Frontline Perspectives: Mary Ekey has a few things to teach you about vaccine management.

Since September 2021, Mary Ekey has been embedded at Ghana’s Expanded Program on Immunization (EPI), “I am responsible for making sure COVID-19 vaccines are stored safely and at the required temperature and then distributed from the national level to the regional level and down to the districts and vaccination centers.”

“I'm the only person embedded here at the EPI national level, but staff from the GHSC-PSM office support me when needed, and we have some vaccine logistics support offices with other USAID implementing partners in four regions.”

A pharmacist by profession, Mary previously worked with the Ghana Health Service as the pharmacist in charge at the national and regional medical stores in Greater Accra. “While working as a pharmacist, I developed an interest in the logistics and supply chain of commodities. I was handling some vaccines and other cold chain commodities like oxytocin and anti-rabies, anti-snake, and other immunization devices, but not as much as I'm doing right now.”

“I've learned quite a lot when it comes to vaccines and immunization devices and the various types of vaccines we have in Ghana.” Every day now she works with cold and ultra-cold chain management tools, like cold rooms, cold vans, Ultra-Low Temperature freezers (ULT), and temperature monitoring devices.?

“We conduct vaccine accountability monitoring of vaccines at the national, regional, and district levels to check if any have gone missing or got broken. Another important responsibility is to ensure the cold chain equipment is in good condition and recording temperatures.”

Monitoring vaccines relies on having accurate data. GHSC-PSM integrated vaccines into a robust stock management tool (the Ghana Integrated Logistics Management Information System-GhiLMIS) for real-time end-to-end visibility of vaccine stocks.

“We also undertake temperature mapping to know the temperatures at each corner and point of cold rooms. This informs us on how vaccines are to be arranged in the cold rooms” so that vaccines that are more temperature sensitive can be placed in the coldest part of the rooms.?

With the arrival of Pfizer vaccines requiring ultra-cold chain management, “This was our first time having these kinds of temperatures of negative 80 degree Celsius?in storing vaccines, so we needed to learn about these devices and be able to monitor the vaccines with ultra-low temperature monitoring devices and handle them with ultra-low temperature freezers.”?

“One of the first challenges we faced was with cold vans for vaccine transportation. EPI had only two, and at times they were not in good enough shape to travel long distances.” GHSC-PSM contracted a third-party logistics company (3PL) to support EPI with vaccine distribution, one for cold chain and one for the ultra-cold chain needed for Pfizer vaccines.?

“UNICEF provided the support for ultra-low temperature freezers. Those freezers were special. We needed to have special rooms where we fixed air conditioners. Even the energy requirements were different, so we had to do some rewiring before receiving the freezers.”?

Despite having the appropriate cold and ultra-cold equipment and vehicles, temperature excursions can happen at any step of the supply chain. The new ultra-low freezers are self-monitoring and report temperature excursions electronically. “We get the alerts on our emails. We quickly attend to that particular freezer to know what the problem is and have it resolved immediately to protect the integrity of the vaccines inside.” GHSC-PSM also supported the EPI program with remote temperature monitoring devices that are placed in the cold vans to monitor the temperature of the vaccines in transit.

“A major lesson learned for me is to identify cold chain facilities along transportation routes in case there's a problem with the truck that is transporting the vaccines. That way, you can move the vaccines from the cold van into those facilities to keep them until they can continue their journey. This is especially true for the northern part of Ghana, where the journey is very long and tough. Sometimes the roads are not in very good shape, so the trucks break down, and we have to send another transport.”

Mary supports EPI in other ways to ensure vaccine quality. “We collaborate with the Food and Drugs Authority to pick samples and then assess the integrity of the vaccines. We go onto the field to monitor the vaccines at the regional level and to the districts to monitor the vaccines in their fridges and freezers. We go to the facility level to check how they are storing their vaccines and to the vaccination centers to monitor the temperatures at which they are giving vaccination doses.”

The work that Mary and her colleagues have done will have long-term implications for Ghana. “This work has really helped improve our cold chain equipment. And we've been taught a lot about how to manage vaccine logistics and even preparedness for emergencies.” Other vaccination programs have also benefited, “especially the routine vaccines like tuberculosis, polio, and yellow fever, and in case of new vaccine introduction.”?