On Thursday, the publication “Vaccine” publishes a study that shows the mass vaccination in Africa does not require constant refrigeration in specific cases. To be precise, 155,000 people in Benin got a vaccination against meningitis, with a vaccine kept in temperatures of up to 39°C.

To a layman that may not sound like game-changing news in the fight against preventable diseases. But actually, it may be. “It’s a breakthrough, because it breaks a dogma,” Michel Zafran, the WHO coordinator on the project, told beyondbrics.

“For the past forty years, all health workers had been brainwashed to keep vaccines cold, at temperatures between 2-4°C. After this project, we now know that in some cases we can do away with the cold chain.”

What raises the eyebrows is that the vaccine in question was not altered in any way versus its predecessor, which supposedly did require the cold chain. The only thing that did change, says Patrick Lydon, a health economist at the WHO, was the approval stamp on the vaccine: the “new” vaccine got formal approval from authorities in India, the country in which the product was made by the Serum Institute.

The Meningitis Vaccine Project - a partnership of the Seattle-based NGO PATH and the World Health Organization – points out that the news could affect millions of people in the so-called Meningitis Belt. Indeed, many rural regions in these African emerging markets could often physically not be reached without breaking through the cold chain. As a consequence, millions of people went unvaccinated or untreated against preventable diseases. That could become a thing of the past.

And there is more: while the original vaccination campaign was limited to MenAfrivac, a vaccine against meningitis, “the method has potential for a lot more vaccines,” says Patrick Lydon, a health economist at the WHO. The most interesting vaccines that could come next are Hepatitis B, yellow fever and HPV, for which vaccines exist that are – informally – known not to require the cold chain.

As for the direct economic impact of the new method, “the logistics cost of vaccination campaigns can be cut in half,” says Patrick Lydon. “A lot of the costs associated with logistics are keeping the vaccines in freezers, cold boxes, and ice packs,” he explains. Those complicated – and sometimes unrealistic – methods can now be simplified.

Just for the one vaccine in question, MenAfrivac, $12 million could be saved until 2016 in planned campaigns, Lydon estimates. But once the new vaccination method is adapted by other vaccines and medicines, the savings could run into the hundreds of millions of dollars.

More important, says Lydon, are the indirect cost savings: “All the time you used to spend on putting in place the cold chain, you can now spend on other activities, such as patient care.”

The vaccine for Hepatitis B, for example, needs to be given within 24 hours after a baby’s birth. Given the unpredictability of the time and place of birth, the vaccine is often not administered. That could stop if cold temperature is no longer required for keeping the vaccine.

But there is much work to do. According to Lydon, tasks include:

- convincing companies to relicence and relabel their existing drugs, that are already cold resistant (the easier step, since the drugs already exist).

- convincing companies to start to develop new drugs that are cold chain resistant (the hard step, because it requires investment).

Back to beyondbrics

Further reading:
Benefits of using vaccines out of the cold chain: Delivering Meningitis A vaccine in a controlled temperature chain during the mass immunization campaign in Benin, “Vaccine”, Elsevier, March 14, 2014

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