1. Logistics Management
LSM 730
Lecture 29
Dr. Khurrum S. Mughal

2. Economics of Storage/Handling Alternatives
Private warehousing,
automated handling
Public
warehousing
pallet-forklift truck
handling
Leased warehousing a b c d
Cost to company, $
Annual system throughput, cwt.
Economical range for public warehousing.
Economical range for leased warehousing, manual handling.
Economical range for private warehousing, pallet-forklift truck handling.
Economical range for private warehousing, automated handling.
CR (2004) Prentice Hall, Inc.

3. Activity Fragmentation
in the Supply Chain (Cont’d)
Objectives
President
Marketing
Finance
Operations
More inventory
Frequent & short production runs
Fast order processing
Fast delivery
Field warehousing
Less inventory
Cheap order processing
Less warehousing
Long production runs
Lowest cost routing
Plant warehousing
15-5
CR (2004) Prentice Hall, Inc.

4. The Cold Chain and Logistics:
What does anything else matter if the vaccine isn’t good?
I’ll be presenting a short overview of the cold chain as it works in developing countries. There will be more information and discussion on some of these issues in case studies this week. But for now…..
First I’d like to in brief understand about what you will be doing in your assignments? How many of you will be working on SIAs? How many on polio campaigns? Which of you are working on measles campaigns? Routine immunization strengthening? surveillance or data management only?
Every one of you has as part of your job, some role which requires understanding cold chain practices in the field! What does it matter if the vaccines are no good?
But I’ll need your help because some of you have a lot of experience in maintaining cold chain?
How many of you have worked with assuring cold chain in a difficult area already?
Excellent—so you are my resources
What do we mean by cold chain?
Vaccines are sensitive to heat and freezing and must be kept at the correct
temperature from the time they are manufactured until they are used. The
system used for keeping and distributing vaccines in good condition is called
the cold chain. The cold chain consists of a series of storage and transport
links, all designed to keep vaccines within an acceptable range until it reaches
the user.
Logistics and logistics management include vaccines, equipment and supplies that are needed to support the cold chain?

5. The Cold Chain What do we mean by cold chain?
Vaccines are sensitive to heat and freezing and must be kept at the correct
temperature from the time they are manufactured until they are used. The
system used for keeping and distributing vaccines in good condition is called
the cold chain. The cold chain consists of a series of storage and transport
links, all designed to keep vaccines within an acceptable range until it reaches
the user.
Logistics and logistics management include vaccines, equipment and supplies that are needed to support the cold chain?
Maintenance of the cold chain requires vaccines and diluents to be:
• collected from the manufacturer or an airport as soon as they are available;
• transported between 2ºC and 8ºC from the airport and from one store to another;
• stored at the correct temperature in primary/central and intermediate
vaccine stores and in health facilities;
• transported between 2ºC and 8ºC to outreach sites and during mobile sessions;
• kept between 2ºC and 8ºC range during immunization sessions; and
• kept between 2ºC and 8ºC during return to health facilities from outreach sites.
The figure illustrates the cold chain.
After vaccines reach the health facility you must:
• Keep them between 2ºC and 8ºC in your health facility refrigerator.
• Carry them to the immunization session in a vaccine carrier with frozen ice
packs or ice.
• Keep the vaccines cool using a foam pad in the vaccine carrier while you
immunize the children.

6. Which are most sensitive to heat?
In addition to temperature sensitivity , some vaccines are also sensitive to light. BCG and measles are most affected and should be protected from sunlight.
Any loss of potency due to heat or light is cumulative, permanent and irreversible.

7. Which do you never want to freeze?
Do Not
Freeze
Hepatitis B and the tetanus containing vaccines are most sensitive to freezing and should not be frozen.
OPV, measles, MR and MMR are added in as they are completely insensitive to freezing.
(OPV, Measles, MR, MMR, BCG can be frozen, but not diluents)

8. WHO Recommended Storage Conditions for Vaccines
This slide illustrates the temperatures and time frames for storage at each of the levels of the cold chain for the vaccines. Basically, once delivered to the district level and below, vaccines are kept in the refrigerator compartment. Freezers are used to freeze ice packs only. The correct temperature to store vaccines in a health center is between 2 and 8 degrees C, which in the tropics can only be found in the refrigerator, but there is a margin of safety. If vaccines are kept no lower than 0 degrees or higher than 12 degrees for longer than a week, they may be used.

9. Cold Chain Equipment & Logistics
Refrigerators/Freezers
Generators/ Voltage Stabilizers
Cold Boxes
Vaccine Carriers (Foam Pad)
Ice Packs
Check condition every time you visit a facility!

10. Refrigerators/Freezers
Freezers (-15 to -25 degrees C)
Ice Pack Freezers (24 hours)
Refrigerators (usually w/freezer)
Electric
Ice Lined Refrigerators
Kerosene
LP Gas
Solar
What do you see most often in the field. Rules for refrigerators. More information can be found in the STOP binder, cold chain section, in Immunization Essentials, chapt. 6 and in Immunization in Practice on your resource CD

11. Ice Lined Refrigerators (ILRs)
Can maintain temperature
for 16 hours without power
if operate
w/power continuously
for at least 8 hours a day!
Rules for refrigerators. More information can be found in the STOP binder, cold chain section, in Immunization Essentials, chapt. 6 and in Immunization in Practice on your resource CD

12. Refrigerators/Freezers
Reminders
At least 10 cm from wall
Off the floor
Kept clean, esp. dust in coils
Out of direct sunlight
Only vaccine to be stored.
Opened minimal times per day
Generator or kerosene = good ventilation
Voltage stabilizers to avoid damage to compressors caused by changes in electricity.
Rules for refrigerators. More information can be found in the STOP binder, cold chain section, in Immunization Essentials, chapt. 6 and in Immunization in Practice on your resource CD

13. Storage of Vaccines in Refrigerators
The following two slides illustrate how vaccines should be stored in refrigerators in accordance with their heat and cold sensitivity and air flow within the refrigerator. Vaccines are not to be stored in the bottom shelf as they would be too exposed to cold, and the door should be opened as little as possible to minimize the loss of cold.
It takes 24 hours to freeze ice packs.
Vaccine that come back from a vaccination session, opened or unopened, should be kept in a special section in the middle marked “use first”.

14. Loading top loading refrigerators
This slide illustrates placement of vaccines and icepacks in top loading refrigerators, with considerations of expiry date and heat sensitivity affecting the positioning of various vaccines in the refrigerator.

15. Good or Not Good?
In this refrigerator, they have organized vaccines per local policy as well, but they have added in other medicines. Per WHO policy, if this can be avoided through use of a second refrigerator, it should be. In practice, few health centers will be able to have a second fridge. Staff should be careful to minimize opening the fridge and be especially careful in monitoring that temps do not exceed 8 degrees due to excessive opening to get medicines.

16. Good or Not Good?
This is not uncommon, especially in countries that are engaged in campaigns. Fridges will be filled at or beyond capacity during the weeks before a campaign.

17. What do you do?
These are vials of OPV thrown in the freezer compartment and frozen there. They will be difficult to extract for use.
This fridge should also be defrosted for more efficient operations.

18. Is it working?
This slide is of the condition one often finds equipment in. The voltage regulator and outside box of all this equipment was covered in rust. But with proper adjustment, temperatures could be kept within the safe range. (Muzzafarpur District, India)

19. Cold Boxes Insulated for short–term use: 2-7 days
Used in campaigns or when refrigerator out of order
Consideration for use and storage capacity, outside temperture, available transport
. A cold box is an insulated container that can be lined with ice-packs to keep vaccines and
diluents cold during transportation and/or short period storage (from two to seven days).
Cold boxes are used to collect and transport monthly vaccine supplies from district
stores to the health facility. They are also used to store vaccines when the refrigerator
is out of order or being defrosted and for outreach and mobile sessions in addition to
vaccine carriers.
Different models of cold boxes have different vaccine storage capacities. Health facilities
usually need one or more cold boxes that can hold:
• a one-month supply of vaccines and diluents; and
• a one–to–two week reserve stock of vaccines and diluents.
In addition to their vaccine storage capacity, cold boxes are selected according to their
cold life. Different models have a cold life of two to seven days depending on the
temperature outside.
The most suitable cold boxes for a particular health facility are determined by:
• the vaccine storage capacity needed;
• the cold life needed, that is, the longest time that vaccine will be stored in the box;
• the weight and the volume of the box, which depends on how you will
transport it – by motor vehicle, bicycle, or hand; and
• ice-packs compatible with size of the cold box.

20. Vaccine Carriers and Ice Packs
Like cold boxes, vaccine carriers are insulated containers that, when lined with frozen
ice-packs, keep vaccines and diluents cold during transportation and/or temporary
storage. They are smaller than cold boxes and are easier to carry if walking. But they do
not stay cold as long as a cold box – maximum for 48 hours with the lid closed.
Vaccine carriers are used to transport
vaccines and diluents to outreach sites and
for temporary storage during health facility
immunization sessions. In small health facilities
they are used to bring monthly vaccine supplies
from the district store. Vaccine carriers are also
used to store vaccines when the refrigerator is
out of order or is being defrosted.
Different models of vaccine carriers have
different storage capacities.
A foam pad is a piece of soft foam that fits on top
of the ice-packs in a vaccine carrier. There are some
incisions on it to allow vaccines to be inserted in
the foam. During immunization sessions, the foam
pad serves as a temporary lid to keep unopened
vaccines inside the carrier cool while providing a
surface to hold, protect and keep cool opened vaccine
vials. Previously, ice packs were used to keep
vaccines cool during immunization sessions outside
of vaccine carriers. It is now recommended to
use the supplied foam pads for this purpose.
The type of vaccine carrier a particular health facility needs depends on:
• the type of vaccines and diluents to be transported;
• the number of vaccines and diluent vials, and ice-packs to be carried;
• the cold life required;
• ice-packs compatible with the size of vaccine carrier;
• the means of transport to be used.
Ice packs should be placed around the outside. Cold sensitive vaccines should not be placed in the bottom, as cold air accumulates there. Removing the lid is not as damaging as opening the door of a refrigerator, because of this accumulation of cold air at the bottom.
It takes 24 hours to freeze ice packs.
Directions for packing vaccine carriers.
1 At the beginning of the day of the session, take all the frozen ice-packs you need
from the freezer and close the door.
2 Condition frozen ice-packs properly, by allowing ice-packs to sit at room temperature
until ice begins to melt and water starts to form. You should check
to see if an ice-pack has been conditioned by shaking it and listening for water.
This will prevent freeze-sensitive vaccines from freezing.
3 Put conditioned ice-packs against each of the four sides of the cold box or vaccine
carrier and on the bottom of the cold box if required.
4 Put the vaccines and diluents in the middle of the cold box or carrier.
5 Include a freeze indicator in the packing with the vaccines,
6 In vaccine carriers, place a foam pad on top of the conditioned ice-packs. In cold
boxes, place conditioned ice-packs on top of the vaccines.
7 Close the cold box or carrier lid tightly.

21. Good or Not Good?
Like cold boxes, vaccine carriers are insulated containers that, when lined with frozen
ice-packs, keep vaccines and diluents cold during transportation and/or temporary
storage. They are smaller than cold boxes and are easier to carry if walking. But they do
not stay cold as long as a cold box – maximum for 48 hours with the lid closed.
Vaccine carriers are used to transport
vaccines and diluents to outreach sites and
for temporary storage during health facility
immunization sessions. In small health facilities
they are used to bring monthly vaccine supplies
from the district store. Vaccine carriers are also
used to store vaccines when the refrigerator is
out of order or is being defrosted.
Different models of vaccine carriers have
different storage capacities.
A foam pad is a piece of soft foam that fits on top
of the ice-packs in a vaccine carrier. There are some
incisions on it to allow vaccines to be inserted in
the foam. During immunization sessions, the foam
pad serves as a temporary lid to keep unopened
vaccines inside the carrier cool while providing a
surface to hold, protect and keep cool opened vaccine
vials. Previously, ice packs were used to keep
vaccines cool during immunization sessions outside
of vaccine carriers. It is now recommended to
use the supplied foam pads for this purpose.
The type of vaccine carrier a particular health facility needs depends on:
• the type of vaccines and diluents to be transported;
• the number of vaccines and diluent vials, and ice-packs to be carried;
• the cold life required;
• ice-packs compatible with the size of vaccine carrier;
• the means of transport to be used.
Ice packs should be placed around the outside. Cold sensitive vaccines should not be placed in the bottom, as cold air accumulates there. Removing the lid is not as damaging as opening the door of a refrigerator, because of this accumulation of cold air at the bottom.
It takes 24 hours to freeze ice packs.
Directions for packing vaccine carriers.
1 At the beginning of the day of the session, take all the frozen ice-packs you need
from the freezer and close the door.
2 Condition frozen ice-packs properly, by allowing ice-packs to sit at room temperature
until ice begins to melt and water starts to form. You should check
to see if an ice-pack has been conditioned by shaking it and listening for water.
This will prevent freeze-sensitive vaccines from freezing.
3 Put conditioned ice-packs against each of the four sides of the cold box or vaccine
carrier and on the bottom of the cold box if required.
4 Put the vaccines and diluents in the middle of the cold box or carrier.
5 Include a freeze indicator in the packing with the vaccines,
6 In vaccine carriers, place a foam pad on top of the conditioned ice-packs. In cold
boxes, place conditioned ice-packs on top of the vaccines.
7 Close the cold box or carrier lid tightly.

22. Effect of melted ice packs in vaccine carriers on labels
This is to illustrate the labels coming off after repeated trips in the cold box.

23. Tools for monitoring temperature
Temperature monitoring cards
Temperature monitoring charts
Shake test
Vaccine Vial Monitors (VVM)

24. Temperature monitoring chart for facilities
Using the kinds of tools illustrated in the previous slides, a chart such as this one can be generated by facilities to record the temperature of a refrigerator 2x/day.
The monitoring chart should also show maintenance that has been performed, repairs and other.

25. Shake Test (for freeze sensitive vaccines)
The shake test is used to see if a vaccine vial is frozen, which is important for Hep B and tetanus containing vaccines.
To perform the shake test, take a vaccine vial of the same type, manufacturer and
batch number as the vaccine vial you want to test. Freeze the vial for at least 10
hours at -10°C until the contents are solid, and then let it thaw. This vial is the “control”
sample and should be labeled as “frozen” to avoid its use for vaccination.
Then take a vaccine vial from the batch that you suspect has been frozen. This is the
“test” sample. Vigorously shake the control and test samples for 10 seconds, place
both vials on a flat surface to rest, and continuously observe them over the following
20 minutes.
View both vials against the light to compare the rate of sedimentation. If the test
sample shows a much slower sedimentation rate than the control sample, the test
sample has probably not been frozen and may be used.
However, if the sedimentation rate is similar and the test sample contains flakes,
the test sample has probably been damaged by freezing and should be withdrawn
from use. The health worker must notify the supervisor immediately to ensure that
any other damaged vials are also identified and withdrawn from use.

26. Vaccine Vial Monitor (VVM)
VVMs are used in certain areas of the world, including Asia and Africa. They change color at temperatures specific to the vaccine. For example, a VVM will change color for OPV, the most heat sensitive of vaccines, if a vial is kept at 37 degrees C for 2 days. However, for TT, will change if kept for 30 days at 37 degrees.

27. VVMs on Vaccines
2 vaccine vials with VVMs indicating that they are acceptable for use are shown.

28. Cold Chain in Campaign Setting

29. Cold Chain in Campaign Setting - Polio
Ice Pack Freezing/Assuring Power Source
Sunlight is harmful for OPV vaccine
Heavy reliance on VVM
Usually use 4 ice packs but in some countries, fewer ice packs OK
Ice is acceptable if no other choice
Try to protect vials from wet
Can keep vials out of vaccine carrier as needed until VVM turns—especially when using vaccine carriers for more than 1 day and need to preserve the temperature.
Check VVM each time before putting drops in child’s mouth!

30. Cold Chain in Campaign Setting - Measles
Sunlight is harmful for measles containing vaccine
Diluent should be cooled before mixing with vaccine
After reconstitution
Keep the vial out of the light
Keep the vial as cool as possible without freezing it
Use foam pad to keep open vial whenever available
Vaccine should not be pre-drawn
Reconstituted vaccine discarded by 6 hours after adding diluent
Sunlight is harmful for measles containing vaccine
Measles vaccine can’t be frozen
Measles vaccine is not stable if it reaches room temperature
In the absence of VVM, countries should adhere to WHO policy that vaccine must be used in 6 hour session

31. Agility, A New Logistics Leader
Efficient Supply Chain Services and
Introduction of Agility Logistics
Agility, A New Logistics Leader
Meeting the Challenges of Global Trade

32. Supply Chain Solutions

33. Introducing Agility 33 33

34. Our name may be new to you, but we have a long history.34 34

35. The Scale of Our Business
Founded in 1979
550+ offices
100+ countries
$6.2 billion revenue (USD)
Over 32,000 employees
Top ten logistics provider
Publicly traded
6000+ owned vehicles and transport assets
10 million square meters of warehousing space
800,000 pallet positions 35 35

36. Supply Chain Management (SCM)
The strategy, processes, people, technologies and resources responsible for ensuring the flow of materials and services necessary to deliver an organization’s value to its end-user customers.
SCM solution has emerged as a key differentiator for gaining competitive advantage. The on going search for cost control and value creation has impelled organization to turn to SCM to achieve bottom line results.
Some more information on our company’s history:
Founded in 1979
Transformation in 1997, led by our current chairman
From less than 50 offices in 2000 to over 450 offices in 2005
Now a top ten logistics providers worldwide

37. Efficient Supply Chain enabling to be proactive then reactive through seamless flow of information in the chain
Visibility
Consumer
Sourcing & Order Management
Packaging
Planning, Booking & Pre-alerts
Vendor Co-ordination
Custom Brokerage
Inventory
WMS
Distribution
Transportation
Store Operations
Consumer $
Integrated Information Systems

38. Non-integrated information sharing
An everyday situation … “Where is the Shipment/Order?”
You & your offices ?
Agility partners
Your customers
Your suppliers
several airlines
Handling agents
Warehouses

39. Integrated Information Sharing
You & your offices
Customer offices
End customers
EDI
Agility Warehouses
Suppliers
Agility partners
Airlines
Handling agents

40. Put-away
Identify Product
Identify Location
Move Product
Update WMS
Storage
Equipment – MHE
Stock Location
Receiving
Schedule Carrier
Unload Vehicle
Inspect Damages
Compare to ITS
Shipping
Schedule Delivery
Load vehicle
Check commodity
WMS Update
Order Picking
SO – Pick List
Proceed to staging
area

41. Warehouse Management System (WMS)
Why use a dedicated WMS?
Reduced investment
Systems support
Software development
More detailed inventory visibility
Not only is it in the facility, but is it available
Improve Customer service
Shorter Cycle Time of Orders
Better utilization of resources
Increase Productivity
Inventory reduction
Lower inventory cost
Better utilization of Space
Increases accuracy of Orders