Belize Response Initiative for Cold Chain Development

Effective health service delivery around the globe depends on a network of interconnected systems at local, national, and multi-national levels. The management and maintenance of these systems present a host of challenges that are often amplified in low and middle income countries. One of these crucial systems is the delivery of vaccines, pharmaceuticals, and biological samples from provider to end user - otherwise known as the 'cold chain.'

 

The University of Notre Dame's Eck Institute for Global Health (EIGH) has a long history working alongside the Belize Ministry of Health in order to strengthen the country's ability to respond to mosquito-borne diseases such as malaria, dengue fever, and the Zika virus. Led by Dr. Nicole Achee and Dr. John Grieco, EIGH's crucial diagnostic work in Belize depends on the existence of efficient, reliable, and resilient national cold-chain systems to ensure the accuracy of biological sample testing.

 

In January 2021, Carrier Foundation funded a collaborative initiative between EIGH, the Pulte Institute for Global Development, the Belize Vector Ecology Center (BVEC), and the Belize Ministry of Health aimed at strengthening national cold chain systems by identifying and addressing structural and logistical deficiencies in how biological samples are currently stored and transported between local clinics, regional hospitals, and the only laboratory diagnostics center in the country. The project has three phases:

• Phase 1: evaluation of current conditions and procedures used to deliver medical specimens to the existing cold chain process.
• Phase 2: design a pilot implementation strategy that will address areas for improvement in the existing cold chain protocol.
• Phase 3: develop a field-validated pilot solution for a medical cold chain

Overall, the goal is to create a solution for a medical cold chain that can be further scaled in Belize and implemented in other low to middle income countries.

Project Update

While the larger effects of COVID-19 have certainly continued to impact the activities of development projects globally, project activities within BRICC have pushed ahead.

The team is evaluating the current “pain points” in the medical cold chain process used by laboratories throughout Belize.  Currently, the cold chain in Belize consists of the transportation of medical samples from one of eight Regional Laboratories, where the majority of samples are collected, to CML where samples are processed for testing. A large challenge of this process is ensuring a constant temperature threshold of the shipment to maintain sample viability. In order to be considered viable for testing, the standard recommended by the Mayo Clinic is for medical samples to maintain a temperature range of 2-8° Celsius from the time that a sample is collected from a patient until the time that it is processed for diagnostic testing.

Through the generous support of UPS Healthcare, the UPS Foundation, and Carrier, 20 Elite Universal Thermal Shippers and 396 Carrier SensiTech sample loggers were sent to Belize to be used in the study. The loggers provide the team and local partners the ability to assess the time, temperature, and location of medical sample shipments using current packaging materials in Belize to determine any variances in temperature as the samples travel through the cold chain. 

These loggers are also being used in a paired test using the UPS Shippers, which have the capacity to maintain a constant internal temperature for up to 168 hours; this could be a packaging solution for the Belize MoHW to consider.

The data collected from this phase of the project will allow the team to design a pilot program of best practices for implementation that could eventually be scaled in Belize and other low to middle income countries. The pilot is set to begin in the Fall of 2021.

Photo Captions: 1) BVEC personnel receiving the UPS Thermal Shipper at the field site in Orange Walk Town, Belize. 2) BVEC personnel delivering the UPS Universal Shippers and the Carrier SensiTech Logger kits to one of the Regional Laboratories within Belize who is participating in Phase 1 of the study.