Updated: October 21, 2020 2:10:25 pm
A health worker takes a swab sample for Covid-19 testing in New Delhi (Express photo by Praveen Khanna)
We can have a Covid-19 vaccine for this year itself, with some eight candidates nearing the end of late-stage clinical trials, but getting injections delivered safely in different countries and eventually hospitals and pharmacies will be the next challenge.
Since different Covid-19 vaccines require different temperatures and different handling procedures, cold chain facilities, including the equipment and procedures used in transportation and storage, are critical before they are finally administered to the masses. For example, some of the vaccines undergoing phase III trials must now be stored at temperatures as low as minus 94 degrees Celsius. So what is a cold chain? What are the problems in the distribution of Covid-19?
What is a cold chain?
According to the World Health Organization (WHO), the ‘cold chain’ is a system for storing and transporting vaccines at recommended temperatures from the point of manufacture to the point of use. Thus, a cold chain involves three main infrastructure components: airplanes, trucks, and cold stores.
Without a proper cold chain facility, vaccines are at risk of being exposed to temperatures outside the recommended range, resulting in reduced potency and waste. According to a report from the Center of Excellence for Independent Validators in Pharmaceutical Logistics of the International Air Transport Association, 25 percent of vaccines degrade when they reach their destination, while temperature errors cause losses of around $ 34.1 thousand. million a year.
A quick test is underway inside a Honda service center in Chembur East.
At what temperatures should Covid-19 vaccines be stored?
While MMRV (measles, mumps, rubella, and chickenpox), zoster vaccines are stored at temperatures between -58 degrees Fahrenheit and +5 degrees Fahrenheit (-50 ° C and -15 ° C), other traditional vaccines such as BCG generally they stay 35 ° F and 46 ° F (2 ° C and 8 ° C), according to the Centers for Disease Control and Prevention (CDC). However, some of the major Covid-19 vaccines need to be stored at much cooler temperatures.
The Pfizer and Moderna candidate vaccines, which have been developed using messenger RNA technology, require that the injections be stored at sub-zero temperatures. Pfizer’s vaccine candidates, BN1162b2 and BNT162b2, require a storage temperature of minus 94 degrees Fahrenheit. Once thawed, the vials can be refrigerated for just two days.
Why a cold chain is key
Vaccines are delicate products that can be damaged by excessive heat, light, or cold. A temperature-controlled ‘cold’ supply chain is crucial to transport and storage, especially in a large, hot country like India. In anticipation of the arrival of a vaccine for Covid-19, the government has begun to identify additional cold chain storage facilities for the huge expected volumes that will be needed to inoculate the Indians.
Moderna, which initially stored its vaccine at minus 70 degrees Celsius, now plans to send the injections at minus 20, the company said. Once thawed, the vaccine can be kept refrigerated for a week.
Johnson & Johnson’s JNJ-78436735 single-shot vaccine is expected to ship commercially with standard refrigeration, a spokesperson said. The ChAdOx1 vaccine from AstraZeneca-Oxford (also dubbed AZD1222 and Covishield in India), to be manufactured in India by the Serum Institute, will need to be refrigerated at 2-8 degrees Celsius. The Russian Sputnik V vaccine stipulates storage at a temperature not higher than –18 degrees Celsius.
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What are the problems when storing and distributing Covid-19 vaccines?
Investments in infrastructure and storage facilities, especially flash freezing capabilities, have not increased at the same rate that the Covid-19 vaccine is being developed.
Since hospitals are expected to be the initial places where the first vaccines will be administered, several of them lack ultra-cold freezers since most drugs and vaccines do not need them. The chickenpox vaccine is one of the few injections that must be stored frozen, while flu vaccines only require refrigeration.
According to The Lancet, the world is capable of producing and distributing around 6.4 billion flu vaccines a year today, while experts have predicted that around nine billion Covid-19 vaccines would be produced in 2021. By Therefore, without strong cold chain facilities, the distribution of these vaccines, in addition to the regular ones required, would not be possible.
Vast parts of the world, including most of Central Asia, much of India and Southeast Asia, Latin America except the largest countries, and all but a small corner of Africa lack refrigeration to run an effective vaccination program, AP reported. Experts have opined that West African countries that faced the 2014-16 Ebola outbreak would be better off as vaccines against the virus also require ultra-cold storage.
Furthermore, a number of other components such as vials, stoppers, gauze, alcohol swabs, syringes are also required in large quantities to inoculate the masses. India, which has the capacity to manufacture more than 2 billion units of these vials, is being tapped by international players for supplies.
Inside a small clinic in the village of Gampela, on the outskirts of Burkina Faso’s capital, Ouagadougou, empty vaccine bottles are found on a tray. The vaccine cold chain obstacle is just the latest disparity in the pandemic against the poor, who live and work more often in crowded conditions that allow the virus to spread. (AP Photo)
How are countries improving cold chain facilities for Covid-19 vaccines?
Several logistics companies such as the US-based United Parcel Service and the German logistics company DHL have already started building new warehousing facilities. According to Bloomberg, UPS is building two freezer farms, each the size of a football field, to house 600 freezers that can hold 48,000 vials of vaccine each at temperatures as low as -80 degrees Celsius in Louisville, Kentucky and the Netherlands. . UPS is also buying some freezers to install in South America, Frankfurt and the UK. Ultra-cold freezers typically cost between $ 10,000 and $ 15,000.
DHL opened a new $ 1.6 million facility in Indianapolis last month. FedEx is also adding freezers, refrigerated trucks, sensors, and even thermal blankets. Pfizer, which has signed an agreement with the European Commission to supply 200 million doses of its vaccine, has already activated its supply chain in Belgium.
Coming to India the country has more than 27,000 cold chain points of which 750 are at the district level and above. The rest are below the district level, according to government data.
“Our existing cold storage meets the requirements of the three candidate vaccines (Bharat Biotech, Zydus Cadila and Serum Institute) that are being tested in India. However, according to our estimate, we could need more than 16,000 (cold chain storages) and therefore we need to increase, ”a source told The Indian Express.
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