Chilling side of vaccines

Long walks to get children vaccinated call for reliable energy and cooling for rural health centres, JAMES CHAVULA writes.

In 2018, women near Kasungu National Park walked over 30 kilometres (km) to boost babies’ immunity to deadly measles, polio and other diseases prevented by vaccines. However, the Ministry of Health wants everyone not to travel over 5km to get healthcare services they need, but lack of electricity at Kamboni Health Centre nearby was to blame.

Escom has since expanded the grid to the health facility under the Malawi Rural Electrification Programme (Marep), but it still stores perishable vaccines in a gas fridge.

“Since April, we have been using gas and a standby generator,” says Dickson Kachingwe, one of 14 health surveillance assistants at Kamboni. “Previously, we had no steady gas supply and fuel was costly. Every time we ran out of gas, we quickly carried the vaccines on a motorcycle to Kabamba, almost 50km away.”

Staff desperately evacuated the vaccines because the shots do not come cheap.

“Most vaccines are donor funded, so every dose counts,” Kachingwe says.

Nthunduwala residents hope Marep will permanently close energy gaps at the health facility where babies are born in yellowish glows of torches usually seen in rural localities where 84 percent of the country’s population lives.

“Women expecting to give birth at the health centre are required to bring a torch. Candles are banned to avoid fire accidents,” says Evelyn Phiri.

But Eliza Banda, who gave birth to two babies in these conditions, is worried about the safety of vaccines.

“We need reliable electricity. Without refrigeration, vaccines perish before their expiry date,” says Banda, who leads a mothers’ care group going door-to-door to ensure every child gets all six vaccines.

Energy for cooling is essential for Sustainable Development Goal three: Ending communicable diseases by 2030 and delivering safe, effective and affordable medical products for all, including vaccines.

In September, the United Nations Sustainable Energy for All (SEforAll) reported that lack of access to cooling compromises the public health and safe medicine for 365 million people in poor rural settings.

It reads:  “The rural poor lack access to electricity and are likely to live in extreme poverty….Medical cold chains may also not be intact, putting lives at risk from spoiled vaccines.”

Last year, Malawi Health Equity Network (Mhen) tracked the safety of vaccines that require cold storage powered by reliable electricity that was not often available. The assessment sponsored by the Gavi, the global vaccine alliance which finances the country’s immunisation programmes, revealed the potential loss of vaccines worth nearly K9.5 billion due to prolonged blackouts.

Ironically, the blackouts spanned 12 hours at the National Vaccine Store (NVS) in Area 3, Lilongwe, near Mtunthama presidential palace, which enjoyed uninterrupted electricity supply. As light bulbs were chasing shadows from the vacant State House, massive generators powering the national and the Central Region vaccine cold rooms were burning nearly 2.7 litres an hour—costing almost K9 million a year against a K1 million-budget for the purpose.

Says Davie Mwanchumu, who took part in the review: “The country requires dramatic changes in power supply for both national and district vaccine storage facilities. They should be connected to reliable power supply lines, starting with the national stores close to the presidential palace which experiences no blackout.

“Government seems to prioritises symbols of power not the wellbeing of over 566 000 children who were at risk of contracting preventable illnesses due to the potential stock-outs of potent vaccines.”

Temwa Mzengeza, head of the National Expanded Programme on Immunisation, says shorter and infrequent blackouts have greatly reduced reliance on diesel-powered generators and the NVS power supply line “has been taken as one of priority lines”.

“It’s a requirement for effective vaccine management that at no point the NVS should have no power to keep the cold rooms cold. Since blackouts could go between six and 11 hours, consumption of diesel fuel greatly increased,” he says, thanking World Health Organisation (WHO) and US-funded Organised Network of Service for Everyone (Onse) for fuelling the generators “such that no single dose of vaccine was wasted due to the power outages at the NVS”.

But the sensitive labels of vaccines which change colour with continual exposure to high temperatures reacted to the blackouts, forcing them to hastily “move the [five-in-one] vaccines to districts and then to health facilities to be used first”.

As blackouts continue, there is need for reliable energy throughout the process of taking vaccines closer to those in need—even the rural poor surrounding health centres excluded from the power grid benefitting just 12 percent of the population. n

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