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The purpose of this paper is to define the role non-governmental organizations (NGOs) play across the vaccine development and delivery spectrum within the vaccine enterprise. As demonstrated in this paper, NGOs can play a critical role in prioritizing and accelerating the development and introduction of new vaccines against diseases that disproportionally burden children, women, and communities in the poorest countries around the world.

The author has used case studies from decades of work by PATH, an international NGO, to help develop and implement vaccines, to illustrate the roles of NGOs can play during each of the stages along the development and delivery spectrum.

There are four key considerations that can help determine the ability of a given vaccine to be introduced and scaled within a health system: accessibility, affordability, acceptability, and availability. As more vaccine candidates are identified and move along the development and delivery pathway, there will be increased demand for NGOs to continue playing a pivotal role to address these considerations.

This paper aims to highlight a few of the lessons learned from PATH's four decades of experience in the hope they will contribute and be applied to the evolving environment of vaccine enterprise.

The purpose of this paper is to identify the key performance indicators (KPIs) of vaccine supply chain of Universal Immunization Program (UIP) India, and measure their impact on vaccine supply chain performance improvement, so that results of this study can help the decision makers manage the activity and effectiveness of their resources in order to improve vaccine delivery performance and child immunization coverage.

The 41 KPIs in terms of four dimension of the balanced scorecard (BSC), i.e. financial, customer, internal process and learning and growth have been identified and validated from the literature and expert’s opinions. Further, the impact of internal process and learning and growth performance indicators on the vaccine supply chain performance improvement have been evaluated using two-way assessment. The rankings obtained using two-way assessment are then compared to DEMATEL approach to validate the results.

The results from the analysis reveal that “Enhancement in employee work satisfaction” (LG3=10.08 percent), “Enhancement in professional vaccine supply chain managers and leaders” (LG2 = 6.70 percent) “Improvement in planning and coordination in the supply chain” (LG9 = 6.57 percent) are the three critical performance indicators having maximum impact on vaccine supply chain performance improvement. The decision makers should give priority to these performance indicators to improve delivery performance and immunization coverage.

This study focuses on the improvement in vaccine delivery performance, therefore, analysis and findings can be useful to government immunization programs of India to other developing nations to improve child immunization coverage.

To our knowledge, this paper is first to attempt to provide a direction to improve immunization coverage through vaccine supply chain performance indicators.

The recent Childhood Immunization Initiative of the Clinton Administration was a dramatic and ambitious policy response to what we will show is a case of significant management and implementation failure. Interpreted by the Administration as a policy failure, low rates of early childhood immunization met with an aggressive and targeted policy response which ultimately diverted attention away from significant evidence of fundamental problems of service delivery, infrastructure, and parental knowledge and behavior. Analyzes and seeks to evaluate the reasons for the poor fit between the diagnosis of the problem of existing childhood immunization policy and the ultimate policy prescription of the Clinton Administration which relies almost exclusively on reducing the price of vaccines.

Delivering vaccines to the children who need them requires a supply chain that is efficient and effective. In most of the developing countries, however, the unknown and unresolved supply chain issues are causing inefficiencies in distributing vaccines. There is, therefore, a great need in such countries to recognize the issues that cause delays in vaccine delivery. With this purpose, the present study aims to identify and analyze the key issues in the supply chain of basic vaccines required to immunize children in developing countries.

Based on a field survey of three states of India, in-depth review of relevant literature and experts’ opinions, 25 key issues were recognized as factors of the vaccine supply chain (VSC) and categorized into five main domains. Using integrated interpretive structural modeling and fuzzy analytic network process approaches, the issues have been prioritized to determine their relative importance in the VSC. In addition, a sensitivity analysis has been performed to investigate the priority stability of the issues.

The results of the analysis show that among the five domains of VSC issues, the economic domain with a weight of 0.4262 is the most important domain, followed by the management (0.2672), operational (0.2222), environmental (0.0532) and social (0.0312).

This study focuses on the prioritization of VSC issues; therefore, the results of the present study can provide direction to the decision-makers of immunization programs of developing countries in driving their efforts and resources on eliminating the most important obstacles to design successful vaccination programs.

To the authors’ knowledge, this paper is first to provide a direction to the decision-makers in identifying and managing important issues through the use of an analytical approach.

This study provides a systematic literature review and categorization of the costs reported in the literature for the introduction of new vaccines, focusing on sub-Saharan Africa within LMICs, where vaccines are highly needed, financial resources are scarce and data are lacking and scattered.

A systematic literature search of PubMed and Web of Science databases was conducted according to the PRISMA requirements. Searches also included the relevant grey literature. In total, 39 studies were selected and nine cost categories were investigated to build a comprehensive framework.

The paper considers nine cost categories that cover the whole life of the vaccine, from its initial study to its full implementation, including for each of them the relevant subcategories. The systematic review, besides providing specific quantitative data and allowing to assess their variability within each category, points out that delivery, program preparation, administration and procurement costs are the most frequently estimated categories, while the cost of the good sold, costs borne by households and costs associated to AEFI are usually overlooked. Data reported on R&D costs and investment in the production plant differ significantly among the selected contributions.

The literature contributions on cost estimation tend to focus on a precise vaccine, a specific geographic area, or to adopt a narrow approach that captures only a subset of the costs. This article presents a rich and inclusive set of the economic quantitative data on immunization costs in limited-resource countries.

This study aims to focus on building a conceptual closed-loop vaccine supply chain (CLVSC) to decrease vaccine wastage and counterfeit/fake vaccines.

Through a focused literature review, the framework for the CLVSC is described, and the system dynamics (SD) research methodology is used to build a causal loop diagram (CLD) of the proposed model.

In the battle against COVID-19, waste management systems have become overwhelmed, which has created negative environmental and extremely hazardous societal impacts. A key contributing factor is unused vaccine doses, shown as a source for counterfeit/fake vaccines. The findings identify a CLVSC design and transshipment operations to decrease vaccine wastage and the potential for vaccine theft.

This study contributes to establishing a pandemic-specific VSC structure. The proposed model informs the current COVID-19 pandemic as well as potential future pandemics.

A large part of the negative impact of counterfeit/fake vaccines is on human well-being, and this can be avoided with proper CLVSC.

This study develops a novel overarching SD CLD by integrating the epidemic model of disease transmission, VSC and closed-loop structure. This study enhances the policymakers’ understanding of the importance of vaccine waste collection, proper handling and threats to the public, which are born through illicit activities that rely on stolen vaccine doses.

The learning outcomes are to understand the definition of public value and the strategic drivers behind public value creation, understand the nature of social innovation in the public sector, identify the critical opportunities and challenges involved in sustaining innovation in the public sector and identify the role that non-profit organizations can play in supporting and sustaining social innovation.

This case puts participants in the shoes of a global health innovator’s leadership team as the organization approaches a funding crisis. The organization, VillageReach, is on a quest to expand across the public health system of Mozambique and experiences a funding dilemma. The case reveals the challenges of working with governments to achieve large-scale, systemic change. It explores the conundrum of using international donor funding to embed new practices in government service delivery. Ultimately, it asks participants to choose between the pursuit of new, small-scale innovative projects and the large-scale rollout of a national programme.

This teaching case is written for courses focused on social entrepreneurship, social innovation and social change. It can also be used in courses focused on non-profit management and public sector innovation. Specifically, the teaching case is suitable for two audiences: social enterprise and non-profit managers focused on strategy, development and operations (the case focuses on an enterprise that relies primarily on donor funding) and health-care managers and administrators. Generally, the case is suitable for undergraduates in their final year of study as well as graduate-level business and public administration courses, including MBA, MPH, MPA, EMBA and Executive Education courses.

Teaching Notes are available for educators only.

CSS 3: Entrepreneurship.

Each individual needs to be vaccinated to control the spread of the COVID-19 pandemic in the shortest possible time. However, the vaccine distribution with an already strained supply chain in low- and middle-income countries (LMICs) will not be effective enough to vaccinate all the population in stipulated time. The purpose of this paper is to show that there is a need to revolutionize the vaccine supply chain (VSC) by overcoming the challenges of sustainable vaccine distribution.

An integrated lean, agile and green (LAG) framework is proposed to overcome the challenges of the sustainable vaccine supply chain (SVSC). A hybrid best worst method (BWM)–Measurement of Alternatives and Ranking According to COmpromise Solution (MARCOS) methodology is designed to analyze the challenges and solutions.

The analysis shows that vaccine wastage is the most critical challenge for SVSC, and the coordination among stakeholders is the most significant solution followed by effective management support.

The result of the analysis can help the health care organizations (HCOs) to manage the VSC. The effective vaccination in stipulated time will help control the further spread of the virus, which will result in the normalcy of business and availability of livelihood for millions of people.

To the best of the author's knowledge, this is the first study to explore sustainability in VSC by considering the environmental and social impact of vaccination. The LAG-based framework is also a new approach in VSC to find the solution for existing challenges.

The purpose of this paper is to develop a framework to evaluate and assess the performance of the COVID-19 vaccine distribution process that is sensitive to the unique supply-side and demand-side constraints exhibited in the US vaccine rollout.

A queuing framework that operates under two distinct regimes is formulated to analyze service rates that represent system capacity to vaccinate (under the first regime) and hesitancy-induced throughput (under the second regime). These supply- and hesitancy-constrained regimes form the focus of the present paper, as the former reflects the inherent ability of the nation in its various jurisdictions to mobilize, whereas the latter reflects a critical area for public policy to protect the population’s overall health and safety.

The two-regime framework analysis provides insights into the capacity to vaccinate and hesitancy-constrained demand, which is found to vary across the country primarily by politics and region. The framework also allows analysis of the end-to-end supply chain, where it is found that the ability to vaccinate was likely constrained by last-mile administration issues, rather than the capacity of the manufacturing and transportation steps of the supply chain.

This study presents a new framework to consider end-to-end supply chains as dynamic systems that exhibit different regimes because of unique supply- and demand-side characteristics and estimate rollout capacity and underlying determinants at the national, state and county levels.

Immunization is one of the most cost-effective ways to save lives while promoting good health and happiness. The coronavirus disease 2019 (COVID-19) pandemic has served as a stark reminder of vaccines' ability to prevent transmission, save lives, and have a healthier, safer and more prosperous future. This research investigates the sustainable development (SD) of the COVID-19 vaccine supply chain (VSC).

This study investigates the relationship between internal process, organizational growth, and its three pillars of SD environmental sustainability, economic sustainability and social sustainability. Survey-based research is carried out in the hospitals providing COVID-19 vaccines. Nine hypotheses are proposed for the study, and all the hypotheses got accepted. The survey was sent to 428 respondents and received 291 responses from health professionals with a response rate of 68%. For the study, the healthcare professionals working in both private and public hospitals across India were selected.

The structural equation modelling (SEM) approach is used to test the hypothesis. All nine hypotheses are supported. This study examines a link between internal processes and organizational learning and the three sustainability pillars (environmental sustainability, economic sustainability and social sustainability).

This study will help the management and the policymakers to think and adopt SD in the COVID-19 VSC. This paper also implies that robust immunization systems will be required in the future to ensure that people worldwide are protected from COVID-19 and other diseases.

This paper shows the relationship between organizational learning and internal process with environmental sustainability, economic sustainability and social sustainability for the COVID-19. Studies on VSC of COVID-19 are not evident in any previous literature.