Improving cold chain systems: Challenges and solutions.

While a number of new vaccines have been rolled out across the developing world (with more vaccines in the pipeline), cold chain systems are struggling to efficiently support national immunization programs in ensuring the availability of safe and potent vaccines. This article reflects on the Clinton Health Access Initiative, Inc. (CHAI) experience working since 2010 with national immunization programs and partners to improve vaccines cold chains in 10 countries-Ethiopia, Nigeria, Kenya, Malawi, Tanzania, Uganda, Cameroon, Mozambique, Lesotho and India - to identify the root causes and solutions for three common issues limiting cold chain performance. Key recommendations include: Collectively, the solutions detailed in this article chart a path to substantially improving the performance of the cold chain. Combined with an enabling global and in-country environment, it is possible to eliminate cold chain issues as a substantial barrier to effective and full immunization coverage over the next few years.

[1]  M. Murhekar,et al.  Frequent exposure to suboptimal temperatures in vaccine cold-chain system in India: results of temperature monitoring in 10 states. , 2013, Bulletin of the World Health Organization.

[2]  J. Lloyd,et al.  Reducing the loss of vaccines from accidental freezing in the cold chain: The experience of continuous temperature monitoring in Tunisia , 2015, Vaccine.

[3]  Michelle M. Garrison,et al.  Freezing temperatures in the vaccine cold chain: a systematic literature review. , 2007, Vaccine.

[4]  H. Wibisono,et al.  Hepatitis B vaccine freezing in the Indonesian cold chain: evidence and solutions. , 2004, Bulletin of the World Health Organization.

[5]  C. Esimone,et al.  The Potency of Yellow Fever Vaccines Sold in Open Markets in Eastern Nigeria , 2013 .

[6]  L. Gelmon,et al.  The impact of introducing new vaccines on the health system: case studies from six low- and middle-income countries. , 2014, Vaccine.

[7]  L. Brenzel.  What have we learned on costs and financing of routine immunization from the comprehensive multi-year plans in GAVI eligible countries? , 2015, Vaccine.

[8]  Jb Obonyo,et al.  Kenya National Bureau Of Statistics (KNBS) And ICF Macro. Kenya Demographic And Health Survey 2008-09. , 2010 .

[9]  Judith R Kaufmann,et al.  Vaccine supply chains need to be better funded and strengthened, or lives will be at risk. , 2011, Health affairs.

[10]  H. Mainzer,et al.  Frequency and causes of vaccine wastage. , 2002, Vaccine.

[11]  G. Humphreys.  Vaccination: rattling the supply chain. , 2011, Bulletin of the World Health Organization.

[12]  P. Tharmaphornpilas,et al.  Exposure to heat and freezing in the vaccine cold chain in Thailand. , 2007, Vaccine.

[13]  Debra Kristensen,et al.  The imperative for stronger vaccine supply and logistics systems. , 2013, Vaccine.

[14]  Holly N. Dentz,et al.  The impact of new vaccine introduction on immunization and health systems: a review of the published literature. , 2012, Vaccine.

[15]  S. McCarney,et al.  Using solar-powered refrigeration for vaccine storage where other sources of reliable electricity are inadequate or costly. , 2013, Vaccine.