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Johns Hopkins Bloomberg School of Public Health


Keyword: access

By Lois Privor-Dumm

Vaccine Cold Chain Storage: Refrigerators in Nigeria

Vaccine Cold Chain Storage: New refrigerators are one of the many potential interventions that can help increase Nigeria's ability to vaccinate kids.

Without money, many nations can’t afford to tackle health care issues and introduce the life-saving vaccines that are critical to child survival in the developing world.  But even after a vaccine is introduced and money has been spent, some children never see even the first dose.  With so much investment and effort, you wonder -- how can that be? 

Take Nigeria, the country with the second largest number of child deaths globally.  Over the past few years, they’ve raised vaccine coverage in many parts of the country to nearly 70%.  But progress is fragile, and results uneven.  Some areas have coverage rates above 80%; others are barely providing any vaccine. Economic status and presence or absence of donor funding don’t fully explain the disparities. It’s not just the money – there must be something more.

To find out, a team led by Dr. Chizoba Wonodi at our International Vaccine Access Center (IVAC), Johns Hopkins Bloomberg School of Public Health, worked with the government of Nigeria to interview 126 stakeholders in 8 states that best exemplify the range of successes and challenges in immunization coverage. Dr. Wonodi’s team found that often, it’s not the amount of money that’s the problem – it’s getting that money to the right places at the right times, from the federal government all the way down to the community level. When that doesn’t happen, children go unvaccinated. Conversely, innovative mechanisms can lead to success stories. In one Northern state, Zamfara, leaders used a “basket fund” to pool funds at the state and local level, ensuring that resources go where they are needed. 

Other non-monetary issues were important as well. Inadequate transportation was cited in the study as a near universal barrier to vaccine delivery. Transportation contracts are one solution—these contracts could even be preferentially awarded to female-owned business, empowering women while improving service delivery. (I really like this one!) 

Inadequate cold chain – or the refrigeration required from ‘lab to jab’ to keep a vaccine viable –is another frequently-cited barrier. Nigeria has invested in cold chain, and when I visited in July I saw what can be done – and unfortunately, what can sometimes prevent great ideas from being implemented. They have lots of solar fridges, for example, but I learned that without a system to ensure regular repairs, that vital equipment can sit idle. I can go on and on about what we found, but I suggest you read the brief report to get a better understanding of what is both most impactful and feasible.

The good news is that the government and many other stakeholders are fully committed to making a difference. In fact, Nigeria is holding its first National Vaccine Summit, and I’m honored to be a participant.  The Summit shows impressive commitment from the highest level, from the President, Vice-President, ministers, senators, and First Ladies, right on down to the local governments. The Summit is also bringing in the private sector and other non-health groups – even the Minister of Power is engaged to help ensure no interruption in those fridges! It’s a huge effort, but one that will bear fruit in the coming months when a new pentavalent (Diphtheria, Tetanus, Pertussis, Hepatitis B, Hib) vaccine is introduced.

Investment in vaccines makes sense, and saving lives is well worth this effort.  The scaling up of new vaccines to 90% coverage is projected to save over $300M in direct health costs and add up to $17B to the economy in increased productivity! That’s an investment worth making.

Lois Privor-Dumm is the Director of Alliances and Information at IVAC.

Welcome to the brand-new IVAC Blog! We’re pleased to launch this forum where experts, policymakers, advocates, students and other impassioned individuals can share ideas, thoughts and analysis on the latest in global health and vaccine access.

As students and practitioners of public health know well, delivering health interventions is often just as important as discovering them. Despite advances in science that allow us to prevent the world’s deadliest infections, those advances will never bear fruit in a majority of the world’s countries without the evidence base to prove the need, backed up by an advocacy effort that spurs decision makers to act. 

It was this compelling need that inspired the establishment of IVAC at Johns Hopkins Bloomberg School of Public Health just one year ago.

Simply put, IVAC is dedicated to ensuring that safe and effective vaccines reach those who need them most—like children in developing countries, where the disease burden is high and health interventions are tremendously scarce. Though great strides have been made in recent years to fund and improve vaccine delivery in the world’s last-mile communities, there is much work left to be done—and there are many barriers to implementation that remain stubbornly intact. 

Being housed at the Bloomberg School of Public Health allows IVAC to draw upon the tremendous expertise of the faculty as well as other scientific and policy leaders in building the credible case for expanding vaccine access. Our projects are made possible through grants from the Bill & Melinda Gates Foundation, the GAVI Alliance, the US Centers for Disease Control and others and we partner with international organizations, in-country advocates, industry leaders, civil society and others to ensure smart collaboration and accelerate progress. 

Thanks to the work of IVAC and our partners, nearly 50 developing countries have introduced Hib vaccines in the past decade, protecting millions of children and millions more will be protected in the years ahead from pneumococcal and other diseases. For us at IVAC, our aim is to do the same with other vaccines for diseases that claim the lives of children unnecessarily.

The IVAC Blog launches at a particularly important time for its mission. At Johns Hopkins Bloomberg School of Public Health, our third-annual Vaccine Day is tomorrow, Friday, October 29—and globally, the second-annual World Pneumonia Day will take place November 12. We invite you to participate in both events so that we can continue to find innovative and sustainable ways to deliver lifesaving vaccines to children who need them.

As any global health organization knows, the breakthrough in the lab is only half the battle. To be effective, we always need to know what works on the ground and what doesn’t. So please use the comments section to share your thoughts and ideas and highlight the topics and resources you’d like to read and discover in this blog.

--Dr. Orin Levine