Gathering real-time and continuous temperature data

What we have learned in recent years is that when countries can see into their cold chain, decision-makers at all levels of the health system have a shared, objective understanding of cold chain performance. They can make informed decisions around planning, procurement and maintenance, and most importantly, they are better equipped to keep vaccines safe and potent. RTM devices automatically gather real-time, objective and continuous temperature data from vaccine storage and transport equipment, share those data with multiple stakeholders, and automate alerts and dashboard analytics that synthesize and contextualize the data.

The system saves health workers time by automatically and remotely collecting data, and it eliminates opportunities for human-prone errors from paper-based systems. It also provides a cost-effective and customizable way for countries to own their data, identify problems, procure and maintain equipment, and maximize their capacity for safely refrigerating their vaccine supplies. 

ColdTrace currently protects vaccines for one in ten babies born around the world every year. The system has been shown to reduce damage to vaccines by heat and cold by 68 percent and 67 percent, respectively. Helping countries avoid vaccine degradation due to temperature exposure — high or low — reduces waste and ensures effective immunization, ultimately reducing outbreaks of disease. 

Kenya and Tanzania are currently partnering with Nexleaf to get the right data to the right people at the right time, providing Ministry of Health personnel with the information they need to keep their fleet of vaccine fridges and transport carriers up and running. In December 2021, staff at a district vaccine store (DVS) in Tanzania received SMS alerts concerning a couple of faulty fridges and after looking at the data analytics, it was clear there had been a power outage. These data prompted a fast response from the DVS staff and power company who were able to resolve the issue within a few days, restoring reliable cooling to a store that plays a critical role in assuring the safety of thousands of vaccines distributed to local facilities. 

Tracking COVID-19 vaccines in Kenya

This real-time visibility into cold chain performance took on an even greater significance in early 2021 when countries started receiving thousands of doses of COVID-19 vaccines; Nexleaf’s work in remote temperature monitoring during transportation was well underway when the Kenya Ministry of Health requested sensor devices to monitor its valuable Pfizer and Moderna COVID-19 vaccines to ensure they stayed safe. So far, Nexleaf’s battery-powered and Bluetooth-enabled Trek device has been used to monitor all the transport routes of Pfizer (795,600 doses) and Moderna (880,000+ doses) vaccines that have been transported from the central vaccine store to the nine regional vaccine stores throughout Kenya.

The data collected via Trek are shared with health workers to show how the vaccines fared throughout the journey, providing evidence that vaccines are still potent and will protect the population effectively. The data are also organized into various visualizations that Ministry personnel can use to evaluate which vaccine distribution events maintained safe temperatures most effectively. These analytics have allowed for evidence-based discussions around the vaccine cold chain, not only for COVID-19 vaccines, but all childhood vaccines. With very clear protocols around vaccine temperature requirements and vaccine viability, health workers can use Trek data to make informed decisions rather than relying on guesswork, dispose of spoiled vaccines, and take steps to protect vaccines before they lose potency. 

Key to the value of remote temperature monitoring is the remote and automated nature of the data the system gathers. Using sensors to log and upload temperature and power availability data, the system eliminates error-prone manual data entry and enables push-button time-series data visualization. It can also provide insight into health facility power capacity, revealing how many hours of grid power flow to the facility, or whether a solar-battery system is functioning properly. Trek provides GPS route data that can give planners visibility into the locations and timing of problems that hinder efficient vaccine delivery.

As we look to the future, we believe the key to total system improvement lies in full end-to-end RTM at every storage point and transport leg of the vaccine cold chain. By 2025, we hope to see end-to-end RTM implemented in three low- and middle-income countries (LMICs), generating critical data to safeguard vaccines.

Our most crucial measure of success, however, is seeing evidence that the central Ministry of Health, health workers and personnel at every level are using data gathered by the system to guide their actions in their day-to-day work as well as in their country-wide cold chain planning, procurement and management. We also believe that the system will achieve its maximum utility when power availability and Trek route data can be leveraged effectively to provide benefits to planners beyond vaccine management, as more lifesaving equipment (such as oxygen concentrators) and critical medicines (such as insulin) are deployed to more and more remote clinics.

Meet our Global Panel on Access to Cooling member from Nexleaf Analytics

The effort to update Kenya’s cold chain inventory began in 2016 with the country’s successful application to Gavi’s CCEOP and a World Bank loan that resulted in the deployment of 3,082 new refrigerators. 20 percent of these appliances were solar-direct drive (SDD) refrigerators, which use solar energy via photovoltaic panels to maintain the required 2–8°C for vaccine storage. SDD refrigerators allow for expansion to health facilities with no electricity, are low maintenance and have low OPEX costs as they do not require a battery, electricity, or backup power source. The remaining 80 percent of appliances procured were ice-lined refrigerators. While they are mains-powered, the water or PCM-based coolant packs lining the walls enable long holdover times – a minimum of 20 hours and often more than two days. 

As shown in Figure 1, 2,463 units of optimal CCE were introduced to Kenya through these investments over a five-year period, increasing the rate of optimized equipment to 33 percent by 2021. This was accomplished through a blend of deployment across sub-optimal sites, new sites, those with unqualified storage refrigerators [9], and facilities that previously had no CCE. The number of sub-optimal sites decreased by 18 percent (4,036 sites to 3,300), however, this figure also accounts for the introduction of new sub-optimal equipment at other site types. [10]

In 2021, these Grade A refrigerators directly contributed to vaccine administration for 833,238 infants out of a total population of 1.7 million (50 percent) despite only comprising a third of the total CCE. [11]

The road to success 

Despite its success in deploying 8,342 refrigerators to date, Kenya now faces the challenge of maintaining the CCE. The current staff of 490 cold chain technicians are insufficient in number and face the additional challenges of limited transportation and technical resources that hinder their ability to respond to CCE malfunctions effectively and efficiently. [12]

While considerable progress has been achieved to date through nearly 50 percent equipment optimization and 92 percent functionality rates, continued expansion of the cold chain will inevitably result in increased maintenance needs. Kenya’s cold chain expansion proves that this ecosystem is only as strong as its weakest link. There is a need to strengthen the cold chain holistically, rather than in silos. Integrated planning, increased budgetary allocation aligning equipment scale-up with maintenance resources, and a systems approach must be firmly in place to ensure the sustained national scale-up of this lifesaving equipment.

Notes and references

[1] Kenya National Cold Chain Inventory, 2016 and 2021
[2] https://data.worldbank.org/indicator/EG.ELC.ACCS.ZS?locations=KE
[3] Kenya National Cold Chain Inventory, 2016
[4] Costs are based on reported facility expenditure in 2016 and are inclusive of logistical expenditure (i.e., motorbike fuel).
[5] Ibid.
[6] Kenya Temperature Monitoring Study, 2018
[7] Cold Chain Equipment Optimisation Platform: Technology Guide, Gavi, 2019
[8] Ibid.
[9] Unqualified storage refrigerators refer to equipment not designed for vaccine cold chain.
[10] Kenya National Cold Chain Inventory, 2021
[11] Ibid.
[12] Ibid.