Luc Provost, CEO of B Medical System and Dr Abdou Salam Gueye, Regional Emergency Director for WHO AFRO
As we strive for equitable and accessible healthcare for all, one critical but often overlooked aspect of this endeavor is the role of the cold chain. In a world where vaccines, medicines, and diagnostics play pivotal roles in saving lives and preventing illness, networks of temperature-controlled storage and transportation systems aren’t merely logistical components of a healthcare system — they are a lifeline that can make or break the realization of universal health coverage.
Universal health coverage (UHC) envisions health care services being available and affordable for all, regardless of socio-economic status, geographical location, or any other demographic variable. While expanding access through primary health care and reducing costs are fundamental to achieving this goal, the effectiveness of health care interventions is equally important. What good is access to health care if the vaccines administered are ineffective, the medicines rendered impotent, or the diagnostic tests are unreliable due to inadequate temperature control?
Our work has taken us to some of the most remote places on the continent, and while we have seen some extreme challenges, we have also witnessed how simple, cost-effective initiatives can greatly improve access to healthcare. We have also been privileged to be part of organizations supporting improving primary healthcare systems in several African countries.
Vaccines are often called the cornerstone of public health. They have drastically reduced — and in some cases eradicated — countless diseases, saving millions of lives. Most vaccines, however, are sensitive to temperature fluctuations. If vaccines are exposed to temperatures too high or too low, their potency diminishes, rendering them ineffective. Yet many LMICs lack systems and storage capacity for vaccines that enable millions of children on the continent to be vaccinated against deadly and crippling childhood diseases, such as polio and measles. Better coordination between pharmaceutical manufacturers, cold chain companies and governments would be extremely beneficial to the implementation of the vaccination campaigns and achieving UHC. Knowing where vaccines and other drugs are shipped, what the required temperatures are, along with the vaccination schedule would allow for optimization of the cold chain equipment availability and avoid gaps and wastage of these vital goods.
The importance of the cold chain doesn’t stop at vaccines. Many life-saving medications, such as insulin, certain antibiotics, and blood products, also require specific temperature controls. Failure to maintain these controls can lead to decreased potency or, in some cases, dangerous side effects. Ensuring that these medicines are transported and stored at the correct temperature is paramount for universal healthcare’s success.
An additional challenge is that many African countries struggle with intermittent power outages. In fact, the continent’s two biggest economies, Nigeria and South Africa continue to face dwindling electricity supply. This challenge does not only affect homes and industries, but also healthcare facilities and hinders the ability of the facilities to carry out routine vaccination or, in case of an outbreak, are unable to receive and stock adequate vaccines to provide emergency vaccination. In addition to vaccines, other essential medicines, such as oxytocin, used to prevent postpartum hemorrhage in women giving birth, which also requires refrigeration to maintain potency, are affected.
Energy security is essential for health security. However, achieving energy security requires substantial investments over time — a luxury we don’t have. A quick fix with long-term benefits is solar direct drive technology — a refrigerating system recommended by the World Health Organisation and UNICEF — an alternative cold chain solution especially useful in hard-to-reach areas.
Solar drive refrigerators come with numerous advantages. Connecting communities with electricity requires financial resources, which many national and subnational governments on the continent cannot provide, especially with other competing priorities. In addition, with the ever-evolving negative impacts of climate change on the environment and our health, as well as the drive of African countries to provide clean energy, solar-powered refrigerators provide an opportunity to maximize the double benefits of clean, low-cost energy and reduce the environmental and health risk of carbon energy.
Partnering with other sectors may expand the options: connecting health refrigerator to telephone tower offgrid electrical systems, association with the private sector to acquire more reliable generators, or using the empty leg of other sector’ cold chain such as fishery products, meat, dairy products, fruits and vegetables, etc.
Africa is making progress towards improving health security. With numerous investments in disease surveillance and response and top-notch coordination by the Africa Centres for Disease Control and Prevention, the headway is evident. However, health security and UHC can only be achieved with significant investment toward ensuring that health facilities — especially in rural, hard-to-reach communities — are equipped with affordable and reliable cold chain solutions.
To amplify the impact of the recently celebrated UHC Day 2023, we implore governments, international organizations, and other stakeholders to prioritize the strengthening and expansion of the cold chain. This requires funding, technical support, capacity building, as well as research and innovation into renewable resources.
In the journey toward universal health coverage a good start, we believe, is to make sure vaccines, medicines, and diagnostics can be delivered and stored at the right temperature. This is the invisible thread that connects the aspiration of accessible healthcare to the reality of effective healthcare.