Thank you for this new post. 

Under New technologies to avoid freezing during outreach John lists two topics:

• Freeze protected carriers and
• Refrigerated portable containers.

Both of these are critically imortttant and I would like to suggest adding one more technology:

• Freeze-safe vaccines.

1. This means working with the vaccine manufacturers to lower the freezing point of their current freeze-sensitive vaccines.  In two articles in 2009 and a third article in 2014 PATH and others demonstrated that DTaP and DTwP vaccines could be reformulated to only freeze at -20 C and below with "... no impact on pH, particle size distribution, or potency of the vaccines prior to freeze-thaw treatment...".  (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4514036/).  One of the earlier article from 2009 can be seen at https://www.ncbi.nlm.nih.gov/pubmed/18973782. 
2. Alternatively, or perhaps in addition, conduct research to alter the formulation of the vaccine so that even when it freezes and thaws the potency and safety are not affected.  

If either of these changes could be implemented think of the impact:

• no more freeze damaged DTP vaccine
• less need to rely on freeze-free boxes and carriers, which are curently rarely available
• less ice-pack conditioning and fewer shake tests
• not the mention all the work being done to locate and eliminate areas inside refrigerators that drop below zero degrees. 

3. A third article on preventing freeze damage to hepatitis B vaccine failed to demonstrate no loss of potency following freezing but they suggested a direction for more work towards freeze-safe HepB vaccine.  The researchers concluded "[the] data provides evidence that protecting a freeze-labile antigen from subzero exposure is insufficient to maintain vaccine potency. Future studies should focus on adjuvant protection.  Might this be a way forward for the future? 

Message to the manufacturers: can we start with freeze-safe DTP vaccine, please while a solution is found for a freeze-safe hepatitis B vaccine?  Then move on to tetanus vaccine...  

• Does anyone have any suggestions for incentives for the manufacturers to work on getting freeze-safe vaccines into use?  I'm all ears.

SurveyMonkey results 160917

Topic 2 : Advancing technologies and techniques of distribution

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Most respondents (n=6 Saturday) agreed that the impact of improvements in technology. and technique on vaccine distribution is high or somewhat high. But only a third of respondents believe that adequate assessment has been made of the impact of scheduled deliveries to replace ad-hoc collection. Only a quarter believe that consumption data are reported and used routinely in forecasting requirements.This gives some idea of the scale of the task ahead to demonstrate and scale up improvements in assessing requirements and achieving regular and sufficient distribution.

Country managers are hardly involved in the process of development of new equipment and they remain poorly informed on the availability of new options, most respondents feel. This impression may be created by the tendency for early development to be shared by very few countries, then new options appearing on the market without intermediate field assessment in greater numbers of countries before scaling up to the global market. The specific example of a hybrid ILR/SDD refrigerator to simplify choice and procurement was popular among respondents but needs more thought and assessment before radical change to simplify procurement.

This reaction reveals the inadequacy of the current, single global PQS committee that is now responsible for new cold chain product profiles. A broader consideration is needed involving country programme management. Please see the attached file for the full results.