1,000 Years of Expertise Making Sure Vaccines Stay Effective

I’m sure you have heard about the theory that 10,000 hours of practice can allegedly make anyone an expert. Whether this is true or not, last week, UNICEF hosted a meeting where experts with a combined 1,000 years of practice in cold chain maintenance discussed some of the current challenges and opportunities related to cold chain maintenance and temperature monitoring at the country level.

A well-functioning cold chain is required to keep vaccines at the ideal +2⁰ to 8⁰ C range so that they stay potent and effective. Sounds easy enough, except in many low- and middle-income countries there is often sporadic or limited electricity, no spare parts to maintain or repair the equipment, undertrained and underequipped technicians that don’t have the right tools or even a vehicle to reach the most remote places, and little or no reporting as to the performance of the cold chain. That’s where it becomes a challenge.

The impressive part of this meeting was the recognition that with the emergence of new technology, new and different vaccines, and more attention being paid to highly performing supply chains, it’s time to review maintenance practices and update recommendations to meet today’s demands.

A few key themes came out of the meeting:

• Data is key to improving the performance of the cold chain. Up until now, no cold chain equipment data has been reported by health facilities to higher supervisory levels. Every month facilities report on vaccine coverage and stock information. But nothing about the cold chain, which means technicians may not know that a fridge is not working or has had a lot of temperature excursions. The recommendation that was made at this meeting is to start collecting a minimum number of data points to make sure that temperatures are being maintained. This is a huge step toward better monitoring of the cold chain.
• More data is now available through temperature monitoring technology. New technology can put an impressive amount of data on fridge performance into the hands of decision makers. Thirty-day electronic temperature monitors (30DTRs) keep track of temperature excursions out of the ideal range and collect data for a month and more, leading to more accurate reporting and monitoring. Remote temperature monitoring (RTM) devices go a step further and send a text alert to health workers when there is an excursion, driving immediate action. It was duly noted that the new technology must be accompanied by clear guidelines, training, and ongoing support to ensure it is being used most effectively.
• Cold chain maintenance needs to be done differently and better. Currently, a lot of attention is going towards providing new cold chain equipment to countries. Maintenance cannot be forgotten as it is an ongoing requirement to make sure the equipment continues to perform well. A funny analogy was used at the meeting when someone likened cold chain maintenance to getting a divorce—both require payments and maintenance support forever. Vietnam and Uganda both highlighted the innovative approaches they are taking to tackle some of the key maintenance issues—with better regional technical institutes, improved availability of spare parts, and increased technical capacity.

Many ideas and learnings were shared in an effort to improve cold chains around the world. This week of focused discussion added to our collective 1,000 years of experience and should result in better cold chain equipment management, and, as the ultimate goal, healthier children around the world.

Written by Wendy Prosser and Amos Chweya