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Understanding the successful storage, supply chain, and distribution of the Covid-19 vaccine and what Africa needs to do to get it right.

THERE WAS PERSONAL DILIGENCE IN conducting the research for this story, as this writer too tested positive for Covid-19 at the end of December, in South Africa, a country that recorded a million coronavirus infections that same week. Following the story and the world’s quest for an effective
cure, this article now focuses on the concomitant issue of vaccine distribution across Africa even as the continent grapples with a deadly second wave of the pandemic.

Different countries have taken different approaches to securing their supply of vaccines. In North Africa, for example, Morocco has secured over 65 million doses, some of which has come from China’s Sinopharm and Britain’s AstraZeneca and Oxford supplies. The country aims to have
at least 80% of its population vaccinated with this supply.

South Africa, having joined the COVAX coalition, has secured 20 million doses thus far. The country’s government is using a phased approach with healthcare workers being the first to receive the vaccine, and the continent’s second largest economy aims to have 60% of the overall population vaccinated to initiate herd immunity.

Other countries look to their alliances with China and Russia to provide vaccine doses. While countries have had to ensure the security of their supply first, other issues around the vaccine are also to be considered which in turn plays a deciding role in the type of Covid-19 vaccine a country needs.

One such issue is storage. The current vaccines that have been approved as a result of their high efficacy rates pose a difficult challenge when it comes
to shipping and storage. There are certain conditions that have to be met to ensure that a vaccine is stored successfully and still viable for use after being shipped.

This is where the vaccine cold chain comes in. The cold chain is the network of cold storage facilities that are used through every key stage of the vaccines’ journey; from the manufacturing line to their eventual use in a syringe. Proper storage and handling of vaccines during the cold chain process ensures that no part of the vaccine being transported degrades and
becomes unusable for treatment.

Part of the cold chain process is also temperature regulation and includes all equipment and procedures required during the transportation and storage process.

Africa faces a unique challenge in the area of storage. With vaccines requiring resilience in being able to travel across great distances and many facilities, particularly in rural areas not reaching the requirements for long-term storage, certain vaccines have had to be ruled out.

There are enough examples now of businesses and services in this critical area. iKhaya Automation Solutions is a temperature monitoring specialist based in Pietermaritzburg, a town in the province of KwaZulu-Natal in South Africa. The company has received accreditation from the World Health Organization (WHO) which is critical in the roll-out and storage of
vaccines on the African continent.

Eckart Zollner, the sales and marketing executive of iKhaya, says the accreditation could not have come at a more critical juncture. “The temperature of every vaccine (and indeed all temperature-sensitive pharmaceuticals) must be kept as advised by the manufacturers during transport and storage to preserve the vaccine’s effectiveness and safety once administered,” says Zollner.

Temperature monitoring systems such as the ones provided by iKhaya are a key component to ensuring that the viability of a vaccine is maintained throughout the cold chain process. Devices manufactured by iKhaya have been deployed at a number of different storage facilities and laboratories that have been involved in the vaccine process.

“Vaccine storage at the recommended temperatures in Africa is not easy to achieve,” says Zollner.

In order for the accreditation to be achieved, a number of compliances and regulations had to be met. The criteria included a thorough examination of the devices and quality of technology being used in its mechanisms for measurement. There were also strict regulations on how the devices interacted with the environment and the alert systems in place should the temperature and condition of the vaccine face being compromised. Zollner elaborates on the importance of data analysis and data storage systems that were also in place and part of the approval of the accreditation process as “it has been quite an intricate and rigorous process in ensuring our data
systems matched the criteria set out by WHO”.

Given that the storage of the vaccine is determined by the specific temperature range, the devices created have to ensure that the temperature regulation processes can be monitored in real-time and breaches can be controlled immediately.

“The alerts have a three-level hierarchy to ensure that personnel are able to act accordingly and before temperatures reach a critical juncture and the vaccine is compromised,” says Zollner.

In Africa, there are also other issues in the cold chain process. One of them, power.

“Electricity supplies have proven to be unstable in some parts of Africa, which is not ideal for temperature regulation devices; the consistent maintenance of electricity, particularly in rural areas is needed for vaccines to maintain their efficacy,” adds Zollner.

Training is also of importance as personnel needs to be well-versed in the temperature regulation measures needed for the storage of a particular vaccine. Zollner also mentions the lack of qualified staff in certain regions.

Another critical issue is the actual distribution of the vaccine within an African context.

The distribution of Covid-19 vaccines also comes with a subset of issues. Dr John Sargent, one of the co-founders of BroadReach Healthcare, spoke to FORBES AFRICA on some of the issues in Africa.

Sargent explains that the model of distribution for the Covid-19 vaccine is a complex one.

“When you think about from when a vaccine gets into a country to when it gets put into someone’s arm, especially those that require two doses, there are literally a thousand steps that need to happen first,” notes Sargent.

One of the first things that need to happen in each country is regulatory approval.

The second consideration, once approval has been granted, is budget.

“The cost of the actual vaccine is only part of the cost, the cost for the vaccine process needs to be taken into account, this includes costs for syringes, alcohol swabs, personnel to administer the vaccine, and it just continues from there.”

The third area, according to Sargent, is supply chain logistics which he foresees as being a challenge, especially due to the cold chain process. He reasons that this can be overcome by explaining that “in many of the countries I have been in sub- Saharan Africa, I could get ice cream”.

By this, he means partnering with industries and companies in the private sector and using their facilities as an innovation within the cold chain process.

Apart from the technicalities around distribution, Sargent mentions more intrinsic social issues such as community awareness and adherence as potential concerns.

Sargent feels education needs to happen through communication strategies and exploring avenues such as social media campaigns and community programs.

The last thing Sargent feels is needed is effective project management.

By this, he refers to technical nuances such as an effective data management system or how vaccine candidates are being catalogued and the logistics around key facilities that would offer vaccination.

Understanding the supply chain in distributing the vaccine is going to be instrumental in ensuring that the vaccination process is as widespread as it needs to be.

With different countries adopting different approaches in how the vaccine is distributed, only time will tell which has been the most effective in making Covid-19 a thing of the past.

Storage conditions of the vaccines currently available: Currently, there are at least five vaccines that have approval and are being rolled out in different parts of the globe. Each of these vaccines have different storage requirements in terms of the temperatures required to ensure they remain viable. The reason for this is due to the components of each vaccine and how they have been structured biologically.

BNT162b2 (Pfizer and BioNTech): This vaccine needs to be shipped and stored at temperatures between -60 to -80°C. It can be stored for up to five days in normal refrigerator conditions (2-8°C) before use and has a shelf life of up to six months under the right storage conditions.

mRNA-1273 (Moderna): This vaccine has easier conditions to meet than the Pfizer and BioNTech vaccine as it only needs to be shipped and stored
at temperatures between -15 to -25°C, the average temperature of a freezer. It can also be stored in refrigerator conditions for up to 30 days and also has a shelf life of six months.

AZD1222 (AstraZeneca and Oxford): The vaccine created by AstraZeneca and Oxford has the easiest conditions in terms of storage as it can be stored and shipped at temperatures between 2-8°C, the average temperature of a refrigerator. It can also be stored at these temperatures for up to six months without use.

CoronaVac (Sinovac): This vaccine uses an inactivated vaccine approach and as such, can be stored at refrigerator temperatures (between 2-8°C) for extended periods of time.

Sputnik V (Gamaleya): Using a viral vector approach, the viral vector vaccine can be stored at refrigerator temperatures when in dry mass form, and at temperatures of around -18.5°C in liquid form.

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