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 / Autumn 2008 / Issue 52(originally published by Booz & Company)


Smarter Medicine

Lamont had the idea to schedule four regional town hall meetings to reach out to all 64 of the state and municipal vaccine distributors. In order for Lamont to present the recommendations and get feedback from the health-care specialists, the town hall meetings took place over the course of a day and a half. They were usually held at a small hotel near an airport to make the meetings as accessible as possible. At these meetings, he would briefly lay out the ideas to a group of about 20 to 25 people.

Seasoned public health advisor Brock Lamont had become a fan of centralized
third-party distribution.
Photograph © John Nowak

Displaying diplomacy, Lamont was careful to be respectful of the miraculous results that state and local health workers had already accomplished in getting their immunization programs to function as well as they had. Feedback that Lamont heard over and over again from the program managers was that the team’s initial idea of deploying a centralized call center for the centralized distribution system was terrible; accepting vaccine orders from doctors’ offices was one of the few direct points of contact the managers had with health workers. Without this regular opportunity for contact with health workers, they worried that whatever relationship and leverage they had developed to promote new vaccination programs (ultimately to do their job of improving immunization coverage) would be diminished. Lamont heard the complaint and relayed the message. The call center concept was killed.

To cover all their bases, Lane and Lamont briefed the four vaccine manufacturers involved in the program, as well as the American Academy of Pediatrics and the Association of Immunization Managers. By the fall of 2004, Lane, Lamont, and the rest of the team were ready to start implementing their plan. Initially, that meant finding a vendor that could handle the centralized distribution system. Given its size, the procurement took more than a year. One of the key players in that process was Reginald Mebane, the chief management officer in the CDC’s Coordinating Center for Infectious Diseases.

Mebane came to the CDC after 25 years in operations with the FedEx Corporation. Lane would fall back on Mebane’s private-sector expertise again and again. While some health workers were worrying about such third-party details as where the company would position the thermometers in the refrigerators, Mebane hammered away on operations and the critical issue of good customer service. “My background is operations management, so my number one concern is answering questions like, What do you do to make sure you have continuity of operations?” Mebane says. “What is your plan for recruiting and making sure that your workforce is in place? What if the subcontractor you’re working with has a strike? How do you ensure good customer service? How do you take calls after hours? How do you deal with customers when you don’t have power? It really doesn’t matter whether it’s government or private sector, the concept is still the same.” In late 2006, with the input of Mebane and others, the multimillion-dollar, five-year contract for the distribution of an estimated 72 million doses of vaccine per year was awarded to McKesson Specialty, a business unit of McKesson Corporation based in Texas.

When McKesson decided to go after the VFC business, the team sent to pitch the company’s qualifications was well prepared to discuss the intricacies of supply chain management. After all, this was a division of a Fortune 50 company with customers that included the Department of Veterans Affairs and Wal-Mart. McKesson Specialty, a relatively young and small part of the corporation’s business, focuses on the just-in-time distribution of fragile and highly valuable drugs to private hospitals and physicians. So taking on the distribution of fragile children’s vaccine was, in theory, very similar to what the division was already doing for its private-sector customers. However, the team from McKesson quickly found out that working with the CDC was going to be unlike working with Wal-Mart or any other private-sector customer with which they had experience.

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  1. Bill Jackson and Conrad Winkler, “Building the Advantaged Supply Network,” s+b, Fall 2004: Collaborative strategies with examples from aircraft, consumer products, and auto manufacturers, plus advice for step-change planners.
  2. Dan Jones and Jim Womack, Seeing the Whole: Mapping the Extended Value Stream (Lean Enterprise Institute, 2000): Practice guide with diagrams and techniques for mutual analysis and lean thinking.
  3. Keith Oliver, Dermot Shorten, and Harriet Engel, “Supply Chain Strategy: Back to Basics,” s+b, Fall 2004: The best practices of companies that do supply chain management well. 
  4. Association of Immunization Managers Web site: Further information about immuni­zation policy development, partnerships, programs, and program management.
  5. Centers for Disease Control and Prevention Web site: Provides background and resources on the CDC’s goals and operations, including detailed information on vaccine and immunization programs.
  6. For more articles on supply chains, sign up for s+b’s RSS feed.
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