WHO/IVB/09.XX UNICEF/Immunization/09.XX ORIGINAL: ENGLISH User guide for the WHO Vaccine Volume Calculator Version v2012.1 February 2012 Contents Technical terms and acronyms .............................................................................. 3 1. Introduction ..................................................................................................... 5 1.1 Related tools .............................................................................................. 5 2. Organization of the VVC .................................................................................. 5 3. User instructions ............................................................................................. 6 3.1 How to start the tool ................................................................................... 6 3.2 How to use the data input worksheets........................................................ 7 3.2.1 Vaccine_Selection worksheet............................................................. 7 3.2.2 Abacus_Tables worksheet ............................................................... 10 3.2.2.a Storage capacity tables: ............................................................................ 10 3.2.2.b Using the storage capacity tables ............................................................. 12 3.2.2.c Analysis of transport and in-country distribution ....................................... 13 3.2.2.d Analysis of cold chain cost ........................................................................ 14 3.3 Data output sheets – results per recipient ................................................ 14 3.3.1 Volume_inject worksheet ................................................................. 14 3.3.2 Weight_inject worksheet .................................................................. 15 3.3.3 Qty_waste worksheet ....................................................................... 15 3.3.4 Cost_supplies worksheet ................................................................. 16 3.4 Data output sheet – graphical illustration of results .................................. 16 3.5 How to use the graphs ............................................................................. 18 3.6 Reference data worksheets ..................................................................... 20 3.6.1 Passive_containers sheet: ............................................................... 20 3.6.2 PQEquipment sheet: ........................................................................ 20 3.6.3 Supplies ........................................................................................... 20 3.6.4 3.6.5 CR_FR_cost_chart ........................................................................... 21 Vaccine_database sheet: ................................................................. 21 3.6.6 Translation ....................................................................................... 21 3.6.7 Revision history ................................................................................ 21 Revision history .................................................................................................... 22 Document1 2 of 22 20 February 2012 Technical terms and acronyms The following technical terms and acronyms are used in the tool: Equipment utilization factor The percentage of the net storage volume that can effectively be used for storing vaccine. This is always less than the published net storage volume. FIC Fully Immunized Child. FOB Free On Board (Incoterm). A standard way of expressing price information, used in the equipment data tables. Primary store A store which receives some or all of its vaccine directly from a national or international vaccine manufacturer. Example: a national vaccine store. MaxiStock The maximum volume of a product or mix of products that will be held in stock or transported based on a defined delivery frequency. Maximum storage volume The volume of vaccine or safe injection supplies for a specified number of recipients and a specified MaxiStock. Maxi supply interval The Maxi supply interval is the longest supply period that is established for each vaccine received at primary store level. This figure is expressed as the period in months between each vaccine delivery. Net storage volume For a freezer room, cold room, vaccine freezer, vaccine refrigerator or cold box: the total volume inside the appliance where vaccine can safely be stored. Passive container A cold box, vaccine carrier or other device which is used to transport vaccine at the correct temperature without use of a power source to maintain cooling. Pre-qualified Vaccines or cold chain equipment which has been pre-qualified by WHO for purchase by UN agencies. Recipient An individual member of the target group for a specific vaccine. Safety stock Safety stock level is the level established for each vaccine at primary store level. This figure is expressed in months. Service point A health facility or health post where vaccine is administered. SIA Supplementary Immunization Activity Sub-national store A store which receives vaccine from a primary store or a higher level sub-national store and supplies one or more lower level sub-national store and/or one or more lowest delivery level stores. For example, a provincial store supplying one or more district stores. Target group Subset of the country population which is the target for receiving each of the vaccines in the immunization schedule. This can be expressed either in terms of the total number of Fully Immunized Children or as a percentage of the total population. Total population The total population of the country. Document1 3 of 22 20 February 2012 Unit of Population (UP) A notional single member of the population used as a basis for calculating the average vaccine requirements of the country using the percentage of total population method. Wastage factor 1/wastage rate. Wastage rate Expected percentage of a vaccine vial that is wasted. In this application it includes both unopened and opened vial wastage. Document1 4 of 22 20 February 2012 1. Introduction The WHO Vaccine Volume Calculator (VVC) is designed to help cold chain logisticians prepare a preliminary estimate of national cold chain equipment needs and dry store requirements. It can be used to assess current needs based on the existing vaccine schedule and also to forecast future needs based on up to four alternative vaccine schedules. In addition, it provides vaccine volume data to help with the planning of supplementary immunization activities (SIAs). Up to four alternative SIAs can be evaluated. The tool includes a database of WHO pre-qualified vaccines. It also includes databases listing the range of WHO pre-qualified vaccine refrigerators and freezers and passive containers that are likely to be encountered in the field. 1.1 Related tools The EVM Assistant tool should be used to carry out the volume calculations required in the course of an Effective Vaccine Management (EVM) assessment. The Vaccine Store Sizing Tool (VSST) is designed to be used for the detailed sizing of cold rooms, freezer rooms and dry stores as part of a site-specific equipment procurement exercise. Both these tools use the same vaccine volume calculation methodology and the same databases as the VVC. 2. Organization of the VVC VVC is supplied as a ‘read-only’ Excel 2003 workbook. All worksheets are ‘protected’, but no password is used. This section outlines the components of the VVC. The tool is an Excel workbook divided into 29 visible colour-coded worksheets1. The Index worksheet provides basic instructions and includes a hyperlinked index to the individual worksheets. These worksheets are divided into three categories: 1. Data input sheets: Mandatory data entry is only required on the three worksheets named Cover, Vaccine_Select and Abacus_Tables. Cells that require mandatory data entry are coloured white and cells that allow optional data entry are coloured pale yellow. All other cells are protected. Protected cells containing formulae are generally coloured pale green, pale blue or grey. 2. Output data sheets: These make use of the input data to generate lookup material for use by the cold chain logistician. These data are presented as four summary tables, three sheets of bar charts and eleven graphs; how these are used is explained below. 3. Reference data sheets: The tool uses these worksheets for lookup purposes; they also provide the user with a ready reference guide. In addition to the guidance on the Index worksheet the input data sheets include step-by-step notes to guide users through the data entry process. Worksheets tags are colour-coded by type: The index sheet tag is coloured dark grey; data entry sheets are coloured pale yellow; output data sheets are coloured indigo; bar charts and graphs are coloured dark green and database sheets are coloured dark blue. Subsidiary worksheets are coloured pale grey Sample screen shots, graphs and charts are shown in the following sections to explain the use of the tool and how its output can be used. 1 There is a hidden worksheet containing a database of country names. Document1 5 of 22 20 February 2012 3. User instructions This section describes the layout and intended purpose of each of the worksheets. 3.1 How to start the tool Open the ‘read-only’ tool and save it with the country name – for example: VVC_Afghanistan_2011. This will allow you to save your data and avoids overwriting the master version that you have downloaded. Click on the Cover tag. Enter the country name, language choice and date. Currently the tool is available in English, French and Russian; other language versions will be developed in the future. Figure 1 – Cover worksheet VACCINE VOLUME CALCULATOR Country: Erehwonia Language: English Date: 11 January 2012 Click to index page v 2012.1 - January 2012 Contact: kones@who.int Next click on the Index tag; use this worksheet to familiarize yourself with the contents of the workbook and to navigate to the individual worksheets via the hyperlinks provided – see Figure 2. Note that there are no hyperlinks to the graph worksheets. Figure 2 – Index worksheet. Index and instructions 1) The Vaccine Volume Calculator is used to estimate the net volume of vaccines and related supplies at each level in the supply chain. It can also be used to estimate the type of cold chain equipment needed for a specific target population. The effect of new vaccine introductions can be tested by comparing one or more of these against the current schedule. 2) How to use the tool: STEP 1: Estimate net storage volume per recipient using the Vaccine_Selection worksheet. STEP 2: Use the Abacus_Tables worksheet to enter the data needed to generate graphs covering the range of target populations at each supply level. STEP 3: Use the graphs to read off the net storage volumes for a specific catchment population. Then use these data to select appropriate cold chain equipment. Data input sheets: Vaccine_Selection Vaccine storage volumes Abacus_Tables Analysis of national and sub-national storage Data output sheets: results of assessment of requirements per recipient Volume_Inject Weight_Inject Qty_Waste Cost_Supplies Volume of diluents and safe injection equipment per recipient Weight of safe injection equipment per recipient Estimate of the amount of injection waste generated per recipient Cost of vaccines and safe injection equipment per recipient Data output sheets: graphical illustration of results Routine_illustration Illustration of results from analysis of vaccines used in routine vaccination SIAs_illustration Illustration of results from analysis of vaccines planned for vaccination campaign Graphs Abacus_NatStore_1 Abacus_NatStore_2 Abacus_Dist_1 Abacus_Dist_2 Abacus_SP_1 Abacus_SP_2 ds_Abacus_NatStore_1 ds_Abacus_NatStore_2 ds_Abacus_Dist_1 ds_Abacus_Dist_2 ds_Abacus_SP_1 ds_Abacus_SP_2 Graph for cold storage capacity at national and sub-national stores - @ +5°C: (different schedules with same Maximum Stock) Graph for cold storage capacity at national and sub-national stores - @ +5°C: (same schedule with different Maximum Stocks) Graph for cold storage capacity at district stores - @ +5°C: (different schedules with same Maximum Stock) Graph for cold storage capacity at district stores - @ +5°C: (same schedule with different Maximum Stocks) Graph for cold storage capacity at service points - @ +5°C: (different schedules with same Maximum Stock) Graph for cold storage capacity at service points - @ +5°C: (same schedule with different Maximum Stocks) Graph for dry storage capacity at national and sub-national stores: (different schedules with same Maximum Stock) Graph for dry storage capacity at national and sub-national stores: (same schedule with different Maximum Stocks) Graph for dry storage capacity at district stores: (different schedules with same Maximum Stock) Graph for dry storage capacity at district stores: (same schedule with different Maximum Stocks) Graph for dry storage capacity at service points (different schedules with same Maximum Stock) Graph for dry storage capacity at service points: (same schedule with different Maximum Stocks) Sheets with reference data: Vaccine_database Supplies PQEquipment Passive_containers Translation Document1 Vaccine database Safe injection supplies and cold chain equipment Refrigerator and freezer database Passive container database Translation 6 of 22 20 February 2012 3.2 How to use the data input worksheets The next two sections describe how to use the active worksheets to generate the graphs. These graphs are the principal output from the tool. Provided the catchment population for each facility is known, the logistician can use the graphs to estimate cold chain and dry store requirements and costs on a facility by facility basis. 3.2.1 Vaccine_Selection worksheet The first step is to collect all necessary data on the existing national immunization schedule and any proposed new vaccine introductions. Table 1 describes the data required; Table 2 gives an example. Table 1 – Immunization schedule data for the net storage volume estimates Name Description Vaccine type List of all vaccines in the current immunization schedule. If the assessment is also going to review the introduction of new vaccine(s), list the new vaccine(s) and identify which, if any, of the existing vaccines will be replaced. Number of doses per vial, Uniject™, pre-filled syringe, etc. Optional: Indicate the packed volumes as per national figures if these exist. If left blank, the Maxi packed volume will be generated automatically using figures from the database in the tool. Optional: Indicate the national expected vaccine wastage rates. This will override the WHO/GAVI indicative figure. If no national figures are available, leave blank; the WHO/GAVI indicative figure will be generated automatically from the database in the tool. Expressed either as a Fully Immunized Child (FIC) or as a notional Unit of Population (UP). UP is based on the percentage of the total population which receives each of the vaccines in the schedule. As set out in the national immunization schedule. Vaccine presentation Packed volume per dose based on national figure Vaccine wastage rate Target group Number of doses per recipient Maxi supply interval established for primary level Safety stock at primary level The Maxi supply interval is the longest supply period that is established for each vaccine received at primary store level. This figure is expressed as the period in months between each vaccine delivery. Safety stock level is the level established for each vaccine at primary store level. This figure is expressed in months. Table 2 – Example of an immunization schedule data table Vaccine type Presentation (doses/vial or pre-filled) Packed volume per dose/cm3 Wastage rate (%) Recipient group (% of population) Doses per target group Maxi supply interval at primary level in months Safety stock at primary level in months Existing schedule BCG 20 database 50 4.0 1 6 1.5 OPV 10 database 25 3.7 4 6 1.5 DTP 10 database 25 3.7 3 6 1.5 HepB 10 database 25 3.7 3 6 1.5 Measles 10 database 40 3.7 1 6 1.5 TT 10 database 25 4.2 2 6 1.5 YF 5 database 10 3.7 1 6 1.5 BCG 20 database 50 4.0 1 6 1.5 OPV 10 database 25 3.7 4 6 1.5 Measles 10 database 40 3.7 1 6 1.5 New schedule Document1 7 of 22 20 February 2012 Vaccine type Presentation (doses/vial or pre-filled) Packed volume per dose/cm3 Wastage rate (%) Recipient group (% of population) Doses per target group Maxi supply interval at primary level in months Safety stock at primary level in months HepB (2) Uniject database 5 4.0 1 6 1.5 25.0 5 3.7 3 6 1.5 DTPHepBHib (3) Pre-filled (1) TT 10 database 25 4.2 2 6 1.5 YF 5 database 10 3.7 1 6 1.5 Pre-filled database 5 3.7 1 3 0.75 Rota (3) (1) This gives an example of a vaccine that is not recorded in the database. (2) Existing vaccine in new presentation for birth dose. (3) New vaccine added to the schedule Click on the Vaccine_Selection worksheet. Take the immunization schedule data you have already collected and proceed as follows. Refer also to Figure 3: 1. Select the vaccine database filter you want to use in cell E5. You can either choose ‘Min’, ‘Max’ or ‘Average’. The ‘Min’ choice gives you access to the minimum packed volumes figures from the vaccine database. The second choice ‘Max’ offers data on the maximum packed volumes figures for each vaccine presentation. Since vaccines may be supplied to the country from different manufacturers, the ‘max’ or ‘average’ choices are preferable. 2. In cell E8, select the type of target group to be used for estimating vaccine demand. There are two options: FIC, which refers to the requirement for each Fully Immunized Child, or Unit of Population. Choosing Unit of population opens up the cells in column L for data entry. If the FIC option is selected, column L is blanked out. The Unit of Population option provides more flexibility, especially where the schedule includes vaccines such as HPV whose target population does not specifically relate to the annual birth cohort. 3. Use the drop-down lists in the column B data entry cells to enter each of the vaccines in the current schedule. Optionally, you may also enter any additional vaccines that will be present in a new vaccine schedule. You will want to do this if you are investigating the effect on storage capacity of adding or subtracting vaccines from the existing schedule. 4. Use the drop-down lists in column C to specify the vaccine presentations. 5. Optionally, you can use the cells in column D and E to enter packed volume-perdose data for vaccines or diluents using actual national figures2. This will override the maximum packed volume data from the database. If left blank, the maximum packed volume for each vaccine will be extracted from the database. 6. Optionally, you can enter price-per-dose figures for each vaccine in column H. These data are used in the Routine_illustration and SIAs_illustration bar charts to estimate vaccine cost per recipient. 7. Optionally use the cells in column I to enter vaccine wastage rates taken from national figures, if these exist. This will override the WHO/GAVI indicative figures 2 This option may be used for locally produced vaccines and for other vaccines which are not included in the vaccine database. Alternatively, you can add the figures to the database and then use the dropdown list. Document1 8 of 22 20 February 2012 from the data base. If the cells in column I are left blank, the WHO/GAVI indicative figures will automatically be used. 8. 9. If the choice in cell E8 is Unit of Population, enter data for each vaccine in column L. The target group for each vaccine should be expressed as the relevant percentage of the total population – for example, 3.9%. In column M, enter the number of doses per individual recipient for each of the vaccines in the current schedule. 10. Optionally, in cells O16 to Q16, you can enter the name of up to four proposed new routine immunization schedules. For each of these, enter the number of doses per recipient for each of the vaccines in the new schedule in the appropriate column. Note that you must repeat the column O figures for any existing vaccines that are retained in this new schedule. Do not enter a figure if one or more of the existing vaccines is being replaced by the new vaccine. For example if DTP-HepB-Hib is replacing DTP and HepB, only enter doses per recipient for the new pentavalent vaccine, not for DTP and HepB. 11. Optionally use cells S16 to U16 to name up to three alternative supplementary immunization activities. For each of these, enter the number of doses per recipient for each of the vaccines in the new schedule in the appropriate column. Note: Make sure that the vaccine you want to use for the SIA is fully specified in the manner previously described. However, you do not need to specify Maxi supply interval or safety stock levels for SIA vaccines. 12. In column V, enter the Maxi supply interval established at primary level, in months, for each vaccine. 13. In column W, enter the Safety stock level established at primary level, in months, for each vaccine. The calculated volumes per recipient for routine vaccines are accumulated in cells M38-M41 for current immunization schedule and in cells O38-Q41 for the new immunization schedule(s) (if any). Similarly, SIA volumes per recipient are accumulated in cells S40-U41. These figures are used in the Abacus_Tables worksheet to produce graphs based on one or more standardized delivery intervals. Note that the volumes per recipient are largest when the FIC option is chosen. This is because the calculation is based on the requirements of a single Fully Immunized Child (0-11 months). When the Unit of Population (UP) option is selected the calculation is based on the notional vaccine needs of an average individual member of the population regardless of age or sex. For example, if 2% of the population are in the 0-11 month age group, the UP will notionally receive this percentage of all the infant vaccines. If 1% of the population are adolescent girls in the HPV target group, the UP will notionally receive this proportion of HPV vaccine. In the example shown in Figure 3 the UP target group type has been chosen. The vaccines entered include BCG and HepB birth doses, OPV given at birth and 2, 3 and 4 months, DTP-HepB-Hib given at 2, 3 and 4 months, MMR given at 12 months and 6 years, DT given at 6 years and TT give to pregnant women. A new schedule with the addition of HPV is also added. Finally, data for an H1N1 SIA campaign are also included. The ‘UP data’ column shows the percentage of the total population that are planned to receive each of these vaccines. Document1 9 of 22 20 February 2012 Figure 3 – Vaccine_select worksheet 3.2.2 Abacus_Tables worksheet Click on the Abacus_Tables worksheet to enter the remaining data that are needed to generate the graphs. There are five separate tables on the worksheet. These can be shown or hidden using the grouping bar in the left hand margin3. 3.2.2.a Storage capacity tables: The first three tables are used to estimate cold chain and dry storage requirements at fixed storage locations as follows: Analysis of national and sub-national storage (Figure 4). Analysis of district level storage (Figure 5). Analysis of service delivery level (health facility) storage (Figure 6). Within these tables, the user is able to define alternative vaccine and dry store maximum stock levels, select suitable cold chain equipment, define equipment utilization factors, and specify the immunization schedules specified in Vaccine_select is to be used for the analysis. At national, sub-national and district levels, the user can specify different maximum stock levels for vaccines and dry stores. At service delivery level it is assumed that vaccines and dry stores follow the same delivery schedule. 3 Click on the - box to hide a table. Click on the + box to show it. Document1 10 of 22 20 February 2012 Figure 4 – Analysis of national and sub-national storage Analysis of national and sub-national storage Analysis per Total population (minimum) Total population (maximum) MaxiStock Vaccine net volume for supply period and cold room capacities Total population: Estimate of cold-chain capacity per schedule (litres) Current schedule @ per individual vaccine months-MaxiStock HPV added @ per individual vaccine months-MaxiStock 500,000 Estimate of equipment requirements per schedule WICR-10m3 Current schedule @ per individual vaccine months-MaxiStock: WICR-10m3 HPV added @ per individual vaccine months-MaxiStock: WICR-10m3 Estimate of cold-chain capacity per MaxiStock (litres) Current schedule @ 4 months MaxiStock Current schedule @ 6 months MaxiStock Current schedule @ 9 months MaxiStock Estimate of equipment requirements per MaxiStock WICR-10m3 Current schedule @ 4 months MaxiStock - WICR-10m3 Current schedule @ 6 months MaxiStock - WICR-10m3 Current schedule @ 9 months MaxiStock - WICR-10m3 Estimate of net dry storage per schedule (m³) Current schedule @ per individual vaccine months-MaxiStock HPV added @ per individual vaccine months-MaxiStock Estimate of net dry storage per MaxiStock (m³) Current schedule @ 6 months MaxiStock Current schedule @ 9 months MaxiStock Current schedule @ 12 months MaxiStock Current schedule @ months MaxiStock Maximum stock levels (months) Vaccines Safe injection equipment 4 6 6 9 9 12 Unit of Population 500,000 10,000,000 per individual vaccine months 380,000 400,000 900,000 Total population 1,300,000 1,700,000 444 799 1,154 470 846 1,222 Equipment utilization factor (%) 3,030 3,030 3,030 1 1 Select schedule 444 799 1,154 666 1,198 1,730 998 1,797 2,596 Equipment utilization factor (%) 3,030 3,030 3,030 1 1 1 1 1 1 2.33 2.44 3 5 7 - 4 6 4 6 Select schedule 6 9 9 14 13 18 - Cold room cost equation Y1 = -2.5131 Y2 = -3.1565 2,100,000 2,500,000 2,900,000 3,300,000 3,700,000 4,100,000 1,509 1,864 1,598 1,974 65% 3,030 3,030 1 1 1 1 Current schedule 1,509 1,864 2,263 2,795 3,394 4,193 65% 3,030 3,030 1 1 1 1 2 2 - 2,218 2,350 - 2,573 2,726 - 2,928 3,102 - 3,283 3,478 - 3,638 3,854 - 3,030 1 1 - 3,030 1 1 - 3,030 1 2 - 3,030 2 2 - 3,030 2 2 - 2,218 3,328 4,992 - 2,573 3,860 5,790 - 2,928 4,393 6,589 - 3,283 4,925 7,387 - 3,638 5,457 8,186 - 3,030 1 2 3 - 3,030 1 2 3 - 3,030 1 2 3 - 3,030 2 3 4 - 3,030 2 3 4 - 10 10 - 12 12 - 13 14 - 15 16 - 17 18 - 19 20 - 15 22 29 - 17 26 35 - 20 30 40 - 23 35 46 - 26 39 52 - 29 43 57 - 8 8 Current schedule 12 18 24 - Figure 5 – Analysis of district level storage Analysis of district level storage Analysis per Total population (minimum) Total population (maximum) MaxiStock Unit of Population 100,000 300,000 3 Maximum stock levels (months) Vaccines Safe injection equipment 1.5 2 2 3 3 4 Vaccine net volume for supply period and cold equipment capacities (litres) Total population Total population: 100,000 108,000 116,000 124,000 132,000 Estimate of cold-chain capacity per schedule (litres) Current schedule @ 3 months MaxiStock 72 77 83 89 95 HPV added @ 3 months MaxiStock 76 82 88 94 100 Estimate of equipment requirements per schedule Equipment utilization factor (%) 80% HBC-340 200 200 200 200 200 Current schedule @ 3 months MaxiStock - HBC-340 1 1 1 HPV added @ 3 months MaxiStock - HBC-340 1 1 1 1 Estimate of cold-chain capacity per MaxiStock (litres) Select schedule New schedule New schedule @ 1.5 months MaxiStock New schedule @ 2 months MaxiStock New schedule @ 3 months MaxiStock Estimate of equipment requirements per MaxiStock Equipment utilization factor (%) 80% BLF100AC 103 103 103 103 103 New schedule @ 1.5 months MaxiStock - BLF100AC New schedule @ 2 months MaxiStock - BLF100AC New schedule @ 3 months MaxiStock - BLF100AC Estimate of net dry storage per schedule (m³) Current schedule @ 3 months MaxiStock 0.35 0.38 0.40 0.43 0.46 HPV added @ 3 months MaxiStock 0.37 0.40 0.43 0.45 0.48 Estimate of net dry storage per MaxiStock (m³) Select schedule Current schedule Current schedule @ 2 months_MaxiStock 0.23 0.25 0.27 0.29 0.31 Current schedule @ 3 months_MaxiStock 0.35 0.38 0.40 0.43 0.46 Current schedule @ 4 months_MaxiStock 0.47 0.50 0.54 0.58 0.61 - Document1 11 of 22 140,000 148,000 156,000 164,000 172,000 180,000 100 106 - 106 112 - 112 118 - 117 124 - 123 130 - 129 136 - 200 1 1 - 200 1 1 - 200 1 1 - 200 1 1 - 200 1 1 - 200 1 1 - - - - - - - 103 - 103 - 103 - 103 - 103 - 103 - 0.49 0.51 - 0.52 0.54 - 0.54 0.57 - 0.57 0.60 - 0.60 0.63 - 0.63 0.66 - 0.33 0.49 0.65 - 0.34 0.52 0.69 - 0.36 0.54 0.73 - 0.38 0.57 0.76 - 0.40 0.60 0.80 - 0.42 0.63 0.84 - 20 February 2012 Figure 6 – Analysis of service delivery level storage Analysis of service delivery level storage Analysis per Total population (minimum) Total population (maximum) MaxiStock Unit of Population 1,000 40,000 2 Maximum stock levels (months) Vaccines Safe injection equipment 1 2 1.5 3 2 4 Vaccine net volume for supply period and cold equipment capacities (litres) Total population Total population: 1,000 3,000 5,000 7,000 9,000 Estimate of cold-chain capacity per schedule (litres) Current schedule @ 2 months MaxiStock 1 2 3 4 5 HPV added @ 2 months MaxiStock 1 2 3 4 5 Estimate of equipment requirements per schedule Equipment utilization factor (%) 80% MK 074 20 20 20 20 20 Current schedule @ 2 months MaxiStock - MK 074 HPV added @ 2 months MaxiStock - MK 074 Estimate of cold-chain capacity per MaxiStock (litres) Select schedule Current schedule New schedule @ 1 months MaxiStock 0 1 1 2 3 New schedule @ 1.5 months MaxiStock 0 1 2 3 4 New schedule @ 2 months MaxiStock 1 2 3 4 5 Estimate of equipment requirements per MaxiStock Equipment utilization factor (%) 80% MKS044 20 20 20 20 20 New schedule @ 1 months MaxiStock - MKS044 New schedule @ 1.5 months MaxiStock - MKS044 New schedule @ 2 months MaxiStock - MKS044 Estimate of net dry storage per schedule (m³) Current schedule @ 2 months MaxiStock 0.00 0.01 0.01 0.02 0.02 HPV added @ 2 months MaxiStock 0.00 0.01 0.01 0.02 0.02 Estimate of net dry storage per MaxiStock (m³) Select schedule New schedule New schedule @ 2 months MaxiStock 0.01 0.01 0.02 0.02 New schedule @ 3 months MaxiStock 0.00 0.01 0.02 0.02 0.03 New schedule @ 4 months MaxiStock 0.00 0.01 0.02 0.03 0.04 - 11,000 13,000 15,000 17,000 19,000 21,000 6 7 - 7 8 - 9 9 - 10 10 - 11 11 - 12 13 - 20 - 20 - 20 1 1 - 20 1 1 - 20 1 1 - 20 1 1 - 3 5 6 - 4 6 7 - 4 6 9 - 5 7 10 - 5 8 11 - 6 9 12 - 20 - 20 - 20 1 - 20 1 - 20 1 1 - 20 1 1 - 0.03 0.03 - 0.03 0.03 - 0.03 0.04 - 0.04 0.04 - 0.04 0.05 - 0.05 0.05 - 0.03 0.04 0.05 - 0.03 0.05 0.06 - 0.03 0.05 0.07 - 0.04 0.06 0.08 - 0.04 0.07 0.09 - 0.05 0.07 0.10 - 3.2.2.b Using the storage capacity tables Figure 7 shows the procedure for completing the data entry cells; these are common across all the storage capacity tables and similar in the transport at cost tables (see below). STEP 1: The first step in all these tables is to specify a minimum and maximum target population size for the table and associated graphs based on the number of fully immunized children or the total population as appropriate. For example, in the first table, if the smallest sub-national store serves a total population of 600,000 and the total population of the country is 9,000,000, choose minimum and maximum figures that cover this range – say 500,000 to 10,000,000. This will enable data for all the national and sub-national stores in the country to be read off the relevant graphs4. STEP 2: Choose a MaxiStock option to generate a Type 1 chart (see below). Choosing the ‘per individual vaccine’ option in the header tables of the national and sub-national storage table generates storage capacity data based on the supply interval and safety stock data you have entered in columns V and W of the Vaccine_Selection worksheet. These data are only relevant at national (primary) store level where individual vaccines in the schedule may be received from the vaccine supplier at different intervals. In the example shown in Figure 3, most vaccines are on a 4 month supply interval, DTP-HepB-Hib and HPV are supplied 3-monthly and H1N1 is supplied once a year as a campaign vaccine. When calculating maximum stock levels (MaxiStock), the ‘per individual vaccine’ data in the table and on the associated graphs takes account of these variable supply intervals. STEP 3: Choose MaxiStock options to generate a Type 2 chart (see below). The data entry table allows you to enter up to four separate MaxiStock levels for both vaccines and safe injection supplies. STEP 4: Choose appropriate cold chain equipment from the drop down equipment lists. 4 The worksheet automatically rounds up the population intervals in the 25 column headers. Depending on the minimum and maximum figures which you entered in the data entry cells, the maximum population in the column headings to the right of the table may exceed the maximum figure that you entered. Document1 12 of 22 20 February 2012 STEP 5: Enter an appropriate utilization factor for the cold chain equipment. STEP 6: Choose the immunization schedule you want to use to generate the Type 2 graph. Figure 7 – Using the data entry cells (similar for all charts) Target group type from Vaccine_Selection STEP 2: Select MaxiStock option for Chart Type 1 STEP 1: Enter min and max population STEP 3: Select MaxiStock options for Chart Type 2 STEP 4: Choose cold chain equipment from drop-down list STEP 5: Specify equipment utilization factor STEP 6: Choose schedule for Chart Type 2 Colour coding on the chart gives an indication of viable cold chain equipment choices for a particular target population range. Pale blue is clearly viable, pink merits a second look and red indicates an uneconomic choice – for example large number of ice-lined refrigerators when a cold room might be more suitable. 3.2.2.c Analysis of transport and in-country distribution The fourth table in the series covers analysis of transport and in-country distribution. The user specifies the type of cold box used for vaccine distribution. Currently there is no option covering the use of refrigerated vehicles. Figure 8 shows an example. There is no graph associated with this table. Document1 13 of 22 20 February 2012 Figure 8 - Analysis of transport and in-country distribution Analysis of transport and in-country distribution Analysis per Total population (minimum) Total population (maximum) shipments per year shipments per year Vaccines Safe injection equipment 4 4 6 6 12 12 Unit of Population 1,000 20,000 6 Transport estimate per delivery Total population: Total volume of vaccines per delivery (litres) Current schedule @ 6 shipments per year HPV added @ 6 shipments per year Estimate of number of passive containers required CB_large Current schedule @ 6 shipments per year - CB_large HPV added @ 6 shipments per year - CB_large Total volume of safe injection equipment per delivery (m³) Current schedule @ 6 shipments per year HPV added @ 6 shipments per year Total volume of vaccines per delivery (litres) Current schedule @ 4 shipments per year Current schedule @ 6 shipments per year Current schedule @ 12 shipments per year Estimate of number of passive containers required CB_large Current schedule @ 4 shipments per year - CB_large Current schedule @ 6 shipments per year - CB_large Current schedule @ 12 shipments per year - CB_large Total volume of safe injection equipment per delivery (m³) Current schedule @ 4 shipments per year Current schedule @ 6 shipments per year Current schedule @ 12 shipments per year Total population 2,600 3,400 1,000 1,800 4,200 5,000 5,800 6,600 7,400 8,200 9,000 0 1 - 1 1 - 1 1 - 2 2 - 2 2 - 2 3 - 3 3 - 3 3 - 4 4 - 4 4 - 4 5 - 20.00 - 20.00 - 20.00 - 20.00 - 20.00 - 20.00 - 20.00 - 20.00 - 20.00 - 20.00 - 20.00 - 0.01 0.01 0.01 0.01 Current schedule 2 3 2 2 1 1 - 0.01 0.01 - 0.01 0.01 - 0.02 0.02 - 0.02 0.02 - 0.02 0.02 - 0.02 0.02 - 4 2 1 - 4 3 1 - 5 3 2 - 5 4 2 - 6 4 2 - 6 4 2 - 0.00 0.00 1 0 0 - 0.00 0.01 0.00 0.01 Select schedule 1 2 1 1 0 1 - 20.00 - 20.00 - 20.00 - 20.00 - 20.00 - 20.00 - 20.00 - 20.00 - 20.00 - 20.00 - 20.00 - 0.00 0.00 - 0.01 0.00 - 0.01 0.01 - 0.01 0.01 - 0.01 0.01 - 0.02 0.01 - 0.02 0.01 - 0.02 0.02 - 0.03 0.02 - 0.03 0.02 - 0.03 0.02 - 3.2.2.d Analysis of cold chain cost The final table covers analysis of cold chain cost. There are no data entry options for this table. Figure 9 shows and example. Figure 8 shows an example. There is no graph associated with this table. Figure 9 – Analysis of cold chain cost Analysis of cold chain cost Analysis per Total population (minimum) Total population (maximum) MaxiStock Total population: Total estimated cold-chain purchase cost, $ Current schedule @ per individual vaccine months-MaxiStock HPV added @ per individual vaccine months-MaxiStock Estimated purchase cost of litre net capacity of cold chain ($/litre) Current schedule @ per individual vaccine months-MaxiStock HPV added @ per individual vaccine months-MaxiStock Total estimated cold-chain purchase cost, $ Current schedule @ 4 months MaxiStock Current schedule @ 6 months MaxiStock Current schedule @ 9 months MaxiStock Estimated purchase cost of litre net capacity of cold chain ($/litre) Current schedule @ 4 months MaxiStock Current schedule @ 6 months MaxiStock Current schedule @ 9 months MaxiStock 3.3 Unit of Population 500,000 10,000,000 per individual vaccine Maximum stock levels (months) 4 6 9 0 Total population 1,300,000 1,700,000 2,100,000 2,500,000 500,000 900,000 2,900,000 3,300,000 3,700,000 4,100,000 4,500,000 $3,621.09 $4,207.57 $0.00 $0.00 $0.00 $6,504.96 $7,556.06 $0.00 $0.00 $0.00 $9,377.28 $10,888.93 $0.00 $0.00 $0.00 $12,238.03 $14,206.18 $0.00 $0.00 $0.00 $15,087.23 $17,507.81 $0.00 $0.00 $0.00 $17,924.87 $20,793.83 $0.00 $0.00 $0.00 $20,750.95 $24,064.23 $0.00 $0.00 $0.00 $23,565.48 $27,319.01 $0.00 $0.00 $0.00 $26,368.45 $30,558.17 $0.00 $0.00 $0.00 $29,159.85 $33,781.72 $0.00 $0.00 $0.00 $31,939.70 $36,989.64 $0.00 $0.00 $0.00 $7.45 $7.45 $7.44 $7.43 $7.42 $7.41 $7.41 $7.40 $7.39 $7.38 $7.38 $7.36 $7.36 $7.34 $7.35 $7.33 $7.33 $7.31 $7.32 $7.29 $7.30 $7.27 $3,306.37 $4,953.91 $7,418.16 $0.00 $5,940.62 $8,892.65 $13,297.83 $0.00 $8,565.25 $12,809.72 $19,128.74 $0.00 $11,180.24 $16,705.12 $24,910.89 $0.00 $13,785.60 $20,578.85 $30,644.28 $0.00 $16,381.33 $24,430.91 $36,328.90 $0.00 $18,967.43 $28,261.29 $41,964.76 $0.00 $21,543.90 $32,070.00 $47,551.86 $0.00 $24,110.73 $35,857.04 $53,090.20 $0.00 $26,667.93 $39,622.41 $58,579.78 $0.00 $29,215.50 $43,366.11 $64,020.60 $0.00 $7.45 $7.44 $7.43 #DIV/0! $7.44 $7.42 $7.40 #DIV/0! $7.42 $7.40 $7.37 #DIV/0! $7.41 $7.38 $7.34 #DIV/0! $7.40 $7.36 $7.31 #DIV/0! $7.38 $7.34 $7.28 #DIV/0! $7.37 $7.32 $7.25 #DIV/0! $7.36 $7.30 $7.22 #DIV/0! $7.34 $7.28 $7.19 #DIV/0! $7.33 $7.26 $7.16 #DIV/0! $7.32 $7.24 $7.13 #DIV/0! Data output sheets – results per recipient 3.3.1 Volume_inject worksheet Clicking on Volume_inject to will show the volume of diluents and injection equipment per recipient which are required for the schedule(s) specified on the Vaccine_Selection worksheet. The worksheet uses default values for the AD syringe reconstitution syringe and safety box unit volumes. You can over-ride any one of these figures by entering a value in the relevant pale yellow cell. Document1 14 of 22 20 February 2012 Figure 10 – Volume_inject worksheet Weight of safe injection equipment per recipient Optional data entry only 4.4 gram 6.6 gram 376.5 gram BCG OPV HepB DTP-HepB-Hib MMR MMR DT TT HPV H1N1 freeze-dried liquid liquid liquid freeze-dried freeze-dried liquid liquid liquid liquid ID Oral IM IM SC SC IM IM IM IM 20 10 1 1 2 2 10 10 1 10 0 0 0 0 0 0 0 0 0 0 1.2 2.0 18.0 26.1 13.1 13.1 3.0 3.0 15.0 6.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.7 0.0 0.0 0.0 13.1 13.1 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 4.8 4.8 4.8 4.8 4.8 4.8 4.8 4.8 0.7 3.7 3.7 Current schedule Safety boxes Mixing syringe 4.8 National immunization schedule (Routine vaccinations) 4.0 3.8 3.8 5.6 5.6 3.8 3.8 3.8 3.8 - Supplementary activities (SIAs) 1.0 4.0 1.0 3.0 1.0 1.0 1.0 1.0 H1N1 campaign Weight of supplies per injection (g) Injection syringe Diluent volume (cm³/dose) Vaccine volume (cm³/dose) Presentation (doses/vial) Administration Formulation Vaccine type Characteristics of vaccines selected for use Volume data used HPV added OPTION: Over-ride weight of AD syringe, g/unit: OPTION: Over-ride weight of reconstitution syringe, g/unit: OPTION: Over-ride weight of safety box, g/unit: Index 1.0 4.0 1.0 3.0 1.0 1.0 1.0 1.0 1.0 1.0 Total weight of dilution syringes per Unit of Population , g Total weight of injection syringes per Unit of Population , g Total weigth of safety box per Unit of Population , g 0.1 Total weight 0.1 of dilution 0.0 syringes 0.0 per recipient 0.0 0.8 Total 0.9 weight injection 0.0 syringes 0.0 per recipient 0.0 0.7 Total 0.8weight of0.0 safety boxes 0.0 per recipient 0.0 0.0 4.8 3.8 0.0 0.0 0.0 0.0 0.0 0.0 Total weight of injection supplies per Unit of Population Increase of total weight compared to current schedule 1.7Total weight 1.8 of injection 0.0 supplies 0.0 per recipient 0.0 5% 8.6 0.0 0.0 3.3.2 Weight_inject worksheet Click on the Weight_inject tab and you will see a table showing the weight of injection equipment and safety boxes per recipient relating to the schedule(s) specified on the Vaccine_Selection worksheet. The worksheet uses default values for the AD syringe reconstitution syringe and safety box unit weights. You can override any one of these figures by entering a value in the relevant pale yellow cell. Figure 11 – Weight_inject worksheet Weight of safe injection equipment per recipient Optional data entry only 4.4 gram 6.6 gram 376.5 gram BCG OPV DTP-HepB-Hib Measles Rota_liq Measles freeze-dried liquid liquid freeze-dried liquid freeze-dried ID Oral IM SC Oral SC 20 10 1 1 1 10 0 0 0 0 0 0 0 0 0 0 0 0 0 0 5.0 2.0 5.0 26.1 17.1 3.5 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 1.6 0.0 4.0 26.1 0.0 4.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 4.6 0.7 4.6 4.6 7.0 4.6 0.7 4.0 3.8 7.5 4.1 - 1.0 4.0 3.0 1.0 Supplementary activities (SIAs) Measles Current schedule Safety boxes National immunization schedule (Routine vaccinations) New schedule Weight of supplies per injection (g) Mixing syringe Diluent volume (cm³/dose) Vaccine volume (cm³/dose) Presentation (doses/vial) Administration Formulation Vaccine type Characteristics of vaccines selected for use Volume data used Injection syringe OPTION: Over-ride weight of AD syringe, g/unit: OPTION: Over-ride weight of reconstitution syringe, g/unit: OPTION: Over-ride weight of safety box, g/unit: Index 1.0 4.0 3.0 1.0 1.0 1.0 Total weight of dilution syringes per Target Group, g Total weight of injection syringes per Target Group, g Total weigth of safety box per Target Group, g 0.3 Total weight 0.3 of dilution 0.0 syringes 0.0 per recipient 0.0 0.9 Total 0.9 weight injection 0.0 syringes 0.0 per recipient 0.0 0.9 Total 0.9weight of0.0 safety boxes 0.0 per recipient 0.0 0.7 4.6 4.1 0.0 0.0 0.0 0.0 0.0 0.0 Total weight of injection supplies per Target Group Increase of total weight compared to current schedule 2.1Total weight 2.1 of injection 0.0 supplies 0.0 per recipient 0.0 0% 9.4 0.0 0.0 3.3.3 Qty_waste worksheet Click on the Qty_waste tab to show a table containing an estimate of the volume of empty vials and used syringes generated per recipient, for each of the chosen schedules. There are no over-ride options on this worksheet. Document1 15 of 22 20 February 2012 Figure 12 – Qty_waste worksheet Estimate of the amount of injection waste generated per recipient BCG OPV HepB DTP-HepB-Hib MMR MMR DT TT HPV H1N1 freeze-dried liquid liquid liquid freeze-dried freeze-dried liquid liquid liquid liquid ID Oral IM IM SC SC IM IM IM IM 1.2 2.0 18.0 26.1 13.1 13.1 3.0 3.0 15.0 6.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 20 10 1 1 2 2 10 10 1 10 0 0 0 0 0 0 0 0 0 0 0.7 0.0 0.0 0.0 13.1 13.1 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.20 0.13 1.05 1.05 1.11 1.11 0.13 0.13 1.05 0.13 1.1 1.1 1.1 1.1 1.1 1.1 1.1 1.1 1.1 1.0 4.0 1.0 3.0 1.0 1.0 1.0 1.0 0.10 0.56 0.56 H1N1 campaign Supplementary activities (SIAs) HPV added Current schedule National immunization schedule (Routine vaccinations) Mixing syringe Injection syringe No. of empty vials Amount of waste per recipient, units Diluent volume (cm³/dose) Vaccine volume (cm³/dose) Presentation (doses/vial) Administration Formulation Vaccine type Characteristics of vaccines selected for use Volume data used Index 1.0 4.0 1.0 3.0 1.0 1.0 1.0 1.0 1.0 1.0 Nbr. of empty vials, units/ Unit of Population Nbr. of used dilution syringes generated, units/ Unit of Population Total nbr. of used syringes generated, units/ Unit of Population Nbr. of injections, units/ Unit of Population 0.1 Nbr.0.2 of empty vials 0.0 generated 0.0 per recipient 0.0 0.0 Nbr. of dilution 0.0 syringes 0.0 generated 0.0 per recipient 0.0 0.2 Total nbr. 0.2of syringes 0.0 generated 0.0 per recipient 0.0 0.2 0.2 Nbr. 0.0 of injections 0.0 per recipient 0.0 Increase in nbr.of vials compared to current schedule Increase in nbr. of syringes compared to current schedule Increase in nbr. of injections compared to current schedule 0.1 0.0 1.2 1.1 0.0 0.0 0.0 0.0 0.00 0.00 0.00 0.00 8% 5% 6% 3.3.4 Cost_supplies worksheet The Cost_supplies worksheet is the final one in this sequence. It sets out the cost of the vaccines, injection equipment and safety boxes for each of the chosen schedules. An over-ride option is available for syringe and safety box unit costs. Figure 13 – Cost_supplies worksheet Cost of vaccines and safe injection equipment per recipient Optional data entry only $0.07 $0.06 $1.03 BCG OPV HepB DTP-HepB-Hib MMR MMR DT TT HPV H1N1 freeze-dried liquid liquid liquid freeze-dried freeze-dried liquid liquid liquid liquid ID Oral IM IM SC SC IM IM IM IM 20 10 1 1 2 2 10 10 1 10 0 0 0 0 0 0 0 0 0 0 1.2 2.0 18.0 26.1 13.1 13.1 3.0 3.0 15.0 6.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.7 0.0 0.0 0.0 13.1 13.1 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 $0.08 $0.08 $0.08 $0.08 $0.08 $0.08 $0.08 $0.08 $0.08 $0.01 $0.03 $0.03 $0.01 $0.00 $0.01 $0.01 $0.02 $0.02 $0.01 $0.01 $0.01 $0.01 1.0 4.0 1.0 3.0 1.0 1.0 1.0 1.0 Supplementary activities (SIAs) H1N1 campaign HPV added National immunization schedule (Routine vaccinations) Safety boxes Mixing syringe Price of safe injection equipment Injection syringe Diluent volume (cm³/dose) Vaccine volume (cm³/dose) Presentation (doses/vial) Administration Formulation Vaccine type Characteristics of vaccines selected for use Volume data used Current schedule OPTION: Over-ride price of AD syringe, $/unit: OPTION: Over-ride price of reconstitution syringe, $/unit: OPTION: Over-ride price of safety box, $/unit: Index 1.0 4.0 1.0 3.0 1.0 1.0 1.0 1.0 1.0 1.0 Total cost of vaccines per Unit of Population $0.00 $0.00 Total cost $0.00 of vaccines $0.00per recipient $0.00 Total cost of safe injection equipment per Unit of Population Total cost $0.02 of safe $0.02 injection $0.00 equipment $0.00per recipient $0.00 $0.00 $0.09 $0.00 $0.00 $0.00 $0.00 Total cost of vaccines & safe injection equipment per Unit of Total Population cost of vaccines $0.02& safe $0.02 injection $0.00 equipment $0.00per recipient $0.00 Increase of total cost per recipient compared to current schedule 5% $0.09 $0.00 $0.00 3.4 Data output sheet – graphical illustration of results Click on the Routine_illustration tab to display four bar charts showing key data which has been calculated on a ‘per recipient’ basis: vaccine storage volumes, volume of diluents and injection equipment, cost of vaccines and injection equipment and the volume of waste generated. Document1 16 of 22 20 February 2012 Figure 14 – Routine_illustration charts Vaccine storage volumes Volume of diluents and safe injection equipment per recipient HPV added HPV added Current schedule Current schedule 0.0 0.5 1.0 1.5 2.0 2.5 3.0 3.5 4.0 Volume, cm3 Net volume of vaccines and diluents, stored at +5°C at service points, per Unit of Population 0.0 Net volume of all vaccines, including OPV, stored at +5°C in lower level stores, per Unit of Population Net volume of all vaccines except OPV stored at +5°C in higher level stores, per Unit of Population 2.0 4.0 6.0 8.0 10.0 12.0 Cost of vaccines and safe injection equipment per recipient 14.0 16.0 Volume, cm3 Total net storage volume of injection supplies per Unit of Population , cm3 Estimate of the amount of injection waste generated per recipient HPV added HPV added Current schedule Current schedule $0.00 $0.00 $0.00 $0.01 $0.01 $0.01 $0.01 $0.01 $0.02 $0.02 0.0 $0.02 0.1 0.1 0.2 0.2 0.3 Total nbr. of used syringes generated, units/ Unit of Population Nbr. of empty vials, units/ Unit of Population Total cost of safe injection equipment per Unit of Population Total cost of vaccines per Unit of Population Click on the SIAs_illustration tab to display the same four bar charts for SIA activities. Figure 15 – SIAs_illustration charts Vaccine storage volumes Volume of diluents and safe injection equipment per recipient H1N1 campaign H1N1 campaign 0.0 1.0 2.0 3.0 4.0 5.0 6.0 7.0 8.0 9.0 0.0 Total net storage volume of vaccines & diluents per recipient Cost of vaccines and safe injection equipment per recipient 30.0 40.0 50.0 60.0 70.0 80.0 H1N1 campaign $0.01 $0.02 $0.03 Total cost of vaccines per recipient Document1 20.0 Estimate of the amount of injection waste generated per recipient H1N1 campaign $0.00 10.0 Total net storage volume of injection supplies per recipient $0.04 $0.05 $0.06 $0.07 $0.08 $0.09 $0.10 Total cost of safe injection equipment per recipient 17 of 22 0.0 0.2 0.4 0.6 0.8 1.0 1.2 Total nbr. of syringes generated per recipient Nbr. of empty vials generated per recipient 20 February 2012 1.4 3.5 How to use the graphs This section describes how to use the graphs. There are a total of 12 graphs, arranged in six pairs. The first set of six graphs covers vaccine storage at primary and sub-national level, district level and service delivery level. At each of these three levels one chart in the pair (Type 1) compares the effect of different schedule with a common delivery interval (designated different schedules with same Maximum stock on the charts). The other graph in the pair (Type 2) covers the condition where a common schedule is used, but different delivery intervals are modelled (designated same schedule with different Maximum stocks on the charts). Refer to section 3.2.2b for a more detailed description of the data entry requirements of the two graph types. The second set of six graphs covers dry storage at primary and sub-national level, district level and service delivery level. The graphs are arranged in the same three pairs (Type I and Type 2) as described in the previous paragraph. If you know the population of a specific facility, you can use the graphs to read off the net vaccine or dry store volumes for that facility directly from the relevant chart for any one of the scenarios you have chosen to model. Representative examples of the two graph types are shown in Figures 16 and 17. Both charts show vaccine storage capacity requirements at national and sub-national levels for the population range entered in the Abacus_Tables worksheet. At these two upper levels in the supply chain, polio vaccine is kept separately in a -20°C freezer or freezer room. The charts show the capacity needed at +5°C only5. The figures on the vertical y-axis show the net volume of vaccines in litres. Figure 16 – Type 1 graph: different schedules with same Maximum Stock Graph for cold storage capacity at national and sub-national stores - @ +5°C: (different schedules with same Maximum Stock) 14,000 Net volume of vaccines, litres 12,000 10,000 8,000 6,000 4,000 2,000 10,500,000 10,100,000 9,700,000 9,300,000 8,900,000 8,500,000 8,100,000 7,700,000 7,300,000 6,900,000 6,500,000 6,100,000 5,700,000 5,300,000 4,900,000 4,500,000 4,100,000 3,700,000 3,300,000 2,900,000 2,500,000 2,100,000 1,700,000 900,000 1,300,000 500,000 - Total population Current schedule @ per individual vaccine months-MaxiStock HPV added @ per individual vaccine months-MaxiStock Legend Target population type 5 Only OPV is now routinely stored at -20°C at national and sub-national levels. No vaccines are routinely stored at -20°C at lower levels. Required freezer room or freezer capacity at can be estimated using data generated by the Vaccine_Selection worksheet, multiplied by the relevant target population. Document1 18 of 22 20 February 2012 Figure 16 shows the relationship between net storage capacity and population for the existing schedule and for a proposed new schedule with HPV vaccine added. In the example, the underlying calculation is on a ‘per individual vaccine basis’, as described in section 3.2.2b STEP 2. Figure 17 – Type 2 graph: same schedule with different Maximum Stocks Graph for cold storage capacity at national and sub-national stores - @ +5°C: (same schedule with different Maximum Stocks) 25,000 Net volume of vaccines, litres 20,000 15,000 10,000 5,000 10,500,000 10,100,000 9,700,000 9,300,000 8,900,000 8,500,000 8,100,000 7,700,000 7,300,000 6,900,000 6,500,000 6,100,000 5,700,000 5,300,000 4,900,000 4,500,000 4,100,000 3,700,000 3,300,000 2,900,000 2,500,000 2,100,000 1,700,000 1,300,000 900,000 500,000 - Total population Current schedule @ 4 months MaxiStock Current schedule @ 6 months MaxiStock Legend shows which schedule is used Current schedule @ 9 months MaxiStock Target population type In this example we see the effect of different maximum stock levels (4, 6 and 9 months) for a single chosen schedule – in this case the current schedule defined in Vaccine_Selection. Figure 18 shows how to read a typical graph. Here we have taken the Figure 16 example and decided that we want to establish the required net capacity of the cold room(s) at the national vaccine store for our fictional country with a population of 9 million people. We do this by drawing a vertical line from the 9,000,000 population figure on the x-axis and extending horizontal lines from the intersection with the two schedule lines to the y-axis. By interpolation, this gives us a required net storage capacity of about 8,700 litres for the current schedule and about 10,200 litres for the new schedule with HPV added. Similar principles apply to the use of all the other graphs. Document1 19 of 22 20 February 2012 Figure 18 – Reading a graph Graph for cold storage capacity at national and sub-national stores - @ +5°C: (different schedules with same Maximum Stock) 14,000 Net volume of vaccines, litres 12,000 10,000 8,000 6,000 4,000 2,000 10,500,000 10,100,000 9,700,000 9,300,000 8,900,000 8,500,000 8,100,000 7,700,000 7,300,000 6,900,000 6,500,000 6,100,000 5,700,000 5,300,000 4,900,000 4,500,000 4,100,000 3,700,000 3,300,000 2,900,000 2,500,000 2,100,000 1,700,000 900,000 1,300,000 500,000 - Total population Current schedule @ per individual vaccine months-MaxiStock HPV added @ per individual vaccine months-MaxiStock 3.6 Reference data worksheets In addition to the ‘active’ worksheets, there are five further worksheets which contain database information; these data are either used dynamically in the tool or by the user in the field to identify equipment. 3.6.1 Passive_containers sheet: This sheet provides data on WHO pre-qualified cold boxes and vaccine carriers currently or historically available from all WHO pre-qualified manufacturers. This worksheet is used as a look-up table to establish the net vaccine storage capacity, icepack size and icepack numbers that are needed to complete the transport capacity table in the Abacus_Tables worksheet. 3.6.2 PQEquipment sheet: This sheet provides up-to-date information on refrigerators and freezers currently or historically available from all WHO pre-qualified manufacturers. This worksheet is used as a look-up table to extract the relevant equipment parameters needed to calculate refrigerator and freezer needs once an equipment choice is made in the Abacus_Tables worksheet. 3.6.3 Supplies This sheet includes six tables which provide lookup data on the following: Table 1: Characteristics of safe injection equipment Table 2: Characteristics of supplies for other child survival interventions Document1 20 of 22 20 February 2012 Note: this table is for information only – it is not directly used by the tool. Table 3: Characteristics of walk in cold/freezer rooms Table 4: Characteristics of icepack freezers Table 5: Characteristics of vaccine shipping containers Table 6: Purchase and running cost of cold chain equipment 3.6.4 CR_FR_cost_chart This chart plots the purchase cost of walk-in freezer rooms and cold rooms using data provided by UNICEF Supply Division. Regression lines have been fitted to the two datasets. The associated formulae are used by the Abacus_Tables worksheet to establish cold chain equipment costs in the Analysis of cold chain cost table. Refer back Figure 4, mauve box. 3.6.5 Vaccine_database sheet: This sheet provides all necessary information on the vaccines currently available from WHO pre-qualified manufacturers. The table include type; presentation; trade name; mode of administration; packed volume per dose; availability of VVM, source of data, etc. A link is also given to the relevant WHO webpage describing the vaccine. Users can update the database to include vaccines from other manufacturers, including locally produced vaccines that may be used in individual countries. Warning: Be very careful if you make additions and proceed as follows: Unprotect the sheet Insert a row where you want to add a vaccine. Make sure it is in the correct place, e.g. Measles with other measles; JE with other JEs. Make sure that you enter the correct vaccine initials in column C. Do not create new initials. If you do, the vaccine will not appear on the drop-down list in the Vaccine_Select worksheet. Enter all the necessary data specifying volume per dose, diluent volume per dose, etc. Protect the worksheet again when you have finished. 3.6.6 Translation The Translation data sheet contains the data used for the available language versions of the tool (English, French and Russian6). Follow the guidance notes if you want to create a new language version. If you intend to do this, contact kones@who.int for further advice, to share the translation, and to avoid duplicated effort. 3.6.7 Revision history The Revision_history worksheet records a history of changes made to the tool. 6 At the time of writing, the Russian version was incomplete. Document1 21 of 22 20 February 2012 Revision history Date Change summary 20.02.2012 New document Document1 Reason for change 22 of 22 Approved 20 February 2012