by Tina Lorenson, PATH, and Joanie Robertson, GAVI Alliance Newer vaccines often require more cold chain space and more reliable cooling equipment than traditional ones. For many national immunization programs, these requirements present a serious challenge. Aware of the problem, for the last five years project Optimize has been working closely with cold chain equipment manufacturers and other partners to identify possible solutions. An early landscape analysis of cold chain equipment pointed to the need for innovation in several areas, including: -Freeze-proof cold chain equipment. -Next-generation solar vaccine refrigerators that do not require energy-storage batteries. -Large-sized vaccine cold boxes and carriers for transport. -Long-life cold boxes that can provide up to 30 days of cooling for locations without refrigerators. To encourage innovation in these areas, Optimize issued “industry challenge” contests to companies and rewarded those that presented viable products by supporting laboratory- and field-testing of their products. Optimize also worked closely with the WHO Performance, Quality, and Safety (PQS) programme to ensure that new specifications were developed for solar direct-drive refrigerators (which do not require energy storage in batteries) and large-sized and long-life cold boxes. The results of this work have been gratifying. As of July 2013, eight new solar direct-drive refrigerators and/or freezer combination units have been prequalified by the WHO PQS programme and several promising long-life and large-size coolers are being refined for prequalification. The need to prevent freezing in vaccine cold chain equipment has also led to new innovations throughout the supply chain. Along with the United Nations Children’s Fund and the Cold Chain and Logistics (CCL) Task Force, Optimize has invested in testing temperature-monitoring devices that can detect heat or freeze incidents. In some cases, data from these temperature-monitoring devices can be transmitted via the Internet or cellular phones, enabling faulty refrigerators and incorrect procedures to be more readily identified. Manufacturers are also starting to explore the possibility of using phase change materials instead of water packs in cold boxes and vaccine carriers to avoid the risk of freezing. Other manufacturers have experimented with insulation materials and configurations to prevent the risk of freezing in refrigerators and other cooling devices. These technologies are needed worldwide, where it has been documented that 35 to 70 percent of vaccine is exposed to freezing temperatures during its journey along the cold chain.[sup]1[/sup] Ongoing innovation in cold chain equipment will require encouragement—manufacturers need clear signals from vaccine supply chain experts about what ideal requirements are needed for this market. Field-tests that provide feedback to manufacturers can lead to ongoing product improvements. Better documentation of equipment performance can also help users decide where to invest their limited resources and keep equipment in good working order over time. Several organizations and groups are currently working on cold chain equipment improvements, including the CCL Task Force, WHO, UNICEF, PATH, the Bill & Melinda Gates Foundation, and the GAVI Secretariat. Look for new products in the PQS catalogue online. The following summaries of Optimize demonstrations and field-tests with cold chain equipment are available: -Direct-drive solar vaccine refrigerators: a new choice for vaccine storage (evidence brief) -Installing and testing battery-free solar refrigerators in Vietnam (photo book) -Innovative passive cooling options for vaccines (evidence brief) -Unplugged and keeping cool: testing off-grid storage solutions in Vietnam (demonstration summary) -Using solar-powered refrigeration for vaccine storage where other sources of reliable electricity are inadequate or costly (article in Vaccine) _________ 1. Matthias DM, Robertson J, Garrison MM, Newland S, Nelson C. Freezing temperatures in the vaccine cold chain: a systematic literature review. Vaccine. 2007;25(20):3980–3986.
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