Customizing immunization clinic operations to minimize open vial waste

•Vaccine clinics can reduce wastage by adjusting their hours of operation.•Focus first on increasing guaranteed hours and second on session frequency.•Coverage is sensitive to session frequency for large vial sizes.•Appealing, easy to implement heuristics perform favorably even in the presence of random vial yield.•Potential cost savings are large.

Many multi-dose vaccine vials must be used within hours of reconstitution; unused doses are discarded as “open vial waste.” Building on Mofrad et al. (2014), we evaluate operating strategies that maximize coverage by controlling open vial waste. We define novel metrics for determining thresholds on vaccination clinic operating hours and session frequency. We study the performance of optimal and heuristic policies in the presence of random vial yield. Cost analyses indicate significant potential savings. Because optimal strategies are context specific, we also develop a decision support tool (available online) to easily replicate the analysis for any problem setting.