The Times of India: 25% of vaccines go waste due to lack of cold chain

Dear James

Thanks for responding. Absecnce of ice-lining is an "acquired" defect. Manufacturers supply the ILR with Ice-lining. How it gets removed and who removes it is an enigma by itself. Some of the Cold Chain Handlers / pharmacist in charge / staff nurse in charge / Medical officer have no idea of ice-lining. During the supervisory visit often they expressed that the equipment was handed over to them in that condition as if it is a "congenital error" but they got convinced only after dressing the denuded ILR with icelining. Some of the districts which I do not wish to mention had more than 60% of ILRs without Icelining and were rectified with technical support during the short postings. It is an evergreen finding, even now if we vist any district we may get a few ILRs with this "acquired / congenital defect".

I have attached 2 of the many examples where I could extend my social service.

regards

Holla

Dear Dr. Holla,

Thank you for this post on TechNet. You say"There are Ice-lined refrigerators without Ice lining."

Would it be possible for you to post three additional pieces of information:

• a photo of an ice-lined refrigerator without an ice lining
• mention the name the manufacturer and
• let us know roughly the length of time it has been in service.

This additional information will be very useful.

I am a dedicated follower of your frequent posts…

Thank you.

Dera sir

The ways in which the vaccines get wasted are innumerable.

In the public sector supplied with proper cold chain equipments, maintenance is not satisfactory. There are Ice-lined refrigerators without Ice lining. Presence or absence of ice-lining is not a check point in the supportive supervision checklist. Without ice-lining baskets cannot be placed in the ILR and hence the “T” series and now the Inactivated Polio Vaccine (IPV) can get frozen in the bottom zone of ILR. Freezing of IPV can be seen but shake test is not applicable for IPV.

Private sector is not having the luxury of proper equipment and is not covered by the supportive supervision team unlike in public sector where the programme managers, development partners monitor on a regular basis, provide hands-on training, technical assistance, feedback-feedforward. There is no way to ensure potency of the vaccine while administering as the vaccines in the private sector rarely have VVM. In the last week, a company representative reveled that there is lot of resistance from the manufacturers and the private service providers in supplying / receiving vaccines with VVM. He suggested that demand from the community – both the beneficiaries receiving vaccines and doctors administering vaccines can ensure supply of vaccines with VVM. As of now, availability of IPV with public sector has put a check on administering IPV without VVM and schedule incompatible with that of NIS – especially to the children of elite group. Because of short supply as “teething problem” created a backlog and hence policy makers are requested to issue modified circular / guideline to clear the backlog on receiving the supply.

Practicing “Road Regime” is very common as expressed by the heads of community Medicine departments as done for tuberculosis and malaria. No immunization card from private sector matches with the National Immunization Schedule. Birth dose of monovalent Hepatitis B vaccine was administered on 33^rd day, IPV 2^nd dose – 0.1 ml to be administered intradermally along with 3^rd dose of OPV and pentavalent was administered inadvertently along with 2^nd dose of OPV and pentavalent, that too 0.1ml was pushed either deep subcutaneously or superficial intramuscularly accentuated by not administering bOPV concurrently. Now the vaccinating team is confused whether to consider this dose as effective or to administer 0.1ml intradermally when the baby comes for third dose of OPV and Pentavalent. So on....

I have no idea whether similar problems – some are ethical are there in other countries.

regards

Holla