Real lives

Cold storage facility transforms vaccinations

© UNICEF/2012/Suhail

Dr. Bashir explains the functioning of the cold storage room

By Zeeshan Suhail

Khanewal district, Pakistan, October 2012 – Dr. Afzal Bashir’s enthusiasm and energy are boundless on this humid morning in Khanewal district, Punjab province. He is the Executive District Officer (EDO) for the Health Department in Khanewal district, Punjab province. For a person in his position, a positive outlook would be difficult to envision due to the myriad health problems in his region. However, his district is privileged: Khanewal was a recipient of a cold room for vaccine storage as part of a UNICEF project to strengthen the vaccine cold chain of the Government of Pakistan’s Expanded Programme on Immunization (EPI).

“We now have a fully-equipped cold storage room. This is a blessing for the district, since there is no chance for the vaccines to go bad,” said Dr. Bashir. The cold store will strengthen the cold chain system, which is the backbone of EPI services. The intact cold chain ensures vaccine potency, quality and safety – from the time the vaccine is manufactured till the time it is administered to children and women. All the vaccines which are administered as part of the routine immunization program will be placed in these cold stores, including vaccines for tuberculosis, polio, diphtheria, pertussis, tetanus, hepatitis B, meningitis, pneumonia and measles. Support for this project comes from the Global Alliance for Vaccines and Immunization (GAVI).

Dr. Bashir reveals the difficulties he and his staff faced prior to the arrival of the cold storage room. “Frequent and lengthy periods of load shedding (or electricity outages) are the biggest problem. We used refrigerators and ice packs, but they only worked for 18 hours – with ice – when the power was cut. I am always fearful for the basic health units; they always need additional ice.” Indeed, a steady supply of electricity could mean the difference between a life of sickness and a life of prosperity for the approximately 400,000 children in Khanewal.

© UNICEF/2012/Suhail

The vaccinators receive training on the cold chain as well as on administering the vaccine.

The cold storage has many benefits for the residents of the district. Most importantly, it is a cost effective measure which enhances the life of the vaccine, thereby allowing vaccinators the ability to travel to far flung locations to vaccinate children with potent vaccines who otherwise cannot travel to the district health offices for a routine vaccination. The cold storage also saves tremendous space. Instead of storing vaccines in numerous deep freezers and refrigerators, the entire vaccine stock can be conveniently placed in the cold store.
He is equally vocal about the safety and security of the thousands of staff members who are trained to provide the vaccination services to residents of Khanewal. “In some rural areas, we have to send three men – sometimes armed or with police – to accompany the lady health workers,” he said. “Without these dedicated young women, we would not be where we are right now”.

GAVI support to EPI
All the elements of the cold chain system (staff, equipment and procedures) were already available and practiced in the field. However, after many years of providing active EPI services to vulnerable children and women and the introduction of Pentavalent vaccine in 2008 in the routine EPI schedule, Pakistan’s cold chain system needed to be enhanced. All the elements of the cold chain system were required to be strengthened and developed to an optimum standard in order to ensure vaccine potency, quality and safety.
The contribution from GAVI was utilized in support of EPI through: 1) Enhancement of cold chain capacity and bridging capacity gaps that emerged by the introduction of Pentavalent vaccine and 2) Installation of cold rooms and provision of training to relevant staff on handling/maintenance of cold rooms.

Training and capacity-building

Another aim of the project is to train a competent team of vaccinators and cold storage maintenance staff. One of the trainers, Dr. Ali Athar, was enthusiastic about the whole endeavour. “We provide holistic training to vaccinators, through which we inform them about the vaccine supply chain and how the vaccines must be handled from the time they are entrusted to the vaccinator, till the time it is administered to a child,” said Dr. Athar. “The training takes place over two days and vaccinators come from union councils across the district. They have an important role to play,” he added.

Vaccinators must have a matriculation degree, and then enrol in a vaccination diploma certificate course. Through this project, they’re trained on all aspects of the vaccine cold chain – from the manufacture phase till vaccination. Trained vaccinators then branch out into union councils and villages and build the capacity of community members who, in turn, vaccinate thousands of children across the district. 

The maintenance staff is taught how to keep the machinery in an optimal condition so as to ensure that the vaccines are not adversely affected.

Dr. Muhammad Tariq Iqbal, Health Officer at UNICEF, also reiterated the necessity for such facilities: “The cold rooms will enhance the qualitative as well as quantitative cold chain capacity at the district level. This will ensure the availability of potent vaccines for children and pregnant women.”