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INCORPORATING COLD CHAIN
The cold chain : Logistical challenge at the heart of Covid-19 vaccine distribution By Gérald Cavalier , president of the Science and Technology Council of the International Institute of Refrigeration
Since the beginning of the year 2020 and the Covid-19 pandemic which has affected the whole world , refrigeration has been strongly solicited .
In this article , Cavalier , also president
of the French Association of
Refrigeration and president of the Cemafroid Tecnea Group shares his perspective on the pivotal role that the cold chain will continue to play in the battle against the Covid-19 pandemic , and the race to provide a vaccine worldwide .
Which cold chain for the distribution of Covid-19 vaccine ?
Essential to produce and distribute oxygen in hospitals , to cool patients ' rooms , to store and distribute medicines and food , but also to support the increase of data flows caused by teleworking and lockdown .
With the announcement of the availability of the first vaccines comes the question of their distribution and dispensing to billions of people around the world , and in the shortest possible time to stop the pandemic . This remains to be answered . This is an unprecedented logistical challenge on a global-scale , but also an equally unprecedented
refrigeration challenge .
Thus , when the pharmaceutical laboratory Pfizer announced in November 2020 the imminent application for marketing authorisation of its Covid-19 vaccine , and indicating storage temperatures required of −80 ° C , the cold chain that is usually ignored by all made the headlines . The world is rediscovering the importance of the cold chain and those who manage it .
For 112 years , the International Institute of Refrigeration ( IIR ) and its scientific and technical experts have been there to answer questions in an independent manner . Firstly , it is necessary to know the real requirements of these new vaccines and their logistics and then to analyse the solutions available and identify the players ready to implement them .
Finally , we can study the solutions to efficiently set up , in a very short time frame , an adapted and effective temperature-controlled chain to rapidly deploy a massive global vaccination campaign against Covid-19 .
IIR
What will Covid-19 vaccines require in terms of the cold chain ?
Many health products are heat sensitive . Their properties can be altered by temperature excursions outside a defined preservation range . This is particularly the case with vaccines . Most of the over 4.5 billion doses of vaccines given each year worldwide must be stored correctly .
From the laboratory to the patient , they are stored , transported and distributed under temperaturecontrolled conditions . Downward temperature excursions generally lead to an immediate and irreversible loss of the vaccine ' s full efficacy : they should never be frozen ! Conversely , upward temperature excursions lead to progressive , cumulative , and irreversible loss of vaccine efficacy .
Most heat-sensitive medicines are stored between + 2 ° C and + 8 ° C or between + 15 ° C and + 25 ° C , but some health products must be stored at lower temperatures , below −20 ° C or even below −70 ° C . This is , for example , the case for frozen plasma in very longterm storage . Some medicines also have different storage and distribution temperatures , e . g . storage at + 2 ° C /+ 8 ° C and distribution at room temperature for a limited period of a few days or weeks . In 2018 , 8 out of the 10 best-selling medicines in the world were subject to temperature constraints .
The recent announcements by pharmaceutical companies regarding Covid-19 vaccine candidates may therefore come as a big surprise . Pfizer announced storage temperatures of −80 ° C , and Moderna of −20 ° C . We are clearly far from the usual temperatures and logistics chain for this type of product , even though an Ebola vaccine has recently been transported in dry ice below −70 ° C .
This can be explained by the methods used to obtain these vaccines using biotechnologies such as messenger RNA , or by very short marketing lead times that do not allow all the temperature stability studies to be carried out . The Sanofi and GSK candidate vaccines , developed using the same methods as for seasonal influenza , will no doubt be satisfied with the usual logistical solutions for vaccines , i . e . + 2 ° C /+ 8 ° C .
To date , the data provided does not make it possible to determine the real temperature requirements from the laboratory to the patient of all these new vaccines against Covid-19 . In order to set up the solutions adapted to the needs , it is necessary to first know them well , however this does not prevent us from already exploring possible solutions .
What solutions for the distribution of the Covid-19 vaccine ?
Invented in 1876 by Charles Tellier , the cold chain is today controlled , or at least controllable , and refrigeration professionals have developed solutions adapted to all types of products and temperatures , both in the health and food sectors .
Nevertheless , the capacity of cold chain equipment is still very uneven on a global scale , with a gap of one to ten between developed and developing countries , both for storage and for transport or distribution , throughout the cold chain .
From the laboratory to the patient , solutions are widely deployed for the cold chain of health products in either of the conventional ranges . There are also below −20 ° C logistics solutions , and more recently a + 15 ° C /+ 25 ° C cold chain has been developed . They are used on a daily basis by dozens of cold chain specialists , logisticians , transporters , warehouses and distributors , but unfortunately , they are not yet deployed everywhere . For temperature ranges below −70 ° C , if they exist , the solutions remain even more confidential or specialised .
Regulations , standards and labels have been developed over the last 70 years at regional , national or global level
The Covid19 vaccine requires a specialised cold chain supporting temperatures at −80 ° C , which poses a big challenge currently with too little information being made available for successful distribution .
18 www . coldlinkafrica . co . za COLD LINK AFRICA • January / February 2021