Table 1.

Ten recommendations to help decision makers better understand and address vaccine supply chains.

Recommendations	Examples of possible actions
1. Raise awareness of supply chain issues	• More vaccine supply studies in the scientific literature • More stories on supply chains in the general media (e.g. news stories and documentaries) • Policy briefs and reports on supply chain issues for decision makers • Social media efforts focused on supply chain issues • More supply chain ‘‘evangelists”, thought leaders, and spokespeople
2. Educate and train various decision makers on supply chain principles and practices	• Incorporating supply chain courses into curricula for public health, medicine, and public policy degree programs • Up-to-date textbooks and other educational materials on supply chains for those not in the supply chain field • Intensive short courses for professionals at all career levels • Incorporating systems methods such as computational simulation modeling into courses and course material • Alternative learning methods and approaches such as workshops, online courses, etc.
3. Incorporate supply chain experts and considerations into all vaccine decision making	• Including supply chain experts at all stages of vaccine development and decision making (e.g. inclusion on committees and regulatory bodies) • Including impact on supply chains as a key outcome measure when evaluating different vaccine technologies, policies, and strategies • Utilizing computational modeling to understand the impact of the supply chain on decisions and vice versa
4. Improve communication between vaccine decision makers and vaccine supply chain experts	• Integrating supply chain experts into different committees, conferences, meetings, etc. • Establishing online data sharing sites and communications portals where decision makers and supply chain experts can collaborate • Harmonizing language between the supply chain world and other vaccinerelated disciplines
5. Develop computational simulation models of global and country-level supply chains to serve as virtual laboratories to help evaluate supply chains and test different policies, interventions, and technologies	• Providing resources for computational modeling efforts at every stage of vaccine development and decision making • Integrating computational modeling in different types and stages of vaccine decision making • Making computational modeling tools available to decision makers
6. Establish as a condition of major vaccine-related decisions (e.g. funding, new policy change, new vaccine introduction, etc.) the mapping and modeling of the relevant supply chain and the impact and value of the new policy, intervention, technology, or funds	• Writing such as requirement into requests for proposals, applications, or other decision-making documents • Next steps should be contingent on the mapping/modeling results, which in turn can guide future decision-making • Establishing mechanisms for periodic updating of such maps and models
7. Utilize supply chain models and other analyses to generate target product profiles (TPPs) to guide the design and development of new technology	• Establishing TPPs for all desired and new technologies • Supply chains impact and impact of the supply chain should be part of these TPPs • TPPs serve as blueprints for new technology development
8. Develop a database of vaccine decisions and how supply chain considerations and changes affected these decisions	• Database can include each occasion a major vaccine and supply chain related change is made • Database can help decision makers understand what succeeded and what did not and the relative challenges, obstacles, and benefits • Living database can evolve as more and more case studies are entered
9. Develop and disseminate a playbook on how a country’s supply chain can be approached and improved when making vaccine decisions	• Step-by-step guide on how to evaluate and improve a vaccine supply chain (e.g. map and model the supply chain, identify bottlenecks, constraints, and data gaps, collect needed data, test different changes, policies, and interventions first in the models and then in pilot studies, implement changes, establish monitoring and learning system) • Testing and revising playbook in a set of exemplar countries to serve as a blueprint for other places • Conducting workshops, courses, etc. to train decision makers on use of the playbook
10. Begin implementing these changes systematically in countries, documenting and disseminating their effects, impact, and value	• Using observational studies, modeling, and other approaches to estimate the impact of changes (e.g. efficiency and disease effects) and identify challenges and potential improvements of the process • Publishing reports and scientific literature containing details of each re-design process (including stakeholder engagement, implementation, and impact evaluation) and lessons learned to guide decision makers in future re-design efforts