{"id":330,"date":"2020-11-11T15:17:54","date_gmt":"2020-11-11T13:17:54","guid":{"rendered":"https:\/\/blogs.hanken.fi\/humlog\/?p=330"},"modified":"2023-12-08T18:41:59","modified_gmt":"2023-12-08T16:41:59","slug":"temperature-control-matters-fact-sheet-to-prepare-for-covid-19-vaccination-programmes","status":"publish","type":"post","link":"https:\/\/blogs.hanken.fi\/humlog\/2020\/11\/11\/temperature-control-matters-fact-sheet-to-prepare-for-covid-19-vaccination-programmes\/","title":{"rendered":"Temperature control matters!      Fact sheet to prepare for COVID-19 vaccination programmes"},"content":{"rendered":"\n<p class=\"wp-block-paragraph\"><strong>(by the team of the HUMLOG Institute: Ioanna\nFalagara Sigala, Gy\u00f6ngyi Kov\u00e1cs, Amin Maghsoudi, Wojciech Piotrowicz, Isabell\nStorsj\u00f6, Diego Vega)<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><em>As various COVID-19\nvaccines are in the making, there is a lot we can do to prepare for their\nhandling including necessary cold chain and ultra-cold chain solutions. Here is\na fact sheet with reminders and recommendations. <\/em><\/p>\n\n\n\n<p class=\"wp-block-paragraph\">General issues with\ntemperature control: <\/p>\n\n\n\n<ul class=\"wp-block-list\"><li>Control temperature\n<strong><em>range<\/em><\/strong>, <\/li><li>Control <strong><em>exposure<\/em><\/strong>:\ndeviation from range, time period of exposure<\/li><\/ul>\n\n\n\n<p class=\"wp-block-paragraph\">Typical issues with\nvaccines:<\/p>\n\n\n\n<ul class=\"wp-block-list\"><li>Each\nvaccine comes with their own temperature control requirements<ul><li>e.g.\nVaccines with live components: cannot freeze (kills the live component) <\/li><\/ul><ul><li>Very\nspecial: <strong><em>Ultra-cold chain<\/em> <\/strong>(minus 70-80 degrees C)ones,\ne.g. ebola vaccine<\/li><\/ul><\/li><li>NB!\nPfizer\u2019s potential vaccine needs an ultra-cold chain, but other COVID-19\nvaccines in the making need different temperature ranges.<\/li><\/ul>\n\n\n\n<p class=\"wp-block-paragraph\">Typical issues with\ntemperature control supply chains:<\/p>\n\n\n\n<ul class=\"wp-block-list\"><li>Sticky\npoints aka where temperature control usually breaks down: <ul><li>Materials\nhandling (offloading, cross-docking, intermodal transportation, customs\nclearance)<\/li><\/ul><ul><li>At the\nuser\u2019s end: health care centres without stable electricity, patients (if they\ncan buy a vaccine themselves)<\/li><\/ul><\/li><li>Needs dedicated\nhandling spaces (warehouses, cross-docking spaces, special units at customs)\nand equipment that works with the required temperatures<\/li><li>Needs\nspecial transportation, e.g. reefer containers (the ultra-cold chain a\ncombination of special packaging + special reefer containers). Some of\ncontainers need electric connection during transport and storage.<\/li><li>Vaccines\nneed special medical clearance for materials handling! (i.e. staff that has the\nrequired certifications in warehouses, transportation etc.)<\/li><li>Don\u2019t\nforget about the <strong><em>kits<\/em><\/strong>! (e.g. syringes, gloves, test swabs, lab\nequipment etc.) to go with the items. Note, they may need different\ntemperatures than the vaccine itself!<\/li><li>Packaging\nsizes matter in light of how long you can open a package<ul><li>Peri-urban\/rural\ndistribution<\/li><\/ul><ul><li>Avoiding\ntoo many people coming to a vaccination centre \u2013 disease control!<\/li><\/ul><\/li><\/ul>\n\n\n\n<p class=\"wp-block-paragraph\">Administering\nvaccination programmes<\/p>\n\n\n\n<ul class=\"wp-block-list\"><li>Ideally\nnot overloading the same health care centres<\/li><li>Segregation\nof patients (sick) from those to be vaccinated<\/li><li>Train\n(more) people to administer vaccines \u2013 separate capacity from testing stations\nwill be needed <\/li><\/ul>\n\n\n\n<p class=\"wp-block-paragraph\">Industry initiatives\nfor handling temperature control:<\/p>\n\n\n\n<ul class=\"wp-block-list\"><li>GDP \u2013 good\ndistribution practice, esp. in pharma<\/li><li>CEIV \u2013\nIATA\u2019s pharma distribution practices for freight forwarders (not just airlines)<\/li><\/ul>\n\n\n\n<p class=\"wp-block-paragraph\">Current initiatives\nfor potential COVID-19 vaccines:<\/p>\n\n\n\n<ul class=\"wp-block-list\"><li>UNICEF\nCovax: pre-procurement of items for the kits (e.g. syringes), stocking up<\/li><li>Logistics\nservice providers developing more temperature control warehouses around the\nworld<\/li><li>Pfizer\ndeveloping their own cold chain packages<\/li><\/ul>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Recommendations<\/strong>, aka what different organisations and\ncountries can do to prepare for it now:<\/p>\n\n\n\n<ul class=\"wp-block-list\"><li>Increase\ncold chain, and ultra-cold chain capacity in warehouses and transportation<ul><li>Actual\nspaces and equipment (warehouses, refrigerated containers, vans, trucks,\nrailway carts)<\/li><\/ul><ul><li>Cold chain\ntraining across whole supply chain (warehouse operators, drivers, medics)<\/li><\/ul><ul><li>Certifications\n(GDP, CEIV, medical materials handling requirements)<\/li><\/ul><ul><li>Production\nchangeover in transportation: re-equipping existent aircrafts, containers,\nvehicles for the ultra-cold chain<\/li><\/ul><ul><li>Production\nchangeover in warehousing, e.g. setting up freezer farms near airports and\nother hubs<\/li><\/ul><ul><li>Some\nsolutions exist already in the food and pharmaceutical sectors<\/li><\/ul><\/li><li>Be part of\nvaccine procurement initiatives \u2013 e.g. the EU has one for all EU countries\ntogether, and has signed agreements with several potential providers<ul><li>Joint\nprocurement may give better purchasing power, but this is a sole supplier\nsituation, after all<\/li><\/ul><ul><li>Prepare tenders\nand advanced purchase agreements either individual or jointly with other\norganizations <\/li><\/ul><ul><li>Remember\nequity in health<\/li><\/ul><\/li><li>Start off\ngetting the rest of the kit together! Vaccine distribution will require all the\nrest of it, from materials to set up vaccination centres, to actual testing and\nvaccination kits<ul><li>Potential\nreuse\/adaptation from the Ebola vaccination campaign in challenging contexts<\/li><\/ul><ul><li>Benchmark\/best\npractice from INGOS continuously involved in EVD (e.g. MSF, IFRC, ICRC, UNICEF)<\/li><\/ul><ul><li>Develop\ncontainers for smaller quantities (the current Pfizer solution may not be\napplicable for smaller populations)<\/li><\/ul><ul><li>Check\nexisting inter-agency health kits for vaccination kits. Add also dry ice for\nfurther cooling.<\/li><\/ul><\/li><li>Start\nprocuring logistics services and work with logistics service providers to\nensure they have the right equipment and capabilities<ul><li>Set up\ntracking and tracing through the supply chain, to assure correct procedures are\nfollowed. Special cold chain tracking devices exist on the market already.<\/li><\/ul><ul><li>Design\nsecurity around the chain, to control and protect the flow.<\/li><\/ul><\/li><li>Develop\nvaccine distribution plans<ul><li>Identify\nplaces (health care centres, schools, voting stations or other, depending on\nthe current burden in existing health care centres) with good coverage of the\npopulation. Know your coverage!<\/li><\/ul><ul><li>Identify\ngroups that need to be vaccinated as first (such as those who will administer\nvaccines later), and define criteria to select locations that will be\nvaccinates as first (number of cases, density of population)<\/li><\/ul><ul><li>Contact and\nmake agreements with transportation and logistics service providers for the\nlast mile distribution<\/li><\/ul><ul><li>Collaborate\nwith other organizations or countries for the transportation of the vaccine<\/li><\/ul><ul><li>Identify\nwhich organisations or sectors within the country could support a vaccination\nprogramme, in case if medical system is overwhelmed with COVID19 cases, and\nidentify their needs for training. (Possible organisations include medical humanitarian\norganisations, the Red Cross movement, in some cases even defence forces.)<\/li><\/ul><ul><li>Train\npeople in advance, both in medical logistics, vaccine handling, and for\nmanaging vaccination centres<\/li><\/ul><ul><li>Set up\ncommunication channels, how people will be informed when and where vaccination\nwill take place<\/li><\/ul><ul><li>Set up\ntracking system to identify who already got the vaccine, this is critical when\nmore than single doze is needed<\/li><\/ul><ul><li>Assure\nthat all labelling on packages, instructions and guidelines are in all required\nlanguages<\/li><\/ul><ul><li>Identify\nand review relevant country laws and regulations, to assure that mass\nvaccination programme is in line with them<\/li><\/ul><ul><li>Analyse\nrisks and create response plans, in case of electricity supply cuts, accidents,\nmissing resources<\/li><\/ul><ul><li>Create\nwaste (and re-use) plans for used boxes, gloves, needles and other equipment<\/li><\/ul><ul><li>Before\ngoing life within the programme run simulation, and exercises to check if plan\nis realistic<\/li><\/ul><\/li><\/ul>\n\n\n\n<p class=\"wp-block-paragraph\"> There is a lot more with regards to ethical considerations, trust-building, and even the prioritisation of vaccine recipients etc. Thus, as a final note, please remember that this list focuses on cold chain, and ultra-cold chain capacities and capabilities. Let\u2019s leave the rest to the epidemiologists.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>References<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Comes, T., Bergtora\nSandvik, K. and Van de Walle, B. (2018), &#8220;Cold chains, interrupted: The\nuse of technology and information for decisions that keep humanitarian vaccines\ncool&#8221;, <em>Journal of Humanitarian Logistics and Supply Chain Management<\/em>,\nVol. 8 No. 1, pp. 49-69. <a href=\"https:\/\/doi.org\/10.1108\/JHLSCM-03-2017-0006\">https:\/\/doi.org\/10.1108\/JHLSCM-03-2017-0006<\/a><\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Jusu, M.O., Glauser, G.,\nSeward, J.F., Bawoh, M., Tempel, J., Friend, M., Littlefield, D., Lahai, M.,\nJalloh, H.M., Sesay, A.B. and Caulker, A.F., 2018. Rapid Establishment of a\nCold Chain Capacity of\u201360 C or Colder for the STRIVE Ebola Vaccine Trial During\nthe Ebola Outbreak in Sierra Leone. <em>The Journal of infectious diseases<\/em>, <em>217<\/em>(suppl_1),\npp.S48-S55, at <a href=\"https:\/\/doi.org\/10.1093\/infdis\/jix336\">https:\/\/doi.org\/10.1093\/infdis\/jix336<\/a><\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Kachali, H., Storsj\u00f6, I.,\nHaavisto, I. and Kov\u00e1cs, G., 2018. Inter-sectoral preparedness and mitigation\nfor networked risks and cascading effects. International journal of disaster\nrisk reduction, 30, pp.281-291, at <a href=\"https:\/\/doi.org\/10.1016\/j.ijdrr.2018.01.029\">https:\/\/doi.org\/10.1016\/j.ijdrr.2018.01.029<\/a> <\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Vaillancourt, A., 2016.\nKit management in humanitarian supply chains. <em>International Journal of Disaster\nRisk Reduction<\/em>, <em>18<\/em>, pp.64-71, at <a href=\"https:\/\/doi.org\/10.1016\/j.ijdrr.2016.06.002\">https:\/\/doi.org\/10.1016\/j.ijdrr.2016.06.002<\/a><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Other important links<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\">CEIV Pharma: <a href=\"https:\/\/www.iata.org\/en\/programs\/cargo\/pharma\/ceiv-pharma\/\">https:\/\/www.iata.org\/en\/programs\/cargo\/pharma\/ceiv-pharma\/<\/a> <\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Covid-19 WSJ: <a href=\"https:\/\/eur02.safelinks.protection.outlook.com\/?url=https%3A%2F%2Fwww.wsj.com%2Farticles%2Fcovid-19-vaccine-rollout-calls-for-supply-chain-collaboration-logistics-chief-says-11603713612&amp;data=04%7C01%7Camin.maghsoudi%40hanken.fi%7C0db6f9d9ec624d047b5b08d8863f3baa%7C6f304f3d06b9443c802a0606f683d043%7C0%7C1%7C637406953428083387%7CUnknown%7CTWFpbGZsb3d8eyJWIjoiMC4wLjAwMDAiLCJQIjoiV2luMzIiLCJBTiI6Ik1haWwiLCJXVCI6Mn0%3D%7C2000&amp;sdata=vVETa%2BA0%2F9Rasc0GI4qLm893ucjvSzjf8V21V3laldg%3D&amp;reserved=0\">https:\/\/www.wsj.com\/articles\/covid-19-vaccine-rollout-calls-for-supply-chain-collaboration-logistics-chief-says-11603713612<\/a><\/p>\n\n\n\n<p class=\"wp-block-paragraph\">European Commission \u2013 Covid-19: <a href=\"https:\/\/ec.europa.eu\/commission\/presscorner\/detail\/en\/ip_20_1903\">https:\/\/ec.europa.eu\/commission\/presscorner\/detail\/en\/ip_20_1903<\/a><\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Fact sheet on the Ebola ultra-cold chain: https:\/\/www.who.int\/features\/2015\/guinea-ebola-vaccine\/en\/ &#8211; the same\nhas been used later in DRC according to WHO logistics<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Finnish news on the matter of Pfizer\u2019s vaccine: <a href=\"https:\/\/yle.fi\/uutiset\/3-11641577\">https:\/\/yle.fi\/uutiset\/3-11641577<\/a><\/p>\n\n\n\n<p class=\"wp-block-paragraph\">ICRC Podcast on lessons from Ebola: <a href=\"https:\/\/intercrossblog.icrc.org\/intercross-icrc-podcast-episodes\/episode-1104-covid-conflict-ebola-drc#sthash.5ZUlD3d1.dpbs=\">https:\/\/intercrossblog.icrc.org\/intercross-icrc-podcast-episodes\/episode-1104-covid-conflict-ebola-drc#sthash.5ZUlD3d1.dpbs=<\/a><\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Inter-agency health kits: <a href=\"https:\/\/www.who.int\/emergencies\/emergency-health-kits\">https:\/\/www.who.int\/emergencies\/emergency-health-kits<\/a> <\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Interim Framework for\nCOVID-19 Vaccine Allocation and Distribution in the United States: <a href=\"https:\/\/www.centerforhealthsecurity.org\/our-work\/pubs_archive\/pubs-pdfs\/2020\/200819-vaccine-allocation.pdf\">https:\/\/www.centerforhealthsecurity.org\/our-work\/pubs_archive\/pubs-pdfs\/2020\/200819-vaccine-allocation.pdf<\/a><\/p>\n\n\n\n<p class=\"wp-block-paragraph\">MSF Ebola response: <a href=\"https:\/\/www.msf.org\/ebola\">https:\/\/www.msf.org\/ebola<\/a><\/p>\n\n\n\n<p class=\"wp-block-paragraph\">UNICEF Ebola response: <a href=\"https:\/\/www.unicef.org\/emergencies\/ebola\">https:\/\/www.unicef.org\/emergencies\/ebola<\/a><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Further info<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\">HERoS project, see <a href=\"http:\/\/www.heros-project.eu\">www.heros-project.eu<\/a><\/p>\n\n\n\n<p class=\"wp-block-paragraph\">HUMLOG Institute, see <a href=\"http:\/\/www.hanken.fi\/humloginstitute\">www.hanken.fi\/humloginstitute<\/a> <\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Downloadable graphic of the fact sheet: <\/p>\n\n\n\n<div class=\"wp-block-file\"><a href=\"https:\/\/blogs.hanken.fi\/humlog\/wp-content\/uploads\/sites\/6\/2020\/12\/factsheet_covid-19_A4_final_update.pdf\">Covid-19 Fact Sheet<\/a><a href=\"https:\/\/blogs.hanken.fi\/humlog\/wp-content\/uploads\/sites\/6\/2020\/12\/factsheet_covid-19_A4_final_update.pdf\" class=\"fusion-button-default fusion-button-default-size wp-block-file__button\" download>Download<\/a><\/div>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Contact us with any\nquestions! <\/strong>&nbsp;<\/p>\n\n\n\n<ul class=\"wp-block-list\"><li>Wojciech Piotrowicz, Director of the HUMLOG Institute, <a href=\"mailto:wojciech.piotrowicz@hanken.fi\">wojciech.piotrowicz@hanken.fi<\/a>, +358 50 430 8715 (English)<\/li><li>Gy\u00f6ngyi Kov\u00e1cs, Erkko Professor in Humanitarian Logistics, HERoS project leader, <a href=\"mailto:gyongyi.kovacs@hanken.fi\">gyongyi.kovacs@hanken.fi<\/a>, +358 40 3521 241 (English, Swedish, Finnish)<\/li><\/ul>\n\n\n\n<figure class=\"wp-block-image\"><img decoding=\"async\" width=\"725\" height=\"482\" src=\"https:\/\/blogs.hanken.fi\/humlog\/wp-content\/uploads\/sites\/6\/2020\/11\/GettyImages-136890236-1.jpg\" alt=\"\" class=\"wp-image-334\" srcset=\"https:\/\/blogs.hanken.fi\/humlog\/wp-content\/uploads\/sites\/6\/2020\/11\/GettyImages-136890236-1-300x199.jpg 300w, https:\/\/blogs.hanken.fi\/humlog\/wp-content\/uploads\/sites\/6\/2020\/11\/GettyImages-136890236-1.jpg 725w\" sizes=\"(max-width: 725px) 100vw, 725px\" \/><\/figure>\n","protected":false},"excerpt":{"rendered":"<p>(by the team of the HUMLOG Institute: Ioanna Falagara Sigala, Gy\u00f6ngyi Kov\u00e1cs, Amin Maghsoudi, Wojciech Piotrowicz, Isabell Storsj\u00f6, Diego Vega) As various COVID-19 vaccines are in the making, there is <a href=\"https:\/\/blogs.hanken.fi\/humlog\/2020\/11\/11\/temperature-control-matters-fact-sheet-to-prepare-for-covid-19-vaccination-programmes\/\"> [&#8230;]<\/a><\/p>\n","protected":false},"author":13,"featured_media":333,"comment_status":"closed","ping_status":"open","sticky":true,"template":"","format":"standard","meta":{"footnotes":""},"categories":[42,43],"tags":[],"class_list":["post-330","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-practitioners","category-projects"],"_links":{"self":[{"href":"https:\/\/blogs.hanken.fi\/humlog\/wp-json\/wp\/v2\/posts\/330","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/blogs.hanken.fi\/humlog\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/blogs.hanken.fi\/humlog\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/blogs.hanken.fi\/humlog\/wp-json\/wp\/v2\/users\/13"}],"replies":[{"embeddable":true,"href":"https:\/\/blogs.hanken.fi\/humlog\/wp-json\/wp\/v2\/comments?post=330"}],"version-history":[{"count":6,"href":"https:\/\/blogs.hanken.fi\/humlog\/wp-json\/wp\/v2\/posts\/330\/revisions"}],"predecessor-version":[{"id":668,"href":"https:\/\/blogs.hanken.fi\/humlog\/wp-json\/wp\/v2\/posts\/330\/revisions\/668"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/blogs.hanken.fi\/humlog\/wp-json\/wp\/v2\/media\/333"}],"wp:attachment":[{"href":"https:\/\/blogs.hanken.fi\/humlog\/wp-json\/wp\/v2\/media?parent=330"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/blogs.hanken.fi\/humlog\/wp-json\/wp\/v2\/categories?post=330"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/blogs.hanken.fi\/humlog\/wp-json\/wp\/v2\/tags?post=330"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}