The first cold chain vaccination storage system

Summary

Witness History: The First Cold Chain Vaccination Storage System

BBC World Service - Released July 26, 2024

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Introduction

In this episode of "Witness History", hosted by Justice Beidou, the BBC World Service delves into a pivotal moment in public health—the establishment of the world's first cold chain vaccination storage system in Ghana in 1974. This groundbreaking initiative not only revolutionized the storage and distribution of vaccines but also laid the foundation for global immunization efforts that have saved millions of lives. Through firsthand accounts and expert insights, the episode illuminates the challenges, triumphs, and lasting impact of this medical milestone.

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Historical Context and the Birth of the Cold Chain System

Justice Beidou sets the stage by transporting listeners back to 1974, highlighting the significance of Ghana as the pioneering nation for the cold chain vaccination storage system.

"Today I'm taking you back to 1974 and the launch of a revolutionary new method for transporting medicines with which paved the way for millions around the world to be vaccinated against previously deadly diseases."
[01:40]

Ghana's selection was influenced by the success of earlier vaccination programs, particularly the battle against smallpox in the 1960s. Dr. Kofi Ahmed, a former Chief Medical Officer in Ghana's Health Ministry, provides invaluable historical insight.

"After the smallpox [campaign], they defined a way of trying to control diseases. They tried to make a program where all these things were coming together."
[05:31]
— Dr. Kofi Ahmed

The Expanded Program on Immunization (EPI) was launched by the World Health Organization (WHO) to combat preventable diseases on a global scale. Ghana's role in hosting the first cold chain trials was a testament to its commitment to public health.

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Personal Narratives: Patience Azuma's Story

Patience Azuma, born in Tema, Ghana, shares her personal connection to the EPI and its profound impact on her life and community.

"I feel great about it that our country was chosen so it was tested in our cold rooms to see how viable or effective the vaccines would last. We really had a great opportunity. The world was all looking at us."
[02:13]

As one of the first beneficiaries of the EPI, Azuma reflects on the stark contrast between her generation and those before her.

"Children are. Their health is much, much better than the days before us because as the years go by, I see that they keep adding more and more vaccines."
[09:22]

Her experiences underscore the life-saving potential of vaccination programs. Azuma also highlights ongoing challenges, such as the delayed introduction of vaccines like hepatitis B in Ghana compared to neighboring countries.

"If it's being done in La Cote d'ivoire, why not in Ghana? Why do we wait before we also start this?"
[09:22]

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Overcoming Challenges: Implementing the Cold Chain in Ghana

Establishing a cold chain system in a tropical country like Ghana posed significant logistical hurdles. Dr. Kofi Ahmed elaborates on the technical and infrastructural challenges faced during the implementation.

"Most vaccines have to be kept under about 4 degrees or below. So in order to move your vaccine to one place, there has to be a cold situation."
[06:22]
— Dr. Kofi Ahmed

The solution involved the integration of various cold equipment—cold rooms, cold stores, fridges, freezers, and cold boxes for transportation. Extending the reach beyond urban centers required innovative approaches, such as using gas stoves and solar-powered fridges in areas without reliable electricity.

"Initially it was kerosene gas and then solar to keep their fridges working."
[07:32]

Despite these challenges, the system's success in Ghana demonstrated its viability and set a precedent for other countries to follow.

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Impact and Legacy of the Cold Chain System

The implementation of the cold chain has had a lasting impact on public health, both in Ghana and globally. Justice Beidou highlights its crucial role during the COVID-19 pandemic.

"Cold chain vaccination storage has transformed the effectiveness of vaccinations in Ghana, across Africa and the wider world."
[07:45]

Ghana’s established infrastructure was instrumental in its ability to be the first country to receive COVID-19 vaccines through COVAX, a global initiative aimed at equitable vaccine distribution.

"Ghana has over the years been engaging in vaccination programs, and because of that, they've been able to build an effective vaccine infrastructure to be able to do this."
[08:13]

This legacy underscores the importance of sustained investment in public health infrastructure and the long-term benefits of pioneering initiatives like the cold chain system.

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Expert Insights: Dr. Kofi Ahmed on Public Health Evolution

Dr. Ahmed provides a broader perspective on public health advancements since the 1970s.

"Death among children was very high and they were mainly due to sanitation problems and to diseases which can be prevented. Among them prevented by good drinking water or by vaccines."
[04:03]

He recounts the early days of immunization efforts, emphasizing the role of community health workers in promoting vaccine uptake.

"The nurse you come around and tell the mothers to bring their children for immunization. She knew every house. The mothers lived there."
[04:55]

Dr. Ahmed’s reflections highlight the evolution of public health strategies and the critical role of community engagement in successful health campaigns.

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Conclusion: Continuing the Journey

As Ghana celebrates 50 years since the establishment of its cold chain system, Patience Azuma remains hopeful yet vigilant about the future of immunization programs.

"Their health is much, much better than the days before us... Why do we wait before we also start this [with new vaccines]?"
[09:22]

Justice Beidou concludes by acknowledging the achievements while recognizing the ongoing efforts needed to expand and enhance vaccination coverage.

"Thank you for downloading this edition of Witness History. It was a Made in Manchester production for the BBC World Service."
[10:20]

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Key Takeaways

• Pioneering Initiative: Ghana’s 1974 implementation of the cold chain vaccination storage system was a groundbreaking effort that enabled effective vaccine distribution in a tropical climate.

• Personal Impact: Individuals like Patience Azuma illustrate the life-saving impact of the EPI, highlighting improved child health and survival rates.

• Challenges Overcome: The logistical hurdles of maintaining vaccine temperatures were addressed through innovative solutions, setting a model for other nations.

• Global Legacy: The established cold chain infrastructure was pivotal during the COVID-19 pandemic, demonstrating its lasting importance in global health.

• Ongoing Efforts: Continuous investment and expansion of vaccination programs are essential to address emerging health challenges and ensure equitable access to vaccines.

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This episode of "Witness History" not only commemorates a significant achievement in public health but also serves as a reminder of the relentless efforts required to safeguard global health through effective vaccination systems.

Transcript

[Justice Beidou]

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[Justice Beidou]

Thank you for downloading the Witness History Podcast from the BBC World Service with me, Justice Beidou. Today I'm taking you back to 1974 and the launch of a revolutionary new method for transporting medicines with which paved the way for millions around the world to be vaccinated against previously deadly diseases. I've been speaking to two people involved in the world's first cold chain vaccination storage system here in Ghana.

[Patience Azuma]

I feel great about it that our country was chosen so it was tested in our cold rooms to see how viable or effective the vaccines would last. We really had a great opportunity. The world was all looking at us.

[Justice Beidou]

Patience Azuma, born in the town of Tema, is very conscious of her place in history.

[Patience Azuma]

I feel that we were a privileged group because we had the opportunity to be immunized or vaccinated against all these killer diseases.

[Justice Beidou]

She was one of the first children to benefit from what was known as the Enhanced Immunization Program or the EPI.

[Patience Azuma]

That may possibly have been the reason why we are still surviving. Maybe a greater number of us would have passed on earlier or even if we didn't pass on, would have been infected with so many diseases. And then our parents would really have to fight for our survival.

[Justice Beidou]

For decades, children would die or be disabled by disease.

[Patience Azuma]

We had neighbors, one of whose child had more or less a bad limb. So when I groped further from my mother, she said that child unfortunately was not vaccinated. So I think he got polio or something and so that affected one of his limbs.

[Justice Beidou]

And I can remember my family relatives in Ghana telling me how they were encouraged to have more offspring than they really wanted because so many would die as babies.

[Dr. Kofi Ahmed]

Death among children was very high and they were mainly due to sanitation problems and to diseases which can be prevented. Among them prevented by good drinking water or by vaccines.

[Justice Beidou]

Dr. Kofi Ahmed, a medic who went on to be a chief medical officer in Ghana's Health Ministry.

[Dr. Kofi Ahmed]

The prominent among them were six childhood diseases. Measles, whooping cough, diphtheria, tetanus.

[Patience Azuma]

Our parents were not lucky. I don't think my grandmother even knew anything about immunization. Mothers didn't have the opportunity to vaccinate their children. If I compare myself to the elderly, most especially those who may were born or bred in the villages. They may not have had those opportunities that we had here in the city.

[Justice Beidou]

But there were some vaccinations. Dr. Ahmed was immunized for smallpox in the 1950s. He has a vivid recollection of how the system worked back then.

[Dr. Kofi Ahmed]

In as early as late 40s to 50s, there are child welfare centers where health workers, nurses, midwives, they run clinics. The nurse you come around and tell the mothers to bring their children for immunization. She knew every house. The mothers lived there.

[Justice Beidou]

In the 1960s, the World Health Organization, or the WHO for short, launched a global campaign to eradicate smallpox.

[Dr. Kofi Ahmed]

After the smallpox they define a way of trying to control diseases. They tried to make a program where all these things were coming together. So there was a meeting in Geneva which proposed that to do trials for the vaccines in Ghana.

[Justice Beidou]

So encouraged by the success of the smallpox vaccination program, health officials started to advocate for an expanded range of vaccines to be given to infants and women of childbearing age. In 1974, the WHO established the expanded program on immunizations to combat preventable diseases. As some vaccines need to remain cold from point of manufacture to delivery. How do you do that in a hot country like Ghana?

[Dr. Kofi Ahmed]

Most vaccines have to Be kept under about 4 degrees or below. So in order to move your vaccine for one place, there has to be in a cold situation. The cold change system, consisting of cold equipment like cold rooms, cold stores, fridges, freezers, cold boxes for transportation and vaccine careers.

[Justice Beidou]

For people like yourself who are working in the health system, how was the feeling like Ghana being chosen to be the first place for this to happen?

[Dr. Kofi Ahmed]

I must tell you, this one wasn't big news in the sense that it wasn't something huge in Ghana, but the EPI expanded all over the country. It was news among those who were in public health.

[Justice Beidou]

But there were further hurdles to overcome, particularly in reaching places outside the big cities that didn't have electricity and other.

[Dr. Kofi Ahmed]

Resources you go to beyond the health center, you may not have electricity.

[Justice Beidou]

That must have been a lot of work because if you're going into places in Ghana at a time where there.

[Dr. Kofi Ahmed]

Was no electricity, you give them gas stove, gas fridge. Initially it was kerosene gas and then solar to keep their fridges working.

[Justice Beidou]

Cold chain vaccination storage has transformed the effectiveness of vaccinations in Ghana, across Africa and the wider world.

[Walton Goggins]

Ghana has received the first COVID 19 vaccines through COVAX.

[Justice Beidou]

And Ghana's pioneering system came in particularly useful in 2021 when the country became the first in the world to receive COVID19 vaccinations through COVAX, set up to ensure fair and equitable distribution of jobs.

[Premier Protein Advertiser]

And do you know why Ghana was chosen for this delivery first?

[Justice Beidou]

Ghana has over the years been engaging in vaccination programs, and because of that, they've been able to build an effective vaccine infrastructure to be able to do this. Today, 50 years after it began, I'm seeing the cold chain system in action here at the Aguna Nkwanta health center in Ghana's western region.

[Patience Azuma]

Okay, please hold the baby well. Put your left hand on the baby's. Then you use your right hand to hold the baby's leg.

[Justice Beidou]

Baby Matthew is about to get his vaccinations.

[Patience Azuma]

Sorry, baby. Matthew, sorry. Please thank baby for me.

[Justice Beidou]

Patience. Azuma is grateful to have been one of the first children to have benefited from the revolutionary new cold chain storage system 50 years ago this year. But she thinks Ghana still has work to do.

[Patience Azuma]

Children are. Their health is much, much better than the days before us because as the years go by, I see that they keep adding more and more vaccines. I happened to travel to La Cote d'ivoire, something like hepatitis B. It was not one of the vaccines that were being given to kids, but there In La Cote d'ivoire, it was already there. So I came back to Ghana asking that, but what is happening? We are all in the same region. Later then I had. I had Ghana Health Service now talking about hepatitis B, educating people, coming to churches to even educate people to be vaccinated. But why is it in the same region? It's being done. If it's being done in La Cote d'ivoire, why not in Ghana? Why do we wait before we also start this? These new vaccines that are in place?

[Justice Beidou]

Patience Azuma and Dr. Kofi Ahmed were speaking to me, Justice Beidou here in Ghana. Thank you for downloading this edition of Witness History. It was a Made in Manchester production for the BBC World Service.

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