Waiting for a Malaria Vaccine: Strengthening the supply chain

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With potential malaria vaccines just a couple of years away, there’s a real need to start looking at whether the supply chains found in the developing world will be able to support the sort of mass roll-out that we would expect for a vaccine that has the potential to save millions of lives each year.
With organisations such as the World Health Organisation and the GAVI Alliance offering incentives to big pharma and developers, such as advanced market commitment agreements, as well as the increasing capacity and expertise in the cities of developing countries, the weakest link in the supply chain comes towards the end. It is increasing the availability of vaccinations to people in remote towns and villages that remains the largest hurdle in vaccine supply for developing nations. Lacking vital reliable infrastructure, such as electricity, maintaining the low temperatures at which vaccines must be stored is a challenge that has not yet been overcome completely.

A further weakness in the vaccine supply chain is the amount of vaccines wasted during campaigns. Whilst much of this wastage comes under the banner of cold chain issues such as refrigeration, there is a huge amount waste incurred through mistakenly giving vaccinations to patients more than once.
If a malaria vaccine to be rolled out quickly and effectively, then these issues to need to be addressed. With demand likely to far exceed big pharma’s ability to produce the vaccine, efficiency is key to ensuring the sufficiency of the supply chain in the developing world.

Here are a number of projects and innovations which promise to strengthen the vaccine supply chain in time for the arrival of a malaria vaccine in the next few years. They may not represent long term improvements to infrastructure and policy, such changes would take too long to implement and, if considered on their own, would delay the spread of the vaccine.

Energize the Chain

Energize the Chain is a non-profit organisation that has developed a system which takes advantage of existing mobile phone infrastructure in order to power fridges in remote parts of the world. With around three-quarters of the world’s population having access to a mobile phone, there is significant infrastructure stretching out into remote regions to support this coverage.

By utilising excess power leftover from mobile phone masts, Energize the Chain have created a method for running refrigerators across remote regions without having to invest in new power infra-structure. And the backup systems often installed by phone companies to deal with enevitable power shortages allow the refrigorators to run for even longer without the need to invest in their own generator.

Sure Chill Refrigerators

Sure chill refrigerators have been around for a number of years now, but they continue to represent the best option for clinics and medical posts that have access to between 2.5 and 4 hours of electricity a day.

Sure Chill vaccine fridges are surrounded by a layer of cool water on top of which there is a layer of ice. This layer of ice works to keep the water below it cooler for longer whilst not coming close enough to the vaccines to cause freeze damage. When the ice melts and the water cools, the cool water from the melted ice begins to mix with the warm water below it prolonging the amount of time the water surrounding the fridge remains cold enough to chill the vaccines.

MenAfriVac: Passive coolers and reactive labelling

In February earlier this year, researchers published a paper in Vaccine detailing how they had delivered 15,000 vials of MenAfriVac using just passive coolers. Without the need for ice to keep the vaccines cool healthcare workers were able to complete the ‘last legs’ of their journeys into the most remote parts of Benin.

But the coolers didn’t actually work to keep the vaccines at the WHO recommended 2°C to 8°C, instead the coolers worked to keep the vaccines below 40 °C, with time spent above this temperature reduced to less than four days.

Using experimental reactive labels, designed to change when the vile is exposed to excessive heat for long periods, healthcare workers found that none of the 15,000 vials sustained any heat damage throughout the vaccination campaign.

If the WHO updates it’s guidelines to take into account the temperature limits that developers have claimed their vaccines can do for years, then the reach of the supply chain for vaccines in the developing world can be lengthened overnight.

VaxTrac and Lumidigm: Biometric tracking

As Vaccine Nation recently reported, a partnership between Lumidigm and VaxTrac had seen vaccination rates increase by 10% in Benin, alongside a substantial decrease in wasted vaccines.
Through the use of Lumidigm’s fingerprint technology that requires simple and cheap mobile phone technology to use, this biometric system has the potential to reduce vaccine waste substantially. By keeping a record of the parent and child’s finger print, the risk of patients being given a needless second dose is greatly reduced.

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