Bangladesh is set to start a trial of a new cholera vaccine. This is good news, as cholera is a nasty bug and, as we recently witnessed, capable of heightening geopolitical tensions. As readers of this blog will note, I have taken the bold pro-vaccine position in the past (sorry Jen). However, vaccines are only as effective as their storage.
Basically, most vaccines have to stay cold so bacteria and other microbes don’t grow in them. To stay cool (and safe) from the factory to the patient, vaccines require an effective cold chain. Basically this means a supply chain capable of keeping the product cold every step of the way (the WHO has a cool, if rather technical, page devoted to cold chains).
This isn’t a problem in most of the U.S., where vaccines are shipped cold from the factory, in refrigerated containers, and kept cool at clinics and hospitals. But it may be a challenge in places in like Bangladesh where infrastructure is not as developed. The result is either spoiled vaccines or vaccines that don’t make it to rural, isolated populations.
The purpose of this post is not to disparage the new vaccine or the Bangladeshi health system (how could I criticize anything that combines two of my favorite global health strategies, vaccines and fighting diarrhea?!). Rather, it is to underscore the need for physical infrastructure to complement health system infrastructure. Such a relationship requires cooperation not only between public health and development folks, but also between governments, non-profits, and corporations capable of large scale civil engineering projects.