Keeping vaccines within the recommended temperatures is more than just a duty for health workers in the forests of Panama. Taking vaccine containers through dirt roads, across rivers and seas, under the scorching sun, to ensure doses arrive safely at their destination, requires precision and commitment.
Protecting the vaccines using the appropriate cold chain equipment can be a perilous matter in isolated rural communities. A vaccine kept above or below the recommended temperature may lose some of its efficacy, leaving the population at risk of vaccine-preventable diseases (VPD).
In several villages of the central Veraguas province and the indigenous territory of Ngäbe Buglé, hundreds of miles away from the urban settlements of Panama, the electricity is often out – if not unavailable. Until recently, communities along the Pacific and Caribbean coasts had to rely on vaccine refrigerators powered by gas.
“This was always risky. If there was no timely supply [of gas], then health workers had to rush out from the posts to bring the vaccines to the nearest health center to protect them,” Argelis Espinosa recalled. As the head of the Expanded Program of Immunizations in Veraguas, she has led the COVID-19 vaccine deployment to 45 health posts that serve 148,000 people, some in places that can only be reached by plane or boat.
In these locations, the existing cold chain equipment was not adequate for the massive COVID-19 vaccine rollout of 2021. In some places, the devices were insufficient and in some others the equipment did not include the required temperature monitoring devices.
“We could be vaccinating people but not protecting them. If that happens, we are not achieving our ultimate goal,” Espinosa reflected. “There was an urgent need to provide them with cold chain equipment and supplies that were very important during that time of the pandemic”.
COVID-19 vaccination in a school in the community of Coclesito, in the indigenous territory of Ngäbe Buglé, Panama, in October 2021. (Gerardo Cárdenas/PAHO)
Cold chain consists of a series of refrigeration equipment that allows vaccines to be stored at recommended temperatures while being transported, stored and distributed wherever needed to maintain their efficacy.
Cold boxes that keep vaccines refrigerated up to six days in the field were on the top of their requirement list. Workers at the five posts under the jurisdiction of the Río Luis health center, in the Caribbean basin, had to take turns and wait for days to use one of these coolers to take vaccines to their communities, which are either nestled in the mountains or tucked away on beaches that are inaccessible by road.
As part of an effort led by the Government of Panama and the Pan American Health Organization (PAHO), with the support of the Government of Canada, these communities received cold boxes and smaller vaccine carriers ensuring safe transportation, as well as solar-powered refrigerators and temperature monitoring devices that keep vaccines safe in areas where electricity supply is intermittent.
Through this collaboration, the Panamanian Ministry of Health is in the process of receiving 80 cold boxes, 200 portable carriers, 22 solar refrigerators, and 20 refrigerators and freezers to increase access to COVID-19 vaccines for populations in rural areas, including indigenous communities or migrants crossing the Darien Gap, in the border with Colombia.
Through the collaboration with the Government of Canada, over 445 refrigerators and freezers, seven walk-in cold rooms, 2,222 temperature monitoring devices and over 9,000 parts of equipment, including cold boxes and small carriers, have been provided to 15 countries in Latin America and the Caribbean.
In the Dominican Republic, the Government of Canada and PAHO provided 20 refrigerators, two cold rooms and other equipment to strengthen vaccine storage and distribution capacities with a focus on border communities. Meanwhile, Nicaragua, was the recipient of 13 refrigerators and two cold rooms.
Back in Panama, Argelis Espinosa and her team have transformed their strategy. The new equipment enables nurses across Veraguas to continue to provide COVID-19 vaccines and other vital routine immunization doses.
“This is a great achievement,” Danixa Morales, a nurse working in southern Veraguas said. Morales is part of the team traveling five times a year to vaccinate residents in remote coastal and island communities. “Without this equipment, we could not reach this population and it would be hard for them to go to the health center. This has greatly helped our work and will aid us in completing the [vaccination] series of all persons in our communities.”
In the coming months, new donations of cold chain equipment from the Governments of Canada and United States – through PAHO – will benefit populations across 26 countries of Latin America and the Caribbean. Both countries have provided US$ 8.3 million and US$ 6.7 million, respectively, to strengthen the cold chain operations in the Americas.
PAHO is working with health authorities, local governments and communities to improve equitable access to COVID-19 vaccines across the Americas. With funds from the Government of Canada, the United States of America and other key partners, PAHO is supporting projects and interventions to take vaccines to indigenous peoples, migrants, hard-to-reach communities and other populations in situations of vulnerability, while increasing the capacities of local health systems and fighting the infodemic.