A Dose of Knowledge: “Shelf-Stable” Vaccines for All

Written by: Sudil Mahendra, Associate Scientific Director (he/him)

In 1900, the leading causes of death in the United States were communicable diseases, such as pneumonia, influenza, tuberculosis, diphtheria, smallpox, pertussis, measles, and typhoid fever. These diseases led to an average life expectancy of 47.3 years. Vaccines, in combination with greater access to clean water and sanitation, have helped to reduce or eliminate the spread of all of these diseases.1 Due in large part to that drop, the average United States life expectancy in 2020 was 77 years.2 During efforts to expand childhood immunizations, worldwide global life expectancy increased from 58.5 to 70 years from 1970 through 2010.1,3 Each year, immunization saves the lives of an estimated 2.5 million people around the world.4 However, there is still a disparity in the deaths caused by communicable vs noncommunicable diseases in very low-, low-, middle-, and high-income countries. While high-income countries have seen significant reduction in communicable diseases, lower-income countries have not seen the full benefit of vaccine development.
One of the contributors to that disparity is the existing barrier to delivering vaccines to those in need. Specifically, many vaccines require refrigerator storage during their lifecycle and are not thermostable or “shelf-stable.”5 One of the difficulties with distributing vaccines is the uninterrupted cold storage of vaccines during their journey, or “the cold chain.” The cold chain begins with cold storage at the manufacturing site and continues with transport and delivery of the vaccine. It then requires proper storage at the provider location (pharmacy, hospital, mobile clinic, etc., and finally ends with administration of the vaccine to the patient.6 If the vaccine reaches room temperature at any point, its efficacy drops significantly.
Maintaining the cold chain can be extremely difficult for some regions of the world. The Global Alliance for Vaccines and Immunization (GAVI) estimates that only 10% of health care facilities in the world’s poorest countries have a reliable electricity supply. Due in part to issues with maintaining the cold chain, more than 50% of all vaccines are wasted every year worldwide. The break in the cold chain results in extra doses needed for patients, which can come at a significant cost. For example, UNICEF audits in 2011 in several West and Central African countries reported that more than $1.5 million USD worth of vaccines were damaged in 5 months due to cold chain issues.7 Damage to vaccine doses can also contribute to increased costs for health care providers and a potential decrease in public confidence in vaccines.
The challenges of delivering vaccines around the world contribute to the underimmunization of the global populace. GAVI estimates that 22.7 million children worldwide miss out on basic childhood vaccines annually. In addition, 1.5 million people worldwide die from vaccine-preventable diseases each year.8 Due to low immunization coverage in many parts of the world, communicable disease outbreaks can still occur even with approved vaccines.4 As the last few years have demonstrated, communicable diseases know no borders. The importance of developing and promoting more versatile vaccines has never been more evident. In fact, new technologies that have already been developed to protect some vaccines from varying temperatures.7 Promoting the benefits of shelf-stable vaccine technology could drive additional strategic partnerships between researchers and manufacturers. It could also increase investment from high-income countries, as well as nongovernmental organizations, such as UNICEF and GAVI. Driving further development and purchasing of shelf-stable vaccines is a crucial step forward in sharing the benefits of medical advancements with the entire world.

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References:

  1. Rappuoli R, Pizza M, Del Giudice G, De Gregorio E. Vaccines, new opportunities for a new society. Proc Natl Acad Sci U S A. 2014;111(34):12288-12293.

  2. Murphy SL, Kochanek KD, Xu J, Arias E. Mortality in the United States, 2020. Centers for Disease Control and Prevention. Published December 21, 2021. Accessed April 26, 2022. https://www.cdc.gov/nchs/products/databriefs/db427.htm

  3. Keja K, Chan C, Hayden G, Henderson RH. Expanded programme on immunization. World Health Stat Q. 1988;41(2):59-63.

  4. Simelela PN. Vaccines: the powerful innovations bringing WHO's mission to life every day. World Health Organization. Published April 24, 2018. Accessed April 26, 2022. https://www.who.int/news-room/commentaries/detail/vaccines-the-powerful-innovations-bringing-who-s-mission-to-life-every-day

  5. Storage and handling of immunobiologics. Centers for Disease Control and Prevention. Published April 14, 2022. Accessed April 26, 2022. https://www.cdc.gov/vaccines/hcp/acip-recs/general-recs/storage.html

  6. Vaccine storage and handling toolkit. Centers for Disease Control and Prevention. Published July 11, 2019. Accessed April 26, 2022. https://www.cdc.gov/vaccines/hcp/admin/storage/toolkit/index.html

  7. Thomas J, Peterson G, Naunton M, Kosari S, Boum Y. Over half of vaccines are wasted globally for these simple reasons. World Economic Forum. Published July 24, 2018. Accessed April 26, 2022. https://www.weforum.org/agenda/2018/07/the-biggest-hurdle-to-universal-vaccination-might-just-be-a-fridge

  8. Facts and figures. GAVI, the Vaccine Alliance. Published February 24, 2022. Accessed April 26, 2022. https://www.gavi.org/programmes-impact/our-impact/facts-and-figures

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