Keeping vaccines cold in hot Nkhotakota

"This is what a vial of Covishield looks like," Gift Tembo says, titling open the fridge door to expose the range of Covid-19 vaccines. 
Tembo, a cold chain technician at Nkhotakota District Hospital, is in a short-sleeved shirt: he's accustomed to the chill temperatures maintained inside the 40 cubic metre walk-in fridges of the district's central vaccine storage facility. 
It's a hot sunny day in Nkhotakota; the temperature is 30 degrees Celsius which is modest by Nkhotakota weather standards.
The vial Tembo is holding contains one of the most sought-after commodities in the world today: The covid-19 vaccine. 
Lokesh Sharma, vaccine management consultant at UNICEF, says, as biological products, vaccines can lose their effectiveness when exposed to extreme cold or heat. 
"Because different vaccines react differently to freezing and heat, maintaining the cold chain for the vaccines is crucial. The cold chain and immunization sectors are led by UNICEF globally," he says.
Sharma notes that to store the polio vaccine in Malawi, UNICEF ensures that high-quality cold chain equipment is accessible up to the last mile. 
"UNICEF made sure that there is enough storage capacity accessible up to the last mile throughout the nation, not only in Nkhotakota. UNICEF also ensured that the cold chain equipment was in working order by organizing a special repair and maintenance drive across the country. We fixed 135 cold chain equipment in various districts. 

"This initiative helped to make sure that each district has a functional cold chain at all levels," he says.
Sharma explains that during the polio immunisation campaign, UNICEF supported the Ministry of Health in installing 273 newly supplied cold chain equipment in the country and procured more than 2,000 vaccine carriers for delivery of polio vaccine at the doorstep of beneficiaries.
The Nkhotakota central storage facility currently has six deep freezers for vaccine storage—one of which were donated by UNICEF with funding from the Government of Japan. Nkhotakota also received cold boxes and vaccine carriers to transport vaccines in a recommended temperature range. 
The fridges store various Covid-19 vaccines and polio vaccines for the general vaccination and the national polio immunisation campaign.
According to Tembo, it is from the central storage facility at the district health office where vaccines are distributed to 22 other facilities in the district.
"We order the vaccines from the National Expanded Immunisation Programme in Lilongwe to distribute around the district based on the needs and population," he says.
A handful of the vaccines, including Pfizer's Covid-19 candidate, must be kept at extremely cold temperatures and require the ultra-cold chain—consistent storage at about minus 80 degrees Celsius. 
"There is also a special freezer that stores the Pfizer vaccine at minus 80 degrees Celsius," Tembo beams as he leads the team to the administrator's office, where the special Pfizer freezer is kept.
Tembo explains that the fridge donation from UNICEF has eased many cold chain problems at the district health facility.
"Previously, we lost a lot of vaccines because we had inadequate space, so we used to store all vaccines in one place. With the heat here in Nkhotakota, some vaccines used to get damaged because they were all piled up in the safe fridge. 

Anne Mwale, a health surveillance assistant at Nkhotakota district hospital, says the fridge donation has ensured that there are adequate vaccines whenever people need them.
"Previously, we only used to keep limited vaccine stocks because we did not have the storage facilities. The additional fridges have ensured that we always have vaccine supplies so that people are not turned away when they want to get vaccinated," she says. 
Apart from this, the director of health and social services for Nkhotakota Pilirani Wezi Mumba says some of the hard-to-reach areas in the district were previously left out of the vaccination campaign as they lacked the facilities to store vaccines.
"So, when these fridges supported us, we sent them out to those places where we never had a fridge. In that way, we can reach out to those communities," she says.
Mumba adds that some of the fridges are solar-powered, hence ideal for some of the remotest areas with no electricity supply.
"As we are talking now, all the facilities in the district have fridges which are very good because we can do the immunisation timely because of the support that we have received from UNICEF," she says.