The refrigerator and freezer guide (September 2009) created by New Hampshire Department of Health and Human Services' Division of Public Health Services (Immunization Program) highlights the recommendation by The Centers for Disease Control (2008 CDC Vaccine Storage & Handling Toolkit (CD edition)) :
– be able to maintain required vaccine storage temperatures year round
– be large enough to hold the year’s largest inventory (influenza season)
– have a certified calibrated thermometer inside each storage compartment
– be dedicated to the storage of vaccines. Food and beverages should not be stored in a vaccine storage unit because this practice results infrequent opening of the door and destabilization of the temperature. (emphasis added)
World Health Organization's Fact Sheet states: "Vaccines must be held to a very high standard of safety. Stringent measures are taken to ensure quality and safety in the research and development, manufacturing, licensing, transport, storage and use of vaccines, and in the disposal of needles and other equipment after vaccinations are carried out."
The fact sheet further notes:
"Vaccines must constantly be kept at optimal temperature, typically at between 2 degrees and 8 degrees Celsius, from the place of manufacture to the point of use. This is a logistical challenge, especially in developing countries. The network set up to ensure that the required temperature is maintained is called the “cold chain.” Refrigerators, ice packs, and cold boxes are employed on airplanes, helicopters, and trucks, and in various storage locations; in areas not reached by road, chilled vaccine carriers are transported by hand to reach the point of use.
If electricity is not available, gas, kerosene, or even solar-powered refrigerators or freezers may be used. Most refrigerators and related equipment can be selected to meet WHO-UNICEF Performance Quality and Safety standards. Staff at international, national, and local levels are trained to manage cold chain networks. They include technicians, shippers, customs officers, pilots, drivers, government officials, health workers, and community leaders. Among other things, they monitor the temperature of the vaccines and discard those that have exceeded the established limits.
Vaccine vial monitors (VVMs)—temperature-sensitive labels—can be attached to vaccine vials and indicate through a change in color whether an individual vial has been exposed to heat that is likely to have damaged the vaccine. These labels have been successfully used to monitor vaccines taken beyond well-established cold chain settings, such as clinics, to field sites used for mass immunization campaigns. In these latter settings, which may be remote and without any access to refrigeration, the vaccines need to be kept in containers with cold packs. The VVM vial labels enable health care providers to determine at a glance if a vial has been kept within the needed temperature range or not."
While to address this requirement of dedicated storage, one option is to create a dedicated supply chain for vaccine delivery. The other option is to take advantage of potential economies of scope by prudently managing supply chain needs for a wider portfolio of products (e.g. perishable foods and vaccines). I wonder if there are examples of cold storages that have clearly compartmentalized and dedicated spaces for storing food and pharmaceutical products. Are there some capacity sharing possibilities in storage/transportation? Is it possible to tailor supply chains for unique needs of food and healthcare industry, yet take advantage of complementary supply chain assets in storage, transportation, and information systems? The collaborative effort between WHO and PATH (Optimize: Immunization Systems and Technologies for Tomorrow) present one possible solution. The passively cooled carts used to deliver produce to European supermarkets maintain consistent temperatures, are capable of carrying a significantly higher volume than traditional vaccine cold boxes, and could save considerable expense in both the short and the long term. These carts could be used to move vaccines from one storage location to another in developing countries.
Surely, there must be many such opportunities that remain untapped…