Vaccine Cold Chain In Rural Areas
Millions of lives are saved due to immunization. It is often recognized as one of the most successful and cost-effective interventions in the health industry. Vaccines are biological products that give protection against certain pathogens. However, they have the tendency to lose their potency over time. This may be accelerated when the vaccine is placed at a temperature that falls outside the allowable range. When a vaccine loses its potency, it is irreversible and permanent. In order to ensure an effective immunization program, proper storage of vaccines at the appropriate temperature conditions is essential. This is to make sure that the quality of the vaccine is not degraded before it is administered to the patient. Aside from individual immunity, vaccines also contain a disease outbreak through herd immunity. For the eradication of the disease to occur, a vast majority of the population needs to be immunized whether they are living in urban or rural areas. It is a struggle to safely deliver vaccines in rural areas. They often have inadequate equipment to properly maintain the temperature needed by vaccines to remain potent. Most rural hospitals could not afford the necessary ultra-cold freezers used for storage. Aside from that, it is hard to immunize people due to the lack of hospitals and staff and difficulty in vaccine cold chain in rural areas. People living in a rural community face specific health care challenges that those who live in urban areas do not experience. People often struggle to get adequate healthcare in rural areas due to the lack of equipment. There is also a lack of healthcare providers per capita to accommodate the population.
Not providing the necessary vaccines to remote areas has serious implications for the prevention and containment of vaccine-preventable diseases. Children in remote areas are often not given proper immunization. Around a quarter of children born each year, or 34 million infants, have not been immunized against diseases that have inexpensive vaccines. In 2002, 2.1 million people worldwide died because of illnesses that are preventable by existing vaccines. In 2003, 27 million children in the world were not reached by the DPT3 vaccine. Most of these children are situated in rural areas. Delivering the vaccines to these remote areas is difficult. Aside from the regular cold chain temperature challenges, accessing power to maintain the cold chain is difficult too. It is also hard to procure capable equipment. Due to the hard-to-reach location of the remote areas, 50% of transported vaccines tend to get spoiled before they reach their destination. This is due to a lack of electricity.
The Vaccine Cold Chain
All vaccines are temperature-sensitive. They need to be correctly stored and delivered through an efficient cold chain system. The cold chain is a means for delivering vaccines in a potent state from the manufacturer to the patient that needs to be immunized. It is a series of transport links and interconnected cold rooms, freezers, cold boxes, refrigerators, and carriers. Having an effective cold chain system can increase the efficacy and guarantee the safety of an immunization program.
Proper management of a cold chain during storage and transport is crucial for vaccine effectiveness. A cold chain focuses more on temperature regulation rather than keeping things cold. It is important for the temperature to remain in the allowable range at all times. Excursions can render a box of vaccines ineffective, leading to financial loss and safety risks.
Most vaccines need to be cold but not frozen. The cold chain is plagued with different kinds of challenges. Aside from the external environmental temperature of the location, the equipment needs to be properly managed also.
Situation and Challenges of Vaccine Cold Chain In Rural Areas
In order for vaccines to be effective, regular immunization programs must be conducted. This is to ensure individual and community protection. However, in some rural and low-income countries, vaccine coverage may be limited. The government experiences difficulty at times in delivering vaccines to remote areas. This leads to outbreaks of various vaccine-preventable diseases. In many low-income countries, vaccines are often distributed by the government. They follow the health system administrative structure. The delivery covers the national, provincial, and district level. The districts would then ensure that the vaccines are delivered to the health centers. However, these health centers are located in rural, hard-to-reach areas. They have limited transport available, inadequate telecommunications equipment, and an unstable electricity supply. Some rural areas fail to distribute vaccines to a substantial percentage of the target population. This is due to problems involving program management, policy setting, financing, supply chain, global vaccine market, research, and development of vaccines. In order to achieve immunization in rural areas, cold chain system operators need to understand the complexities. Often, the cold chain is a vulnerable point for national immunization programs in developing countries with tropical climates. The success of immunization programs relies on the effective management and monitoring of the highly sensitive cold chain.
The ‘last-mile’ delivery is often the weakest link in the cold supply chain. This is due to the lack of the necessary equipment, understaffed facilities, and inadequate infrastructure. Additionally, cold chain monitoring is still a significant problem in developing countries. In previous studies, only 56% of health facilities were able to fill out the temperature charts twice a day as per the recommended guidelines.
Large hospitals have been rushing to procure expensive ultra-cold freezers in order to store the approved Covid-19 vaccines. Unfortunately, rural hospitals do not have the necessary funds. This means that health workers and residents residing in those areas may have difficulty getting vaccinated. The extreme temperature-sensitivity of COVID-19 vaccines makes it harder for remote and rural areas to receive the vaccines.
The vaccine developed by Pfizer and BioNTech have been released recently, and they need to be stored at a temperature of -70°C (-94°F) at all times. However, the typical freezer does not have that temperature, which makes distributing the vaccines logistically challenging.
The Center for Disease Control and Prevention has discouraged health departments from purchasing ultra-cold freezers, which cost around $10,000 to $15,000. The reason for this is that other vaccines with more conducive storage requirements may be available soon. The vaccine cold chain in rural areas seems to be impossible due to not having the budget to afford the additional costs and distribute 1,000 doses in seven to ten days. This is true, especially in the first phase of the vaccination initiative when not all will be qualified. The distribution of the COVID-19 vaccines is a logistical challenge. However, every system is susceptible to the challenges of vaccine delivery in the medical industry.
Case Study: Storage and Monitoring in West Cameroon
In order to guarantee a vaccine’s quality, it is important for the cold chain to be monitored. The cold chain monitoring for an expanded program on immunization was studied in West Cameroon through field reports and previous studies. This to assess the functioning and availability of cold chain equipment.
Cameroon has outbreaks of vaccine-preventable diseases like measles despite having immunization programs and high vaccination coverage. Due to this, it was inferred that the quality of vaccines being administered was the cause of the problem. This may be because of storage problems or the initial efficacy of the vaccines produced.
Three urban and five rural districts were randomly selected among 19 health districts. Health care facilities taking part in the EPI were assessed for the availability, functioning, and monitoring of cold chain equipment and power supply. Refrigerator, contingency plans, vaccine carriers, power supply, guidelines, thermometers. Ice packs and temperature charts were checked to see if they were available in the health care facilities. The data of around 70 health facilities were analyzed using the epi-info software. It was found that many of the health care facilities had at least one functional refrigerator that was capable of storing vaccines. Some facilities were found to have an absence of EPI in the health facilities. Half of the facilities that had a temperature chart was incorrectly filled out. Fourteen of the health facilities experienced a temperature excursion in the last two months before data collection. In the previous two months, 239 abnormal temperatures were recorded in the facilities. Meanwhile, 17 staff were not aware of the correct vaccine storage temperature.
There is acceptable availability of vaccine storage equipment in the North West Region of Cameroon. However, the assigned staff for monitoring had limited capacity in all health facilities. Facilities that do not have an operational cold chain are forced to go to others that have a functional one to procure vaccines whenever they hold immunization sessions. This movement exposes the vaccine to overheating and light. It may then lead to significant vaccine damage and impair immunization programs. This can explain why despite having a substantial number of residents that have measles reported that they have been vaccinated against it. There are also problems regarding the proper maintenance of existing equipment in Cameroon.
Since there is available vaccine storage equipment in Cameroon, if maintained and utilized, it would be sufficient to attain the ideal vaccine coverage to ensure herd immunity. Improper cold chain monitoring is also present, which should be addressed immediately. There is also inadequate training and knowledge on the vaccine cold chain in rural areas. Providing sufficient training, supervision, and developing standard operating procedures for vaccine storage will enhance cold chain performance. This will consequently improve vaccination through the distribution of a potent vaccine. By administering potent vaccines, the immunization rate will increase and eventually eliminate vaccine-preventable diseases in the North West Region and Cameroon.