Vaccine storage issues could make 3 billion people inaccessible

Result: Poor people around the world who have been hit hardest by a viral pandemic can also be the last to recover from it.

Vaccine cold chain hurdles weight poor people who often live and work in crowded conditions that allow the virus to spread and have little access to medical oxygen, which is essential for COVID-19 treatment. It is the latest disparity in the pandemic. The healthcare system lacks laboratories, consumables, or technicians to perform large-scale tests.

Maintaining a cold chain of coronavirus vaccines is not easy, even in the wealthiest countries, especially in countries that require ultra-low temperatures of minus 70 degrees Celsius (minus 94 degrees Fahrenheit). Investment in infrastructure and cooling technology lags behind the fast leap of vaccine development this year for viruses.

In the eighth month of the pandemic, logistics experts warn that there is a lack of refrigeration to implement effective vaccination programs in vast parts of the world. This includes most of Central Asia, most of India and Southeast Asia, Latin America except the largest countries, and all but a small part of Africa.

A clinic outside the capital of Burkina Faso, a dirty striped building servicing a population of 11,000, is the epitome of disability.

After the refrigerator broke down last fall, the clinic was unable to store vaccines against tetanus, yellow fever, tuberculosis and other common illnesses on-site, said nurse Julienning Zungrana. Instead, staff used their bikes to remove vials of insulation carriers from the hospital in Ouagadougou and traveled in 40 minutes round trip on narrow roads that varied between soil, gravel, and pavement.

Two mothers who visited the Gampera Clinic said they found coronavirus vaccination programs difficult in their area. 24-year-old Adama Tapsoba walks for four hours in the scorching sun to get her baby routinely vaccinated. Often, wait a few more hours before seeing a doctor. A week ago, Tapsoba’s daughter was ill and could only walk one child, so her five-month-old son missed the planned shot.

“It will be difficult to get the (COIVD-19) vaccine,” Tapsoba said, bouncing her five-month-old son on her lap outside the clinic. “People have to wait in the hospital and they may leave without receiving it.”

To maintain the cold chain of developing countries, international organizations have overseen the installation of tens of thousands of PV vaccine refrigerators. Maintaining a stable temperature from the time the vaccine is produced until it is administered to the patient requires mobile refrigeration, reliable electricity, healthy roads, and above all, advance planning.

For poor countries like Burkina Faso, the most likely to be vaccinated against the coronavirus is the Covax initiative led by the World Health Organization and the Gavi Vaccine Alliance. Covax’s goal is to order multiple promising vaccine candidates and to fairly allocate successful vaccine candidates.

UNICEF, the United Nations Children’s Fund, began laying the foundation for global distribution in Copenhagen a few months ago. At the world’s largest humanitarian warehouse, logistics staff have learned from the past, especially the spring turmoil surrounding the global shortage of masks and other protective equipment ordered from airport parking, stolen or traded in the black market. I’m trying to predict.

According to WHO, 42 coronavirus vaccine candidates are currently in clinical trials, with an additional 151 candidates in preclinical evaluation. The one most likely to be included in a Covax mix should be stored at 2-8 degrees Celsius (25-46 F).

Pfizer candidates are one of the advanced test candidates that require storage at ultra-low temperatures. Designing a special carrying case for vaccines, the company showed interest in Covax and signed contracts with the United States, Europe and Japan.

Medical freezers that drop to minus 70 degrees Celsius are rare in hospitals in the United States and Europe. Many experts believe that West African countries suffering from the 2014-16 outbreak of Ebola are in the best position. Vaccines against the virus also require ultra-low temperature storage.

But for more than two-thirds of the world, there is no advanced technology, according to a study by German logistics company DHL. Meanwhile, billions of people are in countries that do not have the infrastructure needed to maintain the cold chain of either existing vaccines or more conventional coronavirus candidates.

The chances of losing a vaccine increase as the vaccine progresses. DHL estimates that 15,000 freight flights will be required to vaccinate COVID-19 globally, expanding the global capacity of aircraft and the supply of materials such as dry ice.

Katja Busch, DHL’s Chief Commercial Officer, said “you need to find a bridge” for every gap in the cold chain. “We’re talking about investing … as a society, this is what we have to do.”

Prior to the pandemic, Gabi and UNICEF provided refrigerated vaccines to much of Africa and Asia, and have built 40,000 facilities since 2017. UNICEF is currently planning to provide the government with a checklist of what it takes to maintain its vaccine supply chain.

“The government is in charge of what ultimately needs to happen,” said Benjamin Schreiber, head of UNICEF’s vaccination program.

When the vaccine leaves the factory, a global cold chain crack begins. Container ships are not equipped to refrigerate medicines that have a limited shelf life. Airlifting vaccines is even more expensive, and air freight is recovering from pandemic-related border closures.

Even if flights are cold and frequent enough, air cargo carries other potential hazards. WHO estimates that half of the world’s vaccines are lost as waste. This can also be due to exposure to heat during shipping or damage to the vial. Theft is also dangerous with the coronavirus vaccine, one of the most popular products in the world.

“They can’t be left in the parking lot to fight because they’re actually ruined and worthless. To make matters worse, people will still be trying to distribute them,” said Grin, Global Head of Cargo. Hughes said. International Air Transport Association.

Tinglong Dai, a researcher at Johns Hopkins University who specializes in healthcare logistics, said that creativity is needed to keep the cold chain intact while the coronavirus vaccine is being distributed worldwide. Gavi and UNICEF have been experimenting with drone vaccine delivery. Indian authorities have highlighted the idea of ​​securing part of the country’s vast food storage network for coronavirus vaccines.

“If people understand how to transport ice cream, they can transport vaccines,” Die said.

Temperature-sensitive labels that change color when the vaccine is exposed to heat for extended periods of time and become unsafe, and live-streaming tracking to ensure that the vaccine reaches its intended destination also facilitates safe shot delivery. Made it possible.

Still, as the vaccine is ready to leave the country’s depot, the chances of something going wrong are doubled on the ground. Logistics planning is very important because the cold chain is very vulnerable. Syringes and disposal boxes should be available as soon as the vaccine shipment arrives.

By the end of the year, UNICEF will pre-place 520 million syringes for coronavirus vaccines in developing countries, “to ensure that these supplies arrive in the country by the time the vaccine arrives. We plan to create a map of where refrigeration is most needed. Secretary-General Henrietta Fore said.

The last vaccine in need of refrigeration adopted by India’s national program was against rotavirus, a stomach bug that usually affects babies and toddlers. Dr. Gagandeep Kang, who led the research on the vaccine, estimated that India’s storage capacity was about 30% less than the storage capacity required for the coronavirus vaccine.

In countries such as India and Burkina Faso, lack of public transport is another obstacle to immunizing citizens before vaccines go bad.

Dr. Aquinas Edasely, who runs two clinics in one of India’s poorest least developed countries, said patients need to walk for hours to get medical care. According to Edasely, traveling on a single road that winds 86 kilometers (53 miles) over steep hills and is washed away for months at a time will be an insurmountable barrier for many inhabitants of the eastern part of Rayagada. ..

Like most logistics, the last kilometer is the hardest part of delivering a coronavirus vaccine to people in need. In Latin America, perhaps only Venezuela has a glimpse of the possibility of a dramatic off-course vaccine cold chain.

Doctors in some parts of Venezuela reported losing their vaccine inventory when most of the country was exposed to darkness for a week in the last year’s power outage. According to Dr. Huníades Urbina, director of the Venezuelan Pediatric Pediatric Society, the country’s largest children’s hospital had to dispose of thousands of vaccines due to diseases such as diphtheria.

“Coronavirus can’t stop measles,” Urbina said.

Since then, maintaining the cold chain has become increasingly difficult. Gas shortages limit the ability of vaccines to move quickly from one area of ​​Venezuela to another. It is difficult to find dry ice to keep the vaccine cold in transit. And after years of economic decline, fewer doctors and other professionals have been trained to keep the chain intact.

“I’m not optimistic about how the vaccine will be distributed in the state because there is no infrastructure to guarantee delivery, or if it is delivered, it will be guaranteed to be properly stored in cold conditions. “Dr. Albert Paniz Mondolfi, a Venezuelan pathologist, said.

Venezuela gives an extreme example, but the coronavirus vaccine may also test parts of Latin America with a more robust healthcare system. In Peru, private companies that transport fish and beef usually provide trucks, but it is unclear if the Ministry of Health will accept them.

Returning to Burkina Faso, the day of vaccination was a challenge at the Gampera Clinic when the fridge ran out, said nurse Zoungrana. Hospital courier staff often have to buy fuel they can’t afford and make a second trip to and from the capital to return unused doses.

“We are suffering,” said Zongrana, who ran off the road on a motorcycle just a few weeks ago.

A few days after the Associated Press journalist visited the clinic this month, the long-awaited solar refrigerator arrived. Due to the lack of technicians, the clinic was waiting to ensure that the appliance was functioning properly before stockpiling the vaccine.

In Burkina Faso, there is a shortage of about 1,000 clinical refrigerators nationwide, and less than 40% of vaccinated medical facilities have reliable refrigerators, said Issa Ouedraogo, director of national vaccination. ..

Multiple dose vials, which are equivalent to bulk storage of vaccines, can significantly reduce global shipping costs. However, when the vial is opened, its shelf life counts down even faster. If too few people appear in the jab in time, everything left in the large vial should be discarded.

“It’s really annoying to have such waste. It will result in loss of life and pain and suffering. Professor Anna Nagurny of the University of Massachusetts Amherst is studying supply chain logistics.

So far, UNICEF is betting on 20-dose vials of coronavirus vaccine, according to Michelle Cedel, with less than 3% wasted in closed vials and less than 15% in open multi-dose vials that are not exhausted. I expect to stay at. Of UN agency cold chain experts.

If Burkina Faso is given one million coronavirus vaccines today, the country will not be able to handle it, says Junk Road Mubalama, UNICEF’s head of health and nutrition for African countries.

“If we had to vaccinate against the coronavirus now, it wouldn’t be possible at this point,” he said.

Hinant reported from Paris. Also contributed by Aniruddha Ghosal in Delhi, Christine Armario in Bogota, Colombia, and Linda A. Johnson in Fairless Hills, Pennsylvania.

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