title: One size does not fit all: The impact of primary vaccine container size on vaccine distribution and delivery.
abstract: BACKGROUND
  While the size and type of a vaccine container (i.e., primary container) can have many implications on the safety and convenience of a vaccination session, another important but potentially overlooked consideration is how the design of the primary container may affect the distribution of the vaccine, its resulting cost, and whether the vial is ultimately opened.
  
  
  METHODS
  Using our HERMES software platform, we developed a simulation model of the World Health Organization Expanded Program on Immunization supply chain for the Republic of Benin and used the model to explore the effects of different primary containers for various vaccine antigens.
  
  
  RESULTS
  Replacing vaccines with presentations containing fewer doses per vial reduced vaccine availability (proportion of people arriving for vaccines who are successfully immunized) by as much as 13% (from 73% at baseline) and raised logistics costs by up to $0.06 per dose administered (from $0.25 at baseline) due to increased bottlenecks, while reducing total costs by as much as $0.15 per dose administered (from $2.52 at baseline) due to lower open vial wastage. Primary containers with a greater number of doses per vial each improved vaccine availability by 19% and reduced logistics costs by $0.05 per dose administered, while reducing the total costs by up to $0.25 per dose administered. Changes in supply chain performance were more extreme in departments with greater constraints. Implementing a vial opening threshold reversed the direction of many of these effects.
  
  
  CONCLUSIONS
  Our results show that one size may not fit all when choosing a primary vaccine container. Rather, the choice depends on characteristics of the vaccine, the vaccine supply chain, immunization session size, and goals of decision makers. In fact, the optimal vial size may vary among locations within a country. Simulation modeling can help identify tailored approaches to improve availability and efficiency.
authors.affiliation: Public Health Computational and Operations Research (PHICOR), Pittsburgh PA (formerly) and Baltimore MD (currently), United States; Pittsburgh Supercomputing Center (PSC), Carnegie Mellon University, Pittsburgh, PA, United States.
authors.forename: Leila A
authors.initials: LA
authors.lastname: Haidari
authors.affiliation: International Vaccine Access Center (IVAC), Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States.
authors.forename: Brian
authors.initials: B
authors.lastname: Wahl
authors.affiliation: Pittsburgh Supercomputing Center (PSC), Carnegie Mellon University, Pittsburgh, PA, United States.
authors.forename: Shawn T
authors.initials: ST
authors.lastname: Brown
authors.affiliation: International Vaccine Access Center (IVAC), Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States.
authors.forename: Lois
authors.initials: L
authors.lastname: Privor-Dumm
authors.affiliation: International Vaccine Access Center (IVAC), Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States.
authors.forename: Cecily
authors.initials: C
authors.lastname: Wallman-Stokes
authors.affiliation: Public Health Computational and Operations Research (PHICOR), Pittsburgh PA (formerly) and Baltimore MD (currently), United States; International Vaccine Access Center (IVAC), Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States.
authors.forename: Katie
authors.initials: K
authors.lastname: Gorham
authors.affiliation: Public Health Computational and Operations Research (PHICOR), Pittsburgh PA (formerly) and Baltimore MD (currently), United States.
authors.forename: Diana L
authors.initials: DL
authors.lastname: Connor
authors.affiliation: Public Health Computational and Operations Research (PHICOR), Pittsburgh PA (formerly) and Baltimore MD (currently), United States.
authors.forename: Angela R
authors.initials: AR
authors.lastname: Wateska
authors.affiliation: UNICEF, NY, NY, United States.
authors.forename: Benjamin
authors.initials: B
authors.lastname: Schreiber
authors.affiliation: Agence de Médicine Préventive (AMP), Paris, France; Agence de Médicine Préventive (AMP), Cotonou, Benin.
authors.forename: Hamadou
authors.initials: H
authors.lastname: Dicko
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: Agence de Médicine Préventive (AMP), Paris, France; Agence de Médicine Préventive (AMP), Cotonou, Benin.
authors.forename: Melanie
authors.initials: M
authors.lastname: Avella
authors.affiliation: Public Health Computational and Operations Research (PHICOR), Pittsburgh PA (formerly) and Baltimore MD (currently), United States; International Vaccine Access Center (IVAC), Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States. Electronic address: brucelee@jhu.edu.
authors.forename: Bruce Y
authors.initials: BY
authors.lastname: Lee
mesh_terms: D001541:Benin; D003198:Computer Simulation; D004349:Drug Packaging; D004356:Drug Storage / Q000191:economics / Q000592:standards; D006801:Humans; D017589:Immunization Programs / Q000191:economics; D014611:Vaccination / Q000191:economics / Q000592:standards / Q000706:statistics & numerical data; D014612:Vaccines / Q000191:economics* / Q000592:standards / Q000600:supply & distribution*; D014944:World Health Organization
chemical_list: D014612:Vaccines
keywords: Immunization; Simulation modeling; Supply chain; Vial size