Cold chains, interrupted

Abstract

Purpose The purpose of this paper is to analyze how far technology and information enable, facilitate or support the planning and implementation decisions in humanitarian vaccine cold chains for vaccination campaigns. The authors specifically focus on three emerging technologies that have the potential to create more flexible conditions in the field, and identify the need to further explore the link between uncertainty, information and irreversibility. Design/methodology/approach The authors present a basic structure for the analysis of cold chain disruptions in terms of three distinct yet connected layers of deficient infrastructure and capacity, information gaps and failures in decision making. The authors then review three humanitarian technologies and their impact on vaccine campaigns along these layers. From there, a research agenda is developed to address research gaps this review brought forward. Findings Three critical research gaps in the areas of technology innovation for humanitarian vaccine cold chain management are presented. The authors argue that technology to improve capacity, information and decisions need to be aligned, and that the areas of uncertainty, information and irreversibility require further investigation to achieve this alignment. In this way, the paper contributes to setting the research agenda on vaccine cold chains and connects humanitarian logistics to technology, information management and decision making. Originality/value This paper presents the humanitarian vaccine cold chain problem from an original angle by illuminating the implications of technology and information on the decisions made during the planning and implementation phases of a vaccine campaign. The authors develop an agenda to provide researchers and humanitarians with a perspective to improve cold chain planning and implementation at the intersection of technology, information and decisions.

Thermostabilization of viruses via complex coacervation

“…2,3 If temperatures are not main-tained, the vaccine may lose its potency and could no longer be effective in fighting disease. 4 Approximately half of the vaccines produced each year are discarded due to poor thermal stability. 5 The unreliable cold chain system is one of the major causes of inadequate immunization coverage in developing countries.…”

“…5 The unreliable cold chain system is one of the major causes of inadequate immunization coverage in developing countries. 4 Therefore, developing robust, thermostable viral vaccines that are less dependent on the cold chain is urgent and crucial for universal access to immunizations.…”

Knowledge and Perceptions of Adverse Events Following Immunization among Healthcare Professionals in Africa: A Case Study from Ghana

“…Vaccines lose their potency when stored at temperatures below and above the cold chain temperature range of 2 degrees Celsius to 8 degrees Celsius [20]. Apart from losing their potency through poor cold chain maintenance, temperature fluctuations could cause vaccine products to change to toxic forms, which could cause AEFIs [21,22]. For instance, in May 2017, 15 children died of severe sepsis and toxicity from contaminated measles vaccines in Kapoeta, South Sudan, due to poor vaccine cold chain storage [23].…”

The status of refrigeration techniques for vaccine storage and transportation in low-income settings

“…According to the amount of vaccines to be carried, each stage of the cold chain (national, regional, villages) requires specific transport and storage equipment [4]. While the choice of transport is mainly influenced by road conditions [5], the choice of storage equipment depends on the availability of energy resources (mainly electricity), the duration of transportation or storage as well as the volume of vaccines [6,7].…”

“…While the choice of transport is mainly influenced by road conditions [5], the choice of storage equipment depends on the availability of energy resources (mainly electricity), the duration of transportation or storage as well as the volume of vaccines [6,7]. This cold chain involves logistical challenges [8], particularly in low-income settings where equipment might be defective, electricity supply unreliable, roads impassable and health workers not adequately trained [4,9]. To ensure a safe and effective delivery of immunization, the World Health Organization (WHO) has developed the Performance, Quality and Safety (PQS) system [10].…”