[The fragile beginning of the vaccine cold chain in Spain]

Two studies aiming to analyze the vaccine cold chain throughout Spain, performed from 1988-89, sparked interest in vaccine logistics among public health authorities. The studies were performed using evaluation methodology based on cold chain monitor cards with a time-temperature indicator (Battersby's report) and cross-sectional surveys on the conditions of the cold chain (Ferrando's report) in the second and third levels (provincial and local stores). The technical reports revealed the precariousness of the situation, identified the weak points that were jeopardizing the vaccines' efficiency, and favored awareness of an activity that constitutes the vertebral column of any immunization program. The improvements proposed were gradually implemented by regional governments. More funds for equipment and personnel training were provided and specific management protocols were established.