Bill & Melinda Gates Foundation

The Wisdom of a Fridge: Insight into creative problem solving for immunization

April 29, 2014
On a recent grantee visit to a high-tech startup company that makes vaccine refrigerators in rural Wales, it struck me that almost all of our work in immunization—and maybe even all of our work in global development and health—comes together in the cold chain for vaccines, specifically the refrigerator. I know—an audacious statement. Where’s the data? Let me explain.

As I wandered through rows of large, cold white boxes, I wondered about the broader implications of the cold chain as a player in immunization systems.  

Who are the end users of these refrigerators? How many refrigerators need to be produced every year? What size is needed for them to accommodate all the new vaccines countries are introducing through GAVI? And who is going to fix them when they break down in the middle of nowhere? 

Feeling a bit overwhelmed (perhaps due to the freezing temperature in the testing lab), I began contemplating whether or not we will even need the cold chain if our work to make vaccines more stable at outside temperatures succeeds. Then it hit me that many of my questions have answers in the broader immunization work going on all around me. 

At the Gates Foundation, we organize ourselves around program areas (such as polio) and functional areas (such as vaccine delivery). No single one of us can answer all of my questions; we all need to bring our combined knowledge to bear. On this issue and others, we achieve our most creative, breakthrough solutions when we collaborate, and extend our thinking across our programmatic and functional areas from research and development to delivery. 

You may not think of a fridge as a device that merits this kind of collective problem-solving. Before my career in vaccine delivery, I considered the fridge nothing more than a place where lettuce goes to die. But it’s a critical component in a complex system designed to ensure that vaccines save lives and it helps demonstrate how different types of expertise fit together to achieve collective impact.

Vaccine discovery sciences, for example, help us uncover new technologies to make vaccines resistant to temperatures above and below 2 - 8°C (35.6 - 46.4°F). Next, experts in vaccine development figure out how to safely and efficiently manufacture those vaccines, and then they help get them to market.  

From there, the vaccine delivery community—working with partners and country governments—helps bring everything together at the last mile to make sure that refrigerators with the best available technology are procured and installed, and that someone is there to fix them if they break. Finally, advocacy and communications efforts help us share successes and learn from failures—whether we’re embracing the wisdom of the coolest kitchen appliance or thinking about a future when we are no longer burdened by deadly diseases.  

From there, collaboration keeps extending like ripples in a pond. A broad range of global partners play a big role in cost-effectively and efficiently getting safe vaccines to all children—partners like UNICEF (which provides procurement support for vaccines and cold chain equipment), WHO (which provides technical assistance to manage countries’ vaccination programs), government donors including Canada and the UK, and implementing partners such as CHAI and PATH.

The power of partnership simply can’t be understated—nor can its benefits for everyone—including those who never have to think about refrigerators as anything more than a favored kitchen appliance, but who benefit every day from the lifesaving technology that comes together across many disciplines and organizations working together.
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