Although the flu causes tens of thousands of deaths each year in the United States, vaccine to fight the illness is often in short supply when the flu season is at its peak.
Now MIT-affiliated researchers have come up with some ways to get the vaccine where it's needed in a timely fashion. Implementing these recommendations could make future influenza outbreaks less deadly.
The vaccine supply chain study is led by Prashant Yadav, professor of supply chain management at the Zaragoza Logistics Center (ZLC), which is a partner in the MIT-Zaragoza International Logistics Program, a research and education collaboration among the MIT Center for Transportation and Logistics, the University of Zaragoza (Spain), the government of Aragon, Spain, and industry partners.
A study carried out by Yadav and David Williams, a recent graduate of logistics and supply chain management at Zaragoza, has identified a number of ways to make the vaccine supply chain more efficient.
At the heart of the vaccine shortage problem are imbalances between supply and demand, they said. On the supply side, manufacturers have opted out of the unpredictable vaccine market, causing a chronic shortage of production capacity. Only two manufacturers now produce the vaccine.
Demand-side factors are just as erratic, Yadav said. The type of vaccine required changes from year to year depending on the strain of virus that hits populations. And there are market mechanisms that compound the uncertainty. Some buyers, such as hospitals, over-order to cover themselves in case of future shortages, and then cancel the surplus.
Sellers use these supply/demand imbalances to push up prices, Yadav said. "There is a great deal of gaming and price gouging."
These market ambiguities often lead to midseason shortages of vaccine and end-of-season excesses, said Yadav. For example, when the U.S. flu outbreak was in full swing in 2004, there was much heated debate over vaccine scarcities, "but at the end of the season there was an excess of about 5 million doses," he said.
The study makes several recommendations to address these problems:
- Create an online clearinghouse for information on vaccine supply and demand to provide a market overview and help to eliminate order gaming and price gouging.
- Give health-care providers some tools to help them better estimate how much vaccine they will need.
- Set up regional vaccine redistribution pools to shift supplies from areas with surpluses to areas experiencing shortages.
Cutting the time taken to produce and deliver vaccine would also eliminate many supply problems. Using a human cell line to manufacture vaccine, rather than chicken eggs, could cut lead times by more than half, the researchers found.
The influenza season in the northern hemisphere runs from October to March. Influenza causes some 35,000 deaths and 100 million lost working days annually in the United States. About 20 percent of the population is affected, at a total cost of about $12 billion to $15 billion.
There has been much debate in the United States over the inadequacies of the country's vaccine supply, but little attention has been paid to the idea of mending the network by curing its supply chain ailments. "The problem is that people such as policymakers who have studied the problem are not supply chain experts," said Yadav.
The ZLC research team is beginning to collaborate with researchers at UCLA and other centers around the world that are also looking at this problem. "These supply chain solutions will not cure all flu vaccine supply problems, but by eliminating many of the uncertainties, they will save lives, alleviate much suffering, and reduce the immense cost of flu outbreaks," said Yadav.
The Centers for Disease Control are already embracing practices similar to some of the team's recommendations.