Impact of COVID-19 on Access to Cooling Globally
According to the World Bank, between 119 and 124 million people were driven into extreme poverty as a result of the pandemic alone, with this group described as the “new poor.”
The economic impacts have been most significantly felt by women, particularly those in developing countries where 70 percent of the female workforce is in the informal sector. 
In 2020, the COVID-19 pandemic and the measures to limit its spread had widespread impacts on global health, economies, social security and well-being, threatening the progress on many areas of the Sustainable Development Goals (SDGs). Social impacts have also been evident. Since stay-at-home measures were implemented, domestic violence against women has intensified evidenced by the increased reports of domestic violence around the world.  Approximately 1.5 billion students have faced some type of school closure,  and 370 million children globally, many of whom are reliant on school meals as a main source of their daily nutrition, have on average missed around 40 percent of these meals.  Routine vaccinations are one health service that has suffered. As of October 2020, 94 million children in 26 countries had missed out on a measles vaccine. 
With a series of COVID-19 vaccine approvals beginning in late 2020 and recognition that, with time, these vaccines can be adapted for virus mutations, there is consensus among public health experts globally that vaccination for a large portion of the population is necessary to reduce hospitalizations and excessive mortality. Achieving global herd immunity however is estimated to require vaccinating at least 60–70 percent of the population against COVID-19 effectively and equitably, posing a massive distribution challenge.
COVID-19 vaccines are characterized by a range of factors that affect their potential role in achieving global herd immunity. In addition to regulatory approval, this includes their efficacy and risks across age, gender, race and ethnicity demographics, production capacity in 2021, price, dose quantity and cold chain requirements. Each of these factors plays a role in their suitability to support herd immunity in different geographic locations.
Table 3.1: Key characteristics of leading vaccines with traffic-light system signalling potential for achieving global herd immunity (Adapted from the Lancet )
Following the first regulatory approvals of the Pfizer and Moderna vaccines, requiring storage at -70°C and -20°C respectively, cold storage requirements quickly became one major concern for all countries seeking to utilize these products given that most routine immunization vaccines require temperatures between 2 and 8°C at all stages in the distribution cold chain. Almost simultaneously there was public recognition that the first vaccines requiring sub-zero storage temperatures meant they were inaccessible for certain countries and regions that lack extensive cold-chain infrastructure, raising concerns about equitable access.
For example, Dr. Gagandeep Kang, Professor of Microbiology at Christian Medical College, Vellore, said that with its cold storage requirement at -70°C to -80°C, the Pfizer vaccine is “very unlikely to be a solution for India.”  Among other factors, it would require the procurement of significant volumes of sub-zero cold storage at a high cost. Cold boxes equipped to perform at -80°C typically cost between USD 10,000 and USD 20,000 USD, a prohibitive price for the scale needed to achieve herd immunity, and most developing countries outside those that vaccinated against Ebola would have few of these types of cold boxes already. 
At the time of writing, the World Health Organization (WHO) had issued “Emergency Use Listings” for vaccines from Pfizer/BioNTech, AstraZeneca with Oxford University, the Serum Institute of India, Moderna and Johnson and Johnson to expedite country authorization of vaccine distribution. Additional vaccines from Novovax, Sonofi, and others are expected to complement those vaccines as part of the supply secured by the COVAX initiative, a platform to secure and distribute COVID-19 vaccines. With the exception of Pfizer/BioNTech, these vaccines require storage at 2°C to 8°C, the conventional cold storage range for influenza-type and other routine vaccines and are viewed as more practical solutions in countries where logistics and cold chain challenges exist because existing cold chains can be expanded rather than new systems having to be built. 
As of April 2021, vaccine rollout across the developing world has proceeded slowly. The COVAX initiative has forecast that by the end of 2021, it would be able to make approximately 2.16 billion doses available, including 1.7 billion doses made available to 92 low- and middle-income countries participating in the Gavi-COVAX Advance Market Commitment (AMC) Facility. Current estimates are that vaccines provided through this initiative would protect 26 percent of the population of AMC countries in 2021. Countries participating in COVAX may also self-finance vaccine purchases, with those making up a larger proportion of the supply forecast for developed countries. 
While the COVAX effort and self-financed purchases amongst low- to middle-income countries will support many vaccinations, it will not reach the necessary target of 60–70 percent necessary to achieve herd immunity in these regions in 2021.
Figure 3.1: COVAX regional supply forecast for 2021 (millions)
1 Policy Brief: The Impact of COVID-19 on Women, UN Women, 9 April 2020. Link
2 The Shadow Pandemic: Violence Against Women and Girls and COVID-19, UN Women. Link
3 Blake, Paul and Divyanshi Wadhwa, “2020 Year in Review: The impact of COVID-19 in 12 charts,” World Bank Group, 14 December 2020. Link
4 Borkowski, Artur, et. al. “COVID-19: Missing More Than a Classroom: The impact of school closures on children’s nutrition,” UNICEF and World Food Programme, January 2021. Link
5 Mulholland, Kim, Katrina Kretsinger, Liya Wondwossen and Natasha Crowcroft, “Action needed now to prevent further increases in measles and measles deaths in the coming years,” The Lancet, Volume 396, Issue 10265. 12 November 2020. Link
6 Wouters, Oliver J et al. “Challenges in ensuring global access to COVID-19 vaccines: production, affordability, allocation, and deployment. Health Policy, Vol. 397, Issue 10278, 13 March 2021. For a full description of the methodology used for the traffic light system, please see Appendix 1.
7 Interview with Gagandeep Kang, The Wire, 17 November 2020. Link
8 Baskar, Pranav, “What Is A Cold Chain? And Why Do So Many Vaccines Need It?” NPR, 24 February 2021. Link
9 Assessing Country Readiness for COVID-19 Vaccines, the World Bank Group, March 2021. Link
10 COVAX Global Supply Forecast, CEPI, Gavi, UNCEF and WHO, 7 April 2021. Link
11 COVAX Global Supply Forecast, CEPI, Gavi, UNCEF and WHO, 7 April 2021. Link