Now is the time to build a truly global cold chain

The rapid development of effective vaccines against Covid-19 has been a scientific triumph. Now, the race is on to vaccinate the whole world before new variants of the virus emerge that could prove vaccine resistant.

The challenge of vaccinating the world’s entire population goes way beyond even the mammoth task of manufacturing sufficient doses. The distribution logistics are just as challenging because vaccines require a cold chain: equipment to ensure that they are transported and stored at sub-zero temperatures. Without a cold chain, vaccines quickly break down and cease to be viable.

Just as richer countries have the money to secure all the vaccine doses they need — in fact, several have ordered multiples of the number actually required — so too they have the cold chains in place to support vaccine distribution. Unfortunately, the converse is also true. Poorer countries have neither the means to buy all the doses they need nor an extensive cold chain infrastructure in place.

The resulting imbalances are what COVAX has been set up to counteract, but the scheme has its limits. It is focused on a limited number of countries, and even within those countries, on urban areas. This is a logical first step. For one thing, the virus is most likely to spread where populations are dense. For another, cities and towns are more likely to have mains electricity supplies that can power the refrigerators in which the vaccines are stored.

However, the danger is that an international imbalance will merely be replaced by an intranational one, where urban populations are protected but rural ones miss out on the benefits of vaccination. As the COVAX mantra has it, ‘no one is safe, unless everyone is safe’, so how can a vaccination programme fulfil the WHO’s parallel aspiration to ‘Reach Every District’?

One part of the solution comes in the shape of SDD (Solar Direct Drive) refrigerators. Even a single such refrigerator can store sufficient doses to vaccinate thousands of people. Moreover, relying as they do on unlimited solar power, they bring no adverse side effects to the simultaneous battle we are fighting against climate change.

Ruth Chapman, Managing Director of UK-based company Dulas, points out that the technology is tried and tested. ‘We have been designing, manufacturing and distributing SDD refrigerators for nearly four decades now, helping to meet the ambitions of schemes led by GAVI, UNICEF and others to vaccinate against common childhood illnesses, in remote locations far beyond the reach of mains electricity. We have built relationships with in-country partners to make it feasible to distribute units to even the most remote of villages. As a result, hundreds of thousands of people have been vaccinated against a range of diseases. There is no reason why Covid vaccines cannot be stored in the same way, but it means expanding existing networks and building new ones, doing it quickly, and on a very large scale.

‘In fact, this could be a golden opportunity to create a truly global cold chain for the benefit of all. The global pandemic has brought home to the leaders of the world’s richest countries that vaccinating everybody, everywhere, is not solely a question of ethics. Even the most aid-sceptic politician can see that so long as there are communities anywhere in the world who have not been vaccinated, the threat of a new wave of virus — and all its consequences — will hang over everyone.

‘In the short to medium term, the urgent need is to build the cold chain infrastructure to distribute Covid vaccines. Logically, this has to happen before vaccines can be shipped. Although vaccine production has hit some hurdles, it is expected to peak at the end of this year and into 2022. If the cold chain is not in place, much of this enormous effort could be wasted and vaccination programmes significantly delayed.

‘In the longer term, if a cold chain is established to support the vaccination of everyone against Covid, it could have tremendous long-term benefits. Once in place, much of the equipment will last for years, and in the case of SDD refrigerators, continue to run on free, unlimited and green solar energy. The infrastructure would be in place to enable global vaccinations against multiple killer diseases, including any new pandemic strains which emerge (and scientists are unanimous that they will).’

It will require a huge, multinational effort to create a cold chain that serves the whole world, but the political will necessary to act on a global scale seems to be closer now than it has ever been or may ever be again. The G7 leaders made big commitments to share vaccines with developing countries at the recent Carbis Bay summit, and ‘to strengthen the global health and health security system to be better prepared for future pandemics and to tackle long standing global health threats.’

Ironically, for all the pain and damage it has wrought, we may yet look back on this pandemic as the spur for vaccination becoming everybody’s right. Let’s hope our leaders go down in history for their wisdom, ambition and — above all — action, rather than for missing what could be a unique opportunity.