Plugging the cold chain gap for rural vaccinations in Kenya

In remote and off-grid areas in Kenya, a lack of suitable medical refrigeration solutions has left many children with a gap in their vaccination records. Now, a portable solar-powered fridge, the Vaccibox, can be taken to where it’s needed via bike or boat, and keeps vaccines cold even when there is no electricity supply. Ingenia spoke to Norah Magero, who won the Royal Academy of Engineering’s 2022 Africa Prize for Engineering Innovation with her breakthrough.

As a mechanical engineer and a mother, Norah started thinking about medical refrigeration when she was living in a rural town and struggling to get her young daughter all the vaccines she needed. “I’d find myself moving from one point to the other, looking for a specific vaccine because it had to be delivered at a specific week.”

At the time, she was also the local hospital’s technical and energy manager. A major source of frustration for her was how every time there was a blackout, she had to ensure the vaccines didn’t go bad. “Oh Lord, it was a race against time!” she exclaims. The root cause was the grid infrastructure – not an easy problem for one person to solve – so Norah began wondering how else she could keep the vaccines cool. “[Maybe] I can’t fix the grid, but I can fix something a bit smaller,” she says.

It wasn’t until she began running her own startup, Drop Access, that the idea for Vaccibox started to take shape. She and her team had started providing solar pumping solutions for dairy farmers, and her clients were struggling to sell all the surplus milk that they were producing before it soured in the heat.

Her initial inclination was to try an off-the-shelf refrigeration solution. However, the portable fridge that the team imported from China was not only very expensive, but also constantly broke and was unable to keep cool. “I have never seen so much trouble as with this gadget!” she says. They decided to develop their own fridge. “We were in way over our heads like a bunch of crazy kids. The only thing we had was confidence, and faith,” she laughs. “We were like, we’re engineers, we can do this!” And then, the COVID-19 pandemic hit. With the pressing need to vaccinate the population, the gap in medical cold-chain infrastructure Norah had battled with before had re-emerged on a grand scale – so the team pivoted.

As they set out to design the fridge, the needs of the user communities were always at front of mind. “We sat down with nurses, and with mothers just like me who were having challenges getting their children vaccinated. We sat down with healthcare managers of these low income and hard-to-reach healthcare facilities and asked them, ‘What do you expect in a solution?’ It’s designed for them, with them.”

Designing beyond a fridge

The importance of careful design had become obvious to Norah earlier in her career. After graduating from the University of Nairobi, Norah had taken a role auditing energy efficiency in buildings such as schools. She soon noticed that they were fighting a losing battle. Although the second-hand appliances inherited from Europe or the US still worked, they had been discarded because they no longer complied with energy efficiency standards where they had originally been used – making it impossible for the facilities to become energy efficient overall. “It was so sad when I came to realise this,” she says. “The design should incorporate what Africa needs, not what was made in some other country.” She is referring to a problem with a huge scope, encompassing everything “from solar pumping to solar refrigeration to solar panels, to something as simple as a microwave, or a fridge, home cooker or lightbulb”.

With its users’ needs in mind, the Vaccibox has not just been designed to keep the vaccines cold at a single given site; it can also help healthcare managers bring vaccines or other medical items, such as blood, to those that need them, no matter how far or inaccessible the roads are. Furthermore, the Internet of Things- and artificial intelligence-enabled device monitors internal temperature, battery, stock level, and location. This, along with an accompanying data entry system, means that the fridge also acts as a vaccination planning tool. By tracking vaccination doses carried and delivered, the technology can tell users if the stock is sufficient for the next day, or if they should make another order.

But getting to this point wasn’t without its challenges. One was that the COVID-19 pandemic was still at its height, and the team was hampered by part delays. They also hired external refrigeration experts to ensure the fridge they built would meet energy efficiency standards while remaining low cost. “We were pretty [new to] this, so we didn't have all that much financial muscle to finance it. Most of it was bootstrapped,” says Norah. “It was really, really frustrating. And when you simply don't have money to pay for something, you shelve it and you wait, and your dreams equally just wait on the shelf with you.”

Even once the designs were in place, getting it made presented other hurdles. Every manufacturing step, down to cutting the sheet metal for the casing, had to be done by Norah and her team. This sometimes meant travelling to specialist workshops, incurring extra transport and accommodation costs, or sourcing components or materials “from God knows where!” But they ended up with a working prototype all the same. When it was successfully trialled overnight, then over two days, a week and then a month at a facility, Norah says, “it was so amazing.”

During the tougher periods, encouragement from strangers discovering the product helped keep her going. “My head was all over, literally in the fridge, [I couldn’t] see the bigger picture.” But others did, with organisations like the Royal Academy of Engineering offering support and mentorship. “That tells us, you guys are onto something here and it’s good. That’s kept me sane to date,” says Norah.

Creating jobs and boosting local economies

Now, the Vaccibox has been piloted in two remote facilities. One is off-grid and fully dependent on solar power. Here, the fridge has allowed the facility to store vaccines for longer, allowing people greater flexibility in coming in for their vaccinations. Another pilot took place in a healthcare facility based on a Maasai conservancy. Because of the Maasai’s nomadic way of life and sparse population, women at the conservancy must often walk for tens of kilometres to bring children to the facility for vaccinations. With the Vaccibox, vaccinations could be brought to the child instead, in a door-to-door style campaign.

With these successful trials under the Drop Access team’s belt, what does the future for them look like beyond more equitable access to vaccines? “Drop Access is on a mission to provide affordable, practical, clean technologies to communities that are based in the rural, off-grid, low-income areas,” she says. “And it's developing economies for places that were rather considered dead – the workshop where we built VacciBox has employed people from the area, and now we see thriving markets around it.

“We’ve been able to employ so many people by manufacturing Vaccibox. And we saw how providing clean energy solutions in the way we’re doing creates so many jobs for youth, for women.” All of this hints at a much broader vision, of economic hubs centred around clean energy designed with and for the local communities. “As much as we are engineers and love engineering and making things, we’ve seen how providing these solutions can build economies and provide jobs for young people,” Norah says. “We get to revolutionise manufacturing in the African space.”