; D014612:Vaccines / Q000191:economics* / Q000600:supply & distribution*
chemical_list: D014612:Vaccines
keywords: Benin; Computational modeling; Supply chain; Vaccine