Programmatic Impact of Vaccine Presentation (Dose Per Container)

Geographic Scope: Worldwide

Countries: Benin, Democratic Republic of Congo, Cote d'Ivoire, Ghana, Philippines, Senegal, Vietnam, Zambia

Client(s): Bill & Melinda Gates Foundation

Technical Expertise: Immunization, Maternal, Newborn & Child Health

The global effort to protect all children from vaccine preventable disease has historically used multi-dose containers in low and middle income countries in order to offer lower prices, higher supply volumes, and minimize cold chain storage and distribution requirements. As newer, more expensive vaccines are introduced in multi-dose presentations, however, stakeholders are becoming increasingly aware that the burden of cost efficiency moves from the purchaser to the healthcare worker (HCW). In order to achieve maximum utilization of every dose in a container, HCWs need to be strategic about when to open a container, diligent about how they care for open containers, and potentially more active with communication and community outreach to ensure optimal attendance and timely vaccination of every child. This calculation may reduce their willingness to open a container for every eligible child they see. Thus, the number of doses per container (DCP) may also have an impact on the ability to efficiently achieve goals of timely, safe and equitable vaccination coverage.

Given the complexity associated with assessing the trade-offs between cost and health impact, particularly in lower and middle income countries where resources are limited, it is important that immunization stakeholders have the information and tools they need to assess which dose per container presentations are appropriate given a country’s programmatic and financial priorities.


With Bill & Melinda Gates Foundation support between April and October, 2015, JSI Research & Training Institute, Inc. (JSI) identified evidence gaps by interviewing key stakeholders and analyzing existing research. JSI then convened a consultative meeting in July, 2015 that helped create an informal network of partners interested in advancing this work. JSI continues to serve as the coordinating body and technical architect of the next phase of activity which aims to fill the agreed upon list of critical gaps in knowledge, analysis, and processes for decision-making.

The Dose Per Container Partnership (DPCP) is a project, funded by the Bill & Melinda Gates Foundation and implemented by JSI and its partners AMP Services, Clinton Health Access Initiative, the HERMES modeling team and the International Vaccine Access Center (IVAC) through Johns Hopkins University, Bloomberg School of Public Health, and PATH, which aims to address the complexity of vaccine product and program decision-making to include considerations of DPC. Understanding and assessing the trade-offs between cost and health systems impact allows better informed decisions about the impact of the dose per container selected and how that decision would affect coverage (equity, timeliness and session size), wastage rate, cost effectiveness and cost benefit, safety, cold and supply chains , distribution capacity and healthcare worker behavior and needs.

DPCP builds upon and collects additional evidence to assess how DPC choices affect cost / immunization systems tradeoffs (high, equitable, and timely coverage; vaccine wastage; safety; cold chain and supply chain; and HCW behaviors) with primary stakeholders:

a) Global stakeholders: Providing evidence that fills critical gaps in knowledge, analysis, and policy; making processes guiding stake¬holders to make informed, sustainable decisions on DPC when considering vaccine products and program designs; and
b) Country stakeholders: Producing easy-to-use and -understand guides and tools to assess DPC tradeoffs, including cost and systems impact to inform vaccine product selection.


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