It was 3:30 a.m. on a Sunday, September 26, 2021, and officials of the Ministry of Health were at the Kotoka International Airport to receive 1.5 million doses of AstraZeneca covishield to help fight the deadly COVID-19 pandemic.

Also at the airport were officials from the Ghana Health Service, Food and Drugs Authority (FDA), World Health Organization (WHO), and UNICEF who had defied the cold weather to ensure the doses were delivered, transported, and properly stored for the public to have access to safe and effective COVID 19 vaccines.

A few minutes earlier huge metal-coated cold crates arrived on a cargo flight carrying vials of Covishield and the main aim of the team at the airport is to ensure the vaccines are delivered in a timely and effective state.

Shortly after the aircraft landed, the German Ambassador to Ghana, Mr Daniel Krull in a brief ceremony, handed over, the consignment and documents covering the donation to one of Ghana’s Deputy Minister of Health, Alhaji Mahama Asei Seini who also handed them over to the Director General of the Ghana Health Service, Dr Patrick Kuma Aboagye.

After taking delivery of it, Dr Aboagye also handed it over to the Manager of the Expanded Programme on Immunization (EPI) Dr Kwame Amponsa-Achiano.

Immediately after the handing over ceremony, the crates of vaccines marked “time and temperature-sensitive product” were offloaded into an ultra cold vans which quickly conveyed the consignment to the national cold storage facilities for onward deliveries to cold storage facilities spread across the country.

The cold vans drove straight to the national cold rooms located in Ghana’s premier medical facility, the Korle-Bu Teaching Hospital in the heart of the capital of Ghana.

At the location,  there are five walk-in freezers—three of them capable of storing vaccines at temperatures between +2  to + 8 degree Celsius. The other two freezers are capable of storing vaccines at temperatures below -20 Degrees Celsius.
There is also a specialised ultra-cold room which has eight freezers with a capacity to store vaccines at between -60 and -80 Degree Celsius. These ultra cold facilities are more than adequate to store the large quantities of vaccines that the government has been importing to cater for the population.

Once the vaccines are delivered to the ultra cold freezers in the city, they are distributed to the two cold storage facilities located in each of the 16 regional capitals of Ghana.

From the regional points the managers at the district levels pick the vaccines and store them in their fridges and freezers which are not walk-in but are able to story at + 2 to +8 degrees celsius for onward distribution to the subdistricts made up of health facilities where the vaccines are stored in fridges and cold boxes.

At the health facilities where the vaccines are administered, freezers are used to prepare ice packs to maintain the temperatures in the cold boxes and also ensure the vaccines are not frozen before use.

All the storage facilities from the national level to the sub district level are used for storing both routine vaccines and COVID-19 vaccines.

The safe transportation and storage of the COVID-19 vaccines is also to preserve the shelf life as experts say onces the vaccines are removed from one storage point and delivered at a destination storage facility in-country with the help of a cold van at the right temperature they can be stored for up to six months.
Ghana is also using drones to deliver vaccines to areas without roads and have sent vaccinators out into communities , especially the migratory population that travels routinely from north to south across the country so their animals can graze. These vaccinators stay with the community for periods of time while administering the vaccines.

Target 

Ghana’s strategy is to create herd immunity by vaccinating at least 20 million out of the current estimated 30.8 million Ghanaians. President Nana Addo Dankwa Akufo-Addo, in his residential COVID-19 response updates in January and February, 2021 respectively gave an assurance that the government would ensure that Ghanaians had access to vaccines.  He also indicated that the government would ensure that the COVID-19 vaccines deployed in the country were effective and safe.

The President announced that the country was expected to receive its first consignment of the vaccines in March 2021.

Through bilateral and multilateral means, he said “we are hopeful that, by the end of June, a total of 17.6 million vaccine doses would have been procured for the Ghanaian people”.

The target was to vaccinate “the entire population, with an initial target of 20 million people”.

Vaccines 

The first consignment of 600,000 doses of the AstraZeneca COVID-19 vaccine, Covishield, arrived at the Kotoka International Airport on February 24, 2021, under the COVAX facility.

Subsequently, the first-ever COVID-19 vaccination in Ghana was rolled out on Tuesday, March 2, 2021, as part of optimal measures to stop the further spread of the disease.

This vaccination exercise made Ghana the first of 92 beneficiary countries to receive the COVID-19 vaccines from the COVID-19 Vaccine Global Access Facility (COVAX) facility according to the World Health Organisation (WHO).

The facility, being championed by the Global Alliance for Vaccine and Immunisation (GAVI), the WHO, and other international organisation is offering beneficiary countries a total vaccine amounting to at least 20 percent of its population for free.

The government says the initial delivery constituted the first consignment of vaccines the country would receive.

As of December 16, 2021 a total of 21,905,210 vaccines had come into the country comprising 9,555,170 AstraZeneca, 8,032,850 Jasen 1,229,620 Mordena, 3,066,570 Pfizer-BioNTech and 21,000 Sputnik-V.

They had come from various sources including AVATT/AU/WB, COVAX and bilateral partners.

Out of the total number of vaccines received, 9,667,602 doses have so far been distributed leaving 10,434,308 being kept safe in the national storage facilities.

The different vaccines require different storage temperatures and administration which has presented a challenge. For example, the Johnson and Johnson vaccines which come in a pack of 5 or 10 dose vials requires a different size syringe (0.5ml) while the Pfizer vaccine packed in six dose vials, requires a 0.3ml syringe.

Deployment 

Ghana is not new to immunization programmes as it has over four decades of experience at delivering large-scale campaigns for polio, measles, yellow fever, and other vaccines for especially babies.

The Manager of the Expanded Programme on Immunisation (EPI) Dr Kwame Amponsa-Achiano is confident the lessons learned from the over 40 years of vaccination and the accompanying successes from the various immunization programmes were enough to assure Ghanaians of a successful COVID-19 vaccination programme.

Dr Amponsa-Achiano said the country had been able to deploy safe and highly efficacious vaccines that had drastically reduced the national infectious disease burden.

 He is confident that with the capacity, experience, and structure at Ghana’s disposal carrying out the COVID-19 vaccination programme “would not be a big deal.”

He was confident that Ghana’s robust immunisation programme, which was one of the best in the region, would be able to handle the new vaccination rollout. Currently, he said the COVID-19 vaccines were being deployed within the existing healthcare infrastructure under the GHS.

To ensure effective administration of the vaccines, Mr Amposa-Achiano said a cascaded training is organised for vaccinitores and personnel who keep records using the digital tablets for the exercise.

He said the training is done before and after each roll out to ensure the vaccinators and recorders were well vest with knowledge and carry out their duties effectively.

Storage

All vaccines, based on their characteristics, required a certain strict storage and movement temperature known as cold chain requirements, right from the point of manufacturing right into the syringe for it to stay efficient, safe, and potent.

Some COVID-19 vaccines, such as Pfizer’s and Moderna’s, needs “ultra-cold” storage while the Oxford-AstraZeneca vaccine is relatively low-maintenance and requires storage at temperatures between two and eight degrees Celsius.

For some once open, a vial can survive at temperatures of up to 30 degrees Celsius until its six-hour usage window expires.

For proper cold chain handling of the various vaccines, the Minister of Health, Mr Kwaku Agyeman-Manu said Ghana’s existing robust vaccination system had been given “a little boost” to cover the demands of COVID-19 vaccination that would be used to conduct the COVID-19 vaccination across the country.

The boost, he said included 4,407 vaccine storage fridges, freezers, and cold boxes procured to boost immunisation in the country.

The storage facilities comprise 58 ultra-low temperature vaccine freezers, 50 normal vaccine fridges, 3,000 ice pack freezers, and 300 cold boxes.

The items, valued at $8 million, are expected to enhance the country's capacity to deploy a variety of vaccines with different storage (temperature) requirements, particularly, for COVID-19.

The amount also covers additional 18 distribution cold vans which the Ministry of Health had procured.

With such logistics, Mr Agyeman-Manu said Ghana is now in a better position to deploy a wide range of vaccines, irrespective of their temperature requirements, and help win the fight against the COVID-19 virus.

Until recently Ghana had been limited to the traditional vaccine storage facilities of temperatures between -2°C to -8°C. 

"We were, therefore, restricted to vaccines that required these storage temperatures. We were restricted to AstraZeneca, Sputnik, Johnson & Johnson among others which offered us supply in limited quantities," Mr Agyemang-Manu said.

He also indicated that with the number of countries resorting to the same vaccines Ghana was also sourcing, it had become difficult to get adequate supply from the vaccine manufacturers.

To continue that way, meant that Ghana would not be able to achieve its target of reaching head immunity, the health minister stated.

"To overcome this challenge and widen the range of vaccines for the COVID-19 immunisation, we initiated efforts to procure more of the vaccine fridges and freezers that can provide us with storage temperatures from -83°C to +8°C.

“In this case, we are able to import any of the approved vaccines," Mr Agyeman-Manu said

Challenges

Currently more than 90 percent of the cold chain facilities are on the national grid for power supply with the rest on other sources of energy such as solar and gas because of the lack of electricity supply in the areas they are located.

Ghana also had challenges with inadequate cold storage facilities and vans with some of the walk-in freezers at the national level being as old at 25 years.

However, with the outbreak of the Covid-19 pandemic which has been a bane the country’s cold chain system is being revamped.Maintenance of the cold storage facilities is also a challenge as the nation is faced with limited resources to fix break downs.

Due to power outages the system also faces frequent breakdowns leading to the provision of stand by fuel-driven generators which is expensive due to the high cost of fuel. Access to spare parts to fix the generators when they break down is being provided with the support of GAVI.

Safe vaccines 

At the Oduman Polyclinic in the Ga West Municipality, a nurse pulled out a vial of Covishield from a cooler box while a queue of people, many of them elderly, were waiting patiently to get their jabs. The logistics involved in getting the vaccine to the health facility is of no great concern. They are not interested in the makeup of the vaccine. They are just happy that finally, they too have a chance at getting a vaccine which will protect them against the virus.
“I am ready to wait in the queue no matter how long it takes for me to get the vaccine,” said 75- year old Catherine Golo who had been waiting for her shot for two hours by the time we interviewed her.

The queue was moving at a snails pace but the people were patient as one by one they entered the vaccine room where a nurse was administering the vaccine. Prior to entering the vaccination room, their details — age, location, identification information and the batch number of the dose they were receiving was being collected digitally.

“We are working hard to ensure that we provide all those present with a jab. Each dose we administer brings us one step closer to ensuring everyone is protected against COVID-19 including all high-risk populations,” a nurse at the vaccination room said.
A similar throng of people were queuing outside a tent mounted at the West Hills Mall, on the Kasoa road where dozens of health workers were administering the vaccines.