The vaccine cold chain exists to protect patients. But when it fails, the consequences ripple outward: wasted doses, disrupted vaccination campaigns, financial strain and a growing shadow over public confidence.
INCORPORATING COLD CHAIN
FEATURE
Where the chain breaks By Eamonn Ryan
The vaccine cold chain exists to protect patients. But when it fails, the consequences ripple outward: wasted doses, disrupted vaccination campaigns, financial strain and a growing shadow over public confidence.
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Breakdowns can occur anywhere along the journey: during international transport, at national storage hubs, in regional distribution centres, in local clinics – or even in a practice refrigerator accidentally unplugged over a weekend.
When temperatures deviate outside the approved range for a defined period, the vaccine must be thrown away. There is no grey area. The scale of this waste is staggering. Up to 50 % of vaccines globally are discarded each year due to cold chain failures and related inefficiencies. In other words, one in two doses manufactured never reaches a patient effectively.
The impact is not merely economic. If a compromised vaccine is unknowingly administered, patients may believe they are protected when they are not. Conversely, when vaccination campaigns falter because doses are discarded, communities may interpret the disruption as incompetence or risk – fuel for vaccine hesitancy.
The public rarely sees the cold chain. But they experience its consequences. Cold chain challenges are often framed as issues for low- and middle-income countries. Certainly, delivering temperature-sensitive products across vast rural regions in Africa, Latin America or parts of Asia presents formidable infrastructure challenges.
HOW COST AND WASTE TURN ACCESS INTO A LOTTERY
In a recent episode of the IQVIA Podcast, Stefan Lutzmayer of IQVIA speaks with Özgür Tuncer, CEO and executive director of Stablepharma, about a problem hiding in plain sight: the global vaccine cold chain.
What emerges from the discussion is that the requirement to‘ keep it cold’ is not just a logistical technicality. It is a structural barrier to access – driving enormous waste, inflating costs, undermining trust, and effectively turning vaccination into a postcode lottery.
The pharmaceutical cold chain refers to the temperature-controlled supply of medicines from manufacturing to the point
of administration. For most vaccines, this means constant storage between 2 ° C and 8 ° C. Some advanced biologics and mRNA( ribonucleic acid) products require even colder conditions.
Crucially, this is not ordinary refrigeration. It is uninterrupted, tightly monitored temperature control, sometimes for years. Any deviation above or below the required range can compromise potency. Freezing is as dangerous as overheating, particularly for aluminium-adjuvanted vaccines( something added to a vaccine to boost the immune response), which make up a large proportion of global supply. Once frozen( or overheated), these vaccines lose effectiveness and must be discarded.
Yet the podcast highlights that this is equally a developed-world issue. In Europe alone, annual vaccine spending is forecast at approximately R595-billion. Of that, around R384-billion is associated not with acquiring vaccines, but with cold chain logistics and wastage. Even in well-resourced systems, nearly a third of vaccines are frozen at some point and must be discarded.
This reality exposes a misconception: reliability does not equal efficiency. Wealthier systems may maintain more stable infrastructure, but the economic and environmental burden remains immense. The cold chain is not simply an access problem for remote regions, it is a systemic inefficiency embedded in global healthcare.
THE HIDDEN COSTS AND ENVIRONMENTAL BURDEN
Beyond direct financial losses, the cold chain carries substantial hidden costs. Continuous refrigeration requires energyintensive infrastructure: specialised storage, monitoring systems, insulated transport and emergency contingencies.
The environmental impact is equally concerning. Emissions associated with refrigeration and wasted doses equate to millions of kilometres driven in CO₂ output each year. As healthcare systems commit to sustainability targets, this burden becomes harder to justify.
GS1 is a global standards organisation that develops and maintains systems for uniquely identifying products, locations and assets.
The metaphor used in a white paper associated with this podcast –‘ The Tip of the Iceberg’ – is apt. Procurement costs are visible. Freezers and refrigerated trucks are visible. But beneath the surface lie systemic inefficiencies that strain budgets and climate goals alike. Healthcare systems worldwide face growing demand, constrained funding, and pressure to decarbonise. A model in which half of manufactured vaccines are discarded is fundamentally unsustainable.
ACCESS BECOMES LOTTERY
Perhaps the most troubling consequence is inequity. If a region has robust, uninterrupted cold chain infrastructure, its population is far more likely to receive effective vaccination. If it does not, access becomes uncertain. Geography, infrastructure reliability and logistics competence determine outcomes.
This is what Tuncer describes as a‘ postcode lottery’. In some locations, vaccination is seamless. In others, supply interruptions, wastage or compromised storage create uncertainty. Patients may not even know whether the dose they received was fully potent. Such variability feeds distrust. When protection feels inconsistent or campaigns falter, confidence erodes – not necessarily because of vaccine science, but because of the delivery system behind it.
THE PROMISE OF THERMOSTABLE TECHNOLOGY
If the cold chain is the problem, the logical solution is to reduce dependence on it. Stablepharma’ s approach is to convert existing, proven vaccines into fridge-free formulations that remain stable at ambient temperatures. Rather than inventing new vaccines, the company reformulates current products while retaining their active ingredients and delivery formats.
Its lead programme – a fridge-free aluminium-adjuvanted tetanus-diphtheria vaccine – has completed Phase I clinical trials. If successful at scale, such technologies could eliminate the need for continuous refrigeration, reduce wastage dramatically, cut costs and expand access in both developed and emerging markets.
Other innovators are exploring complementary approaches, including microneedle patches and alternative delivery systems. The common goal is to make vaccines inherently stable, rather than endlessly investing in fragile temperaturecontrolled infrastructure.
The cold chain was once a necessary safeguard. Today, it may be a limiting factor. As biologics, cell and gene therapies and complex injectables expand, reliance on strict temperature control will only intensify. Without change, costs will rise, waste will grow and inequities will widen.
Reimagining vaccine stability is not merely a technical upgrade. It is an access strategy, a sustainability measure and a trust-building exercise. Until then, the cold chain will continue to determine who gets protected – and who does not.
INSIDE THE PUSH FOR SAFER LABS AND HOSPITALS
The following presentation on the topic‘ How to trap, eliminate and dispose of viruses’ was delivered at SAIRAC Cape Town Centre on 9 September 2025 by Thabo Mngadi( AFMS mechanical design and costing manager) and Cassandra-Anne Baxter( ALPA sales general manager).
In laboratories, hospitals and coldchain environments, air is not simply air. It is a vector, capable of carrying pathogens, chemicals or contaminants that compromise safety. Managing that risk requires more than ventilation; it requires engineering precision, rigorous protocols and technologies that balance safety with efficiency. The speakers unpacked the practical challenges of filtration, decontamination and energy recovery in high-risk environments.
Decontamination unit for use in pharmaceutical clean manufacturing.
Supplied by ALPA
June 2026 www. coldlinkafrica. co. za COLD LINK AFRICA
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