Decommissioning and Safe Disposal of Vaccine Cold Chain Equipment in Low- and Middle-Income Countries: Focusing on...

Area of Science:

• Public Health
• Environmental Science
• Supply Chain Management

Background:

• Low- and middle-income countries (LMICs) face challenges with aging, inefficient cold chain equipment (CCE) for vaccine storage.
• Inadequate end-of-life management of obsolete CCE leads to environmental, occupational, and programmatic risks.
• Existing policies often neglect formal frameworks for decommissioning and disposal of vaccine CCE.

Purpose of the Study:

• To review and analyze end-of-life management practices for electrical vaccine refrigerators and freezers in LMICs.
• To identify risks associated with inadequate decommissioning and disposal of CCE.
• To propose a structured framework for safe and effective CCE end-of-life management.

Main Methods:

• A narrative, process-focused review of electrical vaccine refrigerators and freezers in LMIC settings.
• Synthesis of normative guidance from global health, environment, and waste agencies.
• Analysis of national policies, program reports, and peer-reviewed literature on CCE decommissioning and disposal.

Main Results:

• End-of-life CCE presents hazards including ozone-depleting substances, high global warming potential (GWP) refrigerants, oils, and batteries.
• A structured six-step process for decommissioning and disposal is outlined, from notification to licensed treatment.
• Implementation barriers include fragmented mandates, lack of financing, limited infrastructure, and weak inventories.

Conclusions:

• Safe decommissioning and disposal of vaccine CCE must be integrated into routine lifecycle functions and supply chain planning.
• A structured, stepwise process within existing asset and waste management frameworks can mitigate risks.
• Addressing end-of-life CCE management is essential for immunization supply chain performance in LMICs.