Olivia Vargas is currently in Mozambique conducting a midline evaluation of the ColdTrace pilot program, a remote temperature monitoring system for vaccines currently operating in the southern portion of the Gaza Province where she recently visited a vaccine warehouse as inspiration for this blog.
Vaccines come with a lot of accessories. They are the friend that shows up with four suitcases for a weekend getaway. The friend that packs for every possible weather scenario, and the friend that takes the longest to get ready to leave the house. I learned this lesson while in the Mozambican province of Gaza. I got a tour of the provincial warehouse where all the vaccines are stored before they are distributed to district health centers and remote health posts.
Alberto Mabuto, VillageReach field officer, standing with vaccine fridges and cold boxes
Alberto Mabote, a field officer for VillageReach, was at the warehouse and walked me through all the different considerations that need to be made when storing and distributing vaccines. The warehouse has about 15 freezers, each with different kinds of vaccines – measles, BCG, polio etc. – that all need to be kept at a specific temperature. For example, the Measles, Mumps and Rubellla (MMR) vaccine needs to be stored between – 50 and -15 C, a temperature that would be detrimental to other vaccines, such as polio, which must be stored between 2 C and 8 C. This means that multiple freezers need to be available at each warehouse and separate cool boxes are needed when distribution to the approximately 130 health centers in Gaza begins.
Additionally, there are separate cool boxes to be used when the power goes out for a prolonged period of time, a frequent occurrence. These cool boxes have thick walls and a tight seal around the lid – allowing for vaccines to stay cold for up to a month. And, of course, to keep all these cold boxes cold without power, the warehouse has dozens of large plastic icepacks that are used to line the walls of any cold box.
In low- and middle income countries, where power supplies are often variable and funds are tight, these needs become very difficult to satisfy. It also becomes more difficult when new vaccines are added
Seeing all of these components in the warehouse highlighted the complexity of maintaining a properly functioning cold chain, in particular, the need for a large amount of equipment that is both reliable and functional. In low- and middle income countries, where power supplies are often variable and funds are tight, these needs become very difficult to satisfy. It also becomes more difficult when new vaccines are added to the country’s Expanded Program on Immunizations (EPI).
Mozambique is currently in the process of adding three new vaccines to their vaccination program – rotovirus, a second dose of the measles vaccine and an injectable polio vaccine (the current vaccine in use is oral). While adding these vaccines is essential for improved health and disease prevention, the logistics and planning required to absorb these new products into the supply chain is a challenge. Addressing that challenge starts here – in the warehouses.
Mabote told me the first vaccine they are adding is the rotovirus vaccine. This vaccine, unlike most of the other vaccines, only contains one dose per vial. Most other vaccines contain 10 or 20 doses in a single vial.
Instead of only needing 5 or 10 vials of a vaccine to inoculate 100 people, the rotorivus vaccine will require 100 vials. This means more freezers are needed and additional cold boxes and ice packs need to be purchased. For Gaza to address these needs, Mabote explained, that they will have to tear down the back wall of the warehouse and build additional space. In order to prepare for future vaccine additions, they are building two temperature controlled rooms where individual freezers are not needed as the entire room can be adjusted to the specific temperature requirements of the vaccine.
…improvements require significant investment in cold chain infrastructure – to deliver all of the “accessories” needed to make the cold chain work.
All of these improvements require significant investment in cold chain infrastructure – to deliver all of the “accessories” needed to make the cold chain work. It is encouraging to see this progress in Mozambique first-hand as the country prepares for the introduction of the new vaccines. In the end, all of these accessories are worth the price as they are essential to making #vaccineswork, and to saving more lives through better immunization.