Malaria is caused by Plasmodium parasites (single-celled microorganisms) transmitted to humans through the bites of infected female Anopheles mosquitoes. They infect liver cells as sporozoites and multiply, producing thousands of merozoites. These then invade red blood cells, multiply, and destroy the cells, causing malaria symptoms.
Some of the merozoites develop into sexual forms called gametocytes. When a mosquito bites an infected person, it ingests gametocytes, which develop into sporozoites in the mosquito's intestine, completing the cycle.
Symptoms of malaria include fever, chills, headache, nausea and, in severe cases, complications such as anaemia, respiratory distress and cerebral malaria may occur.
Africa bears a disproportionate share of the global malaria burden. According to the World Health Organisation (WHO), the African region accounted for approximately 94% of malaria cases and 95% of malaria deaths globally in 2022. Children under five (78% of all malaria deaths in the region) and pregnant women are the most vulnerable groups, with malaria being a leading cause of morbidity and mortality among these populations.
Unfortunately, progress in the fight has stalled since 2015, pushing the goal of eradicating the disease by 2030 even further away. If current malaria interventions are to be maintained, Member States will face a budget deficit of US$1.5 billion by 2026. The problem of insecticide and drug resistance, in particular, will require additional funding for next-generation raw materials.
In addition, increasingly extreme weather events are complicating control efforts, and the spread of the Anopheles stephensi mosquito in urban areas is a growing concern.
The health impact is profound. Repeated infection in children can lead to chronic anaemia, which affects cognitive development and physical growth. Pregnant women are at higher risk of maternal and newborn mortality, low birth weight and premature birth if infected. The disease thus puts enormous pressure on health systems and often overwhelms health facilities, especially during peak transmission periods.
The consequences of malaria go beyond health and severely affect the socioeconomic fabric of African societies. Cycles of poverty can emerge as families must bear the costs of treatment, transport to health facilities and loss of income due to illness or caregiving responsibilities. Malaria hampers productivity and affects agricultural production and economic development. Where severe outbreaks occur, investment and tourism are hampered, further slowing economic growth.
The fight against the disease involves a multi-pronged approach, combining prevention, diagnosis and treatment strategies. Key measures include:
Insecticide-Treated Nets (ITNs): The distribution and use of ITNs have significantly reduced malaria transmission by protecting people from mosquito bites while they sleep, as the Anopheles mosquito is primarily active at dusk and night.
Indoor Residual Spraying (IRS): Regularly spraying insecticides on the interior walls of houses attempts to kill mosquitoes that come into contact with the treated surfaces.
Antimalarial Medications
Treatment with artemisinin-based combination therapies (ACTs) and preventive measures for high-risk groups, such as intermittent preventive treatment in pregnancy (IPTp), is proving effective.
Rapid Diagnostic Tests (RDTs): RDTs enable accurate and timely diagnosis to begin appropriate treatment as soon as possible.
Surveillance and Response: Surveillance systems are being strengthened to monitor trends and outbreaks, allowing for targeted responses and resource allocation.
Technological innovations: Increasingly, the latest technologies are also being harnessed to the fight. For example, various mobile apps are used for surveillance, micro-planning, prevention (e.g. Anti-Mosquito Repellent Sound app), diagnosis and management (telehealth apps).
Artificial intelligence (AI) is used in diagnostic tools and monitoring systems. However, reliable data sets and local AI expertise are required to fully exploit these technologies.
Despite all efforts, malaria still represents a heavy burden on the African continent. The introduction of a vaccine against the disease offers new hope of significantly reducing its impact and moving closer to the goal of one day eradicating it completely.
Clinical trials have shown that malaria vaccination can significantly reduce incidence. By reducing the number of malaria cases, the vaccine can also reduce malaria-related deaths and the severe course of the disease, especially among the most vulnerable populations.
The vaccination will not stand alone but will be an essential addition to the existing arsenal of malaria control measures. The WHO currently recommends two vaccines, especially for children in regions with moderate to high transmission.
RTS,S/AS01 (Mosquirix) from GlaxoSmithKline was the first vaccine and was already endorsed for widespread use by the WHO in October 2021. Since 2019, almost 2 million children in Ghana, Kenya and Malawi have been vaccinated as part of the Malaria Vaccine Implementation Programme (MVIP).
This pilot programme demonstrated the safety and effectiveness of the vaccination in addition to the feasibility of the campaign. Both severe malaria cases and overall mortality decreased in vaccinated children. The vaccine is now being gradually introduced into routine childhood immunisation schedules in several countries, including Cameroon and Burkina Faso.
The other vaccine is R21/Matrix-M, developed by the University of Oxford and manufactured by the Serum Institute of India. Clinical trials have shown that the R21 vaccine has an efficacy rate of about 75% against malaria attacks 12 months after administration.
Only recommended and pre-qualified by WHO in October 2023, it is currently being rolled out in some countries, including Côte d'Ivoire. It is expected to be administered to millions of children in 2024 and 2025.
These two vaccines represent significant advances in the fight against malaria and offer new tools to reduce the disease burden in some of the most affected regions. Ongoing monitoring and data collection will continue to inform their use and effectiveness in different settings.
Pharmaceutical integrity is the assurance that medicines are genuine, safe and effective throughout their life cycle, from production to administration to the patient. Ensuring this is of paramount importance for patient safety, public health and, not least, trust in healthcare systems.
The primary concern is undoubtedly patient safety. Ensuring that medicines are not only manufactured under proper conditions but also stored and transported prevents harm. Contaminated or spoiled pharmaceuticals can cause serious health problems, including worsening of the condition or even death.
But integrity is, of course, also essential for pharmaceuticals' main purpose, their potency and effectiveness. If integrity is compromised, treatment failure can result, prolonging the illness and increasing the risk of complications. Reliable medicines are, therefore, essential for achieving the desired therapeutic results.
This is of particular importance in infectious diseases, which rely on containment so that treatment regimes are effective, reducing the spread of disease and preventing outbreaks.
The success of vaccination programs also depends heavily on the integrity of vaccines. Any compromises in quality, storage or transportation can lead to reduced efficacy, thus undermining efforts to control or eradicate diseases.
Integrity disruptions can impact health and have economic consequences, which can adversely affect health issues. For example, the increased costs of ineffective drugs can lead to health systems in countries that already have problems financing them experiencing even more significant difficulties in providing health care to their populations.
It can also damage public trust in health systems, which is fundamental to public cooperation and compliance with medical advice. Any breach of integrity can undermine the trust that has often been built up over a long period of time and effort and prevent people from seeking the medical care they need.
Reefers, or refrigerated shipping containers, face several challenges in Africa. These challenges affect the storage and transport of temperature-sensitive goods, including pharmaceuticals.
Climate and Weather
The greatest challenge is the high temperatures in most regions of the African continent. Due to climate change and the resulting heat waves, the situation is becoming increasingly precarious.
At the same time, there are more storms and floods that can cause severe damage to container terminals and depots. On the one hand, this affects the reefers directly, and on the other hand, it affects their power supply.
Equipment Shortages
There is a high demand for refrigerated containers, especially during the main fruit export seasons (for example, citrus in winter, berries in summer or apples in autumn). This demand often leads to shortages, as a large proportion of reefers are tied up in fruit. A global imbalance in trade flows leads to more extensive stocks of equipment in certain regions while it is sorely lacking in others.
Obsolete Equipment and Processes
Often, outdated and inefficient refrigeration equipment is used, which is prone to failure. The lack of advanced temperature monitoring and data recording systems limits the ability to track and manage temperature conditions throughout the supply chain, increasing the risk of spoilage.
There is also a lack of trained personnel who understand the intricacies of cold chain management, including the handling, monitoring and maintaining temperature-sensitive products.
Infrastructure and Capacity Problems
The electricity supply is not guaranteed everywhere; rural areas, in particular, have little infrastructure or are constantly struggling with power outages. For example, Ghana has 74% - 86% access in rural areas vs 95% in urban areas (Source: UNinGhana on X, 01.02.2024).
Some ports face significant congestion. This is exacerbated during peak seasons and affects the timely loading and unloading of reefers.
So-called 40ft high cube reefers are very popular for the transport of refrigerated goods due to their large capacity and efficient temperature control. They are 1ft (about 30cm) higher than traditional standard containers. However, in South Africa, road traffic legislation imposes height restrictions on trucks (4.3 metres); if transporting high cube containers, the standard flat deck trailer combined with the international standard high cube container stands at 4.5 metres. This restriction can lead to legal and logistical complications, including possible fines and delays.
Transport networks, including roads and railways, are often underdeveloped. Unpaved roads and rugged terrain make transportation difficult.
Regulatory Compliance
Operating across multiple jurisdictions presents significant challenges for companies as they must navigate complex regulatory environments and ensure compliance with diverse standards and protocols.
The Importance of Reefer Monitoring for the Vaccine's Transport
Both current malaria vaccines must be stored and transported at temperatures between 2 and 8 °C (35.6°F and 46.4°F). This can be particularly challenging for distribution in tropical climates with partially limited cold chain infrastructure.
In particular, the adjuvant components, i.e. those auxiliary substances that are intended to strengthen the immune response of the vaccinated persons, are temperature-sensitive. But, the antigen itself can also be damaged at temperatures outside the defined range, thus reducing the effectiveness of the vaccine.
As we have already stated above, pharmaceutical integrity is essential for effectiveness. If the goods spoil, there are often significant financial losses. In addition, vaccination campaigns cannot be carried out as planned. Considering that a single reefer can contain hundreds of thousands of doses, you can imagine the importance of each container.
In addition, the spoilage of the cargo also has an ecological aspect: the expensive serums are now waste that must be disposed of. Pharmaceutical waste typically requires special handling and disposal procedures like incineration, autoclaving, or chemical treatment. Unfortunately, such waste sometimes ends up in landfills, which can have adverse consequences.
Therefore, the relatively narrow temperature range must be maintained throughout the entire process, from production to administration to the patient. Modern cooling systems can maintain precise temperature settings even under extreme external conditions.
If you are interested in other cold chain topics, read: Cold chain Australia
More Than Temperature Monitoring
Even the best cooling system needs monitoring, especially its power supply, without which the temperature in the reefers would rise quite quickly. Systems that provide all critical data in real-time, such as temperature, humidity, and power supply status, are ideal. This ensures immediate detection of deviations from the required parameters.
Warnings and Alarms
Automated monitoring also has another advantage: warnings and alerts are sent if predefined thresholds are reached or exceeded in addition to simply displaying information. This means that problems can be tackled early, for example, by using an emergency power generator in the event of a power failure.
Real-time Monitoring 24/7
If reefers are monitored manually, this often happens once or twice per shift. The rest of the time, the reefer is left to its own devices. This means that violations of the limits may not be discovered until much later, without any chance of solving the problem.
In contrast, automatic monitoring provides an up-to-date overview of all data from all reefers at all times.
Personnel Safety
Manual monitoring also requires workers to move around the busy and risky yard. Automated solutions, on the other hand, provide a detailed, continuous overview of all reefers simultaneously and in real time. Someone only needs to cross the yard to connect the power supply and monitor it in case of an emergency.
Reefer Container Claims
Comprehensive logs of temperature readings and door openings (for inspections) provide a complete history of data, which can be critical when processing claims. This clear and irrefutable evidence can be used to confirm or disprove claims, reducing the likelihood of disputes.
Proactive Measures
The collected data can also be used to identify patterns and implement preventative measures, reducing the risk of issues leading to claims. For example, repeated logs of power interruptions may indicate a plug issue, which can be identified and resolved more quickly.
Building Customer Trust
Automated monitoring systems' transparency and reliability build customer trust in the process. You can also give customers access to their reefers' data. They are more likely to trust a system they can see perform in real-time (see also: Caribbean exports).
What are the trends in the cold Supply Chain Africa?
The African cold chain reefer management market is growing steadily. By 2050, Africa could be home to almost as many people as China and India combined. By then, 60% of the population is expected to be urbanised, and the number of middle-class households will have increased enormously.
In recent years, there has already been a significant increase in demand for effective cold chain solutions due to the growing economy and the increased need to protect the quality and safety of temperature-sensitive items.
In South Africa, for example, the National Transport Master Plan 2050 was established, which envisages the development of a multimodal transport system. There are also efforts and programs in other countries to support the industry. For example, the African Centre of Excellence for Sustainable Cooling and Cold Chain Systems (ACES), based at the University of Rwanda's Rubirizi Campus, is a centre for research, data collection, training, policy support and technology development.
COVID-19 has brought movement to a whole host of things, including awareness of health and addictions. Africa was highly dependent on foreign sources for pharmaceutical products. To counteract this, new plants are being built locally, for example, by Moderna and BioNTech, to name two names that became well-known during the Corona period. The African Union has set itself the goal of covering 60% of its vaccine needs from intra-continental production by 2040.
Whether along the coasts or the major rivers, by train or truck, most pharmaceuticals are transported in reefers. These are to be equipped with real-time monitoring systems to ensure the integrity of the goods, regardless of whether they are medical goods or food.
Despite advances in prevention, diagnosis and treatment, malaria remains a major health threat in sub-Saharan Africa. The recent introduction of malaria vaccines is an essential milestone in the fight against this disease. Ensuring rapid and safe distribution of these vaccines is now of paramount importance.
The integrity of the vaccines must be maintained without compromise, as any compromise would reduce efficacy and undermine efforts. Transporting vaccines in refrigerated containers faces numerous challenges, such as the very high temperatures that prevail across the supply chain Africa, as well as outdated equipment and processes.
Automated temperature monitoring provides real-time data, alerts of deviations for rapid intervention, and transparency. And, very important for the success of the campaigns, the monitoring is building trust. It helps to safely deliver cargo such as malaria vaccines, which is so valuable to the health and future of the populations of African states.
Delve deeper into one of our core topics: Refrigerated containers
Sources:
(1) https://www.who.int/campaigns/world-malaria-day/2024
(2) https://www.logupdateafrica.com/logistics/africas-cold-chain-market-setting-remarkable-trends-1348625
(3) https://www.sustainablecooling.org/aces/