# 6.2 Needs estimation

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## 6.2.1 Vaccines

### Number of vaccines

The vaccine needs (Appendix 18) are estimated based on:

• the target population (population to be vaccinated);
• the objective (> 90% in an epidemic situation);
• the wastage factor: estimated at 1.17 during a vaccination campaign (= 15% wastage); If 100 doses are needed to vaccinated 85 people (85% utilisation rate), then 117 doses need to be ordered to vaccinate 100 people;
• the buffer stock: estimated to be from 10 to 25% (depending on the number of people to be vaccinated and the reliability of the population figures).

Example: to vaccinate all children ages 6 months - 15 years in a total population of 50,000,calculate the number of vaccine doses to order as follows:

 1. Total population 50,000 people 2. Calculate target population (6 months - 15 years) x 40% 20,000 people 3. Vaccination coverage objective x 100% 20,000 people 4. Add 15% for wastage x 1.17 23,400 doses 5. Add a buffer stock (estimated at 25%) x 1.25 29,500 doses 6. Estimate the storage volume (in litres) (a) Citation a. In this example, 1 dose = 2.1 cm3 (1000 cm3 = 1 litre) x 2.1 cm3/1000 62 litres

To prevent errors due to different vaccine presentations, always express needs as the number of doses and not the number of vials (that is, 1,000 doses, not 100 vials).

### Vaccine storage volume

When planning, always consider the volume taken up by:

• vaccines: for cold chain storage needs;
• diluents: they take up the same volume as vaccines, but do not go into the cold chain until 12 to 24 hours before use.

Presentations may vary. The average volume per vaccine dose can range from 2 to 2.5 cm3. Check the volume with the suppliers or, if that is not possible, use the standard volume determined by the WHO (3 cm3 per dose).

Example: a box of fifty 10-dose vials (500 doses) of lyophilised vaccine takes up a total of 18.6 cm x 9.8 cm x 5.8 cm = 1,057 cm3
Thus the volume taken up per dose is 2.1 cm3 (1,057/500).

## 6.2.2 Medical supplies

### Injection supplies

Injection supply needs are based on the number of vaccine doses needed (Appendix 18).

• Count 1 dilution syringe and needle per vial.
• Use only auto-disable syringes (ADS) to administer the vaccine. Allow 5 to 10% wastage due to handling errors.

### Other supplies

• 500 g of cotton wool for every 500 vaccinations
• For vaccinators only: 1 pair of single-use gloves for every 50 injections
• To collect used syringes/needles, use 15-litre safety boxes (about 400 syringes), rather than 5-litre safety boxes (about 100 syringes), if possible.

In sparsely populated areas where fewer people are vaccinated each day, the safety boxes will only be partially filled, so allow for more safety boxes (15% more, for example) for a rural vaccination campaign.

## 6.2.3 Cold chain

### Needs

Needs in terms of the active cold chain (which makes things cold) and the passive cold chain (which keeps them cold) are estimated based on:

• the volume of vaccines to be stored in the refrigerator (expressed in litres);
• the freezing capacity (in kg/24 hours) and storage volume needed for the ice packs;
• the vaccination schedule;
• the cold chain equipment needed at each vaccination site and the maximum number of sites that will be operating simultaneously;
• the cold chain equipment needed for each supervision team and the maximum number of supervision teams working simultaneously;
• existing cold chain equipment available for the campaign.

Cold chain Use Equipment needed Information needed

Active

Storing vaccines
• Refrigerators
• Thermometers
• T° monitoring sheets
• Freeze-tag®
• Total volume of vaccines for the campaign
• Electricity (stability, duration, reliability, security)
Freezing ice packs
• Freezers
• Ice packs
• Thermometers
• T° monitoring sheets
• Freezing volume and capacity needed for the duration of the campaign
• Electricity

Passive

Transporting vaccines/diluents to vaccination sites and storing them there

• Cold boxes + thermometers
• Vaccine carriers
• Ice packs
• Number of cold boxes and vaccine carriers per vaccination team
• Number of vaccination teams and schedule
• Duration of the campaign

### Inventory of available equipment

While a cold chain sometimes needs to be set up quickly from scratch, equipment is often available locally and simply needs to be supplemented. Inventory the equipment available at the various levels before ordering. Verify that the equipment is actually in place and works.

• Refrigerators and freezers: check the available capacities and specify the model, brand, number and energy type. Consider and evaluate other available refrigeration and freezing options such as renting or borrowing equipment, or places that make ice (fisheries, businesses, markets, ice cream manufacturers, etc.).
• Check the electrical systems for reliability, accessibility, quality and security. Check the power and voltage and any potential fluctuations during the day.
• Draw up a list of available generators and indicate which type of fuel they use (e.g., petrol or diesel).
• Cold boxes, vaccine carriers and ice packs: get an inventory of existing equipment at each health care facility. Verify the condition and indicate the type, brand and model and how many there are. Be sure to specify the number of ice packs by volume (0.3-litre, 0.4-litre or 0.6-litre).
• Thermometers, twice-daily monitoring sheets and other cold chain monitoring tools.

See Appendices 19, 20, 21 and 22.

### Cold chain for teams/vaccination sites

Correct storage during transport and at vaccination sites is essential to ensure vaccine quality.

Campaigns require large amounts of ice. The total number of ice packs needed per day is calculated based on the vaccination and supervision team needs (Appendix 23):

• For one vaccination team:
• one RCW25 cold box for storing vaccines and diluents (one cold box may be enough if two teams work at the same site);
• one vaccine carrier for intermediate storage of vaccines and diluents.
• For one supervision team: one cold box (spare vaccines and diluents).

To allow rotation (using/freezing), double the number of ice packs needed per cold box and vaccine carrier.

For calculating storage volume: one frozen 0.6-litre ice pack takes up about 1 litre.

Estimate the total storage volume needed and the freezing capacity (in kg/day) so that there are enough ice packs on the first day of the campaign to ensure a continuous supply for the entire campaign. Always add a safety margin.

## 6.2.4 Vaccination kit

The kit- and module-based supply system simplifies needs calculation and procurement. All of the materials needed are delivered at the same time.

The KMEDKIMM3-- kit (Appendix 24) allows set-up of an emergency vaccination campaign for 10,000 people with 5 vaccination teams.
The kit contains medical and logistics modules.

It can be ordered complete or by module, depending on the strategy chosen, the human resources available and local constraints and resources.

 There are no vaccines in the vaccination kit. They must be ordered separately.

## 6.2.5 Data collection tools

The data collection system should be in place before the campaign begins. The main data entry tools are prepared and the staff trained in their use.

### Vaccination card

At a minimum, the vaccination card should include the last name, first name, age and address of the person vaccinated and the vaccination date. Other information is sometimes requested, such as lot number, vaccine name, gender, vitamin A, etc.

The vaccination card is the only proof of vaccination and should be kept. Different models may be used:

• National immunisation programme card: in this case, make sure that the dose administered during the campaign is clearly identified (specific box or stamp indicating the vaccine and the date).
• Card specific to the current vaccination campaign (Appendix 25). This should be as simple as possible.

### Daily tally sheet

This is used to keep a count of the day’s activity (Appendix 26). The recorder checks off each dose administered by age group (e.g., 6-8 months, 9-11 months, 12-59 months or 5-15 years).

This sheet should also include:

• the vaccination location, site and date;
• the team identifier (for later verification, if needed);
• the number of vaccine and diluent vials received and the lot numbers (for traceability in case there is a problem);
• the supplies received and remaining at the end of the day (for estimating the supplies used);
• the status of the vaccine vial monitors (VVMs) at the end of the day.

### Summary sheets and summary table

Using the tally sheets from the vaccination teams, supervisors compile the data by day or by location on summary sheets (Appendix 27). At the end of the campaign the summary table is used to analyse the results and draft the final report.

• (a)In this example, 1 dose = 2.1 cm3 (1000 cm3 = 1 litre)