Keeping things cool: How MSF maintains a cold chain for supplies
The first rays of sunlight trickle through the sky at a logistics facility in the Democratic Republic of Congo (DRC). Workers wipe a thin layer of frost off cold packs and load them into a cooler that will travel by land, boat — and possibly by horse or mule — to reach its destination.
Once all the supplies are packed and sealed, they are handed off to a driver with a strict condition: Do not open.
These are vaccines heading for places that cannot be reached easily. Nearly all vaccines require refrigeration, but in many remote areas, high temperatures, difficult terrain, and unreliable electricity present significant challenges keeping these essential supplies properly stored until they reach people who need them.
To overcome these challenges, Médecins Sans Frontières/Doctors Without Borders (MSF) transports vaccines using a “cold chain”: a network of drivers and logistics experts who make sure the cargo stays between 2–8 degrees Celsius as it travels over mountains, deserts, and rivers.
MSF logistics manager Heritier Kamuha and logistics supervisor Socrates Makombo discuss how MSF maintains cold chain in DRC.
What is a cold chain?
Heritier Kamuha: The cold chain is the system that ensures the preservation and safety of temperature-sensitive vaccines and medications, from the time of manufacturing to their administration to people.
There are two types of cold chain: an active cold chain — which includes refrigerators, freezers, and devices powered by electricity — and a passive cold chain that consists of coolers, ice packs, and vaccine carriers.
Socrates Makombo: In remote areas, the cold chain is essential because it ensures proper preservation despite the challenges of transportation and storage. It thus guarantees the efficacy of health products, protects people against preventable diseases, and helps limit the spread of epidemics.
How does MSF transport vaccines to remote areas in DRC?
HK: We use various means of transport, including airplanes, cars, trucks, motorcycles, bicycles, boats, dugout canoes (motorised or paddled), and travel on foot. To ensure the preservation of vaccines and medications during transport, we also use equipment such as specialized vaccine coolers and carriers, ice packs, and a triple-packaging system to maintain the required temperature and guarantee product quality.
How do you maintain the temperature?
SM: A deployment day begins very early, sometimes even the night before, at our logistics base. The cold chain logistics specialist prepares the vaccine carriers and coolers. Team members remove cold packs from the freezer to defrost for 20 to 30 minutes, then wipe them dry before loading them in a cooler. Cardboard is placed between the vaccines and the packs to prevent any direct contact that could cause the vaccines to freeze accidentally.
Temperature control devices are then activated and installed inside. The vaccines are then placed in the cooler; the equipment is identified and labelled and then declared ready for transport. Before departure, a briefing is held with the drivers (usually motorcyclists). The instructions are clear: “Do not handle the contents and never open the cooler.”
What happens when vaccines arrive at their destination?
HK: Upon arrival, the vaccines are placed in a passive cold chain installed along the route. Medical teams then take over to carry out a vaccination campaign in the community. To ensure the safety of the operation, the cold packs are replenished every five days to prevent thermal incidents. Here, too, the frequency of resupply depends on the ambient temperature. It can be less than 13 hours.
This process illustrates the rigour, anticipation, and coordination necessary to deliver vaccines to people living in remote areas. Behind each administered dose lies meticulous logistical work, guaranteeing that the vaccine remains effective and safe until the moment of administration.
Why is the cold chain system essential to MSF operations?
HK: The cold chain system has significantly improved access to healthcare in areas where MSF operates, particularly in isolated regions where people are highly vulnerable and where there are few or no other healthcare partners.
Thanks to rigorous cold chain management, stockouts are reduced; vaccines and medicines retain their effectiveness; herd immunity is strengthened, which helps prevent epidemics; and morbidity and mortality decrease, particularly among those most at-risk, such as children, pregnant women, and displaced people.
The cold chain is not limited to the transport of vaccines: it is also about the sustainable strengthening of local capacities. MSF provides locally hired teams with ongoing training and practical support on daily cold chain management. We also work to ensure the sustainability of the system, so the quality of vaccine storage can be maintained even after MSF’s departure.
In short, the cold chain is a long-term investment: It protects not only vaccines but also communities, leaving behind enhanced skills and a more reliable and sustainable system.
