Implementing 4 × 4 truck loops at the lowest level brought greater savings than the Commune level-removed with six Departments scenario (Table 1). Nonetheless, operating costs remained higher than those of comparable Health Zone plus 4 × 4

truck loop scenarios. Our study provides a strong case for supply chain redesign for Benin, potentially saving both capital expenditures and recurrent operating costs by eliminating redundancies in equipment, personnel, locations, Nutlin 3a and routes. Also, our work demonstrates the value of multiple concomitant synergistic changes. While implementing 4 × 4 truck loops alone provided no appreciable advantages and shifting to the Health Zone structure alone did not lower operating costs, combining the two changes (Health Zone plus 4 × 4

truck loops) resulted in the prevailing outcome of lower capital expenditures and lower operating costs, since consolidating Commune level storage locations lengthens distances from Health Posts and yields more Health Posts per Zone, thereby increasing efficiency gains from using 4 × 4 truck loops. A computational model of Benin’s vaccine supply chain can help show the complex economic and operational impact of multiple simultaneous changes, prior to their implementation. Even a seemingly small $0.03 per dose change in costs SRT1720 mouse could cumulatively result in substantial cost savings over time (Table 3). Like others, our model is a simplification of reality and incorporates assumptions such as a Poisson distribution projected from census and birth rate for daily demand, which does not account for potential seasonal variation.[16] and [17] Our scenarios assume that equipment can be readily redistributed.

We do not include the cost of vaccines and thus resulting costs for vaccine wastage; we also exclude all existing building-related expenses other than annual depreciation. In the Republic of Benin, HERMES-generated computational models enabled the evaluation of various vaccine supply chain redesign options. Of the options considered, converting to the Health Zone structure together with implementing shipping loops from among the Health Posts resulted in both the lowest capital expenditures and the lowest operating costs. This demonstrated the potential value of simplifying the supply chain and the synergistic benefits of combining changes in the supply chain. We would like to acknowledge the valuable assistance of Justin Adanmavokin Sossou of the Beninese Ministry of Health, Ndèye Marie Bassabi-Aladji, Evariste Tokplonou, and Justin K. Djidonou from the Agence Nationale des Vaccinations et des Soins de Santé Primaires (National Agency for Vaccinations and Primary Healthcare). This work was funded by the Bill and Melinda Gates Foundation.