An Interview with Dr. Karan Sagar from Gavi, the Vaccine Alliance

The COVID-19 pandemic has shown that now, more than ever, the clean energy access and health sectors need to be working together to accelerate global clean electrification and ensure communities have access to health services and life-saving vaccines

By Hannah Blair, Communications Associate at CLASP, Co-Secretariat of the Efficiency for Access Coalition

The COVID-19 pandemic has shown that now, more than ever, the clean energy access and health sectors need to be working together. Partnership would accelerate both of our efforts to increase global clean electrification and ensure communities have access to health services and life-saving vaccines.

Dr. Karan Sagar, Head at the Health Systems and Immunisation Strengthening team at Gavi, the Vaccine Alliance, has been working to support countries in strengthening their health systems in order to improve immunisation coverage and equity in health and vaccines. Gavi works to improve access to new and under-used vaccines for millions of the most vulnerable children. However, in off- and weak-grid environments, poor health facility electrification and lack of viable refrigeration options pose significant barriers to their mission. With the spotlight on the anticipated global rollout of a COVID-19 vaccine, the Alliance is advocating for increased partnership with the clean energy access sector.

Read more of our interview with Dr. Karan Sagar of Gavi.

Gavi has been working on strengthening health systems and increasing vaccine access for more than a decade. How has the mission and scope of work changed over time?

The Alliance was founded in 2000 to bring together public and private sector actors with the shared goal of creating equal access to new and underused vaccines for children in low- and middle-income countries around the world. Today, we are helping to vaccinate almost half of the world’s children against a number of vaccine preventable diseases. Our mission currently is to save children’s lives by increasing access to vaccines in these countries.

We have made enormous progress in boosting vaccination coverage globally over the past two decades, however there are still millions of children missing out on lifesaving vaccines. That’s why in 2021, we will enter a new strategic period where our focus will be on equity. We should leave no one behind with immunisation, and our mission will be to save lives and protect people’s health by increasing equitable and sustainable use of vaccines in the countries where we work.

Given your work strengthening the vaccine cold chain, do you have any initiatives that focus on high-performing appliances?

In my role, I lead supply chain work within the Gavi Secretariat. One of my focus areas is on cold chain equipment for vaccine refrigeration. A critical component of vaccine rollout is storage, which requires high-quality cold chain equipment. In all of our countries of operation, we must ensure a robust supply and cold chain system to store and move the vaccine from the national level to delivery points (primary health centresor outreach sites). The Vaccine Alliance provides guidance, technical assistance and financial support to countries to help them better plan for, select, install and manage their cold chain equipment.

On the national level, Gavi supports governments with equipment procurement. The equipment includes walk-in coolers and freezers that can store huge volumes of vaccines. We also support countries to procure smaller equipment for individual health facilities. Our role is to come in and support countries to procure the most up-to-date, high-quality equipment.

Gavi has developed a dedicated platform to assist with this process — the Cold Chain Equipment Optimisation Platform. Through this platform, Gavi jointly invests in the purchase, deployment and installation of the modern, high performing cold chain equipment. This is an essential component of our supply chain strategy to ensure that these vaccines are kept at the appropriate temperatures from development to delivery. This is important because children’s lives are at stake.

How do you select high-performing and appropriately designed cold chain equipment?

Through our platform, we only support the procurement of Grade A, World Health Organisation pre-qualified equipment. We want to ensure countries are receiving not just any cold chain appliance but certified, high-efficiency options that are suitable for both on- and off-grid field conditions.

Energy performance is also extremely important. In the past, countries used refrigerators that ran on kerosene or alternative energy sources. We now see that the cold chain in these countries is changing, as we are now moving to more energy-efficient, environmentally friendly equipment, such as solar direct-drive refrigerators.

Tell us more about your experience working with solar appliances designed for off-grid conditions.

The solar direct-drive refrigerators have been transformative, as they have many advantages and require less maintenance. With solar direct-drive, the electricity goes directly to the fridge and the appliance is able to function without a battery. In the past, when we had similar equipment that used batteries for energy storage, there were issues with replacement and maintenance of the batteries.

Countries are able to procure these high-performing products through joint investment with Gavi and other donors. Gavi is investing $250 million and countries invest on their side. We are currently supporting the procurement of close to 65,000 units of refrigerators, including solar direct drive fridges for nearly 50 countries. This huge investment demonstrates the critical role of off-grid and high-performing appliances in vaccine storage and distribution.

Have the solar direct-drive refrigerators performed well and met your needs so far?

We are working closely with countries to evaluate the performance and utility of all products through post-installation inspections and other monitoring mechanisms. We want to see if these products are functioning well and meeting the required value. In terms of the performance of the equipment, we are satisfied with what we have seen and these products are helping to increase immunisation coverage in remote and under-immunised areas.

How is Gavi responding to the COVID-19 pandemic?

The first focus in response to the pandemic is to maintain ongoing immunisation programmes. The pandemic has caused unprecedented disruption to immunisation worldwide, putting millions of children at risk of preventable diseases like yellow fever, measles, meningitis, pneumonia and diarrhea. Gavi and our Alliance partners are working to ensure immunisation programmes are maintained, and are preparing for large-scale catch-up vaccination campaigns to protect those children that are now missing out.

Our second focus is to ensure a global response to COVID-19 pandemic that is effective and fair. We are supporting the global effort to identify and accelerate the development, production and delivery of a COVID-19 vaccine and to ensure those most at risk have access, no matter where they live. We are working with researchers and manufacturers and strategising how we can use our approach to rapidly ensure supplies are available globally.

Gavi has helped introduce pneumococcal vaccine, which protects against the leading cause of severe pneumonia, in 60 countries, including the Republic of Congo. Credit: Gavi Health.

We are also supporting humanitarian responses at the country-level through our health system grant program. We are allowing countries to re-program up to 10% of their health system strengthening grants to support coronavirus-related immediate responses. For example, by using the reprogrammed funds, countries are able to procure personal protective equipment and other infection prevention materials to maintain immunization and other primary health care services.

We are also pivoting towards planning how we can support countries in recovery. There are three main pillars for this:

  1. Maintain and restore immunization services
  2. Ensure adequate cold chain equipment is available for the COVID-19 vaccine response
  3. Respond to the fiscal impact of the pandemic on immunisation programmes

Adequate and extensive cold chain equipment will play an important role in the roll-out of the COVID-19 vaccine. Has Gavi been accelerating cold chain infrastructure in response to the pandemic?

Scaling access to cold chain is a huge part of our response to COVID-19, as we are preparing for a hopeful vaccine. This work is already going on, and we are scoping additional cold chain needs, costs and the market’s ability to respond. We are evaluating manufacturing of this equipment and the ability to deploy quickly.

We still know little about the vaccine itself. The real needs of the response will only be clear when we know the vaccine characteristics and delivery strategy. While the vaccine itself will shape our work moving forward, the Alliance is preparing to respond to country needs through a combination of off-grid, solar direct-drive and on-grid refrigeration options.

A vaccinator in a remote village outside Kinshasa, DRC, prepares for an immunisation session using a Gavi-funded Solar Direct Drive (SDD) vaccine refrigerator. Credit: Gavi Health.

Research and coordination are at the core of Efficiency for Access activities. Is there an area of work we should be emphasisng now to create resilient health systems and communities?

I think engagement with the private sector for off-grid cold chain systems to support health care delivery is important. A large number of health facilities in low- and middle-income countries in sub-Saharan Africa and Asia do not have reliable energy sources for the successful roll-out of health programmes. We may also need to partner with the private sector to fill gaps in the storage and last mile distribution of vaccines. We need to understand how the private sector can augment and support health systems through the deployment of equipment or electrification — whether on- or off-grid.

From your perspective are clean energy and health access stakeholders working together on this issue?

Increasingly, energy sector actors and health sector partners realise that we need to join forces and support each other’s work. We cannot achieve our goals without partnership. I think because of COVID-19, this has become ever more apparent: clean energy access and health service providers are being forced to talk and plan together. In the past, we have worked in parallel, but in silos.

As for Gavi, we are now having conversations about leveraging energy sector resources to bring solar power to health facilities. Working together would accelerate both of our efforts to increase global clean electrification and ensure communities have access to health services and critical vaccines that require refrigeration.