Chain and Logistics Management:
An Essential Part of Safe and Effective Vaccination
Cold chain and logistics refer to the system of people, policies, procedures, vehicles, fuel, equipment, and technologies that work together to make sure that vaccines given to people are safe and effective. Because most vaccines have specific temperature requirements, an effective cold chain and logistics management system prevents both excessive heat and cold from damaging the vaccines from the time of manufacturing until they are used.
Why is this topic important?
An effective logistics system and a well-maintained cold chain are essential for safe and effective immunization service delivery. An improperly functioning cold chain can lead to wasted vaccines, missed opportunities to immunize due to lack of vaccines, and children receiving vaccines that do not protect them as intended or that actually make them sick. Problems with aging or insufficient cold chain equipment, as well as with transport and storage, have become more urgent as new and more expensive vaccines are being introduced (see Snapshots #7 and the box below).
Every immunization program must assess cold chain equipment needs periodically and replace broken equipment not worth repairing. As plans for introducing new vaccines are developed and implemented, additional equipment is needed to handle increased storage requirements. Financing for cold chain and logistics must also be given priority.
The growing contribution of vaccines to global health
“Traditional” vaccines included in the Expanded Program on Immunization (EPI) already save nearly three million lives per year. Effective vaccines are now available that can prevent substantial proportions of two of the most common causes of child mortality: pneumonia and diarrheal disease. As a result, one in four current childhood deaths can be averted through use of vaccines that are currently, or soon to be, introduced in developing countries (See Figure 1).
Challenges to maintaining effective cold chain and logistics in developing countries
Insufficient, outdated and broken cold chain equipment (see box below) are often cited as major problems affecting routine immunization efforts during country immunization program reviews and supervisory visits. Additional problems are lack of technically-trained staff and inadequate financing for procuring new equipment and transporting technicians and/or broken equipment.
Outdated equipment is still in use and often needed
as back-up due to delays in providing new equipment,
insufficient stock capacity (both permanent and
temporary, if the equipment is being used for
immunization campaigns), or occasional problems
with new equipment (e.g. lack of spare parts
or appropriate tools).
There is often a lack of field-based procurement
and repair plans, which means that cold chain
and logistics inventories are not sufficiently
linked with new equipment projections. This makes
it difficult for countries to prioritize districts
and provinces with the greatest need for new
Cold chain inventories, conducted at least annually, are needed to ensure repairs and replenish equipment. However it is often the case that inventories do not allow for appropriate procurement planning because they fail to provide necessary details, such as:
- The equipment is not working, but is repairable
- The extent of the repair needed (e.g. onsite
repair, major overhaul, spare
- The equipment is not working and should be replaced
Relatively recent CFC (Freon)-free requirements have made repair work on cold chain equipment more complicated. Technicians are often insufficiently trained to work on the newest equipment, and/or are not available to ensure proper maintenance and rapid, high-quality repairs.
Technicians need considerable training to be able to correctly use the more expensive tools and instruments for repairing CFC-free equipment. In some cases, it may be cheaper to procure new units than to repair broken units with more complex inner leaks or burned-out compressors.
Finally, few countries clearly define the conditions that merit condemning equipment for scrap or resale, which contributes to the use of outdated equipment.
Environmental factors complicate cold chain and logistics management
Poor or unreliable energy sources, a common problem in developing countries, weaken the effectiveness of equipment and shorten its lifespan. Also, equipment in remote areas is difficult to reach with timely repairs and routine maintenance, which are necessary to avoid more costly repairs or replacement.
Costs of cold chain and logistics management
An analysis of 45 national comprehensive Multi-Year Plans (cMYP), conducted by WHO and presented at the Cold Chain Logistics meeting in Geneva in February 2008, estimated that 40% of non-vaccine needs for 2008-2010 will be for cold chain and maintenance (22%) and vehicles and transport (18%). These cold chain and logistics needs are estimated at $6 per infant for the three-year period between 2008 and 2010, with additional increases as vaccines against rotavirus and pneumococcal disease are introduced. Currently, funding gaps exist to meet this requirement (see graph), with maintenance primarily internally funded and therefore possibly not considered in donor contributions (see graph).
Cold chain and logistics funding gaps in 45 countries, 2008-2010
Source: cMYP data from 45 countries, WHO/Geneva, Global Immunization Meeting, February 2008, presented by Patrick Lydon
What countries can do to protect their cold chain
- Develop or update policies for the purchase,
repair and replacement of cold chain and
transport equipment. Policies and guidelines
Cold chain equipment in Nigeria.
Credit: Jenny Sequeira
- Specify the frequency of conducting cold chain inventories
- Include equipment specifications, appropriate locations and most reliable energy sources in light of health system needs
- Describe procedures for using these inventories to track breakdowns and schedule equipment repair and replacement
- Incorporate "best practices" to achieving rapid, high-quality equipment repairs
- Specify a timeframe for equipment replacement (i.e., poorly working or nonfunctional equipment that is over ten years old should be replaced)
- Outline procedures and a reasonable timeframe for the disposal of nonfunctional equipment (i.e., equipment that is condemned for disposal should be collected from the facility and taken to an environmentally acceptable disposal facility or location)
- Determine the need for new cold chain and transport equipment, spare parts and repair tools and establish a schedule for procuring them.
- Develop and finance a maintenance organization or unit to ensure that cold chain technicians are available at appropriate levels (e.g. in each district or region, or stationed at the central level and able to travel to regions to repair defective equipment). In planning for this unit, clearly define profiles and competency requirements for cold chain technicians, prepare job descriptions, and estimate costs (e.g., salary, travel and transport for technicians, budgets for spare parts and tool kits).
- Plan and finance refresher trainings in cold chain repair and maintenance for technicians and logisticians. Determine if additional staff are needed.
- Build capacity of technicians to manage, monitor, and supervise all aspects of the cold chain and logistics system including routine maintenance and repair, temperature monitoring, correct inventory management (including spare parts and tools), and use of equipment.
- Ensure that cold chain equipment, maintenance and logistics are a part of new vaccine introduction plans and that program support costs are included in budgets and financed appropriately.
- Immunization Essentials, chapter 6: http://pdf.usaid.gov/pdf_docs/PNACU960.pdf#page=102
- WHO/AFRO Mid-Level Management Course for EPI Managers, Block III; Logistics: www.afro.who.int/ddc/vpd/epi_mang_course/
- TECHNET forum: www.technet21.org
- Cold Chain Equipment Management Tool: www.path.org/projects/cold-chain-ccem.php
Acknowledgements: Mogens Munck, John Lloyd, Keerti Kumar, Serge Ganivet, K.G. Kagaruki, Patrick Lydon, Michel Othepa, and the Tanzania and DR Congo EPI offices.