A NEW WRINKLE IN COLD CHAIN SOLUTIONS
From an unexpected source, the OECD, comes a report on global pandemics, at http://www.oecd.org/dataoecd/58/1/46889985.pdf which includes a section on cold chain solutions. The following section is best read, with graphics, at http://www.oecd.org/dataoecd/58/1/46889985.pdf starting on page 72.
(The following section on the cold chain was co written by Harvey Rubin and Alice Conant). Full implementation of Core Mission III requires the successful delivery of drugs and vaccines to the relevant populations. Under certain scenarios, e.g., pandemics or local outbreaks caused by new or difficult to treat agents, bioterrorist attacks, disruptions caused by environmental or governmental dislocations, successful delivery is not yet guaranteed in the developed countries. It is a far distant certainty that vaccines and drugs can be delivered to the populations in developing countries even under usual circumstances. The reason for this is the requirement that many of these drugs and vaccines must be kept cold and the so-called cold chain, the appropriate refrigeration units from the source of the vaccine or drug to the individual recipients, is inadequate. The lack of electrical infrastructure in underdeveloped countries has a direct correlation to the high death rates from preventable diseases in these regions. We propose a solution to this problem that is economically and technically sustainable and which can be implemented immediately. 74
In order for vaccines to maintain their potency and effectively immunize a patient, they must be stored at specific temperatures. When medicines and vaccines are distributed, they must be transported from the point of delivery in the country to the point of delivery to the patient, which is frequently in a rural location. During this transfer, the medicines and vaccines must be transported in a series of refrigeration and storage units that maintain very specific temperature ranges. This maintenance of the medicines and vaccines at critical temperatures is referred to as the cold chain, as illustrated here. 1
At least 2 million people die each year from vaccine preventable diseases. Generally, these deaths are not because there is a lack of vaccines and medications in the world, but because there is an inadequate vaccine distribution process. Maintaining the cold chain is an overwhelming challenge in countries where the energy infrastructure is limited. A study by Dr. Subhash C.Arya pinpointed this unanswered problem:
The cold-chain maintenance is indeed a Herculean task as the transportation and storage facilities are as a rule unsatisfactory in most if not all developing countries. There are difficulties in obtaining spares and accessories and carrying out day-to-day repairs. There are insurmountable problems in satisfactory execution of the cold chain since power supplies tend to be erratic. Constant appraisal of personnel and appliances is required at the central and peripheral vaccine storage sites.2
The cold chain becomes increasingly unreliable as the distance between primary health centers and sub-health centers increases because of the lack of reliable power 75 sources in the rural areas. A study done in 2007 evaluating the success of the cold chain for the oral polio vaccine in a rural district of India showed that as the distance between sub-health centers from the primary health centers increased, the effectiveness of the cold chain decreased by .16% per one-kilometer (see below).3
The study further analyzed the relationship between effective cold chains and reliable power:
Electrical power or an alternative source of energy is crucial to the maintenance of the cold chain, and our data indicate 90% of all primary/community health centers reporting frequent power failures (5–10 hours) during summer months. This is compounded by the fact that only 45% of these primary/community health centers have a power generator that can help maintain the cold chain (Samant, Lanjewar et al. 2007).3
Several other studies evaluating the efficiency of the cold chain and vaccine potency in developing countries agree with this observation (Adu et al.4, Hanjeet et al.5, Senanayake et al6.). The study performed by Adu et al. evaluated the cold chain in Nigeria from the National Cold Store (NCS) to rural village clinics, maternity centers, dispensaries and hospitals. The study identified that "all the locations [from the NCS to rural vaccine destinations] had formally trained and sufficient cold store staff", however significant loss of vaccine potency still occurred between the local government cold stores and the rural vaccination centers due to inadequate energy infrastructure.6
Although cold chain efficacy is not the only impediment to global immunization, it is a major concern. A technology that could allow penetration of the cold chain into rural regions where sub-health centers are located would significantly impact the effectiveness and distribution of critical medicines and vaccines. 76
The Solution to the cold chain problem:
The millions of deaths due to insufficient access to viable vaccines demonstrate a major need in the global immunization movement for sustainable energy sources and infrastructure. At the University of Pennsylvania, the collaborative project "Energize the Chain" addresses this dilemma by connecting access to clean water and viable vaccines to an absolute juggernaut of current global technology - cell phones.
Cell phones are the fastest spreading technology in the world, and customers in developing countries account for two thirds of the universal mobile phones in use. This global growth is illustrated below.8
Cell phones rely on cell towers, and each tower has its own supply of power. The cell tower facilities usually draw their power from the electrical grid, but this energy can also be converted to direct current (DC) power at 24 volts for the wireless networks.9 Each cell tower is also connected to a backup power source in case the electrical grid fails. In recent years, however, the global mobile network expansion has been increasingly present in off-grid cell tower projects due to the lack of grid connectivity in many locations.10 By 2012, the Global System for Mobile Communications (GSMA) estimates that approximately 639,000 off-grid mobile towers will be established in the developing world.11 In these locations, where access to the electrical grid was previously unavailable, cell towers will introduce a private sector sustainable energy source.
The Energize the Chain project focuses on harnessing an adequate portion of this electrical energy from cell towers to power refrigeration units and water filtration systems. Although providing energy to non-tower related sources is not part of the mobile network design, the GSMA Development Fund recently initiated a new movement called "Community Power" founded upon this idea. In the Community Power January 2010 report, the potential global impact of the mobile expansion on energy infrastructure was recognized. 77
A significant opportunity exists to provide environmentally sustainable energy to people in the developing world who live beyond the electricity grid. And it is the mobile telecoms industry – which has already brought phones beyond the fixed telecoms grid – which holds the key to this next infrastructure innovation.11
Currently, with the support of Community Power, mobile network operators are exploring ways of using excess cell tower power to charge mobile handsets, large household batteries and rechargeable lanterns. There is recognition, however, for the potential to power an entire village with the reliable energy supply from cell towers.11 It is this innovative power source that Energize the Chain identifies as the solution to global healthcare's need for sustainable energy. Initially, the project looks to solve the cold chain problem due to the straightforward and minimal energy requirements. This synergy between global healthcare and mobile expansion clearly benefits the cell phone service provider as well as the local population.
Other solutions are being explored to address the global health issue of inadequate power supply in developing countries. Heat stable vaccines, solar powered refrigeration units, and mobile immunization teams with refrigerated cars are under development, however, these methods are very expensive, location specific and require many more years of research. Up until now, no outstanding progress has been made because too often the research has been in the domain of philanthropy and government and is not yet globally comprehensive. Energize the Chain provides a solution with a global drive that is present in all regions of the world and is independent of government funding and targeted philanthropic initiatives. Cell tower, refrigeration and vaccine technologies will continue to evolve, however, as long as the cell towers are maintained by private infrastructure there will be sustainable energy for viable vaccines wherever mobile coverage is present.
This idea has received enthusiastic support for its potentially transformative impact on world health and human security. By piggybacking access to viable vaccines, medications onto the fastest spreading industry in the world, we could solve a perplexing global health problem and save up to 5 million lives. According to the 2010 World Telecommunications/ICT Development Report, approximately 75% of the world's rural inhabitants are covered by a mobile cellular signal, and it is estimated that close to 100% of the world will have mobile coverage by 2015.13 In order to have mobile coverage you must be within the range of a cell tower-a matter of only a few kilometers, depending on the territory, which means that if the power from the towers can be utilized to sustain cold chains and water filtration units, by 2015 close to 100% of the world could have access to viable vaccines and medications.