The Chain of Life
The pharma cold chain may be referred to as the “chain of life.” since it is a system that provides life-saving vaccines to millions of people worldwide. After manufacturing, medical drugs must be stored, transported and delivered to end users. What solutions are there for better pharma cold chain logistics in developing countries?
Cold chain logistics involve teams of qualified people, policies, procedures, equipment, connectivity, data-transfer and technologies. All of these elements must work in sync, to assure that vaccines and other medicines are distributed efficiently. Immunization enables people to resist various diseases, so it is critical to deliver vaccines within a target period.
Vaccines require specific temperatures during storage and transport. Excessive heat and coldness alters the composition of the vaccines and may render it ineffective. Wastage results in delay, and puts the health of people at risk. Millions of dollars’ worth of resources go down the drain if people mishandle these vaccines in the cold chain.
For instance, the World Health Organization Expanded Program on Immunization (EPI) saves nearly three million lives annually. Vaccines prevent children from incurring the most common causes of child mortality: pneumonia and diarrheal disease. One in four childhood deaths is averted due to the implementation of EPI.
Maintaining an effective cold chain is a complex process. It should be managed by competent people who are adept with specific technologies and possess management acumen. Obsolete and malfunctioning systems are just two of the primary situations that cause cold chain breakdowns.
Cold Chain Challenges in Developing Countries
Imagine hundreds of children on the far side of the world scheduled to receive their vaccine shots. Three days before their scheduled immunization, the thermal storage system malfunctioned. No one in the cold chain team monitored the sudden drop in temperature.
Consequently, the storage condition alters the vaccines’ composition, but the medical team proceeded with the immunizations. What might happen to the children injected with corrupted vaccines? Such is one of the problems that may occur in a cold chain system.
Here are a few of the common challenges in the cold chain logistics in developing countries:
Weak political will and government bureaucracy. Some governments have weak political will in implementing global health programs in their country. The lack of a national agenda for immunization and cumbersome bureaucracy impede vaccination initiatives done by global health institutions. Cold chain systems are derailed due to corruption and red tape.
Lack of qualified and well-trained managers. Cold chain technologies require specialized management skills. Storage warehouses must maintain the required temperatures. There must be specific processes in logging in and out of the flow of vaccines. Managers who work in the cold chain must pay attention to details and follow, to the letter, proper procedures.
The cold chain needs qualified and well-trained people, as well as cutting-edge technology to run it effectively. Having a state-of-the-art system without competent people to operate it is useless.
Many other problems in the different tiers of transport and storage could still transpire. Some of the causes of inefficiency are human error, system breakdown, or natural calamities. In some countries, they allow unqualified people to manage the cold chain, which may compromise the systems’ and processes’ integrity.
Use of Outdated Equipment and System. Due to a lack of funding, some countries are compelled to use outdated equipment and systems since they don’t have other alternatives. For them, it is better to use ineffective systems than nothing.
Lack of qualified technicians. Pharma cold storage relies on CFC-free equipment which may be complicated to operate. Only trained technicians can maintain and repair it. In some cases, the lack of available spare parts also affects the running of the systems that store and transport the vaccines.
Environmental Factors that Affect Cold Chain and Logistic Management
Among the environmental factors in developing countries that affect effective cold chain management are:
Unstable supply of electricity and energy source – Thermal storages run on electricity. Cold chains in countries with inadequate electricity have to rely on alternative power sources such as generators and solar panels.
Lack of good roads – Land vehicles must travel roads to reach far-flung places where there are people who need immunizations. Lack of good roads hampers the efficient delivery of vaccines to end-users.
Natural calamities – Storms and typhoons double the obstacles in the sound management of cold chains. Vaccines may be easily damaged during storage or transport if excessive heat, water, dust, or wind infiltrate the system.
Human-made conflicts – Armed conflict and wars halt vaccines’ delivery since they put at risk the people behind the health programs’ implementation.
Proposals on How Developing Countries Can Improve Cold Chain
- Create new policies or revise existing ones to improve the purchase, maintenance, repair, and replacement of cold chain equipment and systems. The public policy and agency guidelines should:
- Define cold chain inventory schedules
- Provide specifications of equipment and alternative sources of energy and power
- Provide clear procedures in tracking inventories, scheduling of maintenance and repair, and replacement of spare parts
- Formulate best practices guidelines for systems-equipment maintenance and repair
- Replacement of equipment and systems after ten years of use
- Responsible disposal of old cold chain equipment and collaterals so they won’t be recycled for use or sold in other countries.
2. Allot long-term-funding that includes the cost for technician training at all levels of the cold chain, periodic maintenance, tools and spare parts
3. Publish clearly defined profile, background, and competencies of technicians involved in the pharma cold chain, including job descriptions and tasks
4. Raise the standards of hiring by requiring certifications for managers, supervisors and technicians in the cold chain
5. Regular retraining of workforce in the use, maintenance, and repair cold chain equipment, system and logistical collaterals
Tanzania: A of Model Efficient Cold Chain for Developing Countries
The recommendations helped Tanzania to improve its cold change and logistic management efficiently. The government reorganized its approach and revised practices in procurement and supply processes. With qualified technicians running the operations, they solved problems on the ground and provided solutions based on forecasts.
The government procured new refrigerators for its health facilities, where vaccines are stored at the correct temperatures. To offset their dependence on coal-powered electricity, they have standby power sources from solar, liquified petroleum gas, and kerosene to keep their storage running during blackouts. Well-trained technicians provided preventive maintenance to ensure that their equipment and systems were in good running condition.
The Tanzanian government helped in the successful implementation of EPI by employing the right people to stock and monitor the vaccines according to industry standards. They used vaccine vial monitors and freeze watch indicators in all stages of the cold chain.
These best practices resulted in zero to minimal wastage, a predictable flow of inventory, quicker transport, and more efficient distribution of vaccines.
Cold Chain: A Future Still in the Making
Tanzania is just one of the handful of countries rehabilitating its cold chain and logistics to ensure that vaccines are stored and delivered efficiently. Yet, in the big picture, the industry’s common problems remain firmly entrenched in many developing countries.
While there are silver linings in this subject, some areas remain bleak. In a study entitled “Poor Performance of Medicines Logistics and Supply Chain Systems in a Developing Country Context: Lessons from Nigeria”, summarizes one of the root causes of the problem:
Logistics companies are not adequately equipped and no monitoring is in place to ensure that standards are set and followed. About 84% of logistics companies had no set of standard operating procedures for medicines logistics. About 37% are capable of providing cold chain logistics depending on the duration. There was no form of regulation enforcing standards for medicines logistics. Pharmacists’ views suggest that poor logistics and SCM practices, weak regulation and policy implementation and lack of support for in‐country medical logisticians are factors affecting efficient SCM of medicinesChukwu, Chukwu and Lemoha, 2018
Despite awareness of the cold chain problems more than a decade ago, the solutions set in place were not fully implemented. Other countries that made initial progress were prone to revert to their old practices due to unsustainable government support, geopolitical challenges, and weak leadership.
The private sector, significantly the billion-dollar pharmaceutical companies, should step up and support the chain to earn astronomical revenues.