Impact of Renewable Energy on Extension of Vaccine Cold-chain: a case study in Nepal

김민수,문정욱,류종하,김민식,비나약 반다리,박정은,Anuj Bhattachan,Vittal Mogasale,추원식,이선영,송철기,안성훈 적정기술학회 2020 적정기술학회지(Journal of Appropriate Technology) Vol.6 No.2

Renewable energy (RE) is essential to comprise sustainable societies, especially, in rural villages of developing countries. Furthermore, application of off-grid RE systems to health care can improve the quality of life. In this research, a RE-based vaccination supply management system was constructed to enlarge the cold-chain in developing countries for the safe storage and delivery of vaccines. The system was comprised of the construction of RE plants and development of vaccine carriers. RE plants were constructed and connected to health posts in local villages. The cooling mechanism of vaccine carriers was improved and monitoring devices were installed. The effect of the system on vaccine cold-chain was evaluated from the field test and topographical analysis in the southern village of Nepal. RE plants were normally operated for the vaccine refrigerator in the health post. The modified vaccine carriers had a longer operation time and better temperature control via monitoring and RE-based recharging functionality. The topographical analysis estimated that the system can cover larger region. The system prototype showed great potential regarding the possibility of a sustainable and enlarged cold-chain. Thus, RE-based vaccine supply management is expected to facilitate vaccine availability while minimizing waste in the supply chain.

Mass Vaccination with a New, Less Expensive Oral Cholera Vaccine Using Public Health Infrastructure in India: The Odisha Model

Kar, Shantanu K.,Sah, Binod,Patnaik, Bikash,Kim, Yang Hee,Kerketta, Anna S.,Shin, Sunheang,Rath, Shyam Bandhu,Ali, Mohammad,Mogasale, Vittal,Khuntia, Hemant K.,Bhattachan, Anuj,You, Young Ae,Puri, Mah Public Library of Science 2014 PLoS neglected tropical diseases Vol.8 No.2

<▼1><P><B>Introduction</B></P><P>The substantial morbidity and mortality associated with recent cholera outbreaks in Haiti and Zimbabwe, as well as with cholera endemicity in countries throughout Asia and Africa, make a compelling case for supplementary cholera control measures in addition to existing interventions. Clinical trials conducted in Kolkata, India, have led to World Health Organization (WHO)-prequalification of Shanchol, an oral cholera vaccine (OCV) with a demonstrated 65% efficacy at 5 years post-vaccination. However, before this vaccine is widely used in endemic areas or in areas at risk of outbreaks, as recommended by the WHO, policymakers will require empirical evidence on its implementation and delivery costs in public health programs. The objective of the present report is to describe the organization, vaccine coverage, and delivery costs of mass vaccination with a new, less expensive OCV (Shanchol) using existing public health infrastructure in Odisha, India, as a model.</P><P><B>Methods</B></P><P>All healthy, non-pregnant residents aged 1 year and above residing in selected villages of the Satyabadi block (Puri district, Odisha, India) were invited to participate in a mass vaccination campaign using two doses of OCV. Prior to the campaign, a <I>de jure</I> census, micro-planning for vaccination and social mobilization activities were implemented. Vaccine coverage for each dose was ascertained as a percentage of the censused population. The direct vaccine delivery costs were estimated by reviewing project expenditure records and by interviewing key personnel.</P><P><B>Results</B></P><P>The mass vaccination was conducted during May and June, 2011, in two phases. In each phase, two vaccine doses were given 14 days apart. Sixty-two vaccination booths, staffed by 395 health workers/volunteers, were established in the community. For the censused population, 31,552 persons (61% of the target population) received the first dose and 23,751 (46%) of these completed their second dose, with a drop-out rate of 25% between the two doses. Higher coverage was observed among females and among 6–17 year-olds. Vaccine cost at market price (about US$1.85/dose) was the costliest item. The vaccine delivery cost was $0.49 per dose or $1.13 per fully vaccinated person.</P><P><B>Discussion</B></P><P>This is the first undertaken project to collect empirical evidence on the use of Shanchol within a mass vaccination campaign using existing public health program resources. Our findings suggest that mass vaccination is feasible but requires detailed micro-planning. The vaccine and delivery cost is affordable for resource poor countries. Given that the vaccine is now WHO pre-qualified, evidence from this study should encourage oral cholera vaccine use in countries where cholera remains a public health problem.</P></▼1><▼2><P><B>Author Summary</B></P><P>Cholera – an acute life-threatening diarrheal illness – continues to disrupt public health in resource poor countries. The devastating outbreaks in Haiti and Zimbabwe – to name just two of many occurrences – calls for the use of available oral cholera vaccines as an additional tool in the arsenal of cholera control measures. An oral cholera vaccine (Shanchol) has been licensed in India since 2009; however, there has only been limited use of this vaccine in government public health programs. A vaccination campaign using 2 doses of Shanchol was conducted in Odisha, India, during May and June, 2011, where 31,552 persons (61% of the target population) received the first dose and 23,751 of them completed their second dose. The vaccine delivery cost was $0.49 per dose. Through our findings and experience, we discuss the organization of the cholera vaccination campaign in Odisha, the challenges met for conducting the campaign and the strategies designed to overcome those challenges, and the delivery costs incurred in the use of this vaccine, the first of

Uptake during an oral cholera vaccine pilot demonstration program, Odisha, India.

Kar, Shantanu K,Pach, Alfred,Sah, Binod,Kerketta, Anna S,Patnaik, Bikash,Mogasale, VijayaLaxmi,Kim, Yang Hee,Rath, Shyam Bandhu,Shin, Sunheang,Khuntia, Hemant K,Bhattachan, Anuj,Puri, Mahesh K,Wierzba Landes Bioscience 2014 Human Vaccines & Immunotherapeutics Vol.10 No.10

<P>Approximately 30% of reported global cholera cases occur in India. In 2011, a household survey was conducted 4 months after an oral cholera vaccine pilot demonstration project in Odisha India to assess factors associated with vaccine up-take and exposure to a communication and social mobilization campaign. Nine villages were purposefully selected based on socio-demographics and demonstration participation rates. Households were stratified by level of participation and randomly selected. Bivariate and ordered logistic regression analyses were conducted. 517/600 (86%) selected households were surveyed. At the household level, participant compared to non-participant households were more likely to use the local primary health centers for general healthcare (P < 0.001). Similarly, at the village level, higher participation was associated with use of the primary health centers (P < 0.001) and private clinics (p = 0.032). Also at the village level, lower participation was associated with greater perceived availability of effective treatment for cholera (p = 0.013) and higher participation was associated with respondents reporting spouse as the sole decision-maker for household participation in the study. In terms of pre-vaccination communication, at the household level verbal communication was reported to be more useful than written communication. However written communication was perceived to be more useful by respondents in low-participating villages compared to average-participating villages (p = 0.007) These data on participation in an oral cholera vaccine demonstration program are important in light of the World Health Organization's (WHO) recommendations for pre-emptive use of cholera vaccine among vulnerable populations in endemic settings. Continued research is needed to further delineate barriers to vaccine up-take within and across targeted communities in low- and middle-income countries.</P>

신재생 에너지를 사용한 네팔 고산지역의 백신 저온 이송 체계 구축

김민수(Min-Soo Kim),반다리 비나약(Binayak Bhandari),반다리 프라티바(Pratibha Bhandari),퍼우델 시워라즈(Shiva Raj Poudel),이경태(Kyung-Tae Lee),추원식(Won-Shik Chu),김형일(Hyung-Il Kim),바타찬 아누즈(Anuj Bhattachan),모가살레 비탈(Vittal Mogasal 적정기술학회 2015 적정기술학회지(Journal of Appropriate Technology) Vol.1 No.1

백신은 감염성 질병을 예방하기 위한 주된 방법으로, 그 효능을 유지하기 위해서 2-8 o C의 온도 조건을 유지하는 것이 중요하다. 이를 위해, 백신 저온 이송 체계를 이용하여 백신을 생산 시점부터 소비 시점까지 적정 온도로 유지하여야 한다. 그러나, 개발도상국은 교통 인프라가 열악하고, 안정적인 전력 공급이 어렵기 때문에 적합한 수준의 백신 저온 이송 체계를 구성하기 어렵다. 특히, 고산지역인 네팔의 경우, 험준한 지형과 잦은 산사태로 인해 국가 전력망 구축이 미비한 실정이다. 반면, 높은 일사량, 강한 바람, 가파른 지형으로부터 충분한 신재생 에너지원(태양광, 풍력, 소수력) 을 확보할 수 있다. 본 연구에서는 네팔의 이러한 자연 환경을 고려하여 마카완푸르 지역의 팅간, 콜콥 마을에 독립형 신재생 에너지 시스템을 구축하였고, 이를 주 전력 공급원으로 하여 백신과 백신 캐리어용 아이스팩을 보관하는 냉장 고를 설치하였고, 부가적으로 비상시를 대비하여 태양광 발전 시스템을 설치하였다. 결과적으로, 신재생 에너지 시스 템을 이용한 백신 저온 이송 체계를 구축하였고, 마카완푸르 지역의 백신 접종 활동을 개선하였다. 또한 이를 이용하여 6명의 유아에 백신을 접종하였다. To maintain efficacy of vaccines, which are effective way to prevent infectious disease, vaccines should be stored between 2 to 8 o C. Hence temperature controlled supply cold-chain must be maintained from the origin of the vaccine to its consumption. However, in developing countries, it is difficult to maintain the cold-chain due to the lack of good transportation and reliable power supply. In the case of Nepal, in particular, central national grid cannot provide reliable power to the remote places because of difficult terrain, high altitude, frequent landslide and heavy investment cost in its infrastructure. However, on the other hand, higher insolation, strong wind and the steep slope terrain can provide enough renewable energy sources (Solar, Wind, Micro-hydro). In this study, considering the natural environment of Nepal, off-grid renewable energy system (RES) was installed on Thingan and Kholkop villages in Makawanpur district of Nepal. The primary power was supplied from the RES, in-addition a small photovoltaic system was installed for emergencies. The vaccines and ice packs for vaccine carriers are stored in the vaccine refrigerator. Finally, vaccine cold-chain using RES which can accommodate vaccines doses for about 6 babies are enabled for smooth door-to-door vaccination campaign in Makawanpur district.