After the excitement of Pfizer’s announcement that the first COVID-19 vaccine has yielded positive data from phase three trials, attention turns to logistical matters, in particular how to store vaccines at ultra-cold temperatures as low as 80’C. You may have read that this temperature is far out of the reach of conventional refrigerators, so specialist infrastructure will be needed. By co-locating ultra-cold refrigeration at cell sites, the telecom and tower industry can play a critical role in completing the ’cold chain’ and enabling the delivery of this vaccine, particularly to low and middle income markets.
TowerXchange: Nearly 3bn of the world’s 7.8bn people live in places where temperature controlled storage is insufficient to get a COVID-19 vaccine to them ’ what can tower owners do to close this gap?
Dr Harvey Rubin, Founder, Energize the Chain: Our partners GAVI, the Vaccine Alliance, are acutely concerned about how to distribute the COVID-19 vaccine to low and middle income countries, where the electricity grid is often not extensive or reliable enough to facilitate vaccine refrigeration.
For tower owners in these low and middle income countries, energy management is a critical consideration, whether they’re seeking to maintain uptime on an unreliable grid connection, or leveraging diesel or renewables to power off grid sites. This gives tower owners unique know-how in energy management.
Energize the Chain seeks to leverage tower owners’ sophisticated engineering capabilities by asking them to co-locate vaccine refrigerators at their cell sites, enabling a whole new supply chain ’ a new ’cold chain’ ’ necessary to distribute the vaccines which will immunise the world against COVID-19.
TowerXchange: How likely are the COVID-19 vaccines to need ultra-cold -80’C refrigeration?
Dr Harvey Rubin, Founder, Energize the Chain: The majority of the vaccines in late stage trials are going to need ultra-cold refrigeration, down to -80’C, including the vaccine from Pfizer, which is seeking emergency approval.
Most countries don’t have the infrastructure to store ultra-cold vaccines ’ the temperature is beyond the reach of existing refrigeration equipment at most local health clinics, but the USA, for example, is building gigantic ultra-cold farms to store vaccines.
EtC’s focus is low and middle income countries, which is where partnerships with tower owners will be critical in extending the ultra-cold chain!
TowerXchange: How have EtC’s requirements has changed to meet the needs of the COVID-19 vaccine? To what extent has your focus shifted from remote to more central sites?
Dr Harvey Rubin, Founder, Energize the Chain: Of course, we continue to seek sites to distribute’ routine vaccinations to children, for the purpose of which we still want remote sites close to villages.
However, to distribute the COVID-19 vaccine, we may want to use more central locations, leveraging a hub and spoke model to branch out to regional areas. So our model may have to change, and the rural sites we have now may not be optimal for distributing the COVID-19 vaccine.
We will determine the sweet spot locations in collaboration with Ministries of Health, and we’re already talking to Ministries about where they would prefer to site ultra-cold refrigeration units. For example, if existing healthcare facilities lack the necessary equipment, we could be seeking sites in the middle of towns, or we may push toward the suburbs if there are already facilities we can use in central areas. Urban and suburban cell sites are invaluable as they represent powered, maintained, monitored, safe and secure potential storage sites.
TowerXchange: You spoke about the added value that cell sites are monitored ’ what data does EtC have and need to effectively leverage cell sites to distribute vaccines?
Dr Harvey Rubin, Founder, Energize the Chain: Data is our Achilles heel. Most cell sites have access control systems combined with remote monitoring systems, often integrated with tower management systems at the NOC (Network Operations Centre). We would love to have access to the tower owner’s NOC from which we could harvest critical data for us, such as temperature and near real time inventory management.
Our Ministry of Healthcare partners will often have baseline data on population demographics ’ particularly COVID-19 positivity rates, who has been vaccinated and who would benefit from the vaccine ’ age groups, pre-existing conditions et cetera. The Ministry will also know about availability of healthcare and other essential workers.
Our goal is to combine the tower owner’s operational data with government demographic and healthcare data to target and track the distribution of the vaccine.
Given that it is likely that most COVID-19 vaccines will need two doses, an initial and a booster shot, it would also be great to partner with the Mobile Network Operators to help us track who has had each shot, and in the hope that we could use cellphones to send a reminder, even track people’s locations. In instances where the country has a symptom tracking or track and trace app in local language(s), we can integrate with that. It’s also important that we keep in contact with people after they have been vaccinated so we can track and help with any adverse events.
TowerXchange: Given the importance of this undertaking, how do we know Energize the Chain can deliver? What has EtC achieved to date?
Dr Harvey Rubin, Founder, Energize the Chain: We have been doing this for ten years! And frankly, there’s no-one else fulfilling this essential role in the cold chain.
EtC first rolled out our programme in partnership with Econet in Zimbabwe, where we delivered hundreds of thousands of vaccines over the years all over the country. We are now in the process of updating that programme with the COVID-19 vaccine front of mind.
Meanwhile, we have signed MOUs and contracts to rollout vaccine fridges at a number of sites in Ghana with our partners American Tower. And we’re up and running in Myanmar on five sites in the Karen Department of Health and Welfare, with a further four sites coming in North Kachin, two of which are Ministry of Health and Sports sites with the Coalition for Epidemic Preparedness Innovations. Most recently, we are scoping a project in Guinea Conakry, whilst also finishing a big survey in Bangladesh, where we are seeking partners among the local MNOs and newly licensed towercos.
We have an MOU in place with GAVI, the Vaccine Alliance, an international organization funded in part by’ Bill & Melinda Gates Foundation, the World Health Organization and the World Bank, which gives us matching funds.
But we urgently need more local partners among MNOs and towercos in low and middle income countries. Towercos now own 70% of the world’s cell sites, while MNOs own the balance, as well as having highly recognised and trusted brands to help ensure their subscribers engage with the vaccine process.
TowerXchange: In addition to cell site owners, does EtC need partners that can help with inland logistics too?
Dr Harvey Rubin, Founder, Energize the Chain: Yes we’d love to partner with telecom managed service providers to help with inland logistics partners for vaccine delivery, restocking and routine maintenance.
TowerXchange: What do you actually need at a cell site, in terms of space and power load? And how does that change when we’re talking about ultra-cold storage?
Dr Harvey Rubin, Founder, Energize the Chain: Let me start with what we need at remote cell sites for the distribution of child vaccines. At remote sites, we would typically like to install a 0.43kW vaccine refrigerator on a 2mx1.5mx0.4m plinth, but ultimately the precise requirement will entirely depend on the size of the community we serve ’ larger communities may need more space and power.
For the distribution of the COVID-19 vaccine, the specific requirements again depend on the population of the community served, and whether it is to be a central storage or smaller distribution sites. But we anticipate the ultra-cold refrigerators will require a little more space and better ventilation.
Whether it’s a rural child vaccine site or an urban / suburban COVID-19 vaccine sites, ideally we are seeking space within the cell site’s secure perimeter ’ or an adjunct which we can secure, and it is important to note that our refrigeration systems are silent, and they run off standard 220 or 120V.
TowerXchange: What’s in it for tower owners in terms of brand and reputation enhancement?
Dr Harvey Rubin, Founder, Energize the Chain: I noticed at the TowerXchange Meetups that government relations are critical for tower companies and MNOs. Becoming a critical government partner in the dissemination of vaccines is a great way to earn favour and could help with future zoning and access to government land.
A partnership with EtC would be a substantial programme for your Corporate Social Responsibility initiatives, and it’s important work, giving your staff a renewed sense of the criticality of their jobs.
And of course, we’re all keen to see a resumption of business as usual after the pandemic. Restoration of normal trade will unlock more subscribers, more data use, more ARPU and a healthier mobile market for all stakeholders.
TowerXchange: What does EtC need from tower owners in low and middle income countries? What are the first steps they should take?
Dr Harvey Rubin, Founder, Energize the Chain: Particularly insofar as the distribution of the COVID-19 vaccine is concerned, we need to hear from tower owners in low and middle income countries NOW! I know of no other entities better positioned to help us complete the cold chain than YOU! So please email me at rubinh@upenn.edu or visit www.energizethechain.org.
We will quickly seek to agree an MOU. We’re looking for any of four things: sites, in-country logistics, access to energy, and access to data. If you can offer any of these four things, we want to hear from you! Once we have all that, EtC can take that to the local Ministry of Health, get them on board, and build an end-to-end cold chain to deliver vaccines.
While we’ve all been thrilled to hear the good news about the progress of phase three trials, the reality is that the vaccine is unlikely to reach most low and middle income countries before the second half of 2021. But the logistics are complicated, and completing the cold chain is perhaps the biggest challenge. This is a major undertaking, requiring many thousands of sites. It’s going to take time ’ it’s important we start now!
I look forward to hearing from your readers!
Please email Harvey today and let him know how you can help: rubinh@upenn.edu. Your message may save lives!
Introducing Dr Harvey Rubin and Energize the Chain
Energize the Chain (EtC) is a non-profit organization that ensures the delivery of vaccines to people in low and middle income countries by utilising power available at cell tower sites to power the refrigeration systems that are necessary to keep vaccines at the proper temperature.
While EtC had been exclusively focused on providing the missing link in the ’cold chain’ provide vaccinations to children in remote areas, the COVID-19 vaccine represents a unique challenge, requiring even more cell sites, but this time more often in urban and sub-urban areas ’ exactly the kind of cell sites TowerXchange’s readers own and manage!
Energize the Chain was founded by respected infectious diseases expert Dr Harvey Rubin. You may recognise Harvey from his passionate contributions (and colourful bow ties!) at TowerXchange Meetups in Africa and Asia. Harvey is a Professor of Medicine with a secondary appointment as Professor of Computer Sciences at the University of Pennsylvania. The NIH, NSF, DARPA and the Global Alliance for TB Drug Discovery have funded his research in infectious diseases, resulting in more than 90 peer-reviewed papers.
