In 2022, Tanzania embarked on a journey to transform its vaccine distribution system. The Ministry of Health (MOH) under the immunization and vaccine development (IVD) program in partnership with the President Office Regional Administration and Local Government (PO-RALG), Nexleaf Analytics and inSupply Health, launched ColdTrace Transport as a pilot project in ten districts with the goal of ensuring that every vaccine dose retained its potency during distribution using real-time temperature tracking. Every vaccine delivery trip was monitored with the ColdTrace Transport device, a Bluetooth-based sensor that pairs with a smartphone app that logs and stores temperature and GPS data. The sensor gets placed with the vaccines, for instance, in a vaccine cold box in the bed of a pickup truck, and monitors and records real-time temperature and location data. Instant, real-time alerts are sent to the paired smartphone—either the driver’s or district officer’s – whenever the temperature goes outside the acceptable set range for transportation, enabling prompt corrective actions to ensure vaccine potency. In less than two years, this effort has expanded across all 31 regions of mainland Tanzania and Zanzibar, reaching over 450 district vaccination officers and safeguarding vaccines for millions.
(Courtesy of Nexleaf Analytics)
Expanding Impact Nationwide
Following a successful pilot program, ColdTrace Transport was scaled nationwide in Tanzania. This initiative equipped immunization officers with advanced temperature monitoring devices and comprehensive training that included practical sessions on essential vaccine handling practices. During the period from January to May 2024, immunization officers from all 31 regions in both the Tanzania mainland and Zanzibar used ColdTrace Transport devices on a total of 1,144 trips, covering an extensive distance of 92,390.76 kilometers and recording 315,900 minutes of transportation time. Notably, the monitoring solution had a significant impact in regions such as Mwanza and Geita, where frequent temperature fluctuations due to geographical difficulties had previously posed challenges to vaccine preservation and delivery.
During this period, over 90% of trips recorded temperature data, demonstrating impressive data completeness. Notably, Dar es Salaam and North Pemba achieved exceptional results with minimal data gaps. However, regions such as Dodoma and South Unguja encountered challenges, with data gaps exceeding 40% of trips. Through continuous learning and monitoring, the ColdTrace Transport device effectively reduced temperature excursions, particularly warm excursions. Initially, excursions affected 52% of distribution days, but a significant improvement was observed in May.
During the training program, immunization officers received comprehensive education on the intricate aspects of vaccine packing and storage during transport. As a result of feedback from the pilot, a national SOP for Vaccine Packing was developed, and the SOP for Temperature Monitoring was revised to include transport. Particular emphasis was placed on the proper handling techniques for heat- and freeze-sensitive vaccines, ensuring adherence to best practices. These hands-on sessions equipped the officers with the skills to monitor real-time data related to the temperature, distance, and location of vaccine shipments directly from their mobile phones. As a result, there was a substantial reduction in temperature excursions – over 40% – leading to a significant decrease in the risk of vaccine spoilage. This improvement enhanced the reliability and effectiveness of Tanzania’s vaccine distribution system.
Overview of distance covered, time spent, and number of trips undertaken during vaccine transportation.
(Courtesy of Nexleaf Analytics)
Overcoming Geographical Challenges for Comprehensive Training
To accommodate Tanzania’s vast geographical expanse, the project team strategically divided the country into five distinct zones: northern, central, southern highlands, lake, and coastal. Within each zone, a central location was meticulously selected to serve as the training hub. For example, immunization officers from Tanga, Kilimanjaro, Arusha, Manyara, and Simanjiro convened in Arusha, a location chosen for its optimal accessibility within the northern zone. The training program was meticulously designed to take place in two rounds, ensuring that both regional and district immunization officers, along with their assistants, received in-depth instruction on ColdTrace Transport. This strategic approach ensured that 100% of the targeted personnel acquired comprehensive knowledge and skills related to the ColdTrace Transport system.
In Tanzania mainland and Zanzibar, over 450 staff involved in vaccine handling and transportation underwent training sessions. This remarkable accomplishment was made possible despite the country’s challenging landscape. Additionally, by implementing the ColdTrace Transport real-time monitoring system, it is estimated that Tanzania has reduced the incidence of vaccine spoilage due to temperature fluctuations by nearly 30%. As a result, over 3,000 vaccines now arrive safely at their destinations each month without critical damage from unsafe temperature exposure.
(Courtesy of Nexleaf Analytics).
Empowering Immunization Officers with Real-Time Data for Decisive Action
ColdTrace Transport’s true impact lies in equipping immunization officers with real-time data through a mobile application. This enables them to continuously monitor vaccine temperatures and promptly address any excursions. The app sends alerts to officers’ phones whenever temperature excursions occur, providing a timely window for intervention. Since implementing this technology, over 150 immediate corrective actions have been taken to avoid vaccine spoilage due to temperature exposure. Data-driven action to protect and preserve vaccines demonstrates the effectiveness of this innovative approach to safeguarding communities from preventable diseases.
One officer shared the immediate benefits of ColdTrace Transport: “We used to discard approximately 20 doses in average per month, but currently it has diminished to zero. I figure the ColdTrace device is the best experience for real-time monitoring of temperature during transportation.”
Furthermore, the “drop off” feature in the app tracks each drop-off location, allowing the Ministry of Health to trace each vaccine shipment’s journey from storage facilities to health centers with unprecedented precision. Remarkably, this feature has enabled the documentation of over 7000 distribution points throughout Tanzania, providing the Ministry with a substantial data set to optimize future distribution strategies.
Bluetooth-based sensor paired with a right smartphone app, provides temperature and GPS data with instant real-time alerts. (Courtesy of Nexleaf Analytics).
Tangible Improvements in Vaccine Safety
In Tanzania, the ColdTrace Transport project allows immunization officers to effectively monitor vaccine integrity during distribution, achieving a remarkable 98% success rate in safe deliveries, a significant improvement from the previous 75%. The project’s focus on reducing temperature excursions has also resulted in a 20% decrease in vaccine wastage.
As one immunization officer put it: “The ColdTrace device is automated and generates real-time information directly to your phone. You can’t miss an alert because you always have your phone with you. This allows immediate action to maintain vaccine quality.”
At the national level, several process modifications came out of the transport data and discussions that impacted how vaccines are distributed today. Distribution routes are streamlined to minimize driving distance, and early morning hours are prioritized to avoid vaccines being exposed to sunlight and heat during peak daylight hours. Where possible, immunization officers now opt for closed-top vehicles, which limit exposure to outdoor temperatures.
Officers also noted cost savings as a result of optimized route management, reduced vaccine wastage, and minimized transportation expenses.
Looking Ahead: Recommendations for Future Integration and Impact
To ensure ColdTrace Transport’s integration into Tanzania’s healthcare infrastructure, stakeholders recommend proactive measures by the Ministry of Health. These steps include incorporating ColdTrace data into official policy guidelines, securing continuous funding, and ensuring local maintenance of devices. To optimize the system, addressing technical needs like network compatibility and improving alarm responsiveness is crucial. Moreover, utilizing GPS for location tracking and expanding device coverage to outreach programs and facility levels can enhance ColdTrace’s accountability and strengthen temperature monitoring capabilities.
To ensure widespread use across all regions and among new healthcare professionals, the Ministry emphasized the significance of Bluetooth connectivity and Training of Trainers (ToT). As a result of the Ministry’s dedication to these improvements, ColdTrace Transport will play a vital role in Tanzania’s vaccination initiatives, creating a resilient and sustainable solution for digitally transformed vaccine distribution throughout the country.
This work was conducted with support from the ELMA Vaccines and Immunization Foundation and Gavi, the Vaccine Alliance, to inform global standards and improve processes to safeguard vaccines during transport.
