Addressing vaccine cold chain access gaps at the last mile

Key messages

  • While vaccine supply is likely to continue to be the primary constraint, it will be those living at the last mile in countries without sufficient vaccine cold chains that will be at risk of not being able to access a COVID-19 vaccine specifically due to cooling requirements.
  • Compared to urban dwellers, rural populations face a number of challenges including less reliable electricity supply, greater risk of vaccine spoilage in transit over large distances, and health facilities with fewer capacities. 

To understand the scope of this population, SEforALL surveyed three key studies:

  • the Economist Intelligence Unit (EIU) work on countries unable to roll out vaccination plans until 2022 or 2023;
  • the DHL temperature-controlled logistics study that identified countries with medium-to-low feasibility for vaccine rollout at conventional 2°C to 8°C storage temperatures; and
  • the WHO list of countries that failed to reach the target rate of 90 percent immunization coverage or higher for the commonly used DPT3 vaccine.

From this survey, a list of 108 countries was identified as either not predicted to have widespread access to the vaccine until 2023 or later (EIU) or were assessed to have medium-to-low feasibility of in-country logistics for vaccine distribution under conventional temperature requirements of 2°C to 8°C (DHL). Within those countries it can be expected that those living rurally will face more serious risks from a lack of access to vaccine cold chains. It is estimated that 1.42 billion people living in the last mile in these countries are at high risk, if temporarily, from a lack of access to cooling that prevents them from accessing the COVID-19 vaccine.

Figure 3.3: Rural populations in countries expected to experience cold chain challenges

The additional infrastructure, services, and equipment to be procured and deployed to facilitate the COVID-19 vaccination present opportunities for many countries to improve their current cold chain systems, but also to strengthen health systems for the long term and help address climate change. Investments in off-grid renewable energy solutions for health facilities, for example, can deliver reliable and cost-effective electricity in countries with electricity access gaps, but short-term impact requires commitments to long-term financing, better data, and enabling policy environments at the local level. 

Cold chain equipment expansion must also recognize the long-term risks of using unsustainable technologies. As the equipment deployed as part of the vaccination programmes will be in place or in circulation at least 10 years, deployment of inefficient and high-GWP cooling technologies to meet the demand quickly may potentially become a barrier for achieving global climate change and development goals, targets and commitments. Sustainability standards for energy consumption and refrigerants must be strongly embedded into the qualification of equipment being assessed for procurement by development entities and governments supporting vaccine rollout.

New business models and innovations can support more sustainable solutions at the local level. Cooling as a Service (CaaS) is one such model that can optimize for short term medical needs in light of 10-year equipment lifespans. Community cooling hubs can similarly provide refrigeration services for a variety of different cooling needs, delivering legacy infrastructure that can also be utilized for agricultural production and communal food refrigeration. New innovations in temperature monitoring, including from vaccine and cooling equipment suppliers, can also reduce wastage and support the digitalization of routine COVID-19 immunizations if they become necessary. 

Ultimately, a dramatic expansion in cold chain equipment will be necessary to guarantee equitable distribution of COVID-19 vaccines. While it is evident that the pace of vaccination is uneven and inequities are likely to be exacerbated in the coming months, support for sustainable cold chains represents an opportunity to address immediate equity considerations and deliver a lasting impact in support of the economic and social recovery from the pandemic.