Extending supply chains and improving immunization coverage and equity through controlled temperature chain use of vaccines

• Published in: Vaccine 2017-04, Vol.35 (17), p.2214-2216
• Main Authors: Kahn, Anna-Lea, Kristensen, Debra, Rao, Raja
• Format: Article
• Language: English
• Subjects: Access control; Allergy and Immunology; Bicycles; Body temperature; Brittleness; Children; Cold; Cold chain; Conditioning; Control stability; Controlled conditions; Controlled temperature chain; Drug delivery systems; Drug Storage - economics; Drug Storage - methods; Exposure; Feet; Freezing; High temperature; Humans; Immunization; Immunization Programs - methods; Immunization Programs - trends; Monitoring; Refrigeration - instrumentation; Refrigeration - methods; Supply chain; Supply chains; Temperature; Temperature effects; Terrain; Tonic immobility; Transportation engineering; Vaccination Coverage; Vaccine; Vaccines; Vaccines - supply & distribution
• ISSN: 0264-410X; 1873-2518
• DOI: 10.1016/j.vaccine.2016.10.091

A method for increasing vaccine access and coverage, especially among hard-to-reach populations, CTC permits certain vaccines used in single antigen delivery strategies or campaign scenarios to be kept outside of the traditional cold chain of +2°C to +8°C for a short period of time under monitored and controlled conditions that are appropriate to the stability of the antigen. The CTC approach also uses two specific and complementary temperature monitoring tools: (1) a peak threshold temperature indicator which allows for brief- though all the same harmful- exposures to high temperatures to be detected and (2) the VVM which measures accumulated heat exposures during unintentional cold chain excursions and is limited to a calibration for an upper temperature limit of +37°C. CTC therefore not only formally allows for cold chain excursions through the regulatory approval process, but also extends their flexibility and improves the associated temperature monitoring. A growing and compelling body of evidence shows CTC offers valuable opportunities for maximizing supply chain efficiencies, safeguarding cold chain investments, and protecting more children and families from vaccine-preventable diseases. Lack of transportation infrastructure, such as navigable roads and sufficiently large vehicles, requiring vaccines to be transported in smaller vaccine carriers and often over arduous terrain by motorcycle, bicycle, or boat, when available, or on foot [3]; Lengthy and burdensome preparation of conditioned ice packs to keep vaccines sufficiently cold while also avoiding freezing, which occupies staff time and diverts attention away from routine activities; Constraints on time, staff, and equipment that result from maintaining...