Cool vaccines for safe, effective vaccination against COVID-19
It was 3 am on a Friday, December 24, 2021, and officials of the Ministry of Health (MoH) were at the Kotoka International Airport (KIA) to receive 1.7 million doses of Pfizer COVID-19 vaccine doses from the US government to help fight the COVID-19 pandemic.
Also at the airport were officials from the Ghana Health Service (GHS), the Food and Drugs Authority (FDA), the World Health Organisation (WHO), and UNICEF to oversee the delivery of the doses, and the proper transportation and storage.
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A few minutes earlier a cargo flight carrying vials of Covishield arrived.
Shortly after the aircraft landed, the US Ambassador to Ghana, Ms Stephanie Sullivan, handed over the consignment and documents covering the donation to the Manager of the Expanded Programme on Immunisation (EPI), Dr Kwame Amponsa-Achiano.
In turn, he handed them over to the chairman of the Health Commodities Group for COVID-19 at the MoH, Dr Matthew Kyeremeh.
Immediately after the handover, crates of vaccines marked “time and temperature-sensitive product” were offloaded onto ultra cold vans, which quickly conveyed the consignment to national cold storage facilities for onward delivery across the country.
Cold rooms
The cold vans drove immediately to the national cold rooms at the Korle Bu Teaching Hospital (KATH).
At the location, there are five walk-in freezers — three of which are capable of storing vaccines at temperatures between +2 to + 8 degree Celsius.
The other two freezers are capable of storing vaccines at temperatures below -20 degrees Celsius.
There is also a specialised ultra-cold room which has eight freezers with a capacity to store vaccines at between -60 and -80 degrees Celsius.
Once the vaccines are delivered to the ultra cold freezers in the city, they are distributed to the two cold storage facilities located in each of the 16 regional capitals of Ghana.
Dr Achiano Amponsah inspecting vaccines stored in one of the ultra cool freezers
From the regional points, the managers at the district levels pick the vaccines and store them in their fridges and freezers, which are not walk-in, but are able to store at + 2 to +8 degrees Celsius for onward distribution to the sub-district health facilities, where the vaccines are stored in fridges and cold boxes.
At the health facilities where the vaccines are administered, freezers are used to prepare ice packs to maintain the temperatures in the cold boxes and also ensure that the vaccines are not frozen before use.
All the storage facilities from the national level to the sub-district level are used for storing both routine vaccines and COVID-19 vaccines.
Shelf life
The safe transportation and storage of the COVID-19 vaccines is also to preserve the shelf life, as experts say that once the vaccines are removed from one storage point and delivered at a destination storage facility in-country, with the help of a cold van at the right temperature they can be stored for up to six months.
Ghana is also using drones to deliver vaccines to areas without roads and have sent vaccinators out into communities, particularly among migratory population that travel routinely from north to south across the country to find pasture for their cattle.
These vaccinators stay within communities while administering the vaccines.
Ghana’s strategy is to create herd immunity by vaccinating at least 20 million out of the current estimated 30.8 million Ghanaians.
The first consignment of 600,000 doses of the AstraZeneca COVID-19 vaccine, Covishield, arrived at the KIA on February 24, 2021, under the COVID-19 Vaccine Global Access Facility (COVAX).
Subsequently, the first-ever COVID-19 vaccination in Ghana was rolled out on Tuesday, March 2, 2021, as part of optimal measures to stop the further spread of the disease.
This vaccination exercise made Ghana the first of 92 beneficiary countries to receive the COVID-19 vaccines from the COVAX facility according to WHO.
As of December 16, 2021 a total of 21,905,210 vaccines had come into the country, comprising 9,555,170 AstraZeneca, 8,032,850 Jasen, 1,229,620 Mordena, 3,066,570 Pfizer-BioNTech and 21,000 Sputnik-V.
They had come from various sources, including the COVAX and bilateral partners.
Deployment
Ghana is not new to immunisation programmes as it has over four decades of experience at delivering large-scale campaigns for polio, measles, yellow fever and other vaccines for especially babies.
The Manager of EPI, Dr Amponsa-Achiano, is confident the lessons learned from the over 40 years of vaccination and the accompanying successes from the various immunisation programmes were enough to assure Ghanaians of a successful COVID-19 vaccination programme.
Currently, he said, the COVID-19 vaccines were being deployed within the existing healthcare infrastructure under the GHS.
Storage
All vaccines, based on their characteristics, require strict storage and movement temperatures, known as cold chain requirements, right from the point of manufacturing into the syringe for it to stay efficient, safe and potent.
Some COVID-19 vaccines, such as Pfizer’s and Moderna’s, need “ultra-cold” storage, while the Oxford-AstraZeneca vaccine is relatively low-maintenance and requires storage at temperatures between two and eight degrees Celsius.
For some once open, a vial can survive at temperatures of up to 30 degrees Celsius until its six-hour usage window expires.
For proper cold chain handling of the various vaccines, the Minister of Health, Mr Kwaku Agyeman-Manu, said Ghana’s existing robust vaccination system had been given “a little boost” to cover the demands of COVID-19 vaccination that would be used to conduct the COVID-19 vaccination across the country.
Mr Kwaku Agyeman-Manu (second right) and Ms Stephanie S. Sullivan (Middle) after the US government had donated 1.7 billion COVID 19 vaccines to Ghana
The boost, he said, included 4,407 vaccine storage fridges, freezers and cold boxes procured to boost immunisation in the country.
The storage facilities comprise 58 ultra-low temperature vaccine freezers, 50 normal vaccine fridges, 3,000 ice pack freezers, and 300 cold boxes. All the items are valued at $8 million and are expected to enhance the country's capacity to deploy a variety of vaccines with different storage (temperature) requirements, particularly for COVID-19.
Challenges
The different vaccines require different storage temperatures and administration which Dr Amponsa-Achiano said had presented a challenge.
For example, the Johnson and Johnson vaccines which come in a pack of five or 10 dose vials require a different size syringe (0.5ml), while the Pfizer vaccine packed in six dose vials, require a 0.3ml syringe.
Currently, more than 90 per cent of the cold chain facilities are on the national grid for power supply, with the rest on other sources of energy, such as, solar and gas because of the lack of electricity supply to those areas.
Some challenges with cold storage of vaccines in the country are that at the national level some cold facilities are as old as 25 years.
With COVID-19 vaccinations, however, the country’s cold chain system is being revamped.
Maintenance of the cold storage facilities is also a challenge as with limited resources.
Due to power outages, there are frequent breakdowns of storage facilities, leading to the provision of stand by fuel-driven generators, which are expensive.
However, access to spare parts to fix the generators when they break is easy with the support of the GAVI.
Safe vaccines
At the Oduman Polyclinic in the Ga West Municipality, a nurse pulled out a vial of Covishield from a cooler box, while a queue of people were waiting patiently to get their jabs.
The logistics involved in getting the vaccine to the health facility is of no great concern to them.
They are not interested in the makeup of the vaccine. They are just happy they have a chance of getting a vaccine which will protect them against the virus.
“I am ready to wait in the queue no matter how long it takes for me to get the vaccine,” said 75-year-old Catherine Golo, who has been waiting for her shot for two hours.
“We are working hard to ensure that we provide all those present with a jab. Each dose we administer brings us one step closer to ensuring everyone is protected against COVID-19, including all high-risk populations,” a nurse at the vaccination room said.