UN Meeting on Partnerships in the Vaccine Cold Chain

Discussants on the cold chain panel, 4/8/2014Leaders and innovators in global health met yesterday at the United Nations to provide guidance about partnerships as the UN considers the next iteration of the Millennium Development Goals. This particular meeting was a side event, sponsored by the Institute for Strategic Threat Analysis and Response, to the UN Economic and Social Council’s two-day meetings on the role of partnerships.

Much progress has been made on the MDGs as their 2015 target date approaches. These successes, and failures, now must inform the setting of new goals, or, as the UN calls them, the Post-2015 Development Agenda.

Harvey Rubin, MD, PhD, FCPP, convened the meeting through ISTAR, the nonprofit organization he founded that has consultative status to the UN. The first panel discussed an innovative partnership to bridge gaps in the vaccine cold chain.

Many vaccines must be kept cold until the time the recipient takes them. In most of the developed world, this does not present significant problems. In remote areas, however, lack of a reliable energy source to power refrigerators can result in vaccine spoilage and may compromise access to vaccines.

Dr. Rubin founded Energize the Chain (EtC) to develop the idea that energy available at mobile telephone base towers could power vaccine refrigerators. Though most mobile health, or mhealth, projects we read about focus on the communications possibilities of the technology (vaccine reminder systems, tele-health, and so on), EtC’s innovative model is to use the infrastructure of telecommunications to improve health. The group recently won a  2014 Global Mobile award from the GSM Association in the category Best Mobile Health Product or Service.

Representatives from EtC spoke about the technical aspects of the project, and one of their partners, mobile telecommunications company Econet Wireless, discussed their contributions. Precious Lunga, PhD, head of Econet Health, said that her company first became involved in health concerns in the 2008 cholera epidemic in Zimbabwe, when their resources proved useful in the response to the crisis. She said they have witnessed the power of mobile phone technology to transform lives and now they want to apply this transformative possibility to broader health concerns.

Lunga noted that 90% of Zimbabwe is covered by the mobile phone network, and her company has an effective technology infrastructure in even the most remote parts of the country. The EtC project installs refrigerators at mobile telephone base station sites, which may be powered by diesel engines, solar energy, or the electrical grid (and in the latter case, a back-up source of power is available to provide continuity of coverage when the grid goes down). These highly energy-efficient refrigerators use less than US $1 a day in excess energy produced at the base stations. These vaccine refrigerators shorten the distance between temperature-stable sites and point of use considerably. Remote sensing technology logs refrigerator data, such as temperature, inventory, how many times the refrigerator has been opened, and so on. Clinics are given mobile phones so they can communicate with the nearby EtC refrigerator. And even with a complete power failure at a base site, the refrigerator can maintain suitably cold temperatures up to seven days, allowing time for technicians to repair the defect or the vaccines to be transported to a safe location.

Econet is currently sponsoring 110 working sites in Zimbabwe and will add 100 more over the coming year in Lesotho and Burundi.

Alice Conant, who directs development for EtC, discussed dimensions of fruitful partnerships as far as EtC is concerned. They look for the ability of their partners to expand pilot projects broadly, and so partners like Econet Wireless, with their wide footprint across not just Zimbabwe but other African countries, are especially valuable.  National ministries of health, local health facilities, and other NGOs are also important partners. The College of Physicians of Philadelphia is one such partner: we have been collaborating with EtC to bring the expertise of the College Fellowship into their projects. Conant will be working to expand the EtC model in India; her work on this effort will be funded by a Fulbright grant.

Anastasia Thatcher, MBA, Global Health Lead for Accenture Development Partnerships, focused on another aspect of the role of the private sector in health projects. Her group provides consulting expertise to EtC as they expand their work beyond pilot projects; they are able to reach out across NGOs, governmental organizations, and private sector companies and use their experience across the sectors to solve health problems in vulnerable populations. Some of their notable projects have involved applying Coca Cola’s successes in delivering cold products in remote areas to vaccine cold chain problems, and delivering vaccination reminders to mothers via mobile technology.

A second panel discussed partnerships in the context of developing much needed medicines for TB, HIV, malaria, and the range of neglected tropical diseases.

Next steps for the group involve producing a white paper from the proceedings in order to inform decision-making for the Post-2015 Development Agenda. Moreover, Dr. Rubin issued a call for developing global governance for health, so that individual organizations can unite their response to global health challenges in a coherent, meaningful way.

Many thanks to Dr. Rubin and Energize the Chain for inviting The College of Physicians of Philadelphia to this meeting.