See discussions, stats, and author profiles for this publication at: https://www.researchgate.

net/publication/257356316

Epidemics control and logistics operations: A review

Article  in  International Journal of Production Economics · October 2012

DOI: 10.1016/j.ijpe.2012.05.023

CITATIONS READS

130 14,439

3 authors:

Thomas K. Dasaklis Costas P. Pappis

University of Piraeus University of Piraeus
41 PUBLICATIONS   1,085 CITATIONS    108 PUBLICATIONS   3,550 CITATIONS   

SEE PROFILE SEE PROFILE

Nikolaos Rachaniotis
University of Piraeus
31 PUBLICATIONS   474 CITATIONS   

SEE PROFILE

Some of the authors of this publication are also working on these related projects:

Blockchain View project

Special Issue "Integrating the Internet of Things and Blockchain-Enabled Applications: Current Practices, Opportunities and Challenges" View project

All content following this page was uploaded by Thomas K. Dasaklis on 31 July 2018.

The user has requested enhancement of the downloaded file.

This article appeared in a journal published by Elsevier. The attached
copy is furnished to the author for internal non-commercial research
and education use, including for instruction at the authors institution
and sharing with colleagues.
Other uses, including reproduction and distribution, or selling or
licensing copies, or posting to personal, institutional or third party
websites are prohibited.
In most cases authors are permitted to post their version of the
article (e.g. in Word or Tex form) to their personal website or
institutional repository. Authors requiring further information
regarding Elsevier’s archiving and manuscript policies are
encouraged to visit:
http://www.elsevier.com/copyright
 Author's personal copy

Int. J. Production Economics 139 (2012) 393–410

Contents lists available at SciVerse ScienceDirect

Int. J. Production Economics

journal homepage: www.elsevier.com/locate/ijpe

Epidemics control and logistics operations: A review

Thomas K. Dasaklis n, Costas P. Pappis, Nikolaos P. Rachaniotis
University of Piraeus, Department of Industrial Management and Technology, 80 Karaoli & Dimitriou Str., 18534 Piraeus, Greece

a r t i c l e i n f o abstract

Article history: Outbreaks of epidemics account for a great number of deaths. Communicable or infectious diseases are
Received 15 September 2010 also a major cause of mortality in the aftermath of natural or man-made disasters. Effective control of
Accepted 17 May 2012 an epidemic outbreak calls for a rapid response. Available resources such as essential medical supplies
Available online 28 May 2012
and well-trained personnel need to be deployed rapidly and to be managed in conjunction with
Keywords: available information and financial resources in order to contain the epidemic before it reaches
Epidemics control uncontrollable or disastrous proportions. Therefore, the establishment and management of an
Emergency supply chains emergency supply chain during the containment effort are of paramount importance. This paper
Epidemics control logistics focuses on defining the role of logistics operations and their management that may assist the control of
epidemic outbreaks, critically reviewing existing literature and pinpointing gaps. Through the analysis
of the selected literature a series of insights are derived and several future research directions are
proposed. In conclusion, this paper provides both academics and practitioners with an overview of
literature on epidemics control and logistics operations aiming at stimulating further interest in the
area of epidemics control supply chain management.
& 2012 Elsevier B.V. All rights reserved.

1. Introduction bioterrorist actions and the release of biological warfare agents

Among disasters, outbreaks of epidemics account for excessive
damages of human and material capital, including a great number of
deaths. Polio, smallpox, cholera and HIV are among the diseases that
continue to pose a threat for many developing and developed
countries. Human history is full of public health incidents where
pandemics occurred in a certain period of time causing suffering and
death. For example, plague epidemics in late Medieval Europe
characterized by high mortality rates caused many fatalities, while
the 1918–1919 Spanish influenza pandemic killed an estimated 20
to 50 million people worldwide (Benedictow, 1987; Tumpey et al.,
2005). Epidemic outbreaks may occur in the context of natural
causes such as the recent outbreak of novel influenza A(H1N1) virus
where, according to the World Health Organization (WHO), from the
start of the pandemic until May 28, 2010, the virus had already
spread over 214 countries causing 18,114 deaths (http://www.who.
int/csr/don/2010_05_28/en/index.html). Epidemic outbreaks are
also very common in the aftermath of natural disasters. Acute
respiratory infections, measles, malaria and diarrhea are the most
prevalent infectious diseases after natural disasters and all of them
are closely related to unsanitary health conditions and malnutrition
of the population affected (Watson et al., 2007). Finally, deliberate
n
Corresponding author. Tel.: þ30 2104142150; fax: þ 30 2104142629.
E-mail addresses: dasaklis@unipi.gr (T.K. Dasaklis),
pappis@unipi.gr (C.P. Pappis), nraxan@unipi.gr (N.P. Rachaniotis).
could also lead to epidemic outbreaks. According to Henderson
(1999) smallpox and anthrax are considered to be among the two
most feared biological agents that could be used in a probable
bioterrorist attack ‘‘as they have the potential to be grown reason-
ably easily and in large quantities and are sturdy organisms that are
resistant to destruction’’. The anthrax attacks of 2001 in the United
States demonstrated the threat of a possible bioterrorist action and
its severe impacts.
The importance of addressing epidemic outbreaks nowadays is
even greater as the general framework in which they may occur
has dramatically changed during the last years. New challenges
have arisen and certain drivers like climate change, population
density and urbanization could serve as catalysts for the accel-
eration of pandemic incidents. Climate change is expected to play
a crucial role in the birth and transmission of specific diseases
(McMichael, 2003). Many studies suggest that diseases such as
yellow fever, dengue and cholera are re-emerging due to climate
change among other factors (Shope, 1991). Specific arbovirus
diseases have recently emerged outside their usual endemic
range and this could be attributed to changes in climate patterns
(Gould and Higgs, 2009). Apart from climate change, the wit-
nessed rapid urbanization of the world’s population along with a
substantial growth in general population could lead to acceler-
ated epidemic outbreaks, rendering socioeconomic systems even
more vulnerable. A possible outbreak combined with changes in
demographic conditions like population distribution, size and
density could potentially lead to a pandemic of unprecedented

0925-5273/$ - see front matter & 2012 Elsevier B.V. All rights reserved.
http://dx.doi.org/10.1016/j.ijpe.2012.05.023
 Author's personal copy
394 T.K. Dasaklis et al. / Int. J. Production Economics 139 (2012) 393–410
proportion where available capacities and resources could be
strained to their limits.
The control of an epidemic’s outbreak calls for a prompt
response. Certain control protocols should be followed and huge
amounts of supplies together with the necessary human
resources (medical and other personnel) should be available in
order to be utilized during the containment effort. For example, if
a smallpox attack happens, vaccination of the affected population
should take place within 4 days while in the case of an anthrax
outbreak the distribution of antibiotics should take place within 2
days of the event (Lee, 2008). As a consequence, any control of an
epidemic’s outbreak should rely on the establishment of an
emergency supply chain as a plethora of logistics issues is raised
according to the control strategy adopted and the very nature of
the agent triggering the outbreak. All the logistics operations such
as transportation of medical supplies and commodities or the
deployment of medical personnel must be managed in conjunc-
tion with available information and financial resources in order to
contain the epidemic before it reaches critical proportions. This is
the reason why leading international health organizations like
World Health Organization and the Pan American Health Organi-
zation explicitly recognize the importance of logistics operations
to any successful health task undertaken for the control of an
outbreak. A basic component of the World Health Organization’s
Epidemic and Pandemic Alert and Response program addresses
logistic issues in order ‘‘to provide operational assistance in the
ongoing management of logistics required for epidemic and pandemic
preparedness and response and for the rapid deployment of medical
and laboratory supplies, transport, communications as well as the
rapid deployment of outbreak response teams’’ (http://www.afro.
who.int/en/divisions-a-programmes/ddc/epidemic-a-pandemic-a
lert-and-response/programme-components/logistics.html). Inter-
national aid organizations, like the United States Agency for
International Development (USAID), also pay attention to logis-
tical issues in the case of epidemic outbreaks control. The
USAID9DELIVER PROJECT, Task Order 2-Supply Chain Manage-
ment for Outbreak Response supports USAID’s efforts to mitigate
existing and emerging pandemic threats by procuring, stock-
piling, and distributing outbreak response commodities (http://
deliver.jsi.com/dhome/topics/health/outbreakresponse).
Although logistics operations are very important for control-
ling an epidemic’s outbreak, the scientific community has yet to
produce a large amount of well-established approaches that
explicitly incorporate epidemics logistics features. Even further,
issues of appropriately managing epidemics logistics operations
have been paid limited attention. So far, epidemics logistics
operations have been seen through the lens of resource allocation
or have been implicitly incorporated as qualitative variables into
preparedness and response plans. For example, a considerable
volume of scientific research has been conducted in the case of
resources allocation for the control of infectious diseases
(Brandeau, 2005; Rachaniotis et al., 2012; Zaric and Brandeau,
2001,2002) or in the case of developing preparedness and
response plans for health-care facilities to deal with epidemic
outbreaks (Ammon et al., 2007; Ippolito et al., 2006; Rebmann
et al., 2007; Savoia et al., 2009; Webby and Webster, 2003). While
resource allocation models and contingency plans provide a
strong insight towards epidemics control, they often overlook
some critical aspects: allocation of resources cannot be accom-
plished unless the availability of these resources is assured at the
right time, right place and right quantity. In addition, contingency
plans often overlook critical logistical parameters like patient
flow logistics and the availability of workforce and, therefore,
several decision variables related to possible bottlenecks or
workforce shortages are omitted. Results of many full-scale
exercises have shown that logistics poses a real challenge when
controlling an epidemic outbreak (Aaby et al., 2006). Logistical
barriers could also be apparent even when establishing a simple
quarantine program in terms of transferring supplies across
quarantine lines, recruiting qualified medical personnel etc.
(Barbera et al., 2001).
The aforementioned gap in the literature concerning epidemics
logistics operations and their management has been our main driver
for conducting this review paper. Our scope is to shed light into the
general context of emergency supply chain management in the case
of epidemics containment. Thus the objectives of the paper may be
summarized as follows:
 To define and inter-correlate the logistics operations taking
place during the containment of an epidemic.
 To find to what extent literature has produced a critical mass
of scientific work in terms of methodologies applied and
research techniques utilized regarding the issues of epidemics
control logistics.
 To determine whether the methodologies applied in business
logistics problems could be utilized in the context of epidemics
control logistics (e.g. Operational Research methods utilization
etc.).
 To develop a more robust definition of the epidemics control
supply chain and enhance its understanding.
 To look for trends in epidemics control supply chain manage-
ment academic research and to propose areas for further
investigation.
The remainder of the paper is structured as follows: in Section 2
some key concepts of emergency and humanitarian supply chain
management are outlined. Section 3 provides an overview of the
research methodology utilized for the purposes of the review and
the boundaries of our research. In Section 4 an inventory of the
logistics operations taking place during the control of an epidemic
is developed. Section 5 deals with the analysis and classification of
the selected literature regarding epidemics logistics operations. In
Section 6 the main findings of the review are discussed. Finally, the
paper ends with some concluding remarks and suggestions for
future research directions.
2. Epidemics control and emergency supply chain
management
The control of infectious diseases may be based on measures
adopted at international, national, provincial or even community
level. Reducing the rate by which susceptibles become infected,
reducing the mortality rate for those already infected and increas-
ing the immunization capacity of the population comprise the
main objectives of any containment effort. Such control measures
demand the launching of vaccination or quarantine programs
over certain geographic regions. They also call for interventions
that will ensure the provision of medical supplies like antiretro-
viral drugs, antibiotics, clean water/adequate sanitation and
better nutrition conditions in order that the multiplication of
the infectious agent be reduced. Control measures could be
adopted with the aim either to prevent the spread after the
initiation of an infectious disease (as pre-event measures) or to
control a confirmed outbreak (post-event measures). In the first
case, a certain level of medical supplies should be kept in order to
be utilized immediately at the initiation of an epidemic. In the
second case the deployment of all the available resources should
rapidly take place providing either treatment to those already
infected or prophylaxis to those susceptible to the agent triggering
the outbreak.
 Author's personal copy
T.K. Dasaklis et al. / Int. J. Production Economics 139 (2012) 393–410
It is therefore evident that the control of any epidemic out-
break should be based on the establishment of an emergency
supply chain as physical movement of large amounts of medical
supplies takes place. For example, manufacturers should produce
vaccines, antiretroviral drugs and complementary medical sup-
plies. Governments and public health institutions should pur-
chase and stockpile well in advance a plethora of such supplies for
a possible outbreak. During the containment effort transportation
and distribution of these supplies from central warehouses to
regional store sites and then to local Points of Dispensing (POD)
will have to take place. In the case of vaccines, a cold supply chain
must be established to assure that vaccines are transported,
stored and packed in accordance with manufacturers’ instructions
(stable temperature). Affected people will proceed to treatment
centers where patient flow operations along with dispensing
activities of the medical supplies should be managed appropri-
ately. Reverse logistics activities should also take place as dan-
gerous wastes must be treated carefully or disposed of in such a
way that they do not pose a threat for the medical personnel and
people engaged in the containment effort. In addition, coordina-
tion issues across the entire emergency supply chain arise.
Manufacturers, governments, primary health care institutes and
possibly military agencies are few among many players that
should be coordinated during the control effort. Finally, managing
the information regarding the demand for medical supplies as
well as the flow of funds is also critical. In Fig. 1 an End-to-End
approach of the epidemics control supply chain is depicted. Note
that the reverse flow may refer to only a part of the medical
supplies.
The outbreak of an epidemic can be related to a high rate of
mortality, thus it may be characterized as a disaster. Disaster
Operations in general are a set of activities that are performed
before, during and after a disaster with the goal of preventing loss
of human life, reducing its impact on the economy and returning
to a state of normalcy (Altay and Green Iii, 2006). Disaster
management is ‘‘an applied science which seeks, by the systematic
observation and analysis of disasters, to improve measures relating to
prevention, mitigation, preparedness, emergency response and recov-
ery’’ (Pettit and Beresford, 2005).
Recent studies have demonstrated the contribution of appro-
priate management of disasters to save or offer relief to as many
people as possible. According to Kovacs and Spens (2007) an
emergency or humanitarian supply chain encompasses a range of
activities, including preparedness, planning, procurement, trans-
port, warehousing, tracking and tracing and customs clearance.
Humanitarian logistics is an umbrella term for a mixed array of
operations, from disaster relief to continuous support for devel-
oping regions, and could be defined as the process of planning,
implementing and controlling the efficient, cost effective flow and
storage of goods and materials as well as related information from
Fig. 1. Materials flow of the epidemics control supply chain (End-to-End approach).
395
the point of origin to the point of consumption for the purpose of
alleviating the suffering of vulnerable people. As an example, one
of the notable aspects of the relief effort following the 2004 Asian
tsunami was the public acknowledgment of the role of logistics in
effective relief (Thomas and Kopczak, 2007).
The management of emergency and/or humanitarian supply
chains has recently attracted the attention of both practitioners
and researchers. Such supply chains have much in common with
commercial supply chains but at the same time they pose
significant challenges as they operate under uncertain, and many
times, chaotic conditions. Research methodologies widely utilized
in solving business logistics problems could be adopted in the
context of emergency supply chain operations. Similarities exist-
ing between commercial and emergency supply chains offer the
opportunity of transferring knowledge from the business sector to
humanitarian organizations (Maon et al., 2009). Even at a long-
term level, strategies adopted in commercial supply chains could
be also adopted in the case of emergency and/or humanitarian
supply chains in an effort to match supply with demand
(Oloruntoba and Gray, 2006; Taylor and Pettit, 2009). A very
comprehensive description towards the issues of humanitarian
logistics can be found in Van Wassenhove (2006).
Research conducted so far towards emergency and/or huma-
nitarian supply chain operations has been targeted towards
inventory management, facility location, transportation problems
and performance measurement. For example, Beamon and
Kotleba (2006) and Clay Whybark (2007) examined the problem
of inventory management in case of response to emergencies.
Balcik and Beamon (2008) examined the facility location problem
of a humanitarian relief chain responding to quick-onset disas-
ters. Balcik et al. (2008) studied the ‘‘last mile’’ distribution
problem of the relief chain, which refers to the distribution of
emergency supplies from local distribution centers to final ben-
eficiaries affected by disasters. Issues of performance measure-
ment in humanitarian supply chains are examined in Beamon and
Balcik (2008) and Van Der Laan et al. (2009). Finally, coordination
and knowledge sharing issues or even the role of all the players
taking part in an emergency and/or humanitarian supply chain
have also been the subject of research (Balcik et al., 2010; Kovács
and Spens, 2010; Pettit and Beresford, 2005).
3. Research methodology and boundaries
The literature regarding epidemics containment is vast. Three
basic streams of research conducted so far may be identified. The
first stream consists of research addressing pharmaceutical inter-
ventions for the control of an epidemic. In this case, public health
treatment programs (like vaccination campaigns) take place
where limited resources are utilized. These resources could be
 Author's personal copy
396 T.K. Dasaklis et al. / Int. J. Production Economics 139 (2012) 393–410
either discrete (like vaccines, antibiotics or antiretroviral drugs,
etc.) or continuous (like funds). The second stream consists of
research approaches addressing non-pharmaceutical interven-
tions like the closure of schools, voluntary quarantines over a
wide area, social distancing and travel limitations. Finally, the
third stream consists of research approaches where the pharma-
ceutical and non-pharmaceutical interventions are combined and
harmonized control actions are proposed.
From the aforementioned literature our focus has been on
pharmaceutical and harmonized approaches where certain logis-
tics operations features are incorporated into the decision making
process (either quantitative or qualitative). Therefore, this review
covers the logistical aspects that support the pre-event as well as
post-event logistics operations in the case of emergencies like an
unprecedented pandemic outbreak, a bioterrorist attack, epi-
demic outbreaks during mass gatherings or epidemic outbreaks
in the aftermath of natural or man-made disasters. As a conse-
quence, this review does not take into consideration logistics
aspects arising in the context of seasonal influenza outbreaks or
relevant diseases’ outbreaks which may be expected, anticipated
or last for a long period of time (like HIV outbreaks).
It is worth mentioning that this review focuses on the opera-
tional issues arising in relation to the control of epidemics. Thus
papers addressing problems such as resource allocation or general
contingency plans have not been included in the main reference
list. For the interested reader an additional reference list can be
found after the main reference list, where several resource
allocation papers as well as contingency plan papers are cited.
Furthermore, modeling approaches not calibrated to the epi-
demics control context have not been included in the classifica-
tion framework of this review. A relevant survey regarding
modeling approaches in the generic context of emergency supply
chain management can be found in Caunhye et al. (2012). Apart
from the aforementioned limitations, in this review two exemp-
tions have been made regarding the papers of Chick et al. (2008)
and Ak et al. (in press). The justification of these exemptions is
provided in the relevant section where both papers are cited.
Finally, this review cannot by any means be considered as an
exhaustive one.
In order to review the available literature our first task was to
define our sources and to establish the appropriate search criteria.
Epidemics control handbooks and relevant information from
several databases (governmental and international agencies such
as the World Health Organization, the Pan-American Health
Organization and the European Centre for Disease Prevention
and Control etc.) were studied in order to determine the logistics
operations taking place during the control of an outbreak. Key-
word searches were made through several scientific databases
including Springer, Science Direct and Scopus. During the selec-
tion process all abstracts or list of references from the papers
were examined in order to locate additional relevant research
works. A total number of 73 papers were finally selected.
We are aware of at least one review regarding OR/MS research
in disaster operations management (Altay and Green Iii, 2006), in
which epidemics control issues were excluded and one review
regarding bioterrorism response logistics (Bravata et al., 2004a).
In addition, Brandeau et al. (2009) made an inventory of health
sector disaster response models in which logistical constraints
were incorporated in the case of epidemic outbreaks, while
Ferguson et al. (2003) reviewed the usage of available mathema-
tical models when planning for smallpox outbreaks. The need for
a more integrated incorporation of logistical constraints into
existing modeling approaches was among the findings of the
review.
For the classification of the selected literature all the logistical
variables and relevant logistics aspects of each reference were
initially identified. Our classification scheme was based on a
three-level assessment framework presented in Fig. 2. In the first
level of assessment the various logistical features incorporated in
each reference are classified according to the time framework in
which they take place (pre-event or post-event). In the second
level of assessment a context-specific classification is made where
the logistics features are correlated to the nature of the epidemic’s
outbreak. Finally, in the third level of assessment the logistical
features and the methodologies applied (qualitative or quantita-
tive) for solving the problem tackled are classified. It is worth
mentioning that in the classification scheme the incorporated
logistical features of each reference have been utilized as the
main driver for the classification process. Such an approach not
only provides the means for better synthesizing and analyzing the
selected literature but also gives us the opportunity to better
understand the interdependencies between logistics operations
and the general control context in which they take place. As a
consequence, the classification scheme highlights several attri-
butes of epidemics logistics operations and enables us to develop
a more robust research agenda towards epidemics control supply
chain management.
4. Epidemics control and logistics operations
Governmental agencies and health institutions should be
prepared in advance for the control of epidemic outbreaks. This
means that they should have in place robust contingency plans
addressing issues like the availability of emergency medical
stocks and well-trained personnel, their appropriate deployment,
the availability of different types of vehicles for the transportation
of essential medical supplies and commodities etc. Generally, it
remains very difficult to define whether the needs for producing
and distributing vaccines in the case of e.g. a possible pandemic
influenza outbreak can be met (Fedson, 2003; Webby and
Webster, 2003) by existing capacities. Consequently, any attempt
to contain an epidemic outbreak demands real-time solutions
that should ensure the effective management of all the logistics
activities taking place, since sometimes these activities may
become a real nightmare if not managed properly (Osterholm,
2001). In the sequence, an inventory of all the logistics operations
taking place during the various phases of an epidemic’s contain-
ment effort is provided. Generally, these phases could be classi-
fied as follows (John Hopkins Bloomberg School of Public Health
Fig. 2. A framework for epidemics logistics literature classification.
 Author's personal copy
T.K. Dasaklis et al. / Int. J. Production Economics 139 (2012) 393–410
and the International Federation of Red Cross and Red Crescent
Societies, 2008; World Health Organization, 2005):
 Preparedness
 Outbreak investigation
 Response
 Evaluation.
4.1. Preparedness
Many organizations around the world have established prepa-
redness plans in the case of epidemic or pandemic outbreaks. Such
plans range from community to national level and they include all
the measures required for the successful containment of an out-
break. The World Health Organization has published several pan-
demic preparedness guidelines since 1999 and it updates them in
the light of new developments regarding increased understanding of
past pandemics, strengthened outbreak communications, greater
insight on disease spread etc. (World Health Organization, 2009).
Epidemic preparedness aims at maintaining a certain level of
available resources so as to reduce morbidity and mortality when
an epidemic outbreak occurs. This means that pharmaceuticals
and supplies should remain accessible or kept in large quantities
(Richards et al., 1999) in order to assist a prompt response, if
necessary. Procurement of vaccines and medical supplies and
their exact storing location play a crucial role for the outcome of
any containment effort. For instance, the Strategic National Stock-
pile (SNS) program in the United States is an indicative prepared-
ness program with the objective to maintain large quantities of
medicine and medical supplies and to provide these materials to
states and communities within twelve hours in the event of a
large-scale public health emergency (Esbitt, 2003). In addition, a
certain amount of vaccines should be available for the immuniza-
tion of control teams and health-care workers. This is of great
importance as medical personnel will treat the very first infected
persons and should be protected against the disease that causes
the outbreak. Among the most important logistics operations
taking place and relevant logistics-oriented decisions to be made
during the phase of preparedness are the following (John Hopkins
Bloomberg School of Public Health and the International
Federation of Red Cross and Red Crescent Societies, 2008; World
Health Organization, 2005, 2008):
 Identification of sources for the procurement of medical
supplies and relevant commodities
 Contract management for all the materials procured
 Inventory management for all the essential medical supplies
(vaccines, antibiotics, antiretroviral drugs) and supplementary
medical commodities (personal protective supplies) kept
 Periodical review and updating of medical supplies
 Facility location and capacity determination for stockpiling
centers
 Network design for transportation/distribution activities and
selection of appropriate means for transportation/distribution
activities
 Selection of appropriate vaccination facilities/health care sys-
tems and their capacity (size, availability of rooms and
designated areas, availability and scheduling of personnel etc.)
 Availability of funds.
4.2. Outbreak investigation
Outbreak investigation consists of the detection of any sus-
pected outbreak and its confirmation through laboratory testing.
397
In order to detect and confirm a suspected outbreak, surveillance
systems must be put in place in order to provide the decision
makers of the health agencies in charge with the essential
information regarding any unexplained infection increases seen
over a period of time through the systematic analysis of data
collected. Surveillance systems provide adequate information that
facilitates the development of an initial response framework
where the type and magnitude of the containment effort could
be determined once epidemic thresholds have been reached. The
term epidemic threshold refers to the level of disease above
which an urgent response is required. It is specific for each
disease and depends on the infectiousness, other determinants
of transmission and local endemicity levels (World Health
Organization, 2005).
Leading world health organizations have developed surveillance
systems covering cases like pandemic outbreaks (European Centre
for Disease Prevention and Control, June, 2009), epidemic out-
breaks following natural disasters (World Health Organization,
2005) or even possible disease outbreaks during mass gatherings
(World Health Organization, 2008). Additionally, surveillance sys-
tems have been developed by the scientific community (Dato et al.,
2004; Krause et al., 2007; Lombardo et al., 2003) and many
researchers have studied relevant issues arising during the detec-
tion and confirmation of diseases outbreaks attributed to bioter-
rorist attacks (Bravata et al., 2004b; Buehler et al., 2003; Lober
et al., 2002; Pavlin et al., 2003; Platt et al., 2003) or epidemic
outbreaks related to specific agents (Arita et al., 2004; Dietz et al.,
1990; Jansson et al., 2005). It is worth mentioning that the
development of a surveillance system to detect epidemic outbreaks
that occur during emergency situations (like a humanitarian crisis)
may necessitate taking into consideration some context-specific
features like the target population, the political context, the poor
infrastructure and, finally, the presence of multiple partners in the
field (M’ikanatha et al., 2007). Among the logistics activities that
support the detection and confirmation mechanisms of a suspected
outbreak are (U.S. Agency for International Development, 2009;
World Health Organization, 2005):
 The provision of all the appropriate materials like report sheets
to hospitals, emergency medical services and local public
health departments that will be used for the collection of
primary data regarding initial cases
 The training of clinical workers to recognize unexpected
patterns of the occurrence of specific diseases and to promptly
identify and report suspected cases using standard definitions
 The provision of all the necessary commodities and resources
to the outbreak response team that will facilitate and ensure
its operational deployment
 The collection of specimens and their labeling
 The secure transportation of specimens to the appropriate
laboratory (using cold boxes and coolant blocks)
 The appropriate storage of specimens in the laboratory (kept
within a specific temperature range)
 The procurement, handling, storing and distribution of labora-
tory commodities, their classification, their quality assurance
and quality control etc.
It is clear that any successful attempt to contain an epidemic
outbreak is closely related to the services provided by labora-
tories. These services rely on a huge number of materials and
commodities that laboratories utilize and they necessitate
increased inventory management capabilities. Additionally, dur-
ing epidemic outbreaks laboratories must ensure that they have
the capacity to cope with increased testing demands (Crawford
et al., 2010). A good reference regarding laboratory logistics can
be found in U.S. Agency for International Development (2009).
 Author's personal copy
398 T.K. Dasaklis et al. / Int. J. Production Economics 139 (2012) 393–410
4.3. Response
Once leading health agencies have confirmed an epidemic
outbreak, measures and control strategies must be implemented
as soon as possible at a regional or national level. Treatment
centers should be established and available resources such as
medical supplies and personnel should be deployed rapidly in
order to contain the epidemic before it reaches uncontrollable
proportions. Vaccination of susceptible groups or isolation and
quarantine of those infected are considered standard interven-
tions for the containment of an epidemic. All measures taken
must be based on a clear understanding of the agent’s nature
triggering the outbreak as some diseases necessitate specific
control protocols to be followed (World Health Organization,
2005). This in turn calls for the availability of additional infra-
structure and medical supplies within health care premises such
as isolation rooms with good ventilation systems, respiratory
equipment etc. The logistics operations and relevant decisions to
be made during the phase of response to a confirmed outbreak
refer to (John Hopkins Bloomberg School of Public Health and the
International Federation of Red Cross and Red Crescent Societies,
2008; World Health Organization, 2005, 2008):
 the selection of facilities to serve as PODs
 the periodical review and updating of supplies and
commodities needed
 the transportation/distribution of supplies and commodities
from central warehouses to local POD
 the procurement of supplies/resources once depleted
 the dispensing of medical supplies, supplementary materials
and commodities to the public
 the establishment of a cold supply chain for the provision of
essential medical supplies like vaccines
 the daily/weekly capacity of available personnel to perform
mass vaccination campaigns (for example the maximum
number of people that can vaccinate per day)
 the scheduling of available vehicles to be used for transporta-
tion and distribution purposes
 adjustments to the capacity of health care facilities to hospitalize
infected people
 the management of patients in triage centers (clinical flow
logistics).
During the phase of response laboratory logistics activities
take place as it is very important for the parties involved to have a
clear understanding of how the epidemic evolves over space and
time (rate of spread among subpopulations). This will allow them
to proceed to the necessary adjustments or modifications of the
measures initially adopted in order for the new measures to be
compliant with the data analysis from laboratories’ tests (World
Health Organization, 2005). Other logistics-oriented activities
necessitated during this phase may be the safe disposal of body
fuels or even the handling of dead bodies, the presence of troops
to keep order etc.
4.4. Evaluation
After the epidemic has been contained, decision makers and
public health policy makers engaged in the control efforts should
proceed to the evaluation of all the measures undertaken during
the previous phases. Generally, the evaluation phase is very useful
as it provides strong insights towards a series of modifications
that need to be made in order to increase the resilience of the
control mechanisms in future epidemic outbreaks. Despite the
fact that the evaluation phase entails limited physical movement
of medical supplies and complementary commodities, it remains
important from a logistical point of view. Many useful conclu-
sions can be drawn with respect to logistics control operations
such as (AHRQ, 2004; John Hopkins Bloomberg School of Public
Health and the International Federation of Red Cross and Red
Crescent Societies, 2008):
 the identification and assessment of possible bottlenecks or
delays that hindered the deployment of the available medical
supplies
 the evaluation of the timeliness that should have been
respected during the control of the epidemic
 the follow-up and monitoring of patients for antibiotic effec-
tiveness or vaccine immunoresponse
 the identification of patients requiring dose modification or
alternative treatment regimen due to adverse effects
 the development of indicators regarding the performance of
the logistics control operations
 the assessment of coordination issues risen among the parties
involved
 the establishment and operation of rehabilitation procedures
in the case of epidemic outbreaks in the aftermath of natural
disasters.
All the above should lead to clear conclusions and, therefore,
recommendations that will enhance the capabilities of the parties
involved and will reduce vulnerabilities of the control mechan-
isms. Finally, the dissemination of knowledge and the lessons
learned should take place among all the parties involved, from
public health policy makers and health agencies to local
communities.
5. Literature classification and analysis
In this section the classification and analysis of the selected
literature takes place in accordance with the classification scheme
presented in Fig. 2.
5.1. Time frame and type of the outbreak
Epidemic control measures may vary depending on the nature
of the outbreak and the time horizon in which they are imple-
mented. For example, a country may face a bioterrorist attack or a
natural influenza outbreak. Communicable disease outbreaks may
also occur in the aftermath of natural disasters where certain sub-
populations are dislocated or subject to a humanitarian crisis.
Disease outbreaks may also occur during big events and mass
gatherings such as the Olympic Games. In addition, the time
frame in which control measures apply may also be different.
Stockpiling of medical supplies for a future outbreak is a proactive
measure and takes place well before the outbreak occurs while
the distributing and dispensing of these supplies take place once
the outbreak has occurred. The classification of the selected
literature according to the aforementioned thresholds can be
seen in Table 1.
37 out of 73 research studies deal with the deployment of the
available resources once the outbreak has occurred and the
majority of them are closely related to bioterrorism (22 out of
37). Research efforts towards pre-event strategies follow (22 out
of 73) and they mostly refer to natural outbreaks (15 out of 22)
like influenza epidemics. Integrated approaches covering both
pre-event and post-event control measures are limited. In the
case of epidemics control in the aftermath of natural disasters a
total of 5 articles were retrieved. Some papers address issues of
epidemics control logistics without explicitly specifying the con-
text of the outbreak. We refer to this type of literature as
 Author's personal copy

T.K. Dasaklis et al. / Int. J. Production Economics 139 (2012) 393–410 399

Table 1
Time-frame and context-specific related literature classification.

Time- Context-specific aspects

frame
Bioterrorist attacks Natural outbreaks Miscellaneous Disaster
aftermath

Pre-event (Berman and Gavious, 2007; (Adu et al., 1996; Arinaminpathy and McLean, (Adida et al., 2011; Jia et al., –
Huang et al., 2010; Murali et al., 2012) 2009; Balicer et al., 2005; Chick et al., 2008; Cinti 2007a,2007b; Rebmann et al.,
et al., 2005; DeLaurentis et al., 2008, 2009; 2011)
Dhankhar et al., 2010, 2009; Harrington and Hsu,
2010; Hashikura and Kizu, 2009; Lee et al., 2006b;
Lugnér and Postma, 2009; Radonovich et al., 2009;
Siddiqui and Edmunds, 2008)

Post- (Barbera et al., 2001; Brandeau et al., 2008; Craft (Collin and de Radigue s, 2009; Ekici et al., 2008; (Aaby et al., 2006; Lee et al., (Blecken
event et al., 2005; Giovachino et al., 2005; Herrmann Hadler, 2005) 2009a, 2009b; Li and Jie, 2010; et al., 2010;
et al., 2009; Hu and Zhao, 2012, 2011; Hui, 2010; Liu, 2007; Pietz et al., 2009; Date et al.,
Hupert et al., 2002; Jingjing et al., 2009; Kaplan Wang et al., 2009) 2011;
et al., 2003; Ke and Zhao, 2008; Lee, 2008; Liu and Moore et al.,
Zhao, 2009, 2011; Liu et al., 2011; Miller et al., 1990;
2006; Patvivatsiri et al., 2007; Porco et al., 2004; Rottkemper
Richter and Khan, 2009; Wein et al., 2003; Zhao and et al.,
Han, 2010) 2011, 2012)

Integrated (Brandeau et al., 2007; Bravata et al., 2006; Manley (Arinaminpathy and McLean, 2008; Conn et al., (Ak et al., in press; Lee et al., –
and Bravata, 2009; Shen et al., 2009; Whitworth, 2008; Duintjer Tebbens et al., 2010; Hessel, 2009; 2006a)
2006; Zaric et al., 2008; Zhao and Sun, 2008) Jennings et al., 2008)

Fig. 3. Time-frame and outbreak-type literature classification.

miscellaneous. It is worth mentioning that no paper dealing with

epidemics control logistics during mass gatherings has been
identified. Fig. 3 shows a numerical allocation of the literature
according to the time frame of the response and the nature of the
outbreak.
5.2. Logistical attributes and methodologies
In the following sub-sections the literature is classified accord-
ing to the logistical attributes embedded within the modeling
frameworks and, of course, the methodologies applied. For this
classification, four clusters have been identified. These refer to the
epidemics logistics network configuration, stockpiling of medical
supplies, triage operations and other approaches. In Fig. 4 an
allocation of the selected papers is provided regarding the afore-
mentioned clustering, their type and source of publication.
Fig. 4. Literature classification according to logistical attributes, type and source
of publication.
5.2.1. Epidemics logistics network configuration
During the containment of an epidemic, medical supplies
(vaccines, antiviral drugs etc.) and commodities (food, water
etc.) held in central storage sites must be distributed to regional
stockpile centers and then to local PODs (Fig. 5). The aforemen-
tioned problem refers to the logistics network design problem
where a series of decisions should be made with respect to:
 the location, number and capacity of both the stockpile centers
and PODs (facilities)
 the assignment of these facilities to serve certain sub-
populations
 the selection of modes of distribution and relevant capacities
 Author's personal copy
400 T.K. Dasaklis et al. / Int. J. Production Economics 139 (2012) 393–410
Fig. 5. Epidemics control logistics network.
 the inventory level of medical supplies and commodities held
as well as the replenishment policies followed.
As far as facility location is concerned, research efforts have been
based on P-median, P-center and maximal covering location model-
ing approaches as well as game theory for the formulation of the
problem. Jia et al. (2007a) propose a series of facility location
approaches based on the covering model, the P-median model and
the P-center model, each suited for different needs according to the
characteristics of several large-scale emergencies. A demonstration of
the P-center and P-median approach is presented (for a possible
anthrax and smallpox bioterrorist attack, respectively). In Jia et al.
(2007b) the problem is formulated as a maximal covering problem
with multiple facility quantity-of-coverage and quality-of-coverage
requirements and a genetic algorithm heuristic, a locate-allocate
heuristic and a Lagrangean relaxation heuristic are developed for
the solution of the problem. An illustrative example (anthrax attack)
and performance analysis for the heuristics are also provided. In
Berman and Gavious (2007) the problem is formulated as a game
between a terrorist and a state where set-up costs along with
preventive ones are considered. Game theory and mathematical
programming are used for the formulation and solution of the
problem. Murali et al. (2012) formulate the problem as a special case
of the maximal covering location problem. Demand uncertainty and
distance-sensitive demand are taken into account by using a loss
function and a locate-allocate heuristic is used for the solution of the
problem. Huang et al. (2010) use a variation of the p-center problem,
where the model presumes that some of the facilities at a node fail to
respond to the node’s demand. Dynamic programming is used for
finding the optimal location on a path network whereas an efficient
algorithm for optimal locations on a general network is used,
respectively.
In the case of logistics network design the majority of the
modeling approaches deals with the estimation of the number of
available facilities to be utilized, the inventory to be held, relevant
replenishment policies as well as transportation and distribution
activities for the supplies from central points to regional sites and,
consequently, local PODs. Differential equations used for the demand
estimation (disease’s progression) are coupled with logistics network
modeling approaches. Hu and Zhao (2012) develop a multi-objective
programming model for the selection of emergency centers and the
determination of the amount of medicine transported from the
replenishment sources to selected emergency centers and from the
selected centers to the points of dispensing. Wang et al. (2009)
examine the selection of storage points and distribution activities of
medical supplies to an affected area by using a multi-objective
stochastic programming model, which is solved by a genetic
algorithm based on Monte Carlo simulation. Hu and Zhao (2011)
use a systems dynamics approach to study the dynamics behavior of
the replenishment sources, receiving warehouses and the dispensing
sites in the case of an anthrax attack. Liu and Zhao (2011) develop a
dynamic optimization model with time-varying demand for the
replenishment and the transportation of medical supplies from local
health departments to affected areas. A heuristic algorithm is used for
solving the optimization problem. The case of food distribution during
an epidemic outbreak and relevant network design aspects have also
been examined (Ekici et al., 2008). Other approaches include logistics
network design frameworks with replenishment and non-replenish-
ment sources (Zhao and Sun, 2008) or network design frameworks
where the objective is total costs (inventory and transportation costs)
and response time minimization (Jingjing et al., 2009; Li and Jie,
2010).
Research has also been directed towards the issues of epidemics
distribution network design. As in the case of logistics network
design, the demand for the medical supplies to be distributed relies
on differential equations describing the progression of the disease. In
most of the cases medical supplies such as vaccines or antiviral drugs
and medical supplements are distributed. Ke and Zhao (2008)
examine the problem of emergency materials distribution in an
anti-bioterrorism system subject to related logistical constraints by
using dynamic programming theory and simulation techniques. Lee
et al. (2009b) develop a simulation model for the distribution of relief
supplies from central distribution centers to local PODs. The model
takes into consideration transshipment between the PODs. Liu et al.
(2011) propose a mixed-collaborative distribution model based on
the point-to-point delivery mode and the multiple traveling salesmen
delivery system. For the solution of the optimization problem a
genetic algorithm is presented. In addition, Zhao and Han (2010)
study the problem of distributing medical supplies to affected areas
taking into account supply base levels, limited response time-frames
and several costs (transportation and shortage costs etc.). Finally,
vehicle routing problems in the context of epidemic control logistics
have also been studied (Herrmann et al., 2009; Liu and Zhao, 2009;
Shen et al., 2009).
Due to the unpredictable nature of epidemic outbreaks a signifi-
cant issue that has to be addressed in the aftermath of natural
disasters is the relocation of inventories. During an ongoing humani-
tarian crisis attributed primarily to a natural disaster (earthquake,
tsunamis etc.) a disease outbreak may occur triggering a surge of
medical supplies and necessitating the deployment of additional
commodities. In this case, available supplies should be relocated
and relevant network design transportation decisions should be made
enabling the rapid supply of regions coming up with new and urgent
demand (Blecken et al., 2010; Rottkemper et al., 2012, 2011). In
Table 2
Logistical features and methodologies applied in epidemic logistics network configuration literature.
References
(Berman and Gavious, 2007)
(Blecken et al., 2010)
(Ekici et al., 2008)
(Herrmann et al., 2009)
(Hu and Zhao, 2012)
(Hu and Zhao, 2011)
(Huang et al., 2010)
(Jia et al., 2007a)
(Jia et al., 2007b)
(Jingjing et al., 2009)
(Ke and Zhao, 2008)
(Lee et al., 2009b)
(Li and Jie, 2010)
(Liu and Zhao, 2009)
(Liu and Zhao, 2011)
(Liu et al., 2011)
(Murali et al., 2012)
(Rottkemper et al., 2011)
(Rottkemper et al., 2012)
(Shen et al., 2009)
(Wang et al., 2009)
(Zhao and Sun, 2008)
(Zhao and Han, 2010)
Literature characteristics
Logistical attribute
Facility location
Inventory relocation,
transportation, transshipment
Facility location, distribution
Vehicle routing, distribution of
medical supplies
Logistics network design
Distribution, inventory
management
Facility location
Facility location
Facility location
Logistics network design
Distribution of medical supplies
Distribution, dispensing, capacity
planning
Logistics network design
Vehicle routing
Logistics network design
Distribution of medical supplies Distance, time minimization
Facility location
Inventory relocation,
transportation
Inventory relocation,
distribution, transshipment
Vehicle routing
Distribution of medical supplies Time and cost minimization
Distribution, production
Distribution of medical supplies Cost minimization
Objectives
Cost (or disutility)
minimization
Cost minimization
Cost minimization
Time minimization
Time and cost minimization
Inventory level, unsatisfied
demand
Minimize the maximum
weighted distance
Demand satisfaction
Demand satisfaction
Cost minimization
Cost minimization
Demand satisfaction
Cost minimization
Time minimization
Cost minimization
Demand satisfaction
Cost minimization
Cost minimization
Unsatisfied demand, visit time
Cost minimization
Constraints Problem formulation/
methodology applied
Number of facilities Game theory, mathematical
programming
Demand satisfaction, supply Integer programming
Capacity, demand satisfaction, supply Mixed integer programming,
simulation
Capacity, demand satisfaction, supply Integer programming
Capacity, demand satisfaction, supply Multi-objective programming
capacity, time, supply System dynamics
number of facilities Integer programming
Number of facilities, demand Integer programming
satisfaction
Number of facilities, demand Integer programming
satisfaction
Capacity, demand satisfaction, supply Mathematical programming
Time, demand, type of material Dynamic programming
Capacity Simulation, mathematical
modeling
Supply, demand satisfaction Network equilibrium model
Number of demand points Multiple traveling salesman
approach
capacity, demand satisfaction, supply Mathematical programming
Capacity, demand satisfaction, supply, Mix integer programming
distance
Capacity, demand satisfaction, supply Integer programming, mix
integer programming
Supply, demand satisfaction, capacity Mixed-integer programming
Supply, demand satisfaction, capacity Mixed-integer programming
Time, demand satisfaction Mixed integer programming
Demand satisfaction Multi-objective programming
– Economic analysis, numerical
simulation
Supply, demand satisfaction Linear programming
Optimization Stochastic/
(solution) deterministic
– Deterministic
Heuristic algorithm Stochastic
– Deterministic
Problem decomposition, Deterministic
two-stage algorithm
– Deterministic
– Deterministic
Dynamic programming Deterministic
algorithm
– Deterministic
Heuristic algorithms Deterministic
Heuristic algorithm Deterministic
– Deterministic
– Deterministic
Numerical analysis, Stochastic
approximation methods
Genetic algorithm Deterministic
Heuristic algorithm Deterministic
Author's personal copy
Genetic algorithm Deterministic
Heuristic algorithm Stochastic
T.K. Dasaklis et al. / Int. J. Production Economics 139 (2012) 393–410
– Deterministic
– Deterministic
Tabu heuristic, Stochastic
approximation heuristic
Genetic algorithm Stochastic
– Deterministic
– deterministic
401
 Author's personal copy
402 T.K. Dasaklis et al. / Int. J. Production Economics 139 (2012) 393–410
Table 2 a classification of the epidemic logistics network configura-
tion can be seen with respect to the methodologies applied, the
objectives of the models and the constraints. We pay special attention
in this sub-section because the literature described here depicts the
core logistics approaches we managed to retrieve. As the control of an
epidemic outbreak entails a range of operations to take place, the
topic is very suitable for OR/MS research.
5.2.2. Stockpiling of medical supplies
Inventory control in the case of epidemics control may relate to
managing specific medical supplies like vaccines, antiviral drugs or
antibiotics as well as ancillary medical resources like Personal
Protective Equipment (PPE) etc. In some cases the problem of
stockpiling of medical supplies has been treated as a joint inventory
stockpiling problem for several groups of hospitals. In this case it is
assumed that mutual aid agreements for inventory sharing are
established among the hospitals. A game theoretical approach is
adopted for the formulation of the problem (Adida et al., 2011;
DeLaurentis et al., 2008, 2009). Some researchers have also tried to
determine the amounts of medical supplies like PPEs to be held that
could serve as a means of preventing influenza pandemics
(Hashikura and Kizu, 2009). Additionally, many researchers have
tried to estimate the capacity of health care facilities to respond to
spreading diseases in terms of materials (Radonovich et al., 2009)
and PPEs needed (Rebmann et al., 2011).
As far as antiviral drugs are concerned, logistical constraints
such as a finite stockpile of drugs and limited distribution rates
during the deployment of antiviral drugs (Arinaminpathy and
McLean, 2008) or different antiviral coverage strategies using a
limited stockpile of drugs (Arinaminpathy and McLean, 2009)
have been examined in the case of an influenza pandemic control.
Lee et al. (2006b) utilize cost-benefit and cost-effectiveness
analyses with Monte Carlo simulations to compare strategies for
stockpiling neuraminidase inhibitors to treat and prevent an
influenza pandemic outbreak. Lugnér and Postma (2009) utilize
cost-effectiveness considerations when stockpiling antiviral drugs
in order to mitigate an influenza pandemic outbreak. Siddiqui and
Edmunds (2008) develop a decision analytical model to investi-
gate the cost-effectiveness of stockpiling antiviral drugs for a
potential influenza pandemic in the United Kingdom and the
possible role of near-patient testing in conserving antiviral drug
stocks. Balicer et al. (2005) analyze strategies for the utilization of
stockpiled antivirals for a future influenza pandemic and estimate
cost-benefit ratios, while Cinti et al. (2005) provide a strategy for
stockpiling certain antivirals at a reasonable cost. Finally,
Harrington and Hsu (2010) examine the so-called Manufacturer
Reserve Programs which are used by manufacturers to promote
stockpiling of anti-viral drugs in preparation for pandemic influ-
enza by non-governmental organizations such as hospitals.
In the case of vaccine inventory control, Liu (2007) considers
the case in which a sudden demand for vaccines attributed to an
urgent incident like a natural outbreak or a bioterrorist attack
occurs and develops mathematical models for estimating the
necessary stockpile levels of vaccines in order to meet future
urgent needs. Dhankhar et al. (2009) examine the quantities to be
held in stock and relevant economic evaluations of vaccines in
accordance with their time of expiration. Vaccine control strate-
gies in the case of secondary bacterial infections (especially
pneumococcal infections) during a pandemic influenza outbreak
have also been examined (Dhankhar et al., 2010). Finally, Duintjer
Tebbens et al. (2010) develop a mathematical framework for
determining the optimal management of a vaccine stockpile
over time where several logistical constraints are considered
like capacity constraints, production and filling delays, risks
associated with the stockpile etc. The case of the polio vaccine
stockpile is selected for the application of the proposed
framework.
5.2.3. Triage operations
Once the medical supplies have been positioned to local PODs,
dispensing operations must take place. In addition, several facil-
ities like hospital and primary health-care premises might need to
be converted into dispensing centers. During the control effort
within the dispensing centers patients will be examined by
medical personnel and will be further offered medical treatment
(vaccination, antiviral treatment etc.). Logistical considerations in
this case may include the facility layout of the selected premises
to serve as dispensing centers, capacity planning, patient flow
logistics, relevant dispensing or vaccination rates etc. Simulation
is the prevalent methodological tool for addressing this kind of
problems.
For example, Porco et al. (2004) develop a continuous-time
event-driven network simulation model of smallpox ring vaccina-
tion taking into consideration aspects like response logistics and
limited numbers of vaccinators. Whitworth (2006) utilizes simu-
lation models for the evaluation of candidate PODs, alternative
dispensing processes, staffing plans and traffic-management stra-
tegies to help a community develop its plan for responding to an
anthrax attack. Wein et al. (2003) develop a mathematical model
to compare various emergency responses in the event of an
airborne anthrax attack where a set of spatially distributed two-
stage queuing systems consisting of antibiotic distribution and
hospital care is considered. Aaby et al. (2006) use discrete-event
simulation queuing theory models for the clinic planning of
public-health services. Some guidelines for the physical design
and lay-out of clinics are also proposed. Miller et al. (2006) apply
combination strategies for controlling a bioterrorist attack (small-
pox) by using discrete-event simulation. The model estimates the
medical resources required for each step in the diagnosis and
treatment within public-health facilities and, therefore, possible
bottlenecks in care delivery. Patvivatsiri et al. (2007) simulate
various possible bioterrorist attack scenarios in order to deter-
mine the total time a patient stays in the system and to identify
staff requirements. Hupert et al. (2002) use discrete event
simulation modeling to determine staffing levels for entry screen-
ing, triage, medical evaluation and drug dispensing stations in a
hypothetical antibiotic distribution center operating in low,
medium, and high disease prevalence bioterrorism response
scenarios.
Apart from simulation, other approaches combine epidemic
diffusion rules and queuing theory and the models developed
could serve as capacity planning tools. Logistical considerations in
this case may relate to limited vaccination or dispensing rates.
Craft et al. (2005) analyze a system of differential equations that
includes among others a set of spatially distributed tandem
queues for distributing antibiotics and providing hospital care.
Giovachino et al. (2005) utilize computer modeling techniques
where real data obtained by an exercise are used in order to
optimize the capacity of a dispensing center in the case of a
bioterrorist attack. Kaplan et al. (2003) evaluate existing and
alternative proposals for emergency response to a deliberate
smallpox attack by embedding key operational features of such
interventions into a smallpox disease transmission model where
the model explicitly incorporates a tracing/vaccination queue, and
hence can be used as a capacity planning tool. Hui (2010)
develops a queuing network model where distribution times
and serving rates of antibiotics are considered.
Decision support systems have also been developed in the case
of triage management operations. In this case, mathematical
modeling, large-scale simulation and optimization techniques
 Author's personal copy

T.K. Dasaklis et al. / Int. J. Production Economics 139 (2012) 393–410 403

Table 3
Logistical features of stockpiling and triage management literature.

References Logistical attributes Problem formulation/methodology applied

(Aaby et al., 2006) Dispensing of medical supplies, Simulation, queuing theory

(Adida et al., 2011)
(Arinaminpathy and McLean, 2008) Stockpiling of medical supplies,
(Arinaminpathy and McLean, 2009) Stockpiling of medical supplies
(Balicer et al., 2005)
(Cinti et al., 2005)
(Craft et al., 2005)
(DeLaurentis et al., 2008)
(DeLaurentis et al., 2009)
(Dhankhar et al., 2010)
(Dhankhar et al., 2009)
(Duintjer Tebbens et al., 2010)
(Giovachino et al., 2005)
(Harrington and Hsu, 2010)
(Hashikura and Kizu, 2009)
(Hui, 2010)
(Hupert et al., 2002)
(Kaplan et al., 2003)
(Lee et al., 2006a)
(Lee et al., 2006b)
(Liu, 2007)
(Lugnér and Postma, 2009)
(Miller et al., 2006)
(Patvivatsiri et al., 2007)
(Pietz et al., 2009)
(Porco et al., 2004)
(Radonovich et al., 2009)
(Rebmann et al., 2011)
(Richter and Khan, 2009)
(Siddiqui and Edmunds, 2008)
(Wein et al., 2003)
patient flow logistics, capacity planning
Stockpiling of medical supplies Game theory
Mathematical modeling (differential equations
capacity planning and compartmental modeling)
Mathematical modeling (differential equations
and compartmental modeling)
Stockpiling of medical supplies Economic analysis or cost benefit analysis
Stockpiling of medical supplies Scenario analysis
Dispensing of medical supplies Queuing theory
Stockpiling of medical supplies Game theory
Stockpiling of medical supplies Game theory
Stockpiling of medical supplies Cost-effectiveness analysis
Stockpiling of medical supplies Economic analysis
Stockpiling of medical supplies Economic analysis, system dynamics
Dispensing of medical supplies, Simulation
patient flow logistics, capacity planning
Stockpiling of medical supplies Mathematical modeling
Stockpiling of medical supplies Calculation system
Dispensing of medical supplies, patient flow logistics Queuing theory
Dispensing of medical supplies, Simulation modeling
patient flow logistics, capacity planning
Capacity planning Queuing theory
Capacity planning, patient flow logistics Simulation, mixed integer programming problem
Stockpiling of medical supplies Economic analysis, simulation
Stockpiling of medical supplies Mathematical programming
Stockpiling of medical supplies Economic analysis
Patient flow logistics, capacity planning Simulation
Capacity planning, patient flow logistics Simulation
Facility layout, patient flow logistics, capacity planning Integer programming, simulation
Capacity planning Simulation
Stockpiling of medical supplies Economic analysis
Stockpiling of medical supplies Review
Dispensing of medical supplies Multi-criteria decision analysis
Stockpiling of medical supplies Economic analysis
Dispensing of medical supplies Queuing theory

are used for analyzing different dispensing scenarios, reconfigur-
ing PODs during the containment effort, estimating the most cost-
effective combination of dispensing strategies and determining
resources’ utilization along with facilities’ set-up and facilities’
lay-out options (Lee et al., 2006a; Pietz et al., 2009). Comparisons
between different dispensing strategies have also been examined.
Richter and Khan (2009) use multi-criteria decision analysis for
assessing the trade-offs of different dispensing strategies in a
large metropolitan area during a biological or chemical event. In
Table 3, the logistical features incorporated in the triage opera-
tions as well as stockpiling of medical supplies literature are
depicted along with the relevant methodologies applied.
5.2.4. Other approaches
This sub-section refers to publications that are both of quali-
tative and quantitative nature that could not be classified within
any of the aforementioned classification schemes. The qualitative
approaches deal with a plethora of logistical issues arising in the
context of vaccine supply chain or when quarantine and vaccina-
tion campaigns are implemented. In addition, aspects of coordi-
nation as well as information management are also examined in
these theoretical papers. More integrated response frameworks
and sourcing aspects of the epidemic control supply chain build
up the remaining quantitative approaches.
Some of the aforementioned approaches embrace a plethora of
logistical considerations from stockpiling of medical supplies to
their distribution and dispensing. Zaric et al. (2008) develop a
dynamic compartmental model that incorporates anthrax disease
progression, prophylaxis and treatment in a population of
exposed and potentially exposed individuals, where aspects of
distribution of supplies from national and regional storage facil-
ities to local communities, stockpiling of local inventories and
dispensing to affected populations are examined. Cost-effective-
ness analysis is utilized to evaluate alternative preparedness
plans under different attack and response scenarios. Bravata
et al. (2006) utilize cost-benefit analysis to evaluate alternative
strategies for maintaining and dispensing local and regional
inventories of antibiotics and medical supplies for responses to
anthrax bioterrorism. Brandeau et al. (2007) identifies five supply
chain strategies that can potentially increase the speed of
response to a bioterrorism attack, reduce inventories and save
money. Among them are the effective supply chain network
design, the effective inventory management, the postponement
of product customization and modularization of component parts,
the coordination of supply chain stakeholders and appropriate
use of incentives and finally the effective information manage-
ment. Lee (2008) develops a simulation model for distributing
and dispensing of medical supplies. The effectiveness of alter-
native dispensing plans is evaluated and several improvement
opportunities in the event of a bioterrorist attack are also
identified. Lee et al. (2009a) utilize a systems approach to analyze
mass dispensing of countermeasures and present a set of power-
ful modeling and computational tools to assist in strategic and
operational planning for the rapid establishment of a network of
dispensing sites and health facilities.
Research has also been directed towards the vaccine supply
chain as well as the management of cold chain. Generally, in a
possible influenza pandemic outbreak logistical challenges and
difficulties such as production, stockpiling and delivering vaccines
 Author's personal copy

404 T.K. Dasaklis et al. / Int. J. Production Economics 139 (2012) 393–410

Table 4
Logistical features of other epidemics control literature.

References Logistical attributes Problem formulation/methodology applied

(Adu et al., 1996) Efficiency of the cold chain Experimental study

(Ak et al., in press) Sourcing Integer programming
(Barbera et al., 2001) Logistical barriers for implementing quarantine programs Review
(Brandeau et al., 2007) Emergency supply chain design, information management, Theoretical framework development
coordination, inventory management, customization
(Brandeau et al., 2008) Information and communications management Theoretical framework development,
simulation, cost/benefit analysis
(Bravata et al., 2006) Stockpiling and dispensing of medical supplies Economic analysis
(Chick et al., 2008) Sourcing Game theory
(Collin and de Radigue s, 2009) Vaccine supply Experimental study
(Conn et al., 2008) Information management, inventory control Case-study analysis
(Date et al., 2011) Logistical and operational considerations for vaccine campaigns Case-study analysis
(Hadler, 2005) Vaccine supply Theoretical study
(Hessel, 2009) Vaccine supply Theoretical study
(Jennings et al., 2008) Vaccine supply Theoretical study
(Lee et al., 2009a) Facility location, dispensing of medical supplies, patient Simulation, mathematical modeling
flow logistics, capacity planning
(Lee, 2008) Distribution and dispensing of medical supplies Simulation
(Manley and Bravata, 2009) Coordination Theoretical framework development, simulation
(Moore et al., 1990) Vaccine supply Case-study analysis
(Zaric et al., 2008) Stockpiling, distribution and dispensing of medical supplies Mathematical modeling, scenario analysis

will arise (Jennings et al., 2008). For example (Adu et al., 1996),
through an exploratory research, examine several issues that
affect the efficiency of cold supply chains like mishandling of
vaccines and false storage conditions. Hessel (2009) examines
issues of vaccine allocation and relevant procurement processes,
the establishment of critical health systems and infrastructure
required for vaccine deployment, storage aspects associated with
stockpiling pre-pandemic vaccines, and finally mutually agreed
contractual arrangements between manufacturers and govern-
ments or international institutions. Other logistics aspects of the
vaccine supply chain may concern vaccines’ production and
distribution (Collin and de Radigue s, 2009). Ethical issues regard-
ing vaccine distribution during an influenza pandemic like who
will likely produce and ‘‘own’’ the vaccine and how vaccine
distribution and administration might be accomplished are stu-
died in Hadler (2005).
Another important aspect of the epidemics control supply
chain is the sourcing decisions to be made. Antiviral drugs as
well as vaccines should be procured in order to be utilized during
the containment effort. Governments around the world and
public health institutes may be faced with uncertainty regarding
the exact amount of medical supplies to be purchased. For
instance, many times huge quantities of vaccines are procured
by governments but they eventually become obsolete as the
demand for vaccinating the population remains low (unwilling-
ness of people to get vaccinated etc.). Chick et al. (2008) examine
several supply contracts that coordinate buyer (governmental
public health service) and supplier (vaccine manufacturer) incen-
tives and design a variant of the cost-sharing contract that
provides incentives to both parties which ultimately leads to
the improvement of the supply of vaccines in the case of annual
influenza outbreaks. In Ak et al. (in press) procurement aspects of
the Pan American Health Organization’s vaccine supply chain are
examined and several recommendations for the improvement of
demand forecast for vaccines are provided. The study also
explores issues of transportation cost for vaccines and the
possible implications of bundle bidding. Despite the fact that
the above papers address issues of seasonal influenza, they have
been included in the analysis as they provide strong insights
towards the issues of contract management and sourcing of
epidemics control supply chain.
The remaining studies address issues of coordination, informa-
tion management and general logistical impediments during the
containment effort. For example, some research approaches
examine the logistical barriers for implementing vaccination
campaigns in the case of complex emergencies like in the after-
math of natural disasters (Date et al., 2011) or in the case of
dislocated people and refugees (Moore et al., 1990). Barbera et al.
(2001) examined the likely effectiveness of quarantine, the
logistic barriers to its implementation, relevant legal issues raised
and possible adverse consequences that might result from quar-
antine action implemented as a response to a possible bioterrorist
attack. Manley and Bravata (2009) developed a detailed frame-
work that facilitates coordination of bioterrorism preparedness
planning among military and civilian decision makers. Cross-
functional drivers of the epidemics control supply chain like
information management have also been studied (Conn et al.,
2008). In Brandeau et al. (2008) issues of alternative communica-
tion strategies for bioterrorism responses are evaluated and the
costs and benefits of these strategies are examined through
simulation. Logistical features of the literature presented in this
sub-section as well as methodologies applied (for the quantitative
approaches) are presented in Table 4.
6. Discussion
From the analysis of the selected literature a series of insights
can be derived with respect to the issues of the outbreaks dealt
with by the researchers, the logistical attributes taken into
consideration as well as the methodologies applied. In the case
of the nature of the outbreaks, most research approaches address
topics of bioterrorist response logistics and natural outbreaks
(influenza). As far as bioterrorist response logistics is concerned, it
seems that the 2001 anthrax attack in United States triggered a
series of publications in this subject. Despite the fact that during
an ongoing humanitarian crisis logistical activities must take
place to ensure the maintenance of a high level of sanitary
conditions and the provision of key medical supplies and vac-
cines, research approaches addressing epidemics control logistics
aspects in the aftermath of natural disasters are limited. Even
further, epidemic outbreaks in the aftermath of natural disasters
 Author's personal copy
T.K. Dasaklis et al. / Int. J. Production Economics 139 (2012) 393–410
still remain controversial among researchers. For example, Floret
et al. (2006) suggest that the likelihood of epidemic outbreaks
following natural disasters remains very low whereas Kouadio
et al. (2012) suggest the opposite. Therefore, this lack of con-
sensus among the scientific community members could explain,
to some extent, the lack of epidemics control logistics approaches
in this context. Finally, research approaches regarding epidemics
control logistics in the case of mass gatherings were not located.
Interesting insights can also be drawn from the analysis based
on the logistical attributes of the research approaches reviewed.
For instance, the research approaches developed so far in the case
of epidemics control logistics network configuration are based on
a series of assumptions and simplifications that have little
correlation with real-world problems and especially problems
arising ‘‘in the field’’. As mentioned in Section 5, most of the
proposed methodologies combine differential equations for mod-
eling the progression of the disease along with logistics network
techniques for the transportation and/or distribution of medical
supplies. In the case of disease progression, it is assumed that the
rates of infection as well as the rates of transition of individuals
between compartments are constant. In the majority of epide-
miologic literature such assumptions are considered rather sim-
plistic. Additionally, most of the research approaches consider
that the commodities transported and/or distributed are homo-
geneous or that medical supplies are bundled together. Practi-
cally, this is a simplification that contradicts with several
guidelines proposed by health-care policy makers (CDC, 2007).
These guidelines clearly state that essential medical supplies and
especially vaccines should be transported by using specific
vehicles under fully monitored conditions. Therefore, it is evident
that issues of capacity and fleet management or breaks in the cold
chain attributed to faulty equipment have been overlooked so far.
Another aspect of the epidemics control supply chain config-
uration that has been paid little attention so far is the inter-
relationship between the agent triggering an outbreak and the
configuration of the control supply chain. In fact, the logistics of
response to a confirmed outbreak should rely heavily on the agent
triggering an outbreak and, therefore, the configuration of the
epidemics control supply chain may be different depending on
the very nature of each agent. For instance, anthrax and smallpox
could be both utilized as bioterrorists weapons but from an
epidemiological point of view their control presents huge differ-
ences. As mentioned in Whitworth (2006), anthrax, which is not
contagious, can be treated with antibiotics dispensed to heads of
households (who can then dispense the antibiotics to all the
family members). On the other hand, smallpox is contagious, is
caused by a virus and can be only prevented by vaccination. In
this case, each individual should be administered vaccination.
Therefore, treatment centers would be more likely to handle a
larger number of people in the case of a smallpox attack than in
the case of an anthrax attack with obvious implications for facility
location decisions. Response time frames are also different in each
case, presenting different logistical challenges for the transporta-
tion and distribution of medical supplies. Generally, according to
AHRQ (2004) there are two conceptual approaches regarding
mass prophylaxis in the case of disease outbreaks: ‘‘push’’ and
‘‘pull.’’ The ‘‘push’’ approach considers bringing medicine directly
to affected individuals and households whereas the ‘‘pull’’
approach requires that individuals leave their homes or work-
places in order to travel to certain treatment centers to receive
medication or get vaccinated. Putting aside any strengths and
weaknesses these two approaches may have, it is evident that the
adoption of each approach calls for a different supply chain
configuration.
In the case of stockpiling of medical supplies most research
approaches include only the cost of actually purchasing the
405
inventory into the problem formulation. Other aspects of inven-
tory cost as well as inventory management operations like
maintenance, in-door handling, and activities of picking, packing
and preparing for shipment are omitted. For example, in the case
of control of influenza outbreaks antiviral drugs can be stockpiled
in various forms (powder, pills etc.) thus their management may
necessitate additional handling operations during the contain-
ment effort. In addition, inventory replenishment policies during
an ongoing epidemic outbreak are scarce. Unfortunately, the
majority of the stockpiling approaches do not consider the fact
that after a period of time inventories will be depleted and
replenishing activities should take place. Finally, it seems that
the possible trade-offs between centralized and decentralized
policies of inventory management have not been paid attention
so far.
Research approaches addressing issues of triage management
operations also rely on several assumptions that may contradict
with real-world problems. The most surprising finding is that
triage operations management approaches assume that there is
an adequate supply of medical commodities and that the surge
capacity of dispensing centers is, in most of the cases, infinite.
Nevertheless, anthrax treatment requires a 60-day regimen of
antibiotics and this treatment will likely be implemented in
consecutive waves (Whitworth, 2006). Therefore, replenishment
policies of essential medical supplies should be taken into
consideration. Apart from replenishment strategies, many
approaches do not consider transporting people to the clinics to
get vaccinated or administered medical treatment. Even further, it
is assumed that the influx of patients to the treatment centers is
constant and that the prevalence and severity of disease are also
constant over certain periods. In addition, issues of handling
vaccines and other medical supplies are not taken into considera-
tion. Service rates within dispensing centers are considered
constant over time without taking into account fatigue of the
personnel or even personnel illness. Issues of transshipment of
medical supplies among dispensing centers are also not studied.
Finally, possible bottlenecks attributed to post-vaccination com-
plications for some people and, generally, severe adverse effects
of vaccination are not modeled.
Other aspects of the epidemics control supply chain poorly
studied in the literature may refer to some cross-functional
drivers like sourcing and information as well as to some aspects
of coordination. Pricing and sourcing decisions in the case of
essential medical supplies procured for the containment of an
epidemic may result inconvenient and costly. Appropriate con-
tractual agreements between manufacturers and public health
institutions could alleviate any negative effects for the parties
involved but so far they have not been studied at a large scale.
Issues of information management in epidemics control supply
chain have also been paid limited attention. Information manage-
ment plays a vital role during an epidemic’s outbreak and the
primary sources of information remain the surveillance systems
put in place. A prompt detection of a suspected disease outbreak
has a great impact on the progression of the disease and triggers
certain responses regarding the deployment of the available
resources while providing strong insights towards real demand
requirements. The flow of essential medical supplies, transporta-
tion activities and demand for medical personnel are some of the
logistics-oriented features that depend on the available informa-
tion regarding disease’s progression. At the same time the
management of materials flow during the containment effort
necessitates its own stream of information. Highly sophisticated
systems in business supply chain and relevant technologies like
RFID could also be adopted in the case of epidemics containment.
Additionally, successful control of an epidemic’s outbreak
requires strong co-ordination amongst the parties involved. For
 Author's personal copy
406 T.K. Dasaklis et al. / Int. J. Production Economics 139 (2012) 393–410
example, in Butler et al. (2002) aspects of coordination between
public health and law enforcement agencies are studied but they
do not relate to the established epidemics control supply chain.
Moreover, synergies between private and public health organiza-
tions and governments should be explicitly studied and coopera-
tion frameworks should be developed. For diseases outbreaks in
the aftermath of natural or man-made disasters the control effort
may be far more difficult as a result of the conflict generated
among the different parties involved (humanitarian organiza-
tions, the army, national agencies, etc.) or real-time problems
like damaged or inadequate infrastructures.
Coordination and information management aspects may also
have various implications for the adoption of several supply chain
strategies. For example, in Brandeau et al. (2007) several strate-
gies are proposed that could lead to substantial increases in the
responsiveness and efficiency of the epidemics control supply
chain. As a matter of fact, strategies like lean, agile or leagile
extensively adopted in the case of the business sector could also
be adopted in the case of epidemics logistics provided that a
series of prerequisites are met. Generally, the adoption of these
strategies may be feasible but a thorough assessment is necessary
for deciding the appropriate strategy to be adopted in each case
(nature of the outbreak, disease type etc.). In addition, the
appropriate mixture of strategies (leagile) should be based on a
clear understanding of the several building blocks of the epi-
demics control supply chain like information, coordination, inte-
gration and alignment. For instance, in the case of the business
sector information sharing and coordination are tied together
(Chen, 2003). This close relationship between them enables the
business supply chains to adopt the appropriate strategy which
ultimately leads them to match supply and demand. On the other
hand, epidemics control supply chains are overwhelmed with
uncertainty and present low levels of coordination and informa-
tion sharing among the parties engaged. Moreover, inherent
uncertainties of the agent triggering the outbreak as well as the
uncertainty of the supply chain itself to meet several needs render
the adoption of these strategies a very difficult task.
As far as methodologies are concerned, economic analysis has
been extensively utilized for decisions regarding stockpiling of
medical supplies (especially in the case of future influenza out-
breaks). Unlike the business sector, we found a small amount of
papers addressing issues of inventory management in epidemic
outbreaks by using well established operations research techni-
ques. In the case of logistics network configuration the problems
addressed are formulated using prescriptive models. The majority
of these models are of deterministic nature and just a few of them
incorporate stochastic parameters. From the analysis provided in
Table 2 it is clear that most of the models incorporate cost
minimization as an objective while in the case of epidemics
containment time is the crucial parameter. Techniques of decom-
posing and/or deconstructing of the initial problems into smaller
ones have been limited and most approaches deal with small-
scale problem. As a consequence, modeling and solving large-
scale problems will necessitate the development of more efficient
and effective heuristic algorithms. Furthermore, a large-scale
epidemic emergency in the future might challenge the scalability
of the existing modeling approaches. In the case of management
of the triage operations and patient flow logistics, the majority of
the developed models are descriptive. Logistical problems in the
context of triage operations have been treated using simulation
and queuing theory models. Finally, in the case of more integrated
approaches both prescriptive and descriptive approaches have
been developed where simulation models have been combined
with mathematical and optimization models.
A previous literature review regarding logistics for bioterror-
ism response revealed that, despite the fact that many
frameworks for bioterrorism response exist, just a few of them
have already been evaluated (Bravata et al., 2004a). Almost ten
years later, most research approaches are still based on a
theoretical ground and they lack any evaluation supported by
real data. This lack of evaluation also depicts the gap between
practitioners and researchers as well as the gap between planning
and implementation of emergency supply chain scenarios. Even
though some research approaches presented in this review are
based on exercises (like the case of some triage management
operations) it still remains vague what the actual requirements in
terms of supply chain capabilities might be in the case of an
unprecedented influenza pandemic outbreak or multiple bioter-
rorist attacks. It is worth mentioning that the problem of multiple
disease outbreak has been treated only from a facility location
point of view (Jia et al., 2007a). The evaluation and validation of
the existing research approaches could provide important feed-
backs with respect to the scalability and adaptability of the
models as well as the efficiency of the proposed solution
approaches.
Epidemics containment presents real challenges for logistics as
specific determinants related to the agent triggering the outbreak
as well as several particularities of the affected populations are
hard to be defined. As a consequence, the real demand for medical
supplies may be far different from the demand initially projected.
A common example of the inherent uncertainty lurking behind
the nature of the agent triggering an outbreak is influenza. In the
case of influenza, not only we are unaware of the possible
demand for vaccines and antiviral drugs during a future outbreak
but we also lack the capability of determining exactly the efficacy
of these supplies due to strain mutations. Unfortunately, a six-
month period for producing the appropriate vaccine will be
needed. Until then, antiviral drugs will be extensively used but
still their level of efficacy against the influenza strain will remain
uncertain (Siddiqui and Edmunds, 2008). Generally, vaccine
supply chain poses significant uncertainties, even in the case of
seasonal influenza (Orenstein and Schaffner, 2008). Another
source of complexity and uncertainty of epidemics logistics
containment is the particularities of the affected sub-populations.
Such particularities may span from different demographic char-
acteristics across sub-populations to the attitude of each indivi-
dual towards the epidemic. For example, different age-groups
may necessitate different dosages of medical treatment or specific
sub-populations groups should be subject to a multi-dose regi-
men. Other issues of demand uncertainty may relate to each
individual’s choice to become vaccinated, the possible benefits
from vaccination that may have been accrued from the participa-
tion in past vaccination campaigns or even how media cover
issues of safety for a new vaccine. All the above have both direct
and indirect effects on the demand for medical supplies.
7. Conclusions and suggestions for further research
Epidemic outbreaks triggered either by natural causes or by
deliberate human actions pose significant risks for modern societies.
Logistics operations play a crucial role during the containment effort
of an epidemic outbreak as they strengthen the ability of all the
parties involved to promptly respond and effectively control the
situation. In this paper several issues of epidemics control logistics
operations have been raised and treated through systematically
reviewing the available literature. A plethora of gaps and discrepan-
cies in the literature regarding epidemics control and logistics
operations has also been highlighted. The evidence from this study
suggests that epidemics control supply chain literature is fragmented.
For example, there exist several building blocks of the epidemics
control supply chain like coordination aspects or cross-functional
 Author's personal copy
T.K. Dasaklis et al. / Int. J. Production Economics 139 (2012) 393–410
drivers that have been paid little attention so far. Moreover, most of
the available frameworks have little correlation with real-case
scenarios and, therefore, the applicability of the modeling approaches
might be limited. Finally, several aspects of the nature of the outbreak
or of the agent triggering the outbreak have not explicitly taken into
consideration when relevant supply chain decisions are to be made.
Despite the fact that some logistical considerations have
already been incorporated into epidemics control approaches,
the area of epidemics control supply chain still remains a
promising research area. Following the insights provided in the
discussion section we believe that there exist a lot of opportu-
nities for future research efforts. More precisely, future research
directions may include:
 Multidisciplinary synergies: the complex and multidisciplin-
ary nature of epidemics containment effort calls for synergies
between epidemiologists and logisticians. Although some
research effort has been directed towards the development
of multidisciplinary modeling approaches, there is a need for
further development of more tailored epidemic logistics fra-
meworks. A typical example refers to the powerful disease
progression methodologies developed by epidemiologists,
which could be combined with relevant supply chain
approaches (multi-echelon, multi-commodity, multi-period,
multi-vehicle approaches etc.).
 End-to-End approaches: containing efficiently a disease out-
break necessitates a holistic approach. More comprehensive
and integrated approaches are needed which will embrace
logistical operations from sourcing of medical supplies and
supplementary commodities to finally dispensing them to
affected populations. Such approaches will enhance our under-
standing of how costs could be minimized while achieving a
higher level of efficiency in terms of time response.
 More realistic assumptions for epidemic control logistics
modeling: future research approaches should incorporate
more realistic features regarding the nature of epidemic out-
breaks. For example, time is a critical parameter in epidemics
control and therefore future modeling approaches should be
based more on containment time minimization. Generally,
there is a gap between policy recommendations and modeling
approaches and, therefore, researchers should follow stan-
dards and guidelines published by health-care organizations
when developing epidemic logistics mathematical models.
Streamlining these assessments by taking into account more
realistic assumptions would lead in more robust models.
 Inventory replenishment policies: during the containment
effort it is more likely that inventories of essential medical
supplies will be depleted. Therefore, future research approaches
should deal with the replenishment aspects of various medical
supplies. Even further, decentralized versus centralized inventory
management policies should also be examined.
 Evaluation of models and large scale exercises: future
research directions should evaluate and assess the applicabil-
ity of the existing epidemics control supply chain frameworks.
Such assessments could validate the adaptability of the exist-
ing frameworks as well as the appropriateness of the meth-
odologies applied. They could also provide useful insights
towards the development of more robust methodological
approaches.
 Development of harmonized approaches: in future research
approaches, pharmaceutical interventions should be combined
with non-pharmaceutical ones. For example, closure of schools
and travel restrictions could be combined with epidemic
control logistics approaches. A better understanding is
required regarding how non pharmaceutical control measures
eventually affect medical supplies and vaccine demand.
407
 Stochasticity: many parameters and variables of epidemics
logistics response systems are of stochastic nature. Among
them are the capacity and supplies’ availability, the transpor-
tation and distribution times, triage processing times, etc. The
development of more robust models could be achieved should
future research models embed stochastic parameters.
 Quantification of contingency plans: preparedness plans of
hospitals and health care facilities should incorporate logistical
constraints like availability of workforce and their quantifica-
tion is imperative in order for surge capacities be optimized.
Such approaches would lead to more tangible results regarding
hospitals’ surge capacity and could provide insights for possi-
ble reconfiguration of health institutions.
 Reverse logistics: during the containment effort huge
amounts of medical waste are produced. This kind of waste
is hazardous and should be treated accordingly. Future
research approaches should cater for the development of
reverse logistics aspects of the epidemic control supply chain.
 Performance metrics: epidemic control supply chains lack
any kind of performance measurement. Therefore, research is
needed for the development of specific performance
indicators.
 Responding to complex emergencies: epidemic logistics
approaches addressing issues of disease outbreaks in the
aftermath of natural disasters or multiple disease outbreaks
as a deliberate terrorist action should also be developed. In
addition, epidemic control logistics approaches should also
address issues of mass gatherings.
 Cross-functional drivers: information and sourcing decisions
in the epidemic control supply chain context have received
limited attention. Future research approaches should deal with
the management of the information regarding the supply
chain and relevant sourcing decisions.
 Coordination issues: the coordination of all the parties
involved like primary health-care agencies, international orga-
nizations, suppliers and national/local authorities presents a
significant challenge, thus further research attempts are neces-
sary to address issues of epidemic control supply chains. More
specifically, the role of each participant in the chain (health
organizations, governments etc.) should be clarified, leading to
more holistic approaches towards epidemics control. Cross
functional, inter-agency collaboration and the role of practi-
tioners should also be considered.
Acknowledgments
Mr. T. Dasaklis has been co-financed by the European Union
(European Social Fund—ESF) and Greek national funds through the
Operational Program ‘‘Education and Lifelong Learning’’ of the
National Strategic Reference Framework (NSRF)—Research Funding
Program: Heracleitus II. Investing in knowledge society through the
European Social Fund.
References
Aaby, K., Herrmann, J.W., Jordan, C.S., Treadwell, M., Wood, K., 2006. Montgomery
county’s public health service uses operations research to plan emergency
mass dispensing and vaccination clinics. Interfaces 36, 569–579.
Adida, E., DeLaurentis, P.C.C., Lawley, M.A., 2011. Hospital stockpiling for disaster
planning. IIE Transactions (Institute of Industrial Engineers) 43, 348–362.
Adu, F.D., Adedeji, A.A., Esan, J.S., Odusanya, O.G., 1996. Live viral vaccine potency:
an index for assessing the cold chain system. Public Health 110, 325–330.
AHRQ, 2004. Agency for Healthcare Research and Quality. Bioterrorism and Other
Public Health Emergencies: Tools and Models for Planning and Preparedness:
Community-Based Mass Prophylaxis, A Planning Guide for Public Health
Preparedness. Retrieved December 08, 2011, from: /http://archive.ahrq.gov/
downloads/pub/biotertools/cbmprophyl.pdfS.
 Author's personal copy
408 T.K. Dasaklis et al. / Int. J. Production Economics 139 (2012) 393–410
Ak, A., Heier Stamm, J.L., Wardell III, C.L., Ergun, O., Keskinocak, P., Improving the
Pan American Health Organization’s Vaccine Supply Chain. To Appear. In:
Humanitarian Logistics and Supply Chains: Case Studies and Research Issues,
Goldsman, D., Goldsman, P., Kumar, S. (Eds.), Taylor and Francis. in press.
Altay, N., Green Iii, W.G., 2006. OR/MS research in disaster operations management.
European Journal of Operational Research 175, 475–493.
Ammon, A., Sasse, J., Riedmann, K., 2007. Early disease management strategies in
case of a smallpox outbreak. Poxviruses, 407–421.
Arinaminpathy, N., McLean, A., 2008. Antiviral treatment for the control of
pandemic influenza: some logistical constraints. Journal of the Royal Society
Interface 5, 545.
Arinaminpathy, N., McLean, A.R., 2009. Logistics of control for an influenza
pandemic. Epidemics 1, 83–88.
Arita, I., Nakane, M., Kojima, K., Yoshihara, N., Nakano, T., El-Gohary, A., 2004. Role
of a sentinel surveillance system in the context of global surveillance of
infectious diseases. Lancet Infectious Diseases 4, 171–177.
Balcik, B., Beamon, B.M., 2008. Facility location in humanitarian relief. Interna-
tional Journal of Logistics Research and Applications 11, 101–121.
Balcik, B., Beamon, B.M., Krejci, C.C., Muramatsu, K.M., Ramirez, M., 2010.
Coordination in humanitarian relief chains: practices, challenges and oppor-
tunities. International Journal of Production Economics 126, 22–34.
Balcik, B., Beamon, B.M., Smilowitz, K., 2008. Last mile distribution in humanitarian
relief. Journal of Intelligent Transportation Systems: Technology, Planning, and
Operations 12, 51–63.
Balicer, R.D., Huerta, M., Davidovitch, N., Grotto, I., 2005. Cost-benefit of stock-
piling drugs for influenza pandemic. Emerging Infectious Diseases 11,
1280–1282.
Barbera, J., Macintyre, A., Gostin, L., Inglesby, T., O’Toole, T., DeAtley, C., Tonat, K.,
Layton, M., 2001. Large-scale quarantine following biological terrorism in the
United States: scientific examination, logistic and legal limits, and possible
consequences. Journal of the American Medical Association 286, 2711–2717.
Beamon, B.M., Balcik, B., 2008. Performance measurement in humanitarian relief
chains. International Journal of Public Sector Management 21, 4–25.
Beamon, B.M., Kotleba, S.A., 2006. Inventory modelling for complex emergencies in
humanitarian relief operations. International Journal of Logistics Research and
Applications: A Leading Journal of Supply Chain Management 9, 1–18.
Benedictow, O.J., 1987. Morbidity in historical plague epidemics (Tuscany and
France). Population Studies 41, 401–431.
Berman, O., Gavious, A., 2007. Location of terror response facilities: a game
between state and terrorist. European Journal of Operational Research 177,
1113–1133.
Blecken, A., Danne, C., Dangelmaier, W., Rottkemper, B., Hellingrath, B., 2010.
Optimal stock relocation under uncertainty in post-disaster humanitarian
operations. In: Proceedings of the 43rd Annual Hawaii International Confer-
ence on System Sciences, HICSS-43, Koloa, Kauai, HI.
Brandeau, M., 2005. Allocating Resources to Control Infectious Diseases, Opera-
tions Research and Health Care. Springer. (pp. 443–464).
Brandeau, M.L., Hutton, D.W., Owens, D.K., Bravata, D.M., 2007. Planning the
bioterrorism response supply chain: learn and live. American Journal of
Disaster Medicine 2, 231–247.
Brandeau, M.L., McCoy, J.H., Hupert, N., Holty, J.-E., Bravata, D.M., 2009. Recom-
mendations for modeling disaster responses in public health and medicine: a
position paper of the society for medical decision making. Medical Decision
Making 29, 438–460.
Brandeau, M.L., Zaric, G.S., Freiesleben, J., Edwards, F.L., Bravata, D.M., 2008. An
ounce of prevention is worth a pound of cure: improving communication to
reduce mortality during bioterrorism responses. American Journal of Disaster
Medicine 3, 65–78.
Bravata, D., McDonald, K., Owens, D., Wilhelm, E., Brandeau, M., Zaric, G., Holty, J.,
Liu, H., Sundaram, V., 2004a. Regionalization of Bioterrorism Preparedness and
Response. Evidence Report/Technology Assessment (Summary), p. 1.
Bravata, D., Zaric, G., Holty, J., Brandeau, M., Wilhelm, E., McDonald, K., Owens, D.,
2006. Reducing mortality from anthrax bioterrorism: strategies for stockpiling
and dispensing medical and pharmaceutical supplies. Biosecurity and Bioter-
rorism: Biodefense Strategy, Practice, and Science 4, 244–262.
Bravata, D.M., McDonald, K.M., Smith, W.M., Rydzak, C., Szeto, H., Buckerdge, D.L.,
Haberland, C., Owens, D.K., 2004b. Systematic review: surveillance systems for
early detection of bioterrorism-related diseases. Annals of Internal Medicine
140, 910–922.
Buehler, J., Berkelman, R., Hartley, D., Peters, C., 2003. Syndromic surveillance and
bioterrorism-related epidemics. Emerging Infectious Diseases 9, 1197–1204.
Butler, J.C., Cohen, M.L., Friedman, C.R., Scripp, R.M., Watz, C.G., 2002. Collabora-
tion between public health and law enforcement: new paradigms and
partnerships for bioterrorism planning and response. Emerging Infectious
Diseases 8, 1152–1156.
Caunhye, A.M., Nie, X., Pokharel, S., 2012. Optimization models in emergency
logistics: a literature review. Socio-Economic Planning Sciences 46, 4–13.
CDC, 2007. Centers for Disease Control and Prevention. Guidelines for Smallpox
Vaccine Packing & Shipping. Retrieved October 5, 2011, from: /http://
emergency.cdc.gov/agent/smallpox/vaccination/pdf/packing-shipping.pdfS.
Chen, F., 2003. Information Sharing and Supply Chain Coordination, pp. 341–421.
Chick, S.E., Mamani, H., Simchi-Levi, D., 2008. Supply chain coordination and
influenza vaccination. Operations Research 56, 1493–1506.
Cinti, S., Chenoweth, C., Monto, A.S., 2005. Preparing for pandemic influenza:
Should hospitals stockpile oseltamivir? Infection Control and Hospital Epide-
miology 26, 852–854.
Clay Whybark, D., 2007. Issues in managing disaster relief inventories. Interna-
tional Journal of Production Economics 108, 228–235.
Collin, N., de Radigue s, X., 2009. Vaccine production capacity for seasonal and
pandemic (H1N1) 2009 influenza. Vaccine 27, 5184–5186.
Conn, R., Welch, F., Popovich, M., 2008. Management of vaccine inventories as a
critical health resource. IEEE Engineering in Medicine and Biology Magazine
27, 61–65.
Craft, D.L., Wein, L.M., Wilkins, A.H., 2005. Analyzing bioterror response logistics:
the case of anthrax. Management Science 51, 679–694.
Crawford, J.M., Stallone, R., Zhang, F., Gerolimatos, M., Korologos, D.D., Sweetapple, C.,
De Geronimo, M., Dlugacz, Y., Armellino, D.M., Ginocchio, C.C., 2010. Laboratory
surge response to pandemic (H1N1) 2009 outbreak, New York City metropolitan
area, USA. Emerging Infectious Diseases 16, 8–13.
Date, K.A., Vicari, A., Hyde, T.B., Mintz, E., Danovaro-Holliday, M.C., Henry, A.,
Tappero, J.W., Roels, T.H., Abrams, J., Burkholder, B.T., Ruiz-Matus, C., Andrus, J.,
Dietz, V., 2011. Considerations for oral cholera vaccine use during outbreak
after earthquake in Haiti, 2010–2011. Emerging Infectious Diseases 17,
2105–2112.
Dato, V., Wagner, M.M., Fapohunda, A., 2004. How outbreaks of infectious disease
are detected: a review of surveillance systems and outbreaks. Public Health
Reports 119, 464–471.
DeLaurentis, P.C., Adida, E., Lawley, M., 2008. A game theoretical approach for
hospital stockpile in preparation for pandemics. In: Procedings of the IIE
Annual Conference and Expo 2008, Vancouver, BC, pp. 1772–1777.
DeLaurentis, P.C.C., Adida, E., Lawley, M., 2009. Hospital stockpiling for influenza
pandemics with pre-determined response levels. In: Proceedings of the 2009
IEEE/INFORMS International Conference on Service Operations, Logistics and
Informatics, SOLI 2009, Chicago, IL, pp. 37–42.
Dhankhar, P., Dasbach, E.J., Elbasha, E.H., 2009. Economics of stockpiling for an
influenza pandemic. The Lancet Infectious Diseases 9, 459–460.
Dhankhar, P., Grabenstein, J.D., O’Brien, M.A., Dasbach, E.J., 2010. Cost-effective-
ness of stockpiling 23-valent pneumococcal polysaccharide vaccine to prevent
secondary pneumococcal infections among a high-risk population in the
united states during an influenza pandemic. Clinical Therapeutics 32,
1501–1516.
Dietz, V.J., Gubler, D.J., Rigau-Perez, J.G., Pinheiro, F., Schatzmayr, H.G., Bailey, R.,
Gunn, R.A., 1990. Epidemic dengue 1 in Brazil, 1986: evaluation of a clinically
based dengue surveillance system. American Journal of Epidemiology 131,
693–701.
Duintjer Tebbens, R.J., Pallansch, M.A., Alexander, J.P., Thompson, K.M., 2010.
Optimal vaccine stockpile design for an eradicated disease: application to
polio. Vaccine 28, 4312–4327.
Ekici, A., Keskinocak, P., Swann, J.L., 2008. Pandemic influenza response. In:
Proceedings of the Winter Simulation Conference, 2008. WSC 2008,
pp. 1592–1600.
Esbitt, D., 2003. The strategic National Stockpile: roles and responsibilities of
health care professionals for receiving the stockpile assets. Disaster Manage-
ment and Response 1, 68–70.
European Centre for Disease Prevention and Control June 2009. Surveillance and
Studies in a Pandemic in Europe-Technical Report. Retrieved May 17, 2010,
from: /http://www.ecdc.europa.eu/en/publications/Publications/0906_TER_
Surveillance_and_Studies_in_a_Pandemic_in_Europe.pdfS.
Fedson, D.S., 2003. Pandemic influenza and the global vaccine supply. Clinical
Infectious Diseases 36, 1552–1561.
Ferguson, N.M., Keeling, M.J., John Edmunds, W., Gani, R., Grenfell, B.T., Anderson, R.M.,
Leach, S., 2003. Planning for smallpox outbreaks. Nature 425, 681–685.
Floret, N., Viel, J.F., Mauny, F., Hoen, B., Piarroux, R., 2006. Negligible risk for
epidemics after geophysical disasters. Emerging Infectious Diseases 12,
543–548.
Giovachino, M., Calhoun, T., Carey, N., Coleman, B., Gonzalez, G., Hardeman, B.,
McCue, B., 2005. Optimizing a District of Columbia Strategic National Stockpile
dispensing center. Journal of Public Health Management and practice: JPHMP
11, 282–290.
Gould, E.A., Higgs, S., 2009. Impact of climate change and other factors on
emerging arbovirus diseases. Transactions of the Royal Society of Tropical
Medicine and Hygiene 103, 109–121.
Hadler, J.L., 2005. Public health strategies for distribution of influenza vaccine
during an influenza pandemic. The Yale Journal of Biology and Medicine 78,
277–286.
Harrington Jr, J.E., Hsu, E.B., 2010. Stockpiling anti-viral drugs for a pandemic: the
role of Manufacturer Reserve Programs. Journal of Health Economics.
Hashikura, M., Kizu, J., 2009. Stockpile of personal protective equipment in
hospital settings: preparedness for influenza pandemics. American Journal of
Infection Control 37, 703–707.
Henderson, D.A., 1999. Biological terrorism—the looming threat of bioterrorism.
Science 283, 1279–1282.
Herrmann, J.W., Lu, S., Schalliol, K., 2009. Delivery volume improvement
for planning medication distribution. In: Proceedings of the IEEE
International Conference on Systems, Man and Cybernetics, 2009. SMC 2009,
pp. 3505–3509.
Hessel, L., 2009. Pandemic influenza vaccines: meeting the supply, distribution
and deployment challenges. Influenza and other Respiratory Viruses 3,
165–170.
Hu, J., Zhao, L., 2011. Emergency logistics strategy in response to anthrax attacks
based on system dynamics. International Journal of Mathematics in Opera-
tional Research 3, 490–509.
 Author's personal copy
T.K. Dasaklis et al. / Int. J. Production Economics 139 (2012) 393–410
Hu, J., Zhao, L., 2012. Emergency logistics network based on integrated supply
chain response to public health emergency. ICIC Express Letters 6, 113–118.
Huang, R., Kim, S., Menezes, M.B.C., 2010. Facility location for large-scale
emergencies. Annals of Operations Research, 1–16.
Hui, Q., 2010. Optimal control of bio-attack induced infectious disease dynamics:
the case of anthrax. In: Proceedings of the International Conference on
Automation Science and Engineering, CASE 2010, Toronto, ON, pp. 911–916.
Hupert, N., Mushlin, A., Callahan, M., 2002. Modeling the public health response to
bioterrorism: using discrete event simulation to design antibiotic distribution
centers. Medical Decision Making 22, s17.
Ippolito, G., Puro, V., Heptonstall, J., 2006. Hospital preparedness to bioterrorism
and other infectious disease emergencies. Cellular and Molecular Life Sciences
63, 2213–2222.
Jansson, A., Arneborn, M., Ekdahl, K., 2005. Sensitivity of the Swedish statutory
surveillance system for communicable diseases 1998–2002, assessed by the
capture-recapture method. Epidemiology and Infection 133, 401–407.
Jennings, L.C., Monto, A.S., Chan, P.K., Szucs, T.D., Nicholson, K.G., 2008. Stockpiling
prepandemic influenza vaccines: a new cornerstone of pandemic prepared-
ness plans. The Lancet Infectious Diseases 8, 650–658.
Jia, H., Ordóñez, F., Dessouky, M., 2007a. A modeling framework for facility
location of medical services for large-scale emergencies. IIE Transactions
(Institute of Industrial Engineers) 39, 41–55.
Jia, H., Ordóñez, F., Dessouky, M.M., 2007b. Solution approaches for facility
location of medical supplies for large-scale emergencies. Computers and
Industrial Engineering 52, 257–276.
Jingjing, X., Lindu, Z., Haiyan, W., 2009. Collaborative research between epidemic
diffusion network and emergency rescue network in anti-bioterrorism system.
In: Proceedings of the International Joint Conference on Computational
Sciences and Optimization, CSO 2009, pp. 630–634.
John Hopkins Bloomberg School of Public Health and the International Federation
of Red Cross and Red Crescent Societies, 2008. The Johns Hopkins and Red
Cross Red Crescent. Public Health Guide for Emergencies. Second edition.
Retrieved July 17, 2010, from: /http://www.jhsph.edu/bin/s/c/Forward.pdfS.
Kaplan, E.H., Craft, D.L., Wein, L.M., 2003. Analyzing bioterror response logistics:
the case of smallpox. Mathematical Biosciences 185, 33–72.
Ke, Y., Zhao, L., 2008. Optimization of emergency logistics delivery model based on
anti-bioterrorism. In: Proceedings of the International Conference on Indus-
trial Engineering and Engineering Management, IEEM 2008, Singapore,
pp. 2077–2081.
Kouadio, I.K., Aljunid, S., Kamigaki, T., Hammad, K., Oshitani, H., 2012. Infectious
diseases following natural disasters: prevention and control measures. Expert
Review of Anti-Infective Therapy 10, 95–104.
Kovacs, G., Spens, K., 2007. Humanitarian logistics in disaster relief operations.
International Journal of Physical Distribution & Logistics Management 37,
99–114.
Kovács, G., Spens, K., 2010. Knowledge sharing in relief supply chains. Interna-
tional Journal of Networking and Virtual Organisations 7, 222–239.
Krause, G., Altmann, D., Faensen, D., Porten, K., Benzler, J., Pfoch, T., Ammon, A.,
Kramer, M.H., Claus, H., 2007. SurvNet electronic surveillance system for
infectious disease outbreaks, Germany. Emerging Infectious Diseases 13,
1548–1555.
Lee, E., Smalley, H., Zhang, Y., Pietz, F., 2009a. Facility location and multi-modality
mass dispensing strategies and emergency response for biodefence and
infectious disease outbreaks. International Journal of Risk Assessment and
Management 12, 311–351.
Lee, E.K., Maheshwary, S., Mason, J., Glisson, W., 2006a. Decision support system
for mass dispensing of medications for infectious disease outbreaks and
bioterrorist attacks. Annals of Operations Research 148, 25–53.
Lee, V.J., Kai, H.P., Chen, M.I., Chow, A., Ma, S., Kee, T.G., Yee, S.L., 2006b. Economics
of neuraminidase inhibitor stockpiling for pandemic influenza, Singapore.
Emerging Infectious Diseases 12, 95–102.
Lee, Y.M., 2008. Analyzing dispensing plan for emergency medical supplies in the
event of bioterrorism. In: Proceedings of the 40th Conference on Winter
Simulation, Winter Simulation Conference, Miami, Florida, pp. 2600–2608.
Lee, Y.M., Ghosh, S., Ettl, M., 2009b. Simulating distribution of emergency relief
supplies for disaster response operations. In: Proceedings of the 2009 Winter
Simulation Conference, WSC 2009, Austin, TX, pp. 2797–2808.
Li, Z., Jie, C., 2010. A network equilibrium model for emergency logistics response
under disaster spreading. In: Proceedings of the International Conference on
Logistics Engineering and Intelligent Transportation Systems (LEITS 2010),
pp. 1–4.
Liu, M., Zhao, L., 2009. Optimization of the emergency materials distribution
network with time windows in anti-bioterrorism system. International Journal
of Innovative Computing, Information and Control 5, 3615–3624.
Liu, M., Zhao, L., 2011. An integrated and dynamic optimisation model for the
multi-level emergency logistics network in anti-bioterrorism system. Interna-
tional Journal of Systems Science, 1–15.
Liu, M., Zhao, L., Sebastian, H.-J., 2011. Mixed-collaborative distribution mode for
emergency resources in an anti-bioterrorism system. International Journal of
Mathematics in Operational Research 3, 148–169.
Liu, Y., 2007. Mathematical models of vaccine inventory design for a breakout of
epidemic disease. PAMM 7, 2150013–2150014.
Lober, W.B., Karras, B.T., Wagner, M.M., Overhage, J.M., Davidson, A.J., Fraser, H.,
Trigg, L.J., Mandl, K.D., Espino, J.U., Tsui, F.C., 2002. Roundtable on bioterrorism
detection: information system-based surveillance. Journal of the American
Medical Informatics Association 9, 105–115.
409
Lombardo, J., Burkom, H., Elbert, E., Magruder, S., Happel Lewis, S., Loschen, W.,
Sari, J., Sniegoski, C., Wojcik, R., Pavlin, J., 2003. A systems overview of the
Electronic Surveillance System for the Early Notification of Community-Based
Epidemics (ESSENCE II). Journal of Urban Health, 80.
Lugnér, A.K., Postma, M.J., 2009. Investment decisions in influenza pandemic
contingency planning: cost-effectiveness of stockpiling antiviral drugs. Eur-
opean Journal of Public Health 19, 516–520.
M’ikanatha, N., Lynfield, R., Van Beneden, C., de Valk, H., 2007. Infectious Disease
Surveillance. Wiley-Blackwell.
Manley, D.K., Bravata, D.M., 2009. A decision framework for coordinating bioter-
rorism planning: lessons from the BioNet program. American Journal of
Disaster Medicine 4, 49–57.
Maon, F., Lindgreen, A., Vanhamme, J., 2009. Developing supply chains in disaster
relief operations through cross-sector socially oriented collaborations: a
theoretical model. Supply Chain Management 14, 149–164.
McMichael, A.J., 2003. Global climate change: will it affect vector-borne infectious
diseases? Internal Medicine Journal 33. (554-U552).
Miller, G., Randolph, S., Patterson, J., 2006. Responding to bioterrorist smallpox in
San Antonio. Interfaces 36, 580–590.
Moore, P.S., Toole, M.J., Nieburg, P., Waldman, R.J., Broome, C.V., 1990. Surveillance
and control of meningococcal meningitis epidemics in refugee populations.
Bulletin of the World Health Organization 68, 587–596.
Murali, P., Ordóñez, F., Dessouky, M.M., 2012. Facility location under demand
uncertainty: response to a large-scale bio-terror attack. Socio-Economic
Planning Sciences 46, 78–87.
Oloruntoba, R., Gray, R., 2006. Humanitarian aid: an agile supply chain? Supply
Chain Management 11, 115–120.
Orenstein, W.A., Schaffner, W., 2008. Lessons learned: role of influenza vaccine
production, distribution, supply, and demand-what it means for the provider.
American Journal of Medicine, 121.
Osterholm, M., 2001. How to vaccinate 30,000 people in three days: realities of
outbreak management. Public Health Reports 116, 74.
Patvivatsiri, L., Montes Jr, E.J., Xi, O., 2007. Modeling bioterrorism preparedness
with simulation in rural healthcare system. In: Proceedings of the Winter
Simulation Conference, WSC 2007 Washington, DC, pp. 1155–1160.
Pavlin, J.A., Mostashari, F., Kortepeter, M.G., Hynes, N.A., Chotani, R.A., Mikol, Y.B.,
Ryan, M.A.K., Neville, J.S., Gantz, D.T., Writer, J.V., Florance, J.E., Culpepper, R.C.,
Henretig, F.M., Kelley, P.W., 2003. Innovative surveillance methods for rapid
detection of disease outbreaks and bioterrorism: results of an interagency
workshop on health indicator surveillance. American Journal of Public Health
93, 1230–1235.
Pettit, S., Beresford, A., 2005. Emergency relief logistics: an evaluation of military,
non-military and composite response models. International Journal of Logis-
tics Research and Applications 8, 313–331.
Pietz, F., Benecke, B., Lee, E.K., Hung Chen, C., 2009. Modeling and optimizing
the public-health infrastructure for emergency response. Interfaces 39,
476–490.
Platt, R., Bocchino, C., Caldwell, B., Harmon, R., Kleinman, K., Lazarus, R., Nelson, A.F.,
Nordin, J.D., Ritzwoller, D.P., 2003. Syndromic surveillance using minimum
transfer of identifiable data: the example of the national bioterrorism syndromic
surveillance demonstration program. Journal of Urban Health, 80.
Porco, T.C., Holbrook, K., Fernyak, S.E., Portnoy, D., Reiter, R., Aragón, T.J., 2004.
Logistics of community smallpox control through contact tracing and ring
vaccination: a stochastic network model. BMC Public Health, 4.
Rachaniotis, N.P., Dasaklis, T.K., Pappis, C.P., 2012. A deterministic resource
scheduling model in epidemic control: a case study. European Journal of
Operational Research 216, 225–231.
Radonovich, L.J., Magalian, P.D., Hollingsworth, M.K., Baracco, G., 2009. Stockpiling
supplies for the next influenza pandemic. Emerging Infectious Diseases, 15.
Rebmann, T., Carrico, R., English, J.F., 2007. Hospital infectious disease emergency
preparedness: a survey of infection control professionals. American Journal of
Infection Control 35, 25–32.
Rebmann, T., Citarella, B., Alexander, S., Russell, B., Volkman, J.C., 2011. Personal
protective equipment use and allocation in home health during disasters.
American Journal of Infection Control 39, 823–831.
Richards, C.F., Burstein, J.L., Waeckerle, J.F., Hutson, H.R., 1999. Emergency
physicians and biological terrorism. Annals of Emergency Medicine 34,
183–190.
Richter, A., Khan, S., 2009. Pilot model: judging alternate modes of dispensing
prophylaxis in Los Angeles County. Interfaces 39, 228–240.
Rottkemper, B., Fischer, K., Blecken, A., 2012. A transshipment model for distribu-
tion and inventory relocation under uncertainty in humanitarian operations.
Socio-Economic Planning Sciences 46, 98–109.
Rottkemper, B., Fischer, K., Blecken, A., Danne, C., 2011. Inventory relocation for
overlapping disaster settings in humanitarian operations. OR Spectrum 33,
721–749.
Savoia, E., Massin-Short, S.B., Rodday, A.M., Aaron, L.A., Higdon, M.A., Stoto, M.A.,
2009. Public health systems research in emergency preparedness. a review of
the literature. American Journal of Preventive Medicine 37, 150–156.
Shen, Z., Dessouky, M.M., Ordóñez, F., 2009. A two-stage vehicle routing model for
large-scale bioterrorism emergencies. Networks 54, 255–269.
Shope, R., 1991. Global climate change and infectious-diseases. Environmental
Health Perspectives 96, 171–174.
Siddiqui, M.R., Edmunds, W.J., 2008. Cost-effectiveness of antiviral stockpiling and
near-patient testing for potential influenza pandemic. Emerging Infectious
Diseases 14, 267–274.
 Author's personal copy
410 T.K. Dasaklis et al. / Int. J. Production Economics 139 (2012) 393–410
Taylor, D., Pettit, S., 2009. A consideration of the relevance of lean supply chain
concepts for humanitarian aid provision. International Journal of Services,
Technology and Management 12, 430–444.
Thomas, A., Kopczak, L., 2007. Life-saving supply chains. Building Supply Chain
Excellence in Emerging Economies, 93–111.
Tumpey, T.M., Basler, C.F., Aguilar, P.V., Zeng, H., Solórzano, A., Swayne, D.E., Cox, N.J.,
Katz, J.M., Taubenger, J.K., Pales, P., Garcı́a-Sastre, A., 2005. Characterization of the
reconstructed 1918 Spanish influenza pandemic virus. Science 310, 77–80.
U.S. Agency for International Development, 2009. Laboratory Logistics Handbook:
A Guide to Designing and Managing Laboratory Logistics Systems. Retrieved
April 18, 2010, from: /http://pdf.usaid.gov/pdf_docs/PNADP082.pdfS.
Van Der Laan, E.A., De Brito, M.P., Vergunst, D.A., 2009. Performance measurement
in humanitarian supply chains. International Journal of Risk Assessment and
Management 13, 22–45.
Van Wassenhove, L.N., 2006. Blackett memorial lecture humanitarian aid logistics:
supply chain management in high gear. Journal of the Operational Research
Society 57, 475–489.
Wang, H., Wang, X., Zeng, A., 2009. Optimal material distribution decisions based
on epidemic diffusion rule and stochastic latent period for emergency rescue.
International Journal of Mathematics in Operational Research 1, 76–96.
Watson, J., Gayer, M., Connolly, M., 2007. Epidemics after natural disasters.
Emerging Infectious Diseases 13, 1.
Webby, R.J., Webster, R.G., 2003. Are we ready for pandemic influenza? Science
302, 1519–1522.
Wein, L., Craft, D., Kaplan, E., 2003. Emergency response to an anthrax attack.
Proceedings of the National Academy of Sciences of the United States of
America 100, 4346.
Whitworth, M.H., 2006. Designing the response to an anthrax attack. Interfaces 36,
562–568.
World Health Organization, 2005. Communicable Disease Control in Emergencies:
a Field Manual. Retrieved April 08, 2010, from: /http://www.who.int/infec
tious-disease-news/IDdocs/whocds200527/ISBN_9241546166.pdfS.
World Health Organization, 2008. Communicable Disease Alert and Response for
Mass Gatherings: Key Considerations. Retrieved February 09, 2010, from:
/http://www.who.int/csr/Mass_gatherings2.pdfS.
World Health Organization, 2009. Pandemic Influenza Preparedness and Response.
World Health Organization. (Retrieved April 20, 2010, from)/http://www.
who.int/csr/disease/influenza/PIPGuidance09.pdfS.
Zaric, G.S., Brandeau, M.L., 2001. Resource allocation for epidemic control over
short time horizons. Mathematical Biosciences 171, 33–58.
Zaric, G.S., Brandeau, M.L., 2002. Dynamic resource allocation for epidemic control
in multiple populations. IMA Journal of Mathematics Applied in Medicine and
Biology 19, 235–255.
Zaric, G.S., Bravata, D.M., Cleophas Holty, J.E., McDonald, K.M., Owens, D.K.,
Brandeau, M.L., 2008. Modeling the logistics of response to anthrax bioterror-
ism. Medical Decision Making 28, 332–350.
Zhao, L., Sun, L., 2008. Emergency service modes of supply chains with replenish-
ment sources. In: Proceedings of the 5th International Conference on Service
Systems and Service Management, ICSSSM’08, Melbourne.
Zhao, W., Han, R., 2010. Optimal model of emergency relief supplies distribution in
anti-bioterrorism system. In: Proceedings of the International Conference on
Logistics Systems and Intelligent Management, ICLSIM 2010, Harbin, pp.
1618–1622.
List of additional references
Chippaux, J.P., Debois, H., Saliou, P., 2002. A critical review of control strategies
against meningococcal meningitis epidemics in sub-Saharan African countries.
Infection 30, 216–224.
Considine, J., Mitchell, B., 2009. Chemical, biological and radiological incidents:
preparedness and perceptions of emergency nurses. Disasters 33, 482–497.
View publication stats
Franco-Paredes, C., Carrasco, P., Santos Preciado, J.I., 2009. The first influenza
pandemic in the new millennium: lessons learned hitherto for current control
efforts and overall pandemic preparedness. Journal of Immune Based Thera-
pies and Vaccines, 7.
Fusco, F.M., Puro, V., Baka, A., Bannister, B., Brodt, H.R., Brouqui, P., Follin, P.,
Gjorup, I.E., Gottschalk, R., Hemmer, R., Hoepelman, I.M., Jarhall, B., Kutsar, K.,
Lanini, S., Lyytikainen, O., Maltezou, H.C., Mansinho, K., Marti, M.C., Ott, K.,
Peleman, R., Perronne, C., Sheehan, G., Siikamakii, H., Skinhoj, P., Trilla, A.,
Vetter, N., Ippolito, G., 2009. Isolation rooms for highly infectious diseases: an
inventory of capabilities in European countries. Journal of Hospital Infection
73, 15–23.
Gomersall, C.D., Tai, D.Y.H., Loo, S., Derrick, J.L., Goh, M.S., Buckley, T.A., Chua, C.,
Ho, K.M., Raghavan, G.P., Ho, O.M., Lee, L.B., Joynt, G.M., 2006. Expanding ICU
facilities in an epidemic: recommendations based on experience from the
SARS epidemic in Hong Kong and Singapore. Intensive Care Medicine 32,
1004–1013.
Hick, J.L., O’Laughlin, D.T., 2006. Concept of operations for triage of mechanical
ventilation in an epidemic. Academic Emergency Medicine 13, 223–229.
Hick, J.L., Rubinson, L., O’Laughlin, D.T., Christopher, J.C., 2007. Clinical review:
allocating ventilators during large-scale disasters—problems, planning, and
process. Critical Care, 11.
Koyuncu, M., Erol, R., 2010. Optimal resource allocation model to mitigate the
impact of pandemic influenza: a case study for Turkey. Journal of Medical
Systems 34, 61–70.
Liu, M., Zhao, L., 2011. Analysis for epidemic diffusion and emergency demand in
an anti-bioterrorism system. International Journal of Mathematical Modelling
and Numerical Optimisation, 2.
Medema, J., Zoellner, Y., Ryan, J., Palache, A., 2004. Modeling pandemic prepared-
ness scenarios: health economic implications of enhanced pandemic vaccine
supply. Virus Research 103, 9–15.
Meltzer, M.I., McNeill, K.M., Miller, J.D., 2010. Laboratory surge capacity and
pandemic influenza. Emerging Infectious Diseases 16, 147–148.
Rachaniotis, N.P., Dasaklis, T.K., Pappis, C.P., 2012. A deterministic resource
scheduling model in epidemic control: a case study. European Journal of
Operational Research 216, 225–231.
Rico, F., Salari, E., Centeno, G., 2007. Emergency departments nurse allocation to
face a pandemic influenza outbreak. In: Proceedings of the 2007 Winter
Simulation Conference, pp. 1292–1298.
Savachkin, A., Uribe, A., 2012. Dynamic redistribution of mitigation resources
during influenza pandemics. Socio-Economic Planning Sciences 46, 33–45.
Sobieraj, J.A., Reyes, J., Dunemn, K.N., Carty, I.H., Pennathur, A., Gutierrez, R.S.,
Harris, M.D., 2007. Modeling hospital response to mild and severe influenza
pandemic scenarios under normal and expanded capacities. Military Medicine
172, 486–490.
Sun, P., Yang, L., De Véricourt, F., 2009. Selfish drug allocation for containing an
international influenza pandemic at the onset. Operations Research 57,
1320–1332.
Talmor, D., Jones, A.E., Rubinson, L., Howell, M.D., Shapiro, N.I., 2007. Simple triage
scoring system predicting death and the need for critical care resources for use
during epidemics. Critical Care Medicine 35, 1251–1256.
Wang, S., de Véricourt, F., Sun, P., 2009. Decentralized resource allocation to
control an epidemic: a game theoretic approach. Mathematical Biosciences
222, 1–12.
Wood, J., McCaw, J., Becker, N., Nolan, T., MacIntyre, C.R., 2009. Optimal dosing and
dynamic distribution of vaccines in an influenza pandemic. American Journal
of Epidemiology 169, 1517–1524.
Zaric, G.S., Brandeau, M.L., 2001. Resource allocation for epidemic control over
short time horizons. Mathematical Biosciences 171, 33–58.
Zaric, G.S., Brandeau, M.L., 2002. Dynamic resource allocation for epidemic control
in multiple populations. IMA Journal of Mathematics Applied in Medicine and
Biology 19, 235–255.