Access to medicine is often discussed in terms of supply and cost, but a quieter problem continues to undermine both. In many cases, essential health products are lost before they reach the patient, not because they are unavailable, but because they cannot withstand the conditions required to deliver them. ALSO READ: New distribution trucks to enhance Rwanda’s medical supply chain Vaccines and biologics need to be stored within a narrow temperature range, typically between 2°C and 8°C, from production to administration. Once exposed to temperatures outside that range for a sustained period, they lose effectiveness. This requirement has given rise to the cold chain, a temperature-controlled system spanning manufacturing, storage, transport, and delivery. READ ALSO: Africa’s vaccine revolution: Why cold-chain innovation matters more than ever Maintaining that system is not straightforward. Across Africa and in many other regions, it operates under conditions that are difficult to stabilize. Electricity supply can be inconsistent, transport routes are often long and unpredictable, and storage infrastructure is unevenly distributed. Delays at any point in the process can compromise temperature control. The World Health Organization estimates that up to half of vaccines globally are wasted, with temperature control failures among the contributing factors. While figures vary, the pattern is widely acknowledged. The risk increases as products move further from tightly controlled environments. The issue extends beyond vaccines. As non-communicable diseases continue to rise, more patients depend on treatments such as insulin and monoclonal antibodies, which are equally sensitive to temperature and often more costly to replace when compromised. There has been steady progress in strengthening cold chain systems, including investments in storage, transport logistics, and workforce capacity. Rwanda is often cited for the efficiency of its health supply chain systems, enabled by strong coordination and the use of technologies such as drone-based distribution. The improvements expanded access and improved reliability but they depend on sustained investment and consistent system performance. Cold chain operations require stable power, regular maintenance, and continuous monitoring across multiple points. Even in well-managed systems, failures still occur. Much of the response to date has focused on strengthening these systems. Less attention has been given to reducing how much products depend on strict temperature control in the first place. Research in this area has been ongoing for some time, with the goal of allowing vaccines and biologics to remain effective at higher temperatures. Advances in formulation science and stabilization techniques are beginning to show potential, although large-scale adoption remains limited. ALSO READ: Rwanda, Bio Usawa ink deal to manufacture affordable eye treatments in Africa Industry interest is also growing. A recent agreement between American company Nanoly Bioscience and Bio Usawa, a Rwanda-based pan-African biotechnology company, reflects this shift. The deal, valued at up to $500 million, gives Bio Usawa rights to use a thermal stabilization technology (DynaShield™) designed to protect vaccines and proteins from heat-related degradation, allowing some products to remain stable outside refrigeration for extended periods. No single solution will address the problem entirely. Continued investment in cold chain infrastructure remains necessary, particularly where access gaps are most pronounced. At the same time, innovations that reduce dependence on strict temperature control could ease pressure on existing systems and improve delivery reliability. A treatment that fails before it is used does not contribute to better health outcomes. Reducing that risk, whether through stronger systems or more resilient products, remains an important part of expanding healthcare access in practice. The writer is a pharmacist and partnerships strategist. He writes on manufacturing and access to medicines in Africa.
