FREETOWN, Sierra Leone — President Biden this month announced plans to ship a half a billion doses of the Pfizer vaccine to the 100 lowest income countries in the world. That would include Sierra Leone and many other sub-Saharan African nations.
But there's a looming problem. The Pfizer vaccine needs to be stored at minus 100 degrees Fahrenheit. In all of Sierra Leone, population 7.8 million, only one functioning freezer can offer storage at that temperature. It's housed in a complex at the Ministry of Health's medical warehouse compound in the capital Freetown. It's only slightly larger than a residential fridge, and it's already being used to store an Ebola vaccine which requires similar temperatures.
"It's definitely a nice gesture by President Biden," says Dinsie Williams, a Sierra Leonean biomedical engineer. "But we do have to think about everything else along the supply chain of how they keep those vaccines at the right temperature for a long period of time and then having people access them regardless of where they live."
Health officials in Sierra Leone say they're likely to request other vaccines such as AstraZeneca and Johnson & Johnson, which only need to be stored in standard refrigerators.
But in Sierra Leone and other sub-Saharan African countries, even ordinary refrigeration is a challenge. Only about 1 in 4 Sierra Leonean households have power. The rate is down to about 6% in rural parts, according to Sustainable Energy for All, a collaboration between the United Nations and the World Bank.
"Access to refrigeration is very limited," says Williams. "Because there's very limited access to electricity, at least stable electricity, in most parts of the country."
Other countries in the region are only slightly better off: only 28% of health facilities in Sub-Saharan Africa have reliable power supplies.
A revolutionary new generation of solar fridges may prove crucial in the upcoming efforts to immunize Sierra Leoneans against COVID. UNICEF and GAVI, the vaccine alliance, have been pushing to deploy these fridges to health clinics in Africa for childhood immunization programs.
Rather than store electricity in batteries to power them through the night, these so called "direct-drive" systems store coldness. They are so efficient and so well-insulated that they can stay cold for 3 days even if the solar panels aren't supplying power. And the lack of batteries makes them far simpler to operate and maintain.
Saffa Kamara, an immunization officer with UNICEF in Sierra Leone, raves about these solar fridges.
He says they are "far, far better" than earlier solar models, gas-powered ones or even conventional fridges run off a generator.
"All we need at the moment is [the new] solar refrigerators so we can reach the hardest areas, the most difficult communities and immunize the children," he says. And they could also be the solution to the COVID vaccine storage problem as well, particularly for the vaccines that don't require ultra-cold temperatures.
The Songo Health Clinic in Northern Province is one of the many government health facilities across Sierra Leone that doesn't have electricity.
Mariama Koroma, who runs the clinic, says at times they have to deliver babies by flashlight. But they do have a solar fridge for their vaccines — one of 371 in the country.
"All the vaccine that we are supposed to use in Sierra Leone, we have here," Koroma says peering into the thick-walled refrigerator.
Sierra Leone is in the early stages of doing COVID vaccinations. So far only a tiny portion of the population has been immunized. And the limited COVID doses haven't yet been distributed to small clinics like Koroma's in Songo.
But as more vaccines do arrive, the new solar freezers will be crucial to allow doses to be distributed, stored and eventually administered to people in many parts of Africa with limited or no electricity — an urgent task as COVID-19 cases rise in Africa.
ARI SHAPIRO, HOST:
As COVID-19 cases rise in Africa, there is added urgency to get more Africans vaccinated. So far, less than 2% of the population is fully immunized against the virus. The lack of vaccines has been the biggest barrier to getting shots into African arms. But there are other challenges as well, including keeping doses cold. NPR's Jason Beaubien reports from Sierra Leone.
JASON BEAUBIEN, BYLINE: In the capital, Freetown, the parking lot of the Ministry of Health's medical supplies warehouse is littered with broken down vehicles. Abandoned ambulances donated by China and Japan sit with their doors splayed open. Four-by-fours list on flat tires. Cars coated in dust are strewn willy-nilly. But at the back of the compound inside a locked beige building, industrial walk-in refrigerators and freezers beep and hum.
SENGEH MOMOH: So for the routine immunization vaccines and the COVID, this is where we keep them.
BEAUBIEN: Sengeh Momoh is the assistant logistics officer at the national warehouse. Three of the shipping-container-sized fridges are set to keep vaccines at just above freezing. Two others, which are also used to make ice packs for shipping medical supplies, are set to minus 20 degrees centigrade. In a separate building, another smaller freezer holds the Ebola vaccine, which requires ultracold temperatures similar to the Pfizer COVID-19 vaccine.
MOMOH: For the Ebola, the other building there - they have the refrigerator. They have - it's minus 70.
BEAUBIEN: But there's only that one functioning freezer in the whole country capable of keeping vaccines at minus 70 degrees centigrade, close to 100 degrees below zero Fahrenheit. Outside of major cities in Sierra Leone, even keeping vaccines that only need to be kept at normal household fridge temperatures is a challenge.
DINSIE WILLIAMS: Access to refrigeration is very limited...
BEAUBIEN: Dinsie Williams is a Sierra Leonean biomedical engineer.
WILLIAMS: ...Particularly because there's very limited access to electricity, at least stable electricity, in most parts of the country.
BEAUBIEN: Sierra Leone has one of the lowest rates of electrification in the world. Only about a quarter of households have power, and the rate drops down to about 6% in rural parts of the country, according to the World Bank. And the issue isn't just limited to Sierra Leone. Across sub-Saharan Africa, 60% of health care facilities lack electricity. President Biden this month announced plans to ship a half a billion doses of the Pfizer vaccine to the 100 lowest-income countries in the world, which would definitely include Sierra Leone. But Williams and others say it would be difficult for many African countries to integrate Pfizer into their immunization plans.
WILLIAMS: It's definitely a nice gesture by President Biden, but we do have to think about everything else along the supply chain - of how do you keep those vaccines at the right temperature for a long period of time and then having people access them regardless of where they live.
BEAUBIEN: A revolutionary new generation of solar refrigerators is helping to preserve vaccines that need to be kept just above freezing. Rather than store electricity and batteries to power them through the night, these so-called direct-drive systems store coldness. They're so efficient and so well-insulated that they can stay cold for three days, even if the solar panels aren't supplying power. And the lack of batteries makes them far simpler to operate and maintain. UNICEF and GAVI, the Vaccine Alliance, started rolling them out in parts of Africa in 2017, primarily to store vaccines for childhood immunization programs.
SAFFA KAMARA: Far, far better than any of the gasoline or whatever electricity, particularly for our country.
BEAUBIEN: Saffa Kamara, an immunization officer with UNICEF in Sierra Leone, raves about these new direct-drive fridges.
KAMARA: All we need at the moment is solar refrigerators, you know, to see how we can reach the hottest areas, the most difficult communities, you know, and immunize the children.
BEAUBIEN: The Songo Health Clinic in Northern Province is one of the many government health facilities across Sierra Leone that doesn't have electricity. Mariama Koroma runs the clinic and shows me the main waiting room.
MARIAMA KOROMA: Here is our (unintelligible) clinic.
BEAUBIEN: She says at times they have to deliver babies by flashlight, but they do have a solar fridge for their vaccines.
KOROMA: All the vaccine that we are supposed to use in Sierra Leone, we have it here. Only the hepatitis vaccine - we don't have it. We don't have a rabies vaccine. But you want that - it's for children who have it.
BEAUBIEN: And she's able to store those vaccines for routine childhood immunizations on site in the solar fridge. Sierra Leone is in the early stages of doing COVID vaccinations. So far, only a tiny portion of the population has been immunized, and the limited COVID doses haven't yet been distributed to small clinics like this one. But as more vaccines do arrive, the solar freezers, like the one in Koroma's clinic, will be crucial to allow doses to be distributed, stored and eventually administered to people all across the country.
Jason Beaubien, NPR News, Freetown, Sierra Leone. Transcript provided by NPR, Copyright NPR.