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Smart bags for bringing vaccines into the bush

Design: Didier Kassaï for Heidi.news

Too hot, too cold: vaccines do not like temperature variations. In Burkina Faso, an engineer created smart, isothermal vaccine transport bags making it possible to regulate the temperature remotely.

This article was originally published in French on Heidi.news. It is the fourth episode of an exploration entitled "11 African Solutions for the Future World".

Too hot, too cold: vaccines do not like temperature variations. They can even lose their active ingredients, which can make vaccination campaigns fail. What if it were possible to regulate them remotely? In Burkina Faso, an engineer has turned the hypothesis into reality by creating smart, isothermal vaccine transport bags.

Nicolas Tiendrebeogo rode his almost all-terrain motorbike, with the cool box fixed on the luggage rack. He did that for many kilometres. Sometimes as many as a hundred a day through the bush to vaccinate dozens of children in the most remote parts of Burkina Faso. "At home, people are often very far from health centres, so we move towards them. We put ice packs in our coolers to keep the vaccines cool, but it's still very complicated to keep those vaccines at the right temperature over long distances," says the health worker, who is in charge of the vaccination programme in south-central Burkina Faso.

Read the article in French: Des sacs intelligents pour amener des vaccins en pleine brousse

Generally, a vaccine must be kept between 2 and 8 degrees to retain all its properties and effectiveness. The Vaccine Control Pellet (VCP) on each vial allows agents to easily recognize a product that has been damaged by exposure to excessive heat. But there is no indication whether the vials have been stored at too low a temperature. "Often vaccines have been over-frozen by the ice packs. You can't really tell which point, because there are no thermometers in the coolers. A temperature monitor would still change our lives," says Nicolas Tiendrebeogo.

Remote temperature control of vaccines

In Ouagadougou, the capital of Burkina Faso, a 29-year-old engineer took up the problem. After years of reflection during his studies at the Polytechnic University of Bobo-Dioulasso, in the west of the country, Christian Cédric Toé finally found the solution. In 2015, he created "Laafi Bag", a smart bag that makes it safe to transport vaccines to the most remote areas. Inside the backpack, an isothermal box, coupled with a thermoregulation system, makes it possible to keep the vaccines between 2 and 8 degrees for more than four days. This is four times longer than the vaccine carriers currently on the market. The temperature of the Laafi Bag can also be controlled remotely. This is a means of ensuring that at no time during transport have the vaccines been altered by too great a temperature variation.

If you have time: Des engrais bio pour sortir les agriculteurs africains de la pauvreté

"Deterioration of vaccines is not dangerous for patients. An inactive vaccine will act like a placebo. It's as if they were injected with physiological liquid," reassures Christian Cédric Toé. Reading immunization reports, his country is one of the African champions of vaccination: according to those reports, more than 90% of Burkinabe children would be vaccinated. In sub-Saharan Africa, the average is at 76%, according to the World Health Organization (WHO). If these children have indeed been vaccinated, have the products administered to them been effective enough to immunize them? The Burkinese engineer doubts it:

"The health worker cannot know the exact temperatures to which his products were exposed during transport. He will administer them to the population and write in the immunization report that everything went well. But he does not know if all the vaccines were active! This distorts the data on immunization coverage in some areas, which will then be at risk of being excluded from future immunization campaigns because it will be assumed that immunization has already been carried out in those areas. But under what conditions?"

Tracing the path of vaccinators

Sometimes the human factor is a problem. Christian Cédric Toé realized this during a scouting mission in northern Burkina Faso. That was three years ago when the Laafi bag was only at the idea stage. "I was told of an agent who had been in the maquis [Burkinese bistro] with his cooler carrying vaccines and who unfortunately left the place drunk. All his vaccines were altered. He buried them and made a false report, saying that he had administered them well, so as not to have a problem with his superiors," the engineer said with a smile on his face. His smart bags, with their chips, make it possible to trace the path of the health workers, from the time they leave the medical centre to the place where the vaccines were administered. Christian Cédric Toé and two of his colleagues are currently working on this device, which is still under development. At the same time, the team was able to test its Laafi bag for the first time last March.

But they had to lower their ambitions because of Covid-19. Initially, the three partners were to travel to three localities in northern Burkina Faso to carry out situational tests with vaccinators. Blocked by the travel ban put in place following Covid-19, they had to make do with a wasteland on the outskirts of Ouagadougou. "The current health crisis has slowed everything down. I've been waiting for weeks for my equipment to be delivered. I still don't know when it’ll come. That's our problem as African inventors: most of the equipment we need is abroad. Unlike the Chinese or the Americans, we're totally dependent on its delivery and are at a disadvantage in the field," says Christian Cédric Toé.

Despite the constraints, the Burkinabe engineer continues on his way. Abroad, his Laafi Bags have attracted partners and the curious. Two Taiwanese and American manufacturers provide part of the equipment for the smart bags. The African Development Bank (ADB) is financing part of the research. As for Christian Cédric Toé, he travels all over the world to talk about this invention which, according to him, could well change the future of vaccination throughout the world. As he did three years ago, when he was in Geneva, he was invited to a forum by Gavi, an international organization that promotes better access to vaccines in poor countries.

"Africa has the lowest immunization coverage in the world."

In sub-Saharan Africa, the needs are titanic. According to the WHO, nearly 31 million children under the age of five suffer each year from diseases that could have been prevented by immunization. Worse, more than half a million of them die every year because they have no access to vaccines. "Africa has the lowest immunization coverage in the world. Unfortunately, many countries still have a supply of vaccines that is non-existent in some places, either because the health system is weak or because the cold chain is almost non-existent in some areas and vaccines cannot be properly stored there," says Dr Richard Mihigo, regional coordinator of the immunization programme at the WHO Africa office.

In Ouagadougou, Christian Cédric Toé is currently finalizing the validation of all the technical components of his Laafi Bag, before tackling what he has always dreamed of: WHO approval of his solution. A complex and lengthy process that would allow Burkina Faso's smart bags to find themselves, who knows, perhaps one day on the back of an Afghan or Australian health worker. Because the stakes of vaccination are global. According to the WHO, 1.5 million additional deaths could be prevented each year by improving immunization coverage.

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Didier Kassaï is a self-taught illustrator, watercolorist and cartoonist, born in 1974 in the Central African Republic. His first comic book, L'Odyssée de Mongou, was published by l'Harmattan BD in 2014. The following year he published Tempête sur Bangui, in two volumes La Boîte à Bulles. For this series on African solutions, he created eleven original illustrations for Heidi.news.

11 African solutions for the future world