Procuring supplies for children

Vaccine safety

Safe injection

Vaccine vial monitors

Vaccine arrival reports

Electronic time temperature monitoring devices

Safe injectionUNICEF procured over 699 million AD syringes in 2007 following 929 million in 2006. $43 million was spent on safe injection supplies including AD syringes and safety boxes.

UNICEF has fully endorsed and implemented the use of Auto-Disable Syringes in Immunization Services as recommended in the WHO-UNICEF-UNFPA Joint Statement of 1999  Auto-disable (AD) syringes are designed to prevent re-use after they have been used once. After one use, the syringes become automatically disabled due to the presence of an internal one-way valve. In addition to this joint policy on injection safety, UNICEF also bases its supply on a bundling policy. The principle of this is that for each vaccine dose, sufficient numbers of AD syringes, reconstitution syringes and safety boxes must be ensured.

To take the injection safety concept further, UNICEF also supplies syringes for reconstitution of vaccines to avoid the risk of re-use which in turn represents a risk for contamination. These type of syringes are called re-use prevention featured (RUP) syringes and have been pre-qualified by WHO.  To avoid the risk of contamination during the reconstitution process, UNICEF will start phasing out regular disposable reconstitution syringes and replacing them with RPF syringes. In the initial stage, UNICEF will offer RPF syringes as an option to countries with the objective to exclusively provide RPF re-constitution syringes by the end of 2010. In addition to expanding the current injection safety policy for immunization purposes, UNICEF and WHO are working on a joint statement to cover any disposable syringes for which RPF alternative exists regardless of whether they are for curative or immunization purposes

There are several elements that imply that there are areas that still need to be addressed, such as (1) lack of creation of budget lines for safety devices for countries having benefited from the GAVI safe injection support and (2) countries still using sterilizable syringes despite the cessation of their supply by UNICEF

The demand for AD syringes has increased substantially to over 929 million pieces in the peaking year 2006 since the implementation of AD syringes, with GAVI being the driving force. The supplies meet demand and prices are generally decreasing. The price level is a couple of cents more expensive than regular disposable syringes. At times, this causes problems to country governments in terms of finding a financially sustainable solution.

The overall procurement objective of UNICEF is to ensure an uninterrupted supply of affordable quality products – on short as well as long term basis. The more countries do their own procurement of injection devices the less is the volume of AD syringes being procured by UNICEF. Those countries, that intend to procure Injection Devices themselves, receive support and assistance from UNICEF for the transition phase, as empowering countries to do self-procurement is an effort UNICEF supports. In case of need, UNICEF is helping with stand-by procurement. - The more the demand side consequently is being diversified, the more important it is from UNICEF's position to strive to sustain sufficient affordable products being available from a variety of potential supply sources also in the long run.

One essential procurement tool being used by UNICEF is the establishment of multiple long term arrangements. The procurement process undertaken by UNICEF falls under rules of public procurement with equal treatment and international competitive tender process. The tender process is subject to internal as well as external control mechanisms such as independent review committees and audit. The current arrangements for the supply of AD syringes and safety boxes have been renewed in the fourth quarter of 2007 for a validity period of two years.

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Vaccine vial monitors

Another safety feature advocated by UNICEF is the vaccine vial monitor (VVM). The VVM is a strip on each vial which changes colour to record the extremes of temperature it has been subjected to in transit. This allows recipients to check that the quality of the vaccine has not suffered due to exposure to extreme temperatures, and helps ensure that children are immunized with potent vaccines. The average cost of a VVM is 7 cents per vial, with a range of between 4 cents and 20 cents. The total cost of VVMs for the quantities of vaccine forecasted by UNICEF over the period 2004-2006 is $7.5 million.

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Vaccine arrival reports

UNICEF has introduced vaccine arrival reports (VARs) to ensure the safety and quality of vaccines. Each vaccine shipment is inspected upon arrival to ensure that the vaccines arrived in good condition, that they were not exposed to extreme temperatures and that they meet all the procurement specifications. This initiative is fundamental to monitoring the cold chain. The VAR return rate was sustained at 76 per cent in 2007. Because of the increased monitoring and inspection resulting from the VARs, there has been an improvement in the quality of vaccines delivered to countries.

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Electronic time temperature monitoring devices

UNICEF suppliers have started using Electronic Time Temperature Monitoring Devices (ETTMDs) for international vaccine shipments following WHO recommendations.  The new devices serve as a quick reference to help recipient countries determine whether the shipment – or parts of the shipment – have been exposed to temperatures at which vaccines could have been damaged; and help the procurement agency determine when, where, and to what extent temperature limits have been exceeded.

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