Most ice-lined refrigerators in India are fully functional at 5 - 45 degrees Celsius (ie, they are able to maintain an internal temperature of 2-8 degrees Celsius when the external temperatures are between 5 and 45 degrees Celsius). Some states of India have an extremely cold climate during winters (for example, the areas of Jammu and Kashmir, Uttarakhand, Sikkim that are in the Himalayas) and so they are prone to high rates of vaccine freezing.
I am sure this is a problem experienced by program managers of Russia, Canada, Greenland, Iceland, northern Europe, Alaska, etc and would be extremely grateful if they could share how they have managed to tackle this in their respective countries/regions.
The only resource that I have been able to find till now after an extensive search is "The Warm Chain", which suggests the use of a low ambient temperature refrigerature which provides protection upto -5 degrees Celsius.Does WHO have any guidelines regarding this?
A related question would be - how do we arrange for outreach immunization in such cold climates? What sort of ice packs should be used in such a scenario?
Dr. Tapas Sadasivan Nair