POST 01254E: REPAIR/NON-REPAIR OF EQUIPMENT AND SIMPLIFYING THE COLD CHAIN

POST 01254E: REPAIR/NON-REPAIR OF EQUIPMENT AND SIMPLIFYING THE COLD CHAIN FOLLOW-UP ON POSTS: 01216E, 01218, 01221E, 01225E, 01227E, 01229E 15 APRIL 2008  *******************************************   In POST 01214E I presented my ideas about how to improve the present state of the cold chain, particularly with regard to cold chain equipment repair and a possible simplification of the cold chain below district level. I also requested response from colleagues in the field in order to initiate a discussion of these topics. So far, several colleagues have responded. K.K. Wadhawan, Soren Spanner, and Lora Shimp, John Lloyd, Anil Varshney and Jenny Sequeira have contributed with very valuable inputs, reflecting their practical experience acquired during many years of fieldwork with repair and maintenance of cold chain equipment. We thus have very good practical examples of conditions in Asia (especially India), but few from other parts of the world, especially Africa. However, I had expected a lot of comments and/or protests regarding my proposals about: repair/non-repair of equipment and [/list]simplifying the cold chain below the district level. [/list] Nobody has so far commented on my suggestion of not repairing cold chain equipment (because of the high cost involved compared with the low price of about 450−500US$ for a new fridge), or only repair equipment that has been pooled in advance at an easily accessible place, where a very qualified, well equipped technician/contractor can do the job. The good news is that, at least in India, it is possible to obtain tool sets for repairing freon-free equipment that cost about 2.000US$ in stead of the very, very costly tool sets available from the PIS. Also nobody has so far responded/commented on my ideas on how to simplify the cold chain at below the district level. I proposed: Avoid using vaccines that need ice packs after reconstitution (at present BCG and Measles) to keep the remaining doses in the opened vial cool. For example, it might be possible to combine Measles and BCG vaccines with other vaccines in a liquid presentation thus not having to use ice packs to keep remaining doses cool. [/list]Take advantage of the thermostability of the present commonly used vaccines. See Table below from the WHO publication: Temperature sensitivity of vaccines. It should be noted that most of the data in this Table are 20−30 years old. Since then we have got VVMs, and vaccine manufacturers could therefore be asked to present to WHO their data on the thermostability of their vaccines at various temperatures (up to 35 degrees C.), which they obviously must have, now that their vaccines come with a VVM on the vial. [/list] Once we have this information we could re-design the cold chain, particularly the cold chain below the district level, where the vaccines are kept for only 1 to 2 months, but where most of the problems with the cold chain originate. Imagine a cold chain at below the district level without the thousands and thousands of fridges and freezers! It is obvious that in order to accommodate new vaccines and/or new presentations of present vaccines that take up much more space, the cold chain will have to be redesigned, and it is logical to start at the bottom of the cold chain, where the storage time is the shortest, and where the logistic burdens are the heaviest. Mogens Munck (%[email protected]%3e) Post generated using Mail2Forum (http://www.mail2forum.com)