Only Adding Stationary Storage to Vaccine Supply Chains May Create and Worsen Transport Bottlenecks

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and Pittsburgh Supercomputing Center (Drs Brown and Welling), Pittsburgh, Pennsylvania."> <meta name="citation_publication_date" content="2013 Sep-Oct"> <meta name="citation_volume" content="19"> <meta name="citation_issue" content="0 2"> <meta name="citation_firstpage" content="S65"> <meta name="citation_doi" content="10.1097/PHH.0b013e31828a83fe"> <meta name="citation_pmid" content="23903398"> <meta name="citation_abstract_html_url" content="https://pmc.ncbi.nlm.nih.gov/articles/PMC4540066/"> <meta name="citation_fulltext_html_url" content="https://pmc.ncbi.nlm.nih.gov/articles/PMC4540066/"> <meta name="citation_pdf_url" content="https://pmc.ncbi.nlm.nih.gov/articles/PMC4540066/pdf/nihms520066.pdf"> <meta name="description" content="Although vaccine supply chains in many countries require additional stationary storage and transport capacity to meet current and future needs, international donors tend to donate stationary storage devices far more often than transport equipment. ..."> <meta name="og:title" content="Only Adding Stationary Storage to Vaccine Supply Chains May Create and Worsen Transport Bottlenecks"> <meta name="og:type" content="article"> <meta name="og:site_name" content="PubMed Central (PMC)"> <meta name="og:description" content="Although vaccine supply chains in many countries require additional stationary storage and transport capacity to meet current and future needs, international donors tend to donate stationary storage devices far more often than transport equipment. ..."> <meta name="og:url" content="https://pmc.ncbi.nlm.nih.gov/articles/PMC4540066/"> <meta name="og:image" content="https://cdn.ncbi.nlm.nih.gov/pmc/cms/images/pmc-card-share.jpg?_=0"> <meta name="twitter:card" content="summary_large_image"> <meta name="twitter:site" content="@ncbi"> </head> <body > <a class="usa-skipnav " href="#main-content"> Skip to main content </a> <section class="usa-banner " aria-label="Official website of the United States government" > <div class="usa-accordion"> <header class="usa-banner__header"> <div class="usa-banner__inner"> <div class="grid-col-auto"> <img aria-hidden="true" class="usa-banner__header-flag" src="/static/img/us_flag.svg" alt="" /> </div> <div class="grid-col-fill tablet:grid-col-auto" aria-hidden="true"> <p class="usa-banner__header-text"> An official website of the United States government </p> <span class="usa-banner__header-action">Here's how you know</span> </div> <button type="button" class="usa-accordion__button usa-banner__button " aria-expanded="false" aria-controls="gov-banner-default" data-testid="storybook-django-banner" > <span class="usa-banner__button-text">Here's how you know</span> </button> </div> </header> <div class="usa-banner__content usa-accordion__content" id="gov-banner-default" hidden> <div class="grid-row grid-gap-lg"> <div class="usa-banner__guidance tablet:grid-col-6"> <img class="usa-banner__icon usa-media-block__img" src="/static/img/icon-dot-gov.svg" alt="" aria-hidden="true" /> <div class="usa-media-block__body"> <p> <strong>Official websites use .gov</strong> <br /> A <strong>.gov</strong> website belongs to an official government organization in the United States. </p> </div> </div> <div class="usa-banner__guidance tablet:grid-col-6"> <img class="usa-banner__icon usa-media-block__img" src="/static/img/icon-https.svg" alt="" aria-hidden="true" /> <div class="usa-media-block__body"> <p> <strong>Secure .gov websites use HTTPS</strong> <br /> A <strong>lock</strong> ( <span class="icon-lock"> <svg xmlns="http://www.w3.org/2000/svg" width="52" height="64" viewBox="0 0 52 64" class="usa-banner__lock-image" role="graphics-symbol" aria-labelledby="banner-lock-description" focusable="false"> <title id="banner-lock-title">Lock</title> <desc id="banner-lock-description"> Locked padlock icon </desc> <path fill="#000000" fill-rule="evenodd" d="M26 0c10.493 0 19 8.507 19 19v9h3a4 4 0 0 1 4 4v28a4 4 0 0 1-4 4H4a4 4 0 0 1-4-4V32a4 4 0 0 1 4-4h3v-9C7 8.507 15.507 0 26 0zm0 8c-5.979 0-10.843 4.77-10.996 10.712L15 19v9h22v-9c0-6.075-4.925-11-11-11z" /> </svg> </span>) or <strong>https://</strong> means you've safely connected to the .gov website. 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Author manuscript; available in PMC: 2015 Aug 18.</div> <div> <em>Published in final edited form as: </em>J Public Health Manag Pract. 2013 Sep-Oct;19(0 2):S65–S67. doi: <a href="https://doi.org/10.1097/PHH.0b013e31828a83fe" class="usa-link usa-link--external" data-ga-action="click_feat_suppl" target="_blank" rel="noopener noreferrer">10.1097/PHH.0b013e31828a83fe</a> </div> <nav id="journal_context_menu" hidden="hidden"><ul class="menu-list font-family-ui" role="menu"> <li role="presentation"><a href="https://www.ncbi.nlm.nih.gov/pmc/?term=%22J%20Public%20Health%20Manag%20Pract%22%5Bjour%5D" class="usa-link" role="menuitem">Search in PMC</a></li> <li role="presentation"><a href="https://pubmed.ncbi.nlm.nih.gov/?term=%22J%20Public%20Health%20Manag%20Pract%22%5Bjour%5D" lang="en" class="usa-link" role="menuitem">Search in PubMed</a></li> <li role="presentation"><a href="https://www.ncbi.nlm.nih.gov/nlmcatalog?term=%22J%20Public%20Health%20Manag%20Pract%22%5BTitle%20Abbreviation%5D" class="usa-link" role="menuitem">View in NLM Catalog</a></li> <li role="presentation"><a href="?term=%22J%20Public%20Health%20Manag%20Pract%22%5Bjour%5D" class="usa-link" role="menuitem" data-add-to-search="true">Add to search</a></li> </ul></nav></section><section class="front-matter"><div class="ameta p font-secondary font-xs"> <hgroup><h1>Only Adding Stationary Storage to Vaccine Supply Chains May Create and Worsen Transport Bottlenecks</h1></hgroup><div class="cg p"> <a href="https://pubmed.ncbi.nlm.nih.gov/?term=%22Haidari%20LA%22%5BAuthor%5D" class="usa-link" aria-describedby="id1"><span class="name western">Leila A Haidari</span></a><div hidden="hidden" id="id1"> <h3> <span class="name western">Leila A Haidari</span>, <span class="degrees">MPH</span> </h3> <div class="p"> <sup>1</sup>Public Health Computational and Operational Research (PHICOR) Group, School of Medicine and Graduate School of Public Health (Mss Haidari, Connor, Wateska, Mueller, Schmitz, and Paul, and Dr Lee), Department of Biostatistics, Graduate School of Public Health (Messrs Leonard and Weng), and Department of Industrial Engineering, School of Engineering (Drs Norman, Rajgopal, Claypool, and Chen), University of Pittsburgh; and Pittsburgh Supercomputing Center (Drs Brown and Welling), Pittsburgh, Pennsylvania.</div> <div class="p">Find articles by <a href="https://pubmed.ncbi.nlm.nih.gov/?term=%22Haidari%20LA%22%5BAuthor%5D" class="usa-link"><span class="name western">Leila A Haidari</span></a> </div> </div> <sup>1</sup>, <a href="https://pubmed.ncbi.nlm.nih.gov/?term=%22Connor%20DL%22%5BAuthor%5D" class="usa-link" aria-describedby="id2"><span class="name western">Diana L Connor</span></a><div hidden="hidden" id="id2"> <h3> <span class="name western">Diana L Connor</span>, <span class="degrees">MPH</span> </h3> <div class="p"> <sup>1</sup>Public Health Computational and Operational Research (PHICOR) Group, School of Medicine and Graduate School of Public Health (Mss Haidari, Connor, Wateska, Mueller, Schmitz, and Paul, and Dr Lee), Department of Biostatistics, Graduate School of Public Health (Messrs Leonard and Weng), and Department of Industrial Engineering, School of Engineering (Drs Norman, Rajgopal, Claypool, and Chen), University of Pittsburgh; and Pittsburgh Supercomputing Center (Drs Brown and Welling), Pittsburgh, Pennsylvania.</div> <div class="p">Find articles by <a href="https://pubmed.ncbi.nlm.nih.gov/?term=%22Connor%20DL%22%5BAuthor%5D" class="usa-link"><span class="name western">Diana L Connor</span></a> </div> </div> <sup>1</sup>, <a href="https://pubmed.ncbi.nlm.nih.gov/?term=%22Wateska%20AR%22%5BAuthor%5D" class="usa-link" aria-describedby="id3"><span class="name western">Angela R Wateska</span></a><div hidden="hidden" id="id3"> <h3> <span class="name western">Angela R Wateska</span>, <span class="degrees">MPH</span> </h3> <div class="p"> <sup>1</sup>Public Health Computational and Operational Research (PHICOR) Group, School of Medicine and Graduate School of Public Health (Mss Haidari, Connor, Wateska, Mueller, Schmitz, and Paul, and Dr Lee), Department of Biostatistics, Graduate School of Public Health (Messrs Leonard and Weng), and Department of Industrial Engineering, School of Engineering (Drs Norman, Rajgopal, Claypool, and Chen), University of Pittsburgh; and Pittsburgh Supercomputing Center (Drs Brown and Welling), Pittsburgh, Pennsylvania.</div> <div class="p">Find articles by <a href="https://pubmed.ncbi.nlm.nih.gov/?term=%22Wateska%20AR%22%5BAuthor%5D" class="usa-link"><span class="name western">Angela R Wateska</span></a> </div> </div> <sup>1</sup>, <a href="https://pubmed.ncbi.nlm.nih.gov/?term=%22Brown%20ST%22%5BAuthor%5D" class="usa-link" aria-describedby="id4"><span class="name western">Shawn T Brown</span></a><div hidden="hidden" id="id4"> <h3> <span class="name western">Shawn T Brown</span>, <span class="degrees">PhD</span> </h3> <div class="p"> <sup>1</sup>Public Health Computational and Operational Research (PHICOR) Group, School of Medicine and Graduate School of Public Health (Mss Haidari, Connor, Wateska, Mueller, Schmitz, and Paul, and Dr Lee), Department of Biostatistics, Graduate School of Public Health (Messrs Leonard and Weng), and Department of Industrial Engineering, School of Engineering (Drs Norman, Rajgopal, Claypool, and Chen), University of Pittsburgh; and Pittsburgh Supercomputing Center (Drs Brown and Welling), Pittsburgh, Pennsylvania.</div> <div class="p">Find articles by <a href="https://pubmed.ncbi.nlm.nih.gov/?term=%22Brown%20ST%22%5BAuthor%5D" class="usa-link"><span class="name western">Shawn T Brown</span></a> </div> </div> <sup>1</sup>, <a href="https://pubmed.ncbi.nlm.nih.gov/?term=%22Mueller%20LE%22%5BAuthor%5D" class="usa-link" aria-describedby="id5"><span class="name western">Leslie E Mueller</span></a><div hidden="hidden" id="id5"> <h3> <span class="name western">Leslie E Mueller</span>, <span class="degrees">MPH</span> </h3> <div class="p"> <sup>1</sup>Public Health Computational and Operational Research (PHICOR) Group, School of Medicine and Graduate School of Public Health (Mss Haidari, Connor, Wateska, Mueller, Schmitz, and Paul, and Dr Lee), Department of Biostatistics, Graduate School of Public Health (Messrs Leonard and Weng), and Department of Industrial Engineering, School of Engineering (Drs Norman, Rajgopal, Claypool, and Chen), University of Pittsburgh; and Pittsburgh Supercomputing Center (Drs Brown and Welling), Pittsburgh, Pennsylvania.</div> <div class="p">Find articles by <a href="https://pubmed.ncbi.nlm.nih.gov/?term=%22Mueller%20LE%22%5BAuthor%5D" class="usa-link"><span class="name western">Leslie E Mueller</span></a> </div> </div> <sup>1</sup>, <a href="https://pubmed.ncbi.nlm.nih.gov/?term=%22Norman%20BA%22%5BAuthor%5D" class="usa-link" aria-describedby="id6"><span class="name western">Bryan A Norman</span></a><div hidden="hidden" id="id6"> <h3> <span class="name western">Bryan A Norman</span>, <span class="degrees">PhD</span> </h3> <div class="p"> <sup>1</sup>Public Health Computational and Operational Research (PHICOR) Group, School of Medicine and Graduate School of Public Health (Mss Haidari, Connor, Wateska, Mueller, Schmitz, and Paul, and Dr Lee), Department of Biostatistics, Graduate School of Public Health (Messrs Leonard and Weng), and Department of Industrial Engineering, School of Engineering (Drs Norman, Rajgopal, Claypool, and Chen), University of Pittsburgh; and Pittsburgh Supercomputing Center (Drs Brown and Welling), Pittsburgh, Pennsylvania.</div> <div class="p">Find articles by <a href="https://pubmed.ncbi.nlm.nih.gov/?term=%22Norman%20BA%22%5BAuthor%5D" class="usa-link"><span class="name western">Bryan A Norman</span></a> </div> </div> <sup>1</sup>, <a href="https://pubmed.ncbi.nlm.nih.gov/?term=%22Schmitz%20MM%22%5BAuthor%5D" class="usa-link" aria-describedby="id7"><span class="name western">Michelle M Schmitz</span></a><div hidden="hidden" id="id7"> <h3> <span class="name western">Michelle M Schmitz</span>, <span class="degrees">BA</span> </h3> <div class="p"> <sup>1</sup>Public Health Computational and Operational Research (PHICOR) Group, School of Medicine and Graduate School of Public Health (Mss Haidari, Connor, Wateska, Mueller, Schmitz, and Paul, and Dr Lee), Department of Biostatistics, Graduate School of Public Health (Messrs Leonard and Weng), and Department of Industrial Engineering, School of Engineering (Drs Norman, Rajgopal, Claypool, and Chen), University of Pittsburgh; and Pittsburgh Supercomputing Center (Drs Brown and Welling), Pittsburgh, Pennsylvania.</div> <div class="p">Find articles by <a href="https://pubmed.ncbi.nlm.nih.gov/?term=%22Schmitz%20MM%22%5BAuthor%5D" class="usa-link"><span class="name western">Michelle M Schmitz</span></a> </div> </div> <sup>1</sup>, <a href="https://pubmed.ncbi.nlm.nih.gov/?term=%22Paul%20P%22%5BAuthor%5D" class="usa-link" aria-describedby="id8"><span class="name western">Proma Paul</span></a><div hidden="hidden" id="id8"> <h3> <span class="name western">Proma Paul</span>, <span class="degrees">MHS</span> </h3> <div class="p"> <sup>1</sup>Public Health Computational and Operational Research (PHICOR) Group, School of Medicine and Graduate School of Public Health (Mss Haidari, Connor, Wateska, Mueller, Schmitz, and Paul, and Dr Lee), Department of Biostatistics, Graduate School of Public Health (Messrs Leonard and Weng), and Department of Industrial Engineering, School of Engineering (Drs Norman, Rajgopal, Claypool, and Chen), University of Pittsburgh; and Pittsburgh Supercomputing Center (Drs Brown and Welling), Pittsburgh, Pennsylvania.</div> <div class="p">Find articles by <a href="https://pubmed.ncbi.nlm.nih.gov/?term=%22Paul%20P%22%5BAuthor%5D" class="usa-link"><span class="name western">Proma Paul</span></a> </div> </div> <sup>1</sup>, <a href="https://pubmed.ncbi.nlm.nih.gov/?term=%22Rajgopal%20J%22%5BAuthor%5D" class="usa-link" aria-describedby="id9"><span class="name western">Jayant Rajgopal</span></a><div hidden="hidden" id="id9"> <h3> <span class="name western">Jayant Rajgopal</span>, <span class="degrees">PhD</span> </h3> <div class="p"> <sup>1</sup>Public Health Computational and Operational Research (PHICOR) Group, School of Medicine and Graduate School of Public Health (Mss Haidari, Connor, Wateska, Mueller, Schmitz, and Paul, and Dr Lee), Department of Biostatistics, Graduate School of Public Health (Messrs Leonard and Weng), and Department of Industrial Engineering, School of Engineering (Drs Norman, Rajgopal, Claypool, and Chen), University of Pittsburgh; and Pittsburgh Supercomputing Center (Drs Brown and Welling), Pittsburgh, Pennsylvania.</div> <div class="p">Find articles by <a href="https://pubmed.ncbi.nlm.nih.gov/?term=%22Rajgopal%20J%22%5BAuthor%5D" class="usa-link"><span class="name western">Jayant Rajgopal</span></a> </div> </div> <sup>1</sup>, <a href="https://pubmed.ncbi.nlm.nih.gov/?term=%22Welling%20JS%22%5BAuthor%5D" class="usa-link" aria-describedby="id10"><span class="name western">Joel S Welling</span></a><div hidden="hidden" id="id10"> <h3> <span class="name western">Joel S Welling</span>, <span class="degrees">PhD</span> </h3> <div class="p"> <sup>1</sup>Public Health Computational and Operational Research (PHICOR) Group, School of Medicine and Graduate School of Public Health (Mss Haidari, Connor, Wateska, Mueller, Schmitz, and Paul, and Dr Lee), Department of Biostatistics, Graduate School of Public Health (Messrs Leonard and Weng), and Department of Industrial Engineering, School of Engineering (Drs Norman, Rajgopal, Claypool, and Chen), University of Pittsburgh; and Pittsburgh Supercomputing Center (Drs Brown and Welling), Pittsburgh, Pennsylvania.</div> <div class="p">Find articles by <a href="https://pubmed.ncbi.nlm.nih.gov/?term=%22Welling%20JS%22%5BAuthor%5D" class="usa-link"><span class="name western">Joel S Welling</span></a> </div> </div> <sup>1</sup>, <a href="https://pubmed.ncbi.nlm.nih.gov/?term=%22Leonard%20J%22%5BAuthor%5D" class="usa-link" aria-describedby="id11"><span class="name western">Jim Leonard</span></a><div hidden="hidden" id="id11"> <h3><span class="name western">Jim Leonard</span></h3> <div class="p"> <sup>1</sup>Public Health Computational and Operational Research (PHICOR) Group, School of Medicine and Graduate School of Public Health (Mss Haidari, Connor, Wateska, Mueller, Schmitz, and Paul, and Dr Lee), Department of Biostatistics, Graduate School of Public Health (Messrs Leonard and Weng), and Department of Industrial Engineering, School of Engineering (Drs Norman, Rajgopal, Claypool, and Chen), University of Pittsburgh; and Pittsburgh Supercomputing Center (Drs Brown and Welling), Pittsburgh, Pennsylvania.</div> <div class="p">Find articles by <a href="https://pubmed.ncbi.nlm.nih.gov/?term=%22Leonard%20J%22%5BAuthor%5D" class="usa-link"><span class="name western">Jim Leonard</span></a> </div> </div> <sup>1</sup>, <a href="https://pubmed.ncbi.nlm.nih.gov/?term=%22Claypool%20EG%22%5BAuthor%5D" class="usa-link" aria-describedby="id12"><span class="name western">Erin G Claypool</span></a><div hidden="hidden" id="id12"> <h3> <span class="name western">Erin G Claypool</span>, <span class="degrees">PhD</span> </h3> <div class="p"> <sup>1</sup>Public Health Computational and Operational Research (PHICOR) Group, School of Medicine and Graduate School of Public Health (Mss Haidari, Connor, Wateska, Mueller, Schmitz, and Paul, and Dr Lee), Department of Biostatistics, Graduate School of Public Health (Messrs Leonard and Weng), and Department of Industrial Engineering, School of Engineering (Drs Norman, Rajgopal, Claypool, and Chen), University of Pittsburgh; and Pittsburgh Supercomputing Center (Drs Brown and Welling), Pittsburgh, Pennsylvania.</div> <div class="p">Find articles by <a href="https://pubmed.ncbi.nlm.nih.gov/?term=%22Claypool%20EG%22%5BAuthor%5D" class="usa-link"><span class="name western">Erin G Claypool</span></a> </div> </div> <sup>1</sup>, <a href="https://pubmed.ncbi.nlm.nih.gov/?term=%22Weng%20YT%22%5BAuthor%5D" class="usa-link" aria-describedby="id13"><span class="name western">Yu-Ting Weng</span></a><div hidden="hidden" id="id13"> <h3> <span class="name western">Yu-Ting Weng</span>, <span class="degrees">MS</span> </h3> <div class="p"> <sup>1</sup>Public Health Computational and Operational Research (PHICOR) Group, School of Medicine and Graduate School of Public Health (Mss Haidari, Connor, Wateska, Mueller, Schmitz, and Paul, and Dr Lee), Department of Biostatistics, Graduate School of Public Health (Messrs Leonard and Weng), and Department of Industrial Engineering, School of Engineering (Drs Norman, Rajgopal, Claypool, and Chen), University of Pittsburgh; and Pittsburgh Supercomputing Center (Drs Brown and Welling), Pittsburgh, Pennsylvania.</div> <div class="p">Find articles by <a href="https://pubmed.ncbi.nlm.nih.gov/?term=%22Weng%20YT%22%5BAuthor%5D" class="usa-link"><span class="name western">Yu-Ting Weng</span></a> </div> </div> <sup>1</sup>, <a href="https://pubmed.ncbi.nlm.nih.gov/?term=%22Chen%20SI%22%5BAuthor%5D" class="usa-link" aria-describedby="id14"><span class="name western">Sheng-I Chen</span></a><div hidden="hidden" id="id14"> <h3> <span class="name western">Sheng-I Chen</span>, <span class="degrees">PhD</span> </h3> <div class="p"> <sup>1</sup>Public Health Computational and Operational Research (PHICOR) Group, School of Medicine and Graduate School of Public Health (Mss Haidari, Connor, Wateska, Mueller, Schmitz, and Paul, and Dr Lee), Department of Biostatistics, Graduate School of Public Health (Messrs Leonard and Weng), and Department of Industrial Engineering, School of Engineering (Drs Norman, Rajgopal, Claypool, and Chen), University of Pittsburgh; and Pittsburgh Supercomputing Center (Drs Brown and Welling), Pittsburgh, Pennsylvania.</div> <div class="p">Find articles by <a href="https://pubmed.ncbi.nlm.nih.gov/?term=%22Chen%20SI%22%5BAuthor%5D" class="usa-link"><span class="name western">Sheng-I Chen</span></a> </div> </div> <sup>1</sup>, <a href="https://pubmed.ncbi.nlm.nih.gov/?term=%22Lee%20BY%22%5BAuthor%5D" class="usa-link" aria-describedby="id15"><span class="name western">Bruce Y Lee</span></a><div hidden="hidden" id="id15"> <h3> <span class="name western">Bruce Y Lee</span>, <span class="degrees">MD, MBA</span> </h3> <div class="p"> <sup>1</sup>Public Health Computational and Operational Research (PHICOR) Group, School of Medicine and Graduate School of Public Health (Mss Haidari, Connor, Wateska, Mueller, Schmitz, and Paul, and Dr Lee), Department of Biostatistics, Graduate School of Public Health (Messrs Leonard and Weng), and Department of Industrial Engineering, School of Engineering (Drs Norman, Rajgopal, Claypool, and Chen), University of Pittsburgh; and Pittsburgh Supercomputing Center (Drs Brown and Welling), Pittsburgh, Pennsylvania.</div> <div class="p">Find articles by <a href="https://pubmed.ncbi.nlm.nih.gov/?term=%22Lee%20BY%22%5BAuthor%5D" class="usa-link"><span class="name western">Bruce Y Lee</span></a> </div> </div> <sup>1</sup> </div> <ul class="d-buttons inline-list"> <li><button class="d-button" aria-controls="aip_a" aria-expanded="false">Author information</button></li> <li><button class="d-button" aria-controls="clp_a" aria-expanded="false">Copyright and License information</button></li> </ul> <div class="d-panels font-secondary-light"> <div id="aip_a" class="d-panel p" style="display: none"> <div class="p" id="A1"> <sup>1</sup>Public Health Computational and Operational Research (PHICOR) Group, School of Medicine and Graduate School of Public Health (Mss Haidari, Connor, Wateska, Mueller, Schmitz, and Paul, and Dr Lee), Department of Biostatistics, Graduate School of Public Health (Messrs Leonard and Weng), and Department of Industrial Engineering, School of Engineering (Drs Norman, Rajgopal, Claypool, and Chen), University of Pittsburgh; and Pittsburgh Supercomputing Center (Drs Brown and Welling), Pittsburgh, Pennsylvania.</div> <div class="author-notes p"><div class="fn" id="cor1"> <sup>✉</sup><p class="display-inline"><strong>Correspondence:</strong> Bruce Y. Lee, MD, MBA, Public Health Computational and Operational Research (PHICOR) Group, University of Pittsburgh, 200 Meyran Ave, Ste 200, Pittsburgh, PA 15213 (<span>BYL1@pitt.edu</span>)</p> </div></div> </div> <div id="clp_a" class="d-panel p" style="display: none"><div class="p"><a href="/about/copyright/" class="usa-link">PMC Copyright notice</a></div></div> </div> <div>PMCID: PMC4540066 NIHMSID: NIHMS520066 PMID: <a href="https://pubmed.ncbi.nlm.nih.gov/23903398/" class="usa-link">23903398</a> </div> <div class="ra xbox p" role="complementary" aria-label="Related or updated information about this article"><div>The publisher's version of this article is available at <a href="https://doi.org/10.1097/PHH.0b013e31828a83fe" class="usa-link usa-link--external" data-ga-action="click_feat_suppl" target="_blank" rel="noopener noreferrer">J Public Health Manag Pract</a> </div></div> </div></section></section><section aria-label="Article content"><section class="body main-article-body"><section class="abstract" id="abstract1"><h2>Abstract</h2> <p id="P1">Although vaccine supply chains in many countries require additional stationary storage and transport capacity to meet current and future needs, international donors tend to donate stationary storage devices far more often than transport equipment. To investigate the impact of only adding stationary storage equipment on the capacity requirements of transport devices and vehicles, we used HERMES (Highly Extensible Resource for Modeling Supply Chains) to construct a discrete event simulation model of the Niger vaccine supply chain. We measured the transport capacity requirement for each mode of transport used in the Niger vaccine cold chain, both before and after adding cold rooms and refrigerators to relieve all stationary storage constraints in the system. With the addition of necessary stationary storage, the average transport capacity requirement increased from 88% to 144% for cold trucks, from 101% to 197% for pickup trucks, and from 366% to 420% for vaccine carriers. Therefore, adding stationary storage alone may worsen or create new transport bottlenecks as more vaccines flow through the system, preventing many vaccines from reaching their target populations. Dynamic modeling can reveal such relationships between stationary storage capacity and transport constraints.</p> <section id="kwd-group1" class="kwd-group"><p><strong>Keywords:</strong> immunization, storage, transport, vaccine supply chains</p></section></section><hr class="headless"> <p id="P2">Vaccine supply chains in many countries currently experience bottlenecks due to limited storage or transport capacity, and these are expected to worsen with the introduction of 12 new vaccines by 2019.<sup><a href="#R1" class="usa-link" aria-describedby="R1">1</a></sup> In efforts to improve vaccine supply chains, international donors have donated stationary storage devices far more often than transport equipment.<sup><a href="#R2" class="usa-link" aria-describedby="R2">2</a>–<a href="#R4" class="usa-link" aria-describedby="R4">4</a></sup> The HERMES (Highly Extensible Resource for Modeling Supply Chains) modeling team at the University of Pittsburgh used a dynamic simulation model of the Niger vaccine supply chain to investigate the impact of adding stationary storage equipment on the capacity requirements of transport devices and vehicles.</p> <section id="S1"><h2 class="pmc_sec_title">Methods</h2> <p id="P3">We used HERMES to construct a discrete-event simulation model of the Niger vaccine supply chain. Previous publications provide detailed descriptions of this model.<sup><a href="#R5" class="usa-link" aria-describedby="R5">5</a>–<a href="#R7" class="usa-link" aria-describedby="R7">7</a></sup> The model simulated the population demand and Expanded Program on Immunization vaccine schedule for 2015, as projected in the Niger Comprehensive Multiyear Plan.<sup><a href="#R8" class="usa-link" aria-describedby="R8">8</a></sup> The transport capacity requirement is the amount of space needed to carry an order of vaccines, expressed as a percentage of the space available in a vehicle or transport device. It is calculated as follows: </p> <ul id="L1" class="list" style="list-style-type:none"><li><p id="P4">Transport capacity requirement = Transport capacity required ÷ Transport capacity available</p></li></ul> <p id="P5">A transport capacity requirement of more than 100% indicates a transport bottleneck. We measured the transport capacity requirement for each of the 3 types of vehicles and transport devices used in the Niger vaccine cold chain (cold trucks, pickup trucks, and vaccine carriers) under the current system, without additional storage or transport equipment. We then added cold rooms and refrigerators to relieve all stationary storage constraints and measured the transport capacity requirement under this altered system.</p></section><section id="S2"><h2 class="pmc_sec_title">Results</h2> <p id="P6">The <a href="#F1" class="usa-link">Figure</a> displays the average transport capacity requirement for each type of transport equipment, before and after the addition of stationary storage to relieve all storage constraints. Relieving storage constraints exacerbated existing transport bottlenecks and created new bottlenecks for routes that did not experience constraints before storage was added. With the addition of stationary storage, the average transport capacity requirement increased from 88% to 144% for cold trucks, from 101% to 197% for pickup trucks, and from 366% to 420% for vaccine carriers.</p> <figure class="fig xbox font-sm" id="F1"><h3 class="obj_head">FIGURE.</h3> <p class="img-box line-height-none margin-x-neg-2 tablet:margin-x-0 text-center"><a class="tileshop" target="_blank" href="https://www.ncbi.nlm.nih.gov/core/lw/2.0/html/tileshop_pmc/tileshop_pmc_inline.html?title=Click%20on%20image%20to%20zoom&p=PMC3&id=4540066_nihms520066f1.jpg"><img class="graphic zoom-in" src="https://cdn.ncbi.nlm.nih.gov/pmc/blobs/cf8a/4540066/be4dc88cfb8c/nihms520066f1.jpg" loading="lazy" height="525" width="1050" alt="FIGURE"></a></p> <div class="p text-right font-secondary"><a href="figure/F1/" class="usa-link" target="_blank" rel="noopener noreferrer">Open in a new tab</a></div> <figcaption><p id="P12">Transport Capacity Requirement Before and After the Addition of Stationary Storage<a href="#P13" class="usa-link">a</a></p> <p id="P13"><sup>a</sup>A transport capacity requirement of more than 100% indicates a transport bottleneck.</p></figcaption></figure></section><section id="S3"><h2 class="pmc_sec_title">Conclusion</h2> <p id="P7">Transport constraints cannot be ignored when augmenting vaccine supply chains. Adding stationary storage equipment alone may actually worsen or create new transport bottlenecks, due to a greater number of vaccines flowing through the system. These bottlenecks ultimately prevent vaccines from arriving where they are needed. Dynamic modeling helped reveal this relationship between stationary storage capacity and transport constraints. HERMES can generate a detailed model of any vaccine supply chain anywhere in the world. For example, in the United States, HERMES could be used to evaluate supply chains to distribute routine immunizations, influenza vaccines, and vaccines in response to epidemics.</p></section><section id="S4" class="ack"><h2 class="pmc_sec_title">Acknowledgments</h2> <p id="P11">This work was supported by the Bill and Melinda Gates Foundation via the Vaccine Modeling Initiative and the National Institute of General Medical Sciences Models of Infectious Disease Agent Study (MIDAS). The funders had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data and preparation, review, or approval of the manuscript.</p></section><section id="fn-group1" class="fn-group"><h2 class="pmc_sec_title">Footnotes</h2> <div class="fn-group p font-secondary-light font-sm"> <div class="fn p" id="FN1"><p id="P8">The HERMES Project team consists of (in alphabetical order): Tina-Marie Assi, PhD, Shawn T. Brown, PhD (Technical Lead), Brigid E. Cakouros, MPH, Sheng-I Chen, PhD, Diana L. Connor, MPH (co-coordinator), Erin G. Claypool, PhD, Leila A. Haidari, MPH, Veena Karir, PharmD, MS, Bruce Y. Lee, MD, MBA (scientific lead), Jim Leonard, Leslie E. Mueller, MPH, Bryan A. Norman, PhD, Proma Paul, MHS, Jayant Rajgopal, PhD, Michelle M. Schmitz, BA, Rachel B. Slayton, PhD, Angela R. Wateska, MPH (co-coordinator), Joel S. Welling, PhD, and Yu-Ting Weng, MS. For further questions regarding HERMES, contact Dr Lee (<span>BYL1@pitt.edu</span>) or Dr Brown (<span>stbrown@psc.edu</span>).</p></div> <div class="fn p" id="FN2"><p id="P9">No other financial disclosures were reported by the authors of this article.</p></div> <div class="fn p" id="FN3"><p id="P10">The authors declare that they have no conflicts of interest.</p></div> </div></section><section id="ref-list1" class="ref-list"><h2 class="pmc_sec_title">REFERENCES</h2> <section id="ref-list1_sec2"><ul class="ref-list font-sm" style="list-style-type:none"> <li id="R1"> <span class="label">1.</span><cite>Kaufmann JR, Miller R, Cheyne J. Vaccine supply chains need to be better funded and strengthened, or lives will be at risk. 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