Protecting the Vaccines that Protect Lives
Vaccines have saved millions of lives worldwide by immunizing people from infectious diseases. They have eradicated or minimized polio, measles, diphtheria, pertussis, German measles, smallpox, mumps, tetanus, and rotavirus that were once common health threats across the world.
Yet, despite global immunization efforts, one in five children in the world remains unvaccinated. Nearly 20 million people are at risk of contracting debilitating diseases due to under-vaccination. Consequently, approximately 1.5 million people die annually from diseases that are preventable through vaccination.
The problem is not due to undersupply or lack of inventory, but because of a weak cold chain that causes vaccine wastage. Mishandling of vials and system breakdown contribute to the loss of vaccines. The wastage delays vaccination programs and exposes unvaccinated children in unhealthy environments for a more extended period.
Lack of Power Supply: A Big Cold Chain Problem
Vaccines must be refrigerated at a particular temperature to preserve their potency. It is challenging to operate efficient cold storage without an adequate power supply. Specific temperatures must be maintained throughout transport, storage and distribution.
Vaccines must be kept at a temperature of between 2°C and 8°C (35.6-46.4°F). Power outages can hamper the cold chain and result in potency loss.
According to the Global Alliance for Vaccines and Immunization, only 10% of health care facilities in poor and developing countries have adequate electrical supply. For instance, only 70% of health care facilities in Uganda have access to power. The lack of cold storage in such conditions results in wastage since storage facilities cannot maintain the required temperatures for vaccine storage.
Challenges and Solutions
Several governments recommend that vaccines from compromised storage locations be discarded; otherwise, they could pose health risks if injected in recipients.
Nearly a decade ago, UNICEF estimated that $1.5 million worth of vaccines had been lost in just five months, due to inefficient cold chains, especially in remote areas without adequate electrical supply.
Concerned about these ongoing challenges in the cold chain, the World Health Organization created a set of guidelines for government compliance as part of its efforts to minimize vaccine wastage. Research revealed, however, that the WHO guidelines lack teeth, so to speak, to curb inefficient cold chains effectively. Its policies lack specific instructions on how facilities and pharmacies must operate backup systems.
In addition to this, the World Health Organization did not issue a list of standardized equipment capable of functioning during power outages, a feature that is extremely important for developing and developing countries.
Vaccination campaigns and cold chain logistics involve thousands of people from distribution and transport to storage. Yet, several solutions to address problems at different levels can be implemented to improve cold chain efficiency, especially during power loss.
Some steps for more effective vaccine management during power loss include:
Compliance of government to WHO guidelines and standards
While it may be true that the WHO lacks comprehensive guidelines, governments must step up to fill in that lack. Health departments of countries must allocate taskforces to ensure that procedures are followed and to find means to fill in the gaps.
The WHO can give a “wish list” of what an ideal and effective cold chain looks like, so governments can source funding for them. At the very least, awareness of the problem is the first step to solving it.
Use an alternative power supply
Electricity is not the only source of power, since solar technology has made headway as an alternative energy source.
Acquire new equipment and systems
There are emerging technologies that enable effective vaccine storage in locations with unreliable power supplies. For instance, a storage device developed by Arktek can maintain the integrity of the vaccines without the use of electricity.
It provides a temperature between 0°C and 8°C for 30 to 60 days by storing and using ice in its chamber. The Arktek equipment requires no power refrigeration nor additional ice to function.
Develop more thermostable vaccines
There are already some vaccines capable of sustaining long periods of storage above 8°C. These thermostable vaccines are more heat-stable compared to standard ones that are more heat-sensitive.
The more heat resistant vaccines include hepatitis A&B, inactivated poliomyelitis, diphtheria, tetanus, and HPV and rotavirus vaccines, have improved heart-stability profiles.
Thermostable vaccines have distinct advantages, but there are technical and regulatory issues. More data is needed to prove that vaccines are still potent despite exposure to high temperatures.
Onsite Operational Procedures During Power Loss
There are protocols to follow in case of power failures in cold chain storage areas. Here are a few guidelines in operating cold chain during power outages:
- During short-term outages, keep refrigerator doors closed. This practice will help maintain the cold temperature in the storage during the duration of the blackout. Record the interior temperature and the direction of the exposure as soon as power returns.
- Put signs on refrigerator doors: DO NOT OPEN. KEEP THE REFRIGERATOR DOOR CLOSED. Health officials emphasize this strict reminder that must be followed by cold chain staff. Lock the refrigerator door if possible.
- Contact health officials and submit a report that includes data about temperature, duration of exposure.
- When using a battery-powered thermostat, record the temperature periodically during a power outage period. Keep track and record the minimum and maximum temperatures.
- Provide a generator for backup power supply during an electric supply disruption. In using generators, follow the same protocols such as keeping the refrigerator doors closed and tracking the temperature when regular power returns.
- Enter into agreements with hospitals and clinics that have power backups during blackouts. The vaccines can be stored in their storage systems during an emergency. Ensure, however, that personnel follow transport protocols during the transfer of vaccines.
- Keep track of all vaccines exposed to varying temperatures and record accordingly. Fill in important data such as the name of the vaccines, time of the blackout, time of power return and date.
“Vaccines are a miracle; they’re fantastic. Anything that makes people hesitate to give their children these vaccines according to the recommended schedule creates risk,” says Bill Gates. “Risk for the children who don’t get vaccinated and risk for children, some of whom don’t have an immune system, so they’re benefiting from the fact that the community protection means the disease doesn’t get to them.”
The undeniable benefits of vaccines are evident as they continue to protect children from diseases. It is critical to ensure that vaccines are stored and distributed in the correct manner for any environmental conditions. Vaccines that protect lives must be protected.