Evaluating the value proposition for improving vaccine thermostability to increase vaccine impact in low and middle-income countries
Evaluating the value proposition for improving vaccine thermostability to increase vaccine impact in low and middle-income countries
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DOI：
10.1016/j.vaccine.2015.05.071
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发表时间：
2015-07-09
期刊：
影响因子：
5.5
通讯作者：
Rao, Raja
中科院分区：
文献类型：
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作者：
Karp, Christopher L.;Lans, Deborah;Rao, Raja
在高环境温度和电力供应不可靠的情况下，需要保持疫苗低温，这是一项挑战，限制了中低收入国家的疫苗覆盖率。更高的疫苗热稳定性通常被吹捧为显而易见的解决方案。尽管有传统智慧，但一直缺乏对增加疫苗热稳定性的价值主张的全面分析。此外，虽然近年来在增加疫苗热稳定性方面进行了大量投资，但结果是没有疫苗产品商业化。我们分析了增加疫苗热稳定性的价值主张，将分析建立在特定疫苗用例的基础上（例如，在常规免疫[RI]计划或活动中使用）以及在冷链技术和国家级供应链系统设计的更广泛背景下使用。结果往往令人惊讶。例如，冷链成本实际上只占疫苗输送系统总成本的一小部分。此外，需要克服关键的疫苗使用病例特异性时间阈值，以从增加疫苗热稳定性中获得显著益处。我们提出了从该分析中得出的许多建议，这些建议提出了释放价值的合理途径（最大限度地扩大覆盖面，最大限度地减少总系统成本）增加疫苗的热稳定性，包括：（1）现有疫苗的热稳定性的全部范围应加以界定，并包括在其标签中;（2）对于新疫苗，应在目标产品概况的水平上预先解决热稳定性目标;（3）改善冷链基础设施和供应链系统设计可能在短期内对系统总成本和覆盖范围产生最大影响，并将影响未来所需的热稳定性程度;（4）从长远来看，监测颠覆性技术的出现仍然有价值，这些技术可能会将整个RI组合从冷链中移除。(C)2015作者爱思唯尔有限公司出版
The need to keep vaccines cold in the face of high ambient temperatures and unreliable access to electricity is a challenge that limits vaccine coverage in low and middle-income countries (LMICs). Greater vaccine thermostability is generally touted as the obvious solution. Despite conventional wisdom, comprehensive analysis of the value proposition for increasing vaccine thermostability has been lacking. Further, while significant investments have been made in increasing vaccine thermostability in recent years, no vaccine products have been commercialized as a result. We analyzed the value proposition for increasing vaccine thermostability, grounding the analysis in specific vaccine use cases (e.g., use in routine immunization [RI] programs, or in campaigns) and in the broader context of cold chain technology and country level supply chain system design. The results were often surprising. For example, cold chain costs actually represent a relatively small fraction of total vaccine delivery system costs. Further, there are critical, vaccine use case-specific temporal thresholds that need to be overcome for significant benefits to be reaped from increasing vaccine thermostability. We present a number of recommendations deriving from this analysis that suggest a rational path toward unlocking the value (maximizing coverage, minimizing total system costs) of increased vaccine thermostability, including: (1) the full range of thermostability of existing vaccines should be defined and included in their labels; (2) for new vaccines, thermostability goals should be addressed up-front at the level of the target product profile; (3) improving cold chain infrastructure and supply chain system design is likely to have the largest impact on total system costs and coverage in the short term and will influence the degree of thermostability required in the future; (4) in the long term, there remains value in monitoring the emergence of disruptive technologies that could remove the entire RI portfolio out of the cold chain. (C) 2015 The Authors. Published by Elsevier Ltd.