Japan’s support for strengthening cold chain and logistics systems

by Terry Hart and Julian Bilous, consultants, and Osman David Mansoor, UNICEF In 2006, the Government of Japan offered funding to the United Nations Children’s Fund (UNICEF) to help countries prevent and prepare for future influenza pandemics. Recognizing that support from cold chain and logistics (CCL) systems would be vital for any vaccine response, US$8 million of this grant was used by the World Health Organization (WHO) and UNICEF in 2007 and 2008 to strengthen CCL systems in 17 countries, based on their assessments of priority needs. UNICEF selected two consultants to review the impact of the grant in 6 of the 17 countries, with a specific focus on two pieces of new technology that can help CCL system performance: the Fridge-tag and the SolarChill refrigerator. The Fridge-tag provides a continuous record of temperatures for 30 days as well as vaccine-relevant alarms for heating and freezing. The SolarChill refrigerator is a solar-powered refrigerator with no external battery (though it currently uses a small internal replaceable battery to operate a fan); the solar panels are connected directly to the refrigerator compressor. A key finding from the assessment was that many countries lack the human and financial resources to effectively implement and use funding for CCL support. These countries depend on external support to distribute and set up new equipment, train staff on its proper use, and monitor use. For example, in three countries only 20% of the Fridge-tags were being used in refrigerators. The lack of trained CCL system personnel, adequate supervision, and funding are major barriers to improving CCL systems. The Fridge-tag assessment confirmed the many benefits of the device, including its value as a temperature monitoring supervisory tool, a reliable indicator of vaccine storage quality, and an indicator of when refrigerator equipment should be repaired or changed. These attributes move the decision process for cold chain equipment replacement away from "age" to "condition," offering potential savings in replacement of cold chain equipment. The device also provides a rapid and reliable indication of the adequacy of a refrigerator’s performance over the past 30 days, in contrast to the current system of twice-daily temperature recording. The assessment identified three issues: (1) training for users to get all the benefits of the Fridge-tag; (2) the two-year life and need for ongoing replacement; and (3) device failures. The first two reflect the nature of the device, and WHO is currently preparing new training materials. A device that has a replaceable battery is technologically feasible but creates other challenges. The nature of this complex device does mean that there will be occasional failures, but these are expected to be less than 1 failure per 1000 units. Further analysis of the reasons for failure is ongoing. Any defective units need to be returned to the manufacturer for analysis as well as for obtaining a replacement. The three countries that introduced the SolarChill refrigerator found it easy to use and liked the fact that it consumes no fuel and eliminates the burdens of fuel costs and transportation of fuel to remote locations poorly served by electricity. The SolarChill is easily installed by technicians with basic mechanical and electrical skills. Better guidance is needed for installation (including correct tilt and orientation of the solar panel, admissible cable lengths, admissible cable sizes, etc.) and maintenance (especially to prevent frost buildup). In average ambient temperatures of up to 27ºC, the SolarChill refrigerators tested met all WHO performance, quality, and safety standards (PQS) except one: excursions greater than 8ºC occur more than 20% of the time in a five-day period. The SolarChill would meet all of the WHO/PQS criteria for qualification if the upper bar for temperature excursions were set at 10ºC rather than the current 8ºC. Another limitation is the relatively small capacity of the SolarChill in the context of increasing storage requirements for new vaccines and other essential health commodities. However, even with increased requirements the SolarChill has enough storage to meet the needs of populations of about 10,000 or less. UNICEF and the CCL Taskforce will continue to explore the best use of these and other new logistics-related technologies and welcome readers to share their own experiences with these technologies or ask questions related to their use. Please contact [[email protected]][email protected][/email].