Solar-Driven Vaccine Cold Chains For Remote Areas of Kenya and Nigeria
Solar Direct Drives in Nigeria and the Vaccibox in Kenya – both solar powered vaccine refrigerators – ensure safe immunization for children in remote, off-grid areas by preventing vaccine spoilage.
By Treezer Michelle Atieno
Routine Immunisation Challenges in Remote Areas
Muhammad Bashir, a routine immunisation service provider in Kumbotso Local Government Area, arrives at the Kumbotso Primary Health Care facility in Kano, Nigeria, at exactly 7 a.m. to pick up vaccines from the cold store using his motorcycle.
It is Friday, October 25, 2024, and today is a field vaccination day; he plans to visit the Fulani settlement in Kumbotso. Bashir must hurry because today is also a prayer day for Muslims, meaning that routine immunisation (RI) activities should conclude by midday.
Ali Umar Idris, the cold chain officer in charge of the Kumbotso Primary Health Care (PHC) cold store, releases the required vaccines from one of the Solar-Direct Drive Refrigerators, confirms their potency with Bashir, and hands them over in a vaccine cooler with several ice packs to maintain the proper temperature.
Bashir’s journey starts smoothly on a paved road, but the ease is short-lived. After ten minutes, the road gives way to rough, uneven terrain, turning the next half hour into a bumpy, dusty ride.
The landscape shifts to more rugged terrain, with dry bushes lining the road. As Bashir perseveres through the final stretch, the Fulani settlement of Batakaye appears in the distance. He parks his motorcycle and approaches Isa Muhammad, the head of the community, to seek permission to vaccinate the children. Today, his mission is to administer the polio and measles vaccines.
Bashir explains that RI involves vaccinating children under five against preventable diseases such as diphtheria, hepatitis, and measles. In Nigeria, the government has designated two to three days each week for this effort.
“Some facilities vaccinate on a daily basis, and there are also outreach services, which deliver vaccines directly to households and track missed children during RI, like what I am doing today,” says Bashir.
He adds that since the Batakaye settlement is about four kilometres from the nearest hospital and is located in a remote area without electricity, there have been challenges in maintaining the vaccine cold chain before Kumbotso PHC received the Solar-Direct Drive Refrigerators (SDDs) from the United Nations Children’s Fund (UNICEF) in 2021.
Maintaining the Vaccine Cold Chain using Solar Direct Drive Refrigerators in Nigeria
All vaccines in the RI programs must be administered while potent, capable of providing protection against diseases. This is only possible if the cold chain is maintained.
According to Dr. Ado Muhammad, the Global Director of the D-8 Health and Social Protection Programme in Nigeria, vaccine potency is monitored through four stages. Stages one and two indicate that the vaccines are still suitable for use, while stages three and four signify that they are spoiled, indicating a break in the cold chain. This monitoring is crucial to ensure that vaccines remain effective when administered.
UNICEF emphasises the importance of maintaining a high-quality cold chain to ensure that vaccines remain potent and effective in protecting against diseases. Vaccines must be stored within the temperature range of 2°C to 8°C, from the time they are manufactured until they are administered. Deviating from this range can permanently reduce the potency of the vaccines.
In response to this need, UNICEF has invested over $56 million in providing solar-powered vaccine cold-chain systems in Nigeria. This investment covers the cost of solar-powered refrigerators across all 37 states of Nigeria, according to Paschal Protus Bwile, a member of the UNICEF health team in Nigeria.
Currently, there is at least one solar direct driven refrigerator per ward in approximately 9,750 primary health centres (PHCs) in Nigeria.
“The Solar Direct Drive refrigerators use solar energy to freeze water or cold storage material, which keeps the vaccines cool even during the night and on cloudy days.” explains Paschal.
In Kumbotso, the solar -powered refrigerators have proven invaluable for preserving vaccines and ensuring that routine immunisation is uninterrupted.
According to Bwile, the solar-driven refrigerators have increased effectiveness by offering user-independent freeze-free protection technologies and demonstrated performance at higher ambient temperatures.
This has improved the management and optimization of vaccine delivery, storage, and the safeguarding of vaccine potency in the immunisation supply chain systems.
Ali Umar Idris, the Cold Chain Officer at Kumbotso PHC, emphasises that the solar direct drive refrigerators have automatic monitors that record their performance and help maintain daily cold chain records. They also produce ice packs from these refrigerators, which are then used to keep vaccines cool inside carriers when transporting them to Fulani villages.
Vaccibox, a Portable Solar-Powered Vaccine Refrigerator in Kenya
Similar innovations have made a difference in Kenya as well. In Ngatu village, Kajiado County, Jeremiah Mutungwa, a community health volunteer attached to Ngatu CDF Dispensary, has been using Vaccibox, a portable solar-powered refrigerator since 2023 for field vaccinations among the Maasai community.
“We initially had a challenge getting vaccines to the children here in Ngatu in a potent state. The ice packs in the vaccine coolers would melt quickly due to the heat, and Ngatu is very hot. But after we received the VacciBox, I can now go around and announce field vaccination dates, then deliver the vaccines to these children as planned.” says Jeremiah.
The Vaccibox helps maintain appropriate vaccine temperatures at Ngatu CDF Dispensary, which is approximately 80 kilometres from Kajiado town and suffers from an unreliable electricity supply.
According to Janet Ogege, a registered nurse in charge of Ngatu CDF Dispensary, the electric power supply at the dispensary was cut over two years ago. As a result, they had to obtain vaccines from Mashuuru Health Centre, which is over seven kilometres away using a motorcycle.
“This was a huge challenge for us because most of the time, the vaccines would spoil before arrival, and there were no regular RI services available at the dispensary. The Vaccibox has really helped with preserving vaccines, and now RI services are accessible to any child at the hospital. We also visit schools for HPV vaccination rounds from time to time. On market days, women take advantage of the opportunity to bring their children in large numbers for vaccinations.” says Janet.
While the Vaccibox can carry up to 3,000 vaccines, Janet reports that she keeps about 600 each month due to low vaccine uptake among the Maasai, influenced by various factors like limited awareness of disease severity and vaccine hesitancy fueled by safety concerns. However, this additional space allows her to assist other health facilities, like Imaroro Dispensary, in preserving their vaccines whenever they experience power cuts.
Janet further states that the Vaccibox can operate for up to 36 hours on a fully charged battery before requiring a connection to a solar panel. Additionally, it can be plugged into grid or AC power, allowing for continuous operation.
The unit automatically monitors and controls its temperature without user intervention, ensuring that the recommended temperature range is consistently maintained and preventing accidental missettings by the user.
The Impact
From the RI records, the number of vaccinations at Ngatu Dispensary in Kajiado, Kenya, has increased to range between 90 to even 200 children in a month, up from the previous 50 to 60 children before the facility started using the Vaccibox.
Petronila Sintoyan, a mother of a four-month-old from Ngatu village, confirms that the availability of the Vaccibox at the dispensary has made accessing vaccines much easier.
“Before Ngatu Dispensary received the Vaccibox, we faced challenges because we had to travel long distances for vaccinations, which was costly for some mothers. Sometimes, the vaccines are brought to our homes, making it more convenient for us. Visiting the hospital can be difficult, especially due to the long walk and heat, and sometimes we don’t have umbrellas to shield our babies from the sun.”
In Nigeria, Isa Muhammad, the head of the Fulani Community in Kumbotso, explains how SDDs have improved vaccine access in the region.
“Previously, we didn’t have vaccines, and we weren’t getting vaccinated, resulting in many illnesses like measles and meningitis. But since the introduction of field vaccinations for our people, the number of these illnesses has significantly decreased. Now, there are only a few cases. Everything has become easier,” he says.
Bashir, however, emphasises that the Fulani community would benefit more from having a hospital nearby than just receiving vaccines. This is because there is a significant need for other healthcare services in the community. He believes that improving overall healthcare access will lead to increased acceptance of vaccines among the Fulani people.
The Need for Expansion of these Solutions and the Existing Plan
Janet confirms that women from as far as Imaroro, Olgera, and Olenarau often have to travel to Ngatu for vaccinations because their local centres lack a Vaccibox. With unreliable electricity in those areas, she suggests that these health facilities also procure the Vaccibox to improve access to RI services.
In a document submitted to the Massachusetts Institute of Technology’s Solve initiative by the Vaccibox team, led by Norah Magero, there are plans to rollout this solution to more health centers across East Africa and beyond, with enough funding.
The goal is to provide immunization access for 20,000 children and evaluate the fridge’s performance in rural, off-grid areas within the next year. Furthermore, the plan includes equipping 1,500 rural hospitals with Vaccibox units over the next five years, ultimately reaching up to 1 million children. To support this initiative, a local manufacturing plant needs to be established, increasing production capacity and ensuring that vaccines are safely stored and effectively tracked in remote locations.
In a previous interview early this year, Dr. Muyi Aina, Executive Director of the National Primary Health Care Development Agency (NPHCDA), emphasized the urgent need for substantial cold storage to meet Nigeria’s growing vaccine demand. To address this challenge, Nigeria has equipped national, zonal, and state stores with Ultra Cold Chain (UCC) equipment and Solar Direct Drive (SDD) refrigerators at local health facilities. As part of its ongoing cold chain expansion, the government has launched the ‘Three-Hub Project,’ aimed at upgrading storage facilities in Abuja, Kano, and Lagos by 2025.
This article was written as part of the OWM’s Health Solutions Programme, alongside the short documentary The Bodaboda Remedy, produced by Ade Oyeyipo & Treezer Michelle Atieno. See project details here.