Improving cold chain systems: Challenges and solutions
Open accessAbstract
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: (1) To address cold chain capacity: • developing an accurate picture of cold chain capacity gaps based on current and future needs; • resource mobilization, and; • effective monitoring during implementation. (2) To encourage upgrade of cold chain with latest technology suitable in country: • in-country piloting of new equipment; • utilization of tools to better understand equipment trade-offs, and; • guide equipment selection and regular engagement with suppliers. (3) To control temperature excursions and equipment breakdowns • introduction of temperature monitoring and control (TMC) devices and practices; • improve competence and availability of existing and future technicians, and; • ensure availability of spare parts. 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.
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Monitoring internal refrigerator temperatures in Haiti has been done only with stem thermometers, which often do not detect vaccine exposures to extreme heat or cold because they cannot provide continuous data on temperatures or generate alarms in the event of excursions.
“monitoring internal refrigerator temperatures has been done only with stem thermometers, which often do not detect vaccine exposures to extreme heat or cold because they cannot provide continuous data on temperatures or generate alarms in the event of excursions. 10”
From Demonstration of the Use of Remote Temperature Monitoring Devices in Vaccine Refrigerators in Haiti (2018) · cites this paper as [10]
Split into 2 atoms — 0 confirmed, 2 partially supported, 0 disputed, 0 misattributed, 0 unverifiable. Expand the claim to see per-atom verdicts.
Experimental — accuracy not yet measuredMany immunization programs worldwide use only stem thermometers.
“Nevertheless, many immunization programs worldwide use only stem thermometers. 10,19”
From Demonstration of the Use of Remote Temperature Monitoring Devices in Vaccine Refrigerators in Haiti (2018) · cites this paper as [10]
Section 3.3.2 says many cold-chain sites rely on stem thermometers, and section 3.3.3.1 recommends replacing them in many countries. The paper does not establish that entire immunization programs worldwide use only stem thermometers; its statement concerns sites and does not say their use is exclusive. Page numbers are unavailable in our copy. (LLM, conf=0.83)
Experimental — accuracy not yet measuredEven with remote access to data on continuous temperatures, the lack of response to documented excursions has been common, not only in low-resource settings where shortages of propane, transportation, and spare parts are commonplace, but also in high-resource areas.
“even with remote access to data on continuous temperatures, the lack of response to documented excursions has been common, not only in low-resource settings where shortages of propane, transportation, and spare parts are commonplace, but also in high-resource areas. 10,19,20”
From Demonstration of the Use of Remote Temperature Monitoring Devices in Vaccine Refrigerators in Haiti (2018) · cites this paper as [10]
Split into 2 atoms — 0 confirmed, 2 partially supported, 0 disputed, 0 misattributed, 0 unverifiable. Expand the claim to see per-atom verdicts.
Experimental — accuracy not yet measuredThe review identified technical issues in Nigeria's medicine and vaccine supply chains, including interruption of drug supplies, unreliable vaccine supply, inefficient procurement systems, damaged products and packages, loss of potency of cold chain medical supplies, irregular power supply, use of archaic technology in vaccine handling, and inadequate ice blocks to maintain a cold chain.
“Interruption of drug supplies, Unreliable vaccine supply, Inefficient procurement systems, Damaged products and packages, loss of potency of cold chain medical supplies, Irregular power supply and use of archaic technology in vaccine handling, inadequate ice blocks to maintain a cold chain”
From Medicines and vaccines supply chains challenges in Nigeria: a scoping review (2022) · cites this paper as [31]
Many reviewed studies used data from multiple centres across the country or population-based surveys, and thus may be nationally representative.
“Many of the reviewed studies used data from multiple centres across the country (or population-based surveys) [3, 8, 15, 20, 22–24, 28, 31, 33, 34, 37, 38], and thus, maybe nationally representative.”
From Medicines and vaccines supply chains challenges in Nigeria: a scoping review (2022) · cites this paper as [31]
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Cites
Kenya Demographic and Health Survey 1989
Kenya, & Std Control Programme (1989) · Cited by 1,756 · see citing works
Obonyo, J. (2010) · Cited by 732 · see citing works
Freezing temperatures in the vaccine cold chain: A systematic literature review
Matthias, D. M., Robertson, J., Garrison, M. M., Newland, S., & Nelson, C. (2007) · Vaccine · doi:10.1016/j.vaccine.2007.02.052 · Cited by 304 · see citing works
The imperative for stronger vaccine supply and logistics systems
Zaffran, M., Vandelaer, J., Kristensen, D. D., Melgaard, B., Yadav, P., Antwi-Agyei, K. O., & Heidi Lasher, B. (2013) · Vaccine · doi:10.1016/j.vaccine.2012.11.036 · Cited by 191 · see citing works
Vaccine Supply Chains Need To Be Better Funded And Strengthened, Or Lives Will Be At Risk
Kaufmann, J. R., Miller, R., & Cheyne, J. (2011) · Health Affairs · doi:10.1377/hlthaff.2011.0368 · Cited by 117 · see citing works
Frequency and causes of vaccine wastage
Setia, S., Mainzer, H. M., Washington, M. L., et al. (2002) · Vaccine · doi:10.1016/s0264-410x(01)00433-9 · Cited by 102 · see citing works
Murhekar, M. V., Dutta, S., Kapoor, A. N., Bitragunta, S., Dodum, R., Ghosh, P., Swamy, K. K., Mukhopadhyay, K., Ningombam, S., Parmar, K., et al. (2013) · Bulletin of the World Health Organization · doi:10.2471/blt.13.119974 · Cited by 98 · see citing works
Hepatitis B vaccine freezing in the Indonesian cold chain: evidence and solutions.
(2004) · Europe PMC (PubMed Central) · Cited by 97 · see citing works
Lloyd, J., Lydon, P., Ouhichi, R., & Zaffran, M. (2015) · Vaccine · doi:10.1016/j.vaccine.2014.10.080 · Cited by 85 · see citing works
Hyde, T. B., Dentz, H. N., Wang, S. A., Burchett, H., Mounier‐Jack, S., & Mantel, C. F. (2012) · Vaccine · doi:10.1016/j.vaccine.2012.08.029 · Cited by 80 · see citing works
Exposure to heat and freezing in the vaccine cold chain in Thailand
Techathawat, S., Varinsathien, P., Rasdjarmrearnsook, A., & Tharmaphornpilas, P. (2007) · Vaccine · doi:10.1016/j.vaccine.2006.09.092 · Cited by 69 · see citing works
McCarney, S., Robertson, J., Arnaud, J., Lorenson, K., & Lloyd, J. (2013) · Vaccine · doi:10.1016/j.vaccine.2013.07.076 · Cited by 62 · see citing works
Vaccination: rattling the supply chain
Humphreys, G. (2011) · Bulletin of the World Health Organization · doi:10.2471/blt.11.030511 · Cited by 48 · see citing works
Burchett, H., Mounier‐Jack, S., Rueda, S. T., et al. (2014) · Vaccine · doi:10.1016/j.vaccine.2014.09.031 · Cited by 40 · see citing works
Brenzel, L. (2015) · Vaccine · doi:10.1016/j.vaccine.2014.12.076 · Cited by 35 · see citing works
The Potency of Yellow Fever Vaccines Sold in Open Markets in Eastern Nigeria
Chukwuma, G. (2013) · Journal of Bioanalysis & Biomedicine · doi:10.4172/1948-593x.1000094 · Cited by 3 · see citing works
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Medicines and vaccines supply chains challenges in Nigeria: a scoping review
Olutuase, V. O., Iwu-Jaja, C. J., Akuoko, C. P., Adewuyi, E. O., & Khanal, V. (2022) · BMC Public Health · doi:10.1186/s12889-021-12361-9 · Cited by 99 · see citing works
Advances in immunomodulatory MOFs for biomedical applications
Zhang, B., Chen, J., Zhu, Z., Zhang, X., & Wang, J. (2024) · Small · doi:10.1002/smll.202307299 · Cited by 31 · see citing works
Demonstration of the Use of Remote Temperature Monitoring Devices in Vaccine Refrigerators in Haiti
Cavallaro, K. F., Francois, J., Jacques, R., Mentor, D., Yalcouye, I., Wilkins, K., Mueller, N., Turner, R., Wallace, A., & Tohme, R. A. (2018) · Public Health Reports · doi:10.1177/0033354917742119 · Cited by 13 · see citing works
- Authors
- Ashok, A., Brison, M., & LeTallec, Y.
- Affiliations
- Clinton Health Access Initiative (US)
- ORCID
- Ashok, Ashvin
- Venue
- Vaccine
- Publisher
- Elsevier BV
- Published
- 2017-04
- Volume
- 35
- Issue
- 17
- Pages
- 2217-2223
- ISSN
- 0264-410X (ISSN-L)
- OpenAlex
- W2522683094
- Cited by
- 308
- References
- 16
- Citations by year
- 2026: 37 · 2025: 41 · 2024: 34 · 2023: 40 · 2022: 46 · 2021: 52 · 2020: 29 · 2019: 14 · 2018: 12 · 2017: 3
- FWCI
- 1.82
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Locations
- Vaccine (publishedVersion, cc-by)
- PubMed (publishedVersion)
- Funders
- Bill and Melinda Gates Foundation
- GAVI Alliance
- Topics
- Social Sciences › Health › Vaccine Coverage and Hesitancy
- Health Sciences › Health Professions › Medical Laboratory Technology › Quality and Safety in Healthcare
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Pharmaceutical Quality and Counterfeiting
- Keywords
- cold chain, vaccine storage and transport, National Immunization Program, resource mobilization, equipment breakdown, spare parts availability, vaccination coverage, developing countries
- MeSH terms
- Africa, Developing Countries, Drug Storage, Humans, India, Refrigeration, Vaccines, Immunization Programs
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