Solar-powered refrigerators keep vaccines cool even in places without electricity – but setting up a huge cold chain for COVID-19 immunization will be a major logistical challenge
Von Peyton Fleming
Boston, Oct. 31 (Thomson Reuters Foundation) – Dozens of children at a clinic in North Kivu, on the eastern border of the Democratic Republic of the Congo (DRC), received measles vaccine in May, made possible by a silent revolution in refrigeration keeping vaccines cold, even in places without reliable electricity.
According to the global vaccine alliance Gavi, “solar-powered” refrigerators – simple, box-like coolers that use neither fuel nor batteries – have helped increase vaccinations for children in the poorest rural provinces of the DRC by 50% over the past year.
This has helped reduce child mortality in the Democratic Republic of the Congo to half what it was two decades ago. More than 18 million children were vaccinated against a deadly measles outbreak last year, which has slowed dramatically in recent weeks.
Now the world wants to kick off a far bigger vaccination surge once vaccines for COVID-19 are available.
Delivering millions of vaccinations in Africa, a sprawling continent with fragile health systems and a lack of electricity to power them will be a daunting task.
And it remains unclear whether existing off-grid refrigerators can keep the vaccines cold enough to help.
Refrigeration is essential for the vaccine to be distributed.
Most vaccines need to be refrigerated between 2 and 8 degrees Celsius, but nearly half of the leading COVID-19 vaccine candidates currently being developed require refrigeration to only minus 80 ° C, according to researchers.
Additionally, a cold chain distribution network for COVID-19 vaccines requires seamlessly low temperatures from manufacturers to airports to remote rural villages.
Despite advances that have likely saved millions of lives in recent years by keeping vaccinations cold, most African countries still have enormous gaps in such networks.
“It is probably the greatest logistical challenge the world has ever faced, and it is a particularly big challenge for sub-Saharan Africa with significant rural populations,” said Toby Peters, professor of food and medicine refrigeration systems British University of Birmingham.
When William Clemmer, a doctor with the nonprofit IMA World Health, came to the Democratic Republic of the Congo in the 1990s, many health centers used outdated kerosene-powered refrigerators, which often damaged or destroyed vaccines.
First generation solar refrigerators were an improvement, but required storage batteries that often stopped working after two to three years and were difficult to replace.
Direct drive solar refrigerators have changed that for about a decade.
They cost between $ 3,500 and $ 9,000 and are directly connected to photovoltaic solar panels that provide thermal energy to freeze a thick layer of water. The ice layer keeps the vaccines cool inside for many days, regardless of the weather.
In 2016, only 16% of rural health centers in the Democratic Republic of the Congo had working refrigerators, according to Gavi.
Today almost 80% are equipped, many of them with directly driven solar systems. They enabled 24,000 monthly vaccination sessions in the nine poorest provinces last year, a 50% increase from 2018.
“You have fundamentally revolutionized vaccine delivery for children in sub-Saharan Africa,” said Clemmer.
Karan Sagar, a doctor who leads the health systems strengthening and vaccination team at Gavi, credits the off-grid equipment to a 25% increase in vaccination rates for children in Africa a decade ago.
As of 2017, a Gavi-led $ 250 million drive has shipped more than 15,300 direct drive solar refrigerators to three dozen African countries, including nearly 3,400 units to the Democratic Republic of the Congo and 5,400 to Nigeria.
According to Sagar, 87% of children in these African countries received their first dose of a vaccine against diphtheria, tetanus and pertussis (whooping cough) in the past year.
“This is evidence of the ability of supply chains to reach even the most remote communities in the world,” he said.
FACTORY TO VILLAGE
It’s not just ultra-cold temperatures for COVID-19 vaccines that Africa may be struggling with.
Solar refrigerators are just the last of many steps required to move vaccines quickly and safely from central manufacturing facilities – whether inside or outside Africa – to urban and rural destinations across the continent.
Every step of the way – planes, warehouses, trucks, motorbikes, bicycles, canoes, and even drones – like other perishable products, the vaccines need to be kept at certain very cold temperatures.
And much larger quantities are required.
While vaccination campaigns for children typically reach around 115 million babies worldwide each year, the COVID-19 vaccine will have to reach up to 750 million people in Africa alone, health experts predict.
To prepare for this challenge, cold chain expert Peters is leading a government-sponsored effort to assess Africa’s needs in the delivery of a potential COVID-19 vaccine and is working with nonprofit, commercial and academic partners.
They draw on lessons from Rwanda, a central East African country that has made tremendous strides in recent years in building efficient, climate-friendly cold chains for the delivery of food and vaccines.
The system consists of a warehouse that serves as a refrigeration center for vaccines that are distributed to county hospitals, health centers, and remote rural health posts, dozens of which use solar refrigerators.
According to the World Health Organization, vaccines reach more than 95% of the population.
But repeating Rwanda’s success will be a daunting task. “Rwanda is small – countries like Nigeria are much more difficult,” said Peters.
Food cold chains with larger commercial capacity established will be the type of model that is needed, he added.
“We know how to get hundreds of millions of tons of fresh food from small farms across Africa to consumer fridges in Europe,” said Peters. “We have to use this expertise and apply it to vaccines.”
However, this is necessary before considering the potential ultracooling needs that COVID-19 vaccines may require – which direct drive solar refrigerators are typically not suitable.
Rwanda and the Democratic Republic of the Congo have first-hand experience of vaccines that require ultra-cold storage in the form of a new vaccine that helped end the Ebola outbreak last summer.
“Super Thermos” coolers filled with blocks of synthetic alcohol ice held the vaccine at minus 60-80 ° C for up to 6.5 days. However, the amounts were only a tiny fraction of what an effective COVID-19 vaccine would be would be needed.
“Few African economies even have ultra-cold chain capacity,” noted Sagar.
Peters hopes COVID-19 vaccines will only need the standard 2-8 ° C cold room that direct-drive solar refrigerators can provide in rural health centers.
“If the mainstream cold chains have to be below that, we have a massive new challenge,” he said.
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(Reporting by Peyton Fleming; Editing by Megan Rowling. Please thank the Thomson Reuters Foundation, the non-profit arm of Thomson Reuters that covers the lives of people around the world who are struggling to live freely or fairly. Visit http : //news.trust .org / climate)
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