Keeping vaccines safe through the last mile of their journey

A large scale, multi-country effort is upgrading cold chain equipment in health facilities to ensure that vaccines remain safe and effective throughout their journey – from manufacturer to child.

UNICEF staff on a rooftop installing solar refrigerators
25 June 2020

A vaccine’s journey through the supply chain is complex. Because most vaccines are sensitive to heat or light, they must be transported and stored under correct conditions to maintain their quality and potency. This requires robust and reliable cold chain equipment. 

Although cold chain equipment for the purposes of vaccine storage has existed for decades, the equipment standards in countries did not match the pace of vaccine development and availability. Furthermore, older technologies had issues, such as poor temperature control that risked wastage if vaccines were exposed to temperature fluctuations. 

As part of a strategy to strengthen vaccine supply chains and achieve better immunization equity and coverage, in 2015, Gavi the Vaccine Alliance, UNICEF and other partners launched the Cold Chain Equipment Optimization Platform (CCEOP) – a $400 million, five-year project to upgrade existing cold chain equipment in 56 countries by 2021. Strengthening cold chains in country also supports agile vaccine response efforts for infectious disease outbreaks, including the COVID-19 vaccine when it becomes available.

However, upgrading thousands of units in health centres across the eligible countries and ensuring that they are properly installed and maintained presented a considerable challenge. It also presented a unique opportunity to move forward with innovations in both equipment and approach.

Newer technologies have included solar powered units to replace gas or battery powered refrigeration systems. Solar technology was aspirational when introduced 10 years ago but is now the standard. Similarly, remote temperature monitoring systems have been introduced and tested at scale to provide information on location and temperature status to guide repair and maintenance planning. 

The CCEOP has also introduced and scaled up a service bundle concept. Under this approach, manufacturers provide the equipment and manage in-country logistics, installation and training of staff. The concept has proven efficient in ensuring quick installation and staff training of the needed equipment. 

UNICEF and partners have worked closely with countries to highlight the advantages of investing in the new and improved cold chain equipment. By the end of 2019, over 20,000 units had been installed in health centres, with nearly 20,000 additional units in process of delivery. 

Building on early lessons learned, cold chain equipment is not a one-size-fits-all approach. The CCEOP implemented measures give countries the flexibility to determine the best fit for their context. 

By investing in new cold chain equipment, countries can ultimately save money over the average 10-year lifespan of the equipment, and safeguard vaccines for routine immunization programmes through the last mile of their journey.