The cold chain: Not just about equipment

The “cold chain”, as we know it, is not simply a matter of machinery and equipment, but it is also a chain of hard-working, dedicated people working towards a singular goal: bringing vaccines safely to where they are needed the most.

By Haruko Yokote
UNICEF Haruko Yoyote inside a walk in cooler at the PHLMC in Janakpur
UNICEF Nepal/2022
25 August 2022
Haruko with Japan-supported WIC

"Unity is strength... when there is teamwork and collaboration, wonderful things can be achieved.” -- Mattie Stepanek

After joining the Health team at UNICEF Nepal in March 2022, one of the first tasks I was charged with was to report on the Government of Japan’s most recent cold chain support to Nepal.

The Government of Japan has been a long-standing partner in terms of fortifying the cold chain capacity in the country, and the health system overall. But this particular grant had been provided to Nepal – through UNICEF – to support vaccine roll-out in the specific context of the COVID-19 pandemic. The grant had included nine walk-in-coolers, 38 solar-driven vaccine refrigerators, 1,109 long-range vaccine carriers and 53 cold boxes, which UNICEF has helped to deliver and install in health facilities around the country, as well as building the capacity of health workforce for effective use of the equipment.

In July 2022, I was part of a team that set off from Kathmandu to Janakpur Sub-Metropolitan City, the capital of Madhesh Province, to visit one of the sites where the cold chain equipment, or CCE, had been installed. Madhesh had faced a number of challenges during the pandemic, owing in large part to the province’s limited cold chain capacity. Not only had COVID-19 and associated risks and restrictions disrupted routine immunization in a lot of places, the added task of storing and distributing COVID-19 vaccines had then placed a sudden burden on the local health system. Before 2022, the province had had to depend on other provinces and the central store for the storage of COVID-19 vaccines.

In such a situation, the Japan-supported CCE had been very welcome, according to the cold chain officials we met at the vaccine store in the Provincial Health Logistics Management Centre in Janakpur. Here, we were able to see the walk-in-cooler in action - it was spacious and clean, being used to store a range of routine vaccinations during the time when we visited. The room temperature was being closely monitored onsite and through the Electronic Temperature Monitoring System (ETMS) which enables remote monitoring with a mobile application. Other equipment, including the solar vaccine refrigerators and vaccine carriers and boxes, had been supplied to vaccine sub-stores and health facilities across the different districts, so that the cold chain could be maintained when taking vaccines to the community.

As a UNICEF staff member who supported the CCE project, and more personally, as a Japanese national, I was moved when I saw how effectively the equipment was being used in one of the provinces of Nepal. I felt it showed the power of joint effort in which we all come together to play varying but equally important roles: The Government of Japan and the people of Japan provided the right equipment at the right moment, and UNICEF staff helped to deliver and install it to the right places, in coordination with the Government of Nepal.

However, the effort would be utterly incomplete without the contribution of the people on the ground, the cold chain technicians, the logisticians, the community health volunteers, and of course the health workers who handle the equipment every day and use it to deliver the vaccines into arms.

This is a true testament to the fact that the “cold chain”, as we know it, is not simply a matter of machinery and equipment, but it is also a chain of hard-working, dedicated people working towards a singular goal: bringing vaccines safely to where they are needed the most.

On behalf of UNICEF Nepal, I am grateful to the generous support of the Government of Japan in helping to strengthen the health system in Nepal. I would also like to thank all those involved in maintaining the cold chain across the provinces, districts, and communities for their great work. I hope and expect that this success will be followed by many other cases in Nepal and other countries. By continuing to work hand-in-hand, we can have more robust health systems – including immunization systems – and improve the lives of millions of children and families.

Haruko is a Health Officer at UNICEF Nepal

A view of a thermometer in the vaccine fridge
UNICEF staff meeting with cold chain officials in Janakpur

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