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Concept: Supply chain management


Vaccine exposure to temperatures below recommended ranges in the cold chain may decrease vaccine potency of freeze-sensitive vaccines leading to a loss of vaccine investments and potentially places children at risk of contracting vaccine preventable illnesses. This literature review is an update to one previously published in 2007 (Matthias et al., 2007), analyzing the prevalence of vaccine exposure to temperatures below recommendations throughout various segments of the cold chain. Overall, 45 studies included in this review assess temperature monitoring, of which 29 specifically assess ‘too cold’ temperatures. The storage segments alone were evaluated in 41 articles, 15 articles examined the transport segment and 4 studied outreach sessions. The sample size of the studies varied, ranging from one to 103 shipments and from three to 440 storage units. Among reviewed articles, the percentage of vaccine exposure to temperatures below recommended ranges during storage was 33% in wealthier countries and 37.1% in lower income countries. Vaccine exposure to temperatures below recommended ranges occurred during shipments in 38% of studies from higher income countries and 19.3% in lower income countries. This review highlights continuing issues of vaccine exposure to temperatures below recommended ranges during various segments of the cold chain. Studies monitoring the number of events vaccines are exposed to ‘too cold’ temperatures as well as the duration of these events are needed. Many reviewed studies emphasize the lack of knowledge of health workers regarding freeze damage of vaccines and how this has an effect on temperature monitoring. It is important to address this issue by educating vaccinators and cold chain staff to improve temperature maintenance and supply chain management, which will facilitate the distribution of potent vaccines to children.

Concepts: Vaccine, Temperature, Influenza, Segment, Cold, Logistics, Supply chain management, Supply chain


{}This paper investigates a practical variant of the vehicle routing problem (VRP), called VRP with simultaneous delivery and pickup and time windows (VRPSDPTW), in the logistics industry. VRPSDPTW is an important logistics problem in closed-loop supply chain network optimization. VRPSDPTW exhibits multiobjective properties in real-world applications. In this paper, a general multiobjective VRPSDPTW (MO-VRPSDPTW) with five objectives is first defined, and then a set of MO-VRPSDPTW instances based on data from the real-world are introduced. These instances represent more realistic multiobjective nature and more challenging MO-VRPSDPTW cases. Finally, two algorithms, multiobjective local search (MOLS) and multiobjective memetic algorithm (MOMA), are designed, implemented and compared for solving MO-VRPSDPTW. The simulation results on the proposed real-world instances and traditional instances show that MOLS outperforms MOMA in most of instances. However, the superiority of MOLS over MOMA in real-world instances is not so obvious as in traditional instances.

Concepts: Management, Operations research, Transport, Problem solving, Logistics, Supply chain management, Supply chain, Vehicle routing problem


Fraud in the global food supply chain is becoming increasingly common due to the huge profits associated with this type of criminal activity. Food commodities and ingredients that are expensive and are part of complex supply chains are particularly vulnerable. Both herbs and spices fit these criteria perfectly and yet strategies to detect fraudulent adulteration are still far from robust. An FT-IR screening method coupled to data analysis using chemometrics and a second method using LC-HRMS were developed, with the latter detecting commonly used adulterants by biomarker identification. The two tier testing strategy was applied to 78 samples obtained from a variety of retail and on-line sources. There was 100% agreement between the two tests that over 24% of all samples tested had some form of adulterants present. The innovative strategy devised could potentially be used for testing the global supply chains for fraud in many different forms of herbs.

Concepts: Software testing, Supply chain management, Adulterant, Supply chain


The US President’s Emergency Plan for AIDS Relief (PEPFAR) has shifted from an emergency response to a sustainable, country-owned response. The process of transition to country ownership is already underway in the Eastern Caribbean; the Office of the US Global AIDS Coordinator (OGAC) has advised the region that PEPFAR funding is being redirected away from the Eastern Caribbean toward Caribbean countries with high disease burden to strengthen services for key populations. This article seeks to highlight and apply lessons learned from other donor transitions to support a successful transition of HIV programs in the Eastern Caribbean. Based on a rapid review of both peer-reviewed and gray literature on donor transitions to country ownership in family planning, HIV, and other areas, we identified 48 resources that addressed key steps in the transition process and determinants of readiness for transition. Analysis of the existing literature revealed 6 steps that could help ensure successful transition, including developing a clear roadmap articulated through high-level diplomacy; investing in extensive stakeholder engagement; and supporting monitoring and evaluation during and after the transition to adjust course as needed. Nine specific areas to assess a country’s readiness for transition include: leadership and management capacity, political and economic factors, the policy environment, identification of alternative funding sources, integration of HIV programs into the wider health system, the institutionalization of processes, the strength of procurement and supply chain management, identification of staffing and training needs, and engagement of civil society and the private sector. In the Caribbean, key areas requiring strengthening to ensure countries in the region can maintain the gains made under PEPFAR include further engaging civil society and the private sector, building the capacity of NGOs to take on essential program functions, and maintaining donor support for targeted capacity building and long-term monitoring and evaluation efforts.

Concepts: United States, Management, Caribbean, Civil society, Supply chain management, Saint Lucia, Caribbean Community, President's Emergency Plan for AIDS Relief


International efforts to eradicate smallpox in the 1960s and 1970s provided the foundation for efforts to expand immunization programmes, including work to develop immunization supply chains. The need to create a reliable system to keep vaccines cold during the lengthy journey from the manufacturer to the point of use, even in remote areas, was a crucial concern during the early days of the Expanded Programme on Immunization. The vaccine cold chain was deliberately separated from other medical distribution systems to assure timely access to and control of vaccines and injection materials. The story of the early development of the vaccine cold chain shows how a number of challenges were overcome with technological and human resource solutions. For example, the lack of methods to monitor exposure of vaccines to heat during transport and storage led to many innovations, including temperature-sensitive vaccine vial monitors and better methods to record and communicate temperatures in vaccine stores. The need for appropriate equipment to store and transport vaccines in tropical developing countries led to innovations in refrigeration equipment as well as the introduction and widespread adoption of novel high performance vaccine cold-boxes and carriers. New technologies also helped to make injection safer. Underlying this work on technologies and equipment was a major effort to develop the human resources required to manage and implement the immunization supply chain. This included creating foundational policies and a management infrastructure; providing training for managers, health workers, technicians, and others. The vaccine cold chain has contributed to one of the world’s public health success stories and provides three priority lessons for future: the vaccine supply chain needs to be integrated with other public health supplies, re-designed for efficiency and effectiveness and work is needed in the longer term to eliminate the need for refrigeration in the supply chain.

Concepts: Immune system, Public health, Vaccine, Vaccination, Smallpox, Logistics, Supply chain management, Supply chain


The United Nations Population Fund (UNFPA) and the United States Agency for International Development (USAID) DELIVER PROJECT work together to strengthen public health commodity supply chains by standardizing bar coding under a single set of global standards. From 2015, UNFPA and USAID collaborated to pilot test how tracking and tracing of bar coded health products could be operationalized in the public health supply chains of Ethiopia and Pakistan and inform the ecosystem needed to begin full implementation. Pakistan had been using proprietary bar codes for inventory management of contraceptive supplies but transitioned to global standards-based bar codes during the pilot. The transition allowed Pakistan to leverage the original bar codes that were preprinted by global manufacturers as opposed to printing new bar codes at the central warehouse. However, barriers at lower service delivery levels prevented full realization of end-to-end data visibility. Key barriers at the district level were the lack of a digital inventory management system and absence of bar codes at the primary-level packaging level, such as single blister packs. The team in Ethiopia developed an open-sourced smartphone application that allowed the team to scan bar codes using the mobile phone’s camera and to push the captured data to the country’s data mart. Real-time tracking and tracing occurred from the central warehouse to the Addis Ababa distribution hub and to 2 health centers. These pilots demonstrated that standardized product identification and bar codes can significantly improve accuracy over manual stock counts while significantly streamlining the stock-taking process, resulting in efficiencies. The pilots also showed that bar coding technology by itself is not sufficient to ensure data visibility. Rather, by using global standards for identification and data capture of pharmaceuticals and medical devices, and integrating the data captured into national and global tracking systems, countries are able to lay the foundation for interoperability and ensure a harmonized language between global health stakeholders.

Concepts: Health care, Code, Standardization, Barcode, Encodings, Supply chain management, Inventory, Automatic identification and data capture


This paper presents the results of a stepwise investigation of the quantity and quality of food losses along the Swiss potato supply chain. Quantitative data were collected from field trials, from structured interviews with wholesalers, processors and retailers, and from consumer surveys in combination with a 30-day diary study. The “Swiss trade customs for potatoes” pose the basis for the qualitative evaluation of losses. The influences of technological, institutional (business and economy; legislation and policy), and social drivers on the generation of fresh potato and processed potato products losses were assessed. Losses due to quality standards driven by food safety and consumer preferences for certain aesthetic standards have been evaluated too. Across the entire potato value chain, approximately 53-55% of the initial fresh potato production and 41-46% of the initial processing potato production are finally lost. Losses between organic and non-organic supply chains differ from 2% to 5%. From the total initial fresh potato production, 15-24% gets lost during agricultural production, a further 12-24% at wholesalers, 1-3% at retailers, and 15% at private households. In comparison, 5-11% of the initial production gets lost at wholesalers, a further 14-15% during processing, 0% at retailers, and 2% at private households. Losses during agricultural production do not vary much (13-25%) between fresh and processing potatoes. Approximately half of total potato losses occur because potatoes do not meet quality standards. 25-34% of these quality-driven losses are caused by food safety reasons, and the remainder are caused by consumer preferences or suitability for storage. In total, social drivers (e.g., consumer preferences, behavior, or socio-demographical factors) are responsible for two-thirds to three-fourths of all fresh potato losses and 40-45% of all processing potato losses. Technological drivers cause circa one-third of the total processing potato losses. The majority of the rejected potatoes are used as animal feed (67-90%) in Switzerland. Approximately 30% of all fresh potato losses are disposed while just 4-5% of all processing potato losses are thrown away. The interviewed experts stated that lower quality specifications might cause lower loss rates at the first stages of the supply chain but higher ones at the later stages due to worse storage or processing abilities of potatoes with defects, which also might affect proper tubers.

Concepts: Causality, Management, Marketing, Potato, Supply chain management, Production and manufacturing, Supply chain, Value chain


Access to free essential medicines is a critical component of universal health coverage. However availability of essential medicines is poor in India with more than two-third of the people having limited or no access. This has pushed up private out-of-pocket expenditure due to medicines. The states of Punjab and Haryana are in the process of institutionalizing drug procurement models to provide uninterrupted access to essential medicines free of cost in all public hospitals and health centres. We undertook this study to assess the availability of medicines in public sector health facilities in the 2 states. Secondly, we also ascertained the quality of storage and inventory management systems in health facilities.

Concepts: Economics, India, Pharmacy, Supply chain management, States and territories of India, Punjab, Haryana, Punjabi language


From the inception of the Medicare program there have been questions regarding whether and how to pay for durable medical equipment, prosthetics, orthotics, and supplies. In 2011 the Centers for Medicare and Medicaid Services (CMS) implemented a competitive bidding program to reduce spending on durable medical equipment and similar items. Previously, CMS had used prices in an administrative fee schedule to reimburse for these items. We compared prices from Round 1 of the Medicare competitive bidding program, which were established for the periods 2011-13 and 2014-16, to prices paid by national commercial insurers for the same types of items in 2011-14. Our results suggest that the initial years of the program produced prices comparable to those obtained, on average, by large commercial insurers-sophisticated purchasers that presumably were able to negotiate prices with suppliers of durable medical equipment and similar items.

Concepts: Medicare, Centers for Medicare and Medicaid Services, Medicaid, Medicare and Medicaid, Medical equipment, Supply chain management, Commerce, Procurement


Manufacturing organizations' environmental impacts are often attributable to processes in the firm’s upstream supply chain. Environmentally preferable procurement (EPP) and the establishment of environmental purchasing criteria can potentially reduce these indirect impacts. Life cycle assessment (LCA) can help identify purchasing criteria most effective in reducing environmental impacts. However, the high costs of LCA and problems associated with the comparability of results have limited efforts to integrate procurement performance with quantitative organizational environmental performance targets. Moreover, environmental purchasing criteria, when implemented, are often established on a product-by-product basis, without consideration of other products in the procurement portfolio. We develop an approach that utilizes streamlined LCA methods, together with linear programming, to determine optimal portfolios of product impact reduction opportunities under budget constraints. The approach is illustrated through a simulated breakfast cereal manufacturing firm procuring grain, containerboard boxes, plastic packaging, electricity, and industrial cleaning solutions. Results suggest that extending EPP decisions and resources to the portfolio level, recently made feasible through the methods illustrated herein, can provide substantially greater CO2e and water depletion reductions per dollar spend than a product-by-product approach, creating opportunities for procurement organizations to participate in firm-wide environmental impact reduction targets.

Concepts: Operations research, Reducing agent, Manufacturing, Indian Reductions, Supply chain management, Life cycle assessment, Breakfast, Industrial ecology