Keeping biological samples, medications, testing supplies and vaccines at the temperatures that do not exceed manufacturer requirements is crucial for public health, and yet this process has proven complex in many countries, including Belize.
Recognizing the need to revamp these systems, known as the cold chain, Nicole Achee and John Grieco, both research professors in the Department of Biological Sciences, forged partnerships that resulted in a new solution in Belize that can be scaled to other countries or organizations within the country.
The Notre Dame Belize Response Initiative for Cold-Chain (ND-BRICC) Development Project is a collaboration with the Belize Ministry of Health and Wellness, which received financial support from Carrier, an industry leader in cold chain innovation, and its Sensitech business, as well as donations from UPS Healthcare. The goal was to monitor the existing biological sample transfer from regional laboratories to the Central Medical Laboratory, the country’s national reference laboratory, and offer solutions to make sure biological samples remained at the proper temperature throughout the journey.
“For a lot of diagnostic tests, including for COVID-19, if the sample is not maintained at a certain temperature, then the pathogen we are trying to test against may degrade,” Achee said. “Having accurate test results is important, and without a reliable cold chain, this could lead to a false negative test.”
Achee and Grieco, who are affiliated with the Pulte Institute and the Eck Institute of Global Health, and co-direct the Belize Vector and Ecology Center (BVEC) in Orange Walk Town, Belize, discussed the opportunity with Belize health officials during the course of their work to prevent mosquito-borne diseases.
The first phase of the project evaluated current conditions and procedures used to deliver biological specimens, while the second phase designed a pilot implementation strategy to address areas of improvement within Belize’s existing cold-chain protocol. The final, third phase of the project, completed in December, validated the solution in the field to see if it worked and if it can be scaled to other countries or organizations within Belize.
As part of this collaboration, Carrier shipped to Belize almost 400 Sensitech TempTale Ultra dataloggers that allow cargo temperature to be monitored in real-time from virtually anywhere in the world, and UPS sent 30 thermal shippers to house and transport the samples. The shippers, which are about 12x12 inches, can maintain samples at the proper temperature for up to a week. This is crucial to the cold-chain system where samples can take days of travel to reach the central laboratory.
“The cold-chain process in Belize is definitely in a better place, but it’s always going to be a continual improvement process,” Grieco said. “To be clear, they had already been implementing strategies, but with the help of Carrier and UPS, who liked this project idea, we can definitely see that the new processes put in place are a big improvement.”
Because some funding remains from the project, Achee and Grieco received an extension from Carrier and Sensitech to expand the program in other possible ways. One strategy might be to target other labs in Belize they weren’t able to engage with, or to expand to vaccines or the transport of biological material from agricultural animal samples or medications for them.
“We are also thinking of going to lower-tier community clinics that offer prenatal care, where women may not be able to travel to regional labs for testing and so samples must be transported even longer distances,” Achee said.
“The ND-BRICC project has provided tangible evidence that the current system and practices for sample referral from hospitals to the Central Medical Laboratory do not meet acceptable quality standards and must be improved,” said Aldo Sosa, senior medical technologist and epidemiology laboratory supervisor at the Central Medical Laboratory, in the Belize Ministry of Health and Wellness, in a written statement.
“Simultaneously, the project produced data for an excellent alternative that would maintain the adequate temperature for samples during transport. Application and integration of this improvement in our national protocols would further strengthen the foundational laboratory principle that quality samples lead to quality results to the benefit of patients.”