Opinionista Ian Lester 26 June 2020

Once we have a Covid-19 vaccine, our challenge lies in getting it safely into rural Africa

If the cold chain is broken at any point along the vaccine’s journey to the end-user, there is a risk that the vaccine can be rendered entirely useless. This could be due to something as common as accidental freezing in an overstocked clinic fridge.

In President Cyril Ramaphosa’s 17 June 2020 address, he stated that “the task of dealing with the coronavirus pandemic is like running a marathon race and not a sprint, and we have therefore had to shape our response according to that reality”. This response began most distinctively with South Africa’s hard lockdown in March when most of the economy – including existing immunisation programmes – was brought to an abrupt halt.

And as the nation absorbs the reality that we will be navigating a long and arduous journey ahead, there is an increasingly urgent focus on a medical breakthrough in the global search for a vaccine. Hearteningly, we have both the skills and opportunity to harness South Africa’s tech innovators right now to ensure that we are well-prepared for a vaccine – and have in place the best systems for its safe and efficient distribution.

But in our quest to vaccinate and protect against Covid-19, we should not lose sight of the fact that the pandemic and the lockdowns applied across the world have disrupted existing immunisation programmes for entirely preventable diseases like measles, polio and mumps.

Last month, the Measles & Rubella Initiative – made up of the American Red Cross, the US Centers for Disease Control, Unicef, the United Nations Foundation and WHO – warned that more than 117 million children globally are at risk of missing their measles vaccines as a result of the Covid-19 surge. So far, 24 countries have delayed their measles immunisation programmes and more are expected to follow. Most of these countries are in Asia, Africa, and South America. Similar concerns have been raised in South Africa specifically.

Recent experience offers an insight into the practical realities of these warnings. In the Democratic Republic of Congo in 2018, the fight against Ebola caused a similar disruption to their general vaccination programme. Tragically this led to the worst measles outbreak ever seen, with a death toll more than double that of Ebola. To avoid a similar outcome, alongside the Covid-19 vaccine, we need to put in place the right infrastructure to fast-track the roll-out of new and old vaccines. A critical component of this process is building effective systems for managing the cold chain.

All vaccines need to be stored at the right temperature. The recommended range for most vaccines is between 2°C and 8°C. A central element of any effective immunisation programme is a functional cold chain management system that can be closely and easily monitored. If the cold chain is broken at any point along the vaccine’s journey to the end user, there is a risk that the vaccine can be rendered entirely useless. This could be due to something as common as accidental freezing in an overstocked clinic fridge.

And when one factors in the myriad other challenges facing public health experts in the developing world, it soon becomes clear that cold chain solutions originating in the first world and premised on reliable transport networks, universal data, and a reliable and stable power supply, will be woefully inadequate. Unlike those of the developed world, public health risk mitigation strategies in Africa have to factor in accepted and daily obstacles that will affect the swift distribution of any vaccine, not just one for Covid-19.

The solution to cold chain complications in Africa’s context isn’t simply the acquisition of imported vaccine-grade refrigerators. Africa faces practical challenges that differ significantly from those of the developed world. With load-shedding making a comeback in Gauteng, we see one example of such a challenge – an unreliable power supply. This is by no means unique to South Africa.

The challenge before us is an enormous one – many lives hang in the balance. But never in the history of the world have we had as many resources available to craft solutions as we do today. When a Covid-19 vaccination is developed, we have the benefit of innovative homegrown tech that already exists to distribute it across the world, and across Africa. 

In other parts of the continent, moving vaccines into key areas is exceptionally difficult. The reasons range from systemic problems like limited transport options or road or rail infrastructure to the more practical realities of rough terrain or tropical heat. These require many more safeguards than an office-based desktop plan might envisage to ensure the practical integrity of the cold chain system in action. 

Encouragingly, African tech solutions are blooming everywhere.

Through the Internet-of-Things (IoT), networks of internet-connected devices can collect and share data without requiring human inputs. This means that frequent travel in difficult terrain or specialist technical skills are unnecessary – leaving immunisation programme specialists and nurses to focus on the essential job at hand in keeping children and communities safer.

And by powering these devices with ultra long-life batteries rather than mains electricity, using SIM cards instead of fibre or fixed-line alternatives, we can overcome unstable power and data connections. Building smart systems with simple solutions means that we can share vital information instantaneously all around the world – critical to the challenge of keeping the cold chain intact when moving and monitoring vaccines around the world.

IoT solutions like remote temperature monitoring and control devices that monitor the cold chain in real time can now provide cheap, effective ways of preserving the efficacy of these life-saving vaccines. These technology-driven hacks are emblematic of the innovative African spirit we will need to apply to virtually any aspect of the Covid-19 pandemic.  

The challenge before us is an enormous one – many lives hang in the balance. But never in the history of the world have we had as many resources available to craft solutions as we do today. When a Covid-19 vaccination is developed, we have the benefit of innovative homegrown tech that already exists to distribute it across the world, and across Africa. 

Let’s make sure we use the time now to put the right systems in place that will deliver it swiftly and safely across Africa. DM

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