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Monoclonal antibody therapies are packed inside cold storage shippers for communities impacted by Covid-19 in 2021. More medications are requiring temperature controls throughout transit. (Lara Cooper/Direct Relief)
When most people think about humanitarian health work, images of medicine arriving in trucks or airplanes come to mind. But the journey is just as critical, particularly with medicines that require consistent temperatures. Medicines, including specialty treatments and insulin, must arrive in safe, stable, and usable condition. That depends on foundational systems most people take for granted, but which take great effort and investment every step of the way.
If a vaccine falls outside its required temperature range on the way to a patient, it can lose its potency and become unusable. According to the World Health Organization (WHO), nearly 50% of vaccines are wasted each year due to cold chain failures, costing billions and leaving millions vulnerable. In crisis and conflict- affected countries, the risk of temperature excursions and loss of medicines increases due to factors such as disrupted and inadequate infrastructure, unreliable power sources, and logistical and security challenges.
For those unfamiliar with the term, ‘cold chain’ refers to the end-to-end process of keeping temperature-sensitive products within a required temperature range at every stage, from manufacturing and shipping to storage and final delivery, to ensure their safety, potency, and quality are preserved.
Through its global operations, Direct Relief manages large volumes of temperature-controlled medical shipments each year while investing in the cold chain infrastructure and logistics needed to keep lifesaving medicines safe from warehouse to patient.
And what keeps vaccines, insulin, and other temperature-sensitive therapies viable isn’t just transportation — it’s reliable power and resilient cold chain systems working behind the scenes, every hour of every day.
Medical staff unpack Direct Relief donated cancer therapies in cold storage at the Uganda Cancer Institute in Kampala, Uganda. (Photo by David Uttley for Direct Relief)
According to an industry analysis by IQVIA published in 2025, temperature-sensitive medicines that require cold-chain handling accounted for about 35% of the total pharmaceutical market in 2022, up from roughly 26% five years earlier – a significant rise reflecting faster growth in cold-chain products compared with ambient-temperature drugs. This increase has been driven largely by growth in biologics and other complex therapies that need controlled temperatures to maintain quality and effectiveness.
That share is expected to climb further, with many forecasts suggesting nearly half of approved drugs in the coming years will require cold-chain handling, underscoring a continued shift toward biologic and precision therapies.
In 2025, nearly a quarter of all medications shipped by Direct Relief (by volume) required cold-chain storage (2–8°C).
This is why planning and infrastructure investments aren’t luxuries. They are essential to health equity and preparedness. When an increasing number of lifesaving medicines depend on reliable refrigeration and power, resilient cold-chain and energy systems are foundational to healthcare delivery, especially in disaster-prone and resource-limited settings.
Infrastructure: The Quiet Backbone of Global Health
To manage the growing complexity of temperature-sensitive shipments, Direct Relief relies on various technologies, including SmartCAE’s Digital Cold Chain platform, to simulate real-world shipping conditions before medicines ever move. By combining global temperature data, historical weather patterns, and digital modeling, Direct Relief operations and logistics teams can predict how products will perform in transit, identify risks like delays or extreme weather, and plan alternative routing in advance. These simulations also help determine how long shipments can safely remain outside refrigeration and allow Direct Relief to coordinate precise handling plans with partners on the ground — protecting medicines from the moment they depart to the moment they arrive.
Direct Relief plays a critical role in safely distributing 2–8°C temperature-sensitive medicines to more than 70 countries each year. Demand for these products is growing rapidly: over the past two years, Direct Relief’s annual cold chain shipment volume has increased by roughly 35%, expanding into regions where infrastructure is often limited, fragile, or uncertain. Infrastructure may be invisible when it works — but when it fails, health systems fail with it.
Power for Health: Preparedness Before the Crisis
Treasure Coast Community Health Center’s Fellsmere site is benefiting from a new solar and battery storage system funded by Direct Relief that will provide resilient back-up power and cost savings for decades to come. (Courtesy photo)
Modern healthcare depends on something many of us take for granted: continuous, reliable power.
Refrigerators maintain the precise temperatures that vaccines, insulin, and specialized therapies require.
Lights, diagnostic equipment, oxygen concentrators, and electronic health records all shut down without electricity — even during short outages.
From community clinics in rural U.S. counties to health centers in low- and middle-income countries, power disruptions and inadequate refrigeration mean lifesaving care is delayed, degraded, or lost altogether.
A grant from Direct Relief’s Power for Health Initiative funded the installation of solar panels and a battery microgrid to provide an uninterrupted power supply in the event of a grid outage at Shingletown Medical Clinic in Shasta County, California. (Adam Courier for Direct Relief)
Recognizing the growing importance of resilient infrastructure, Direct Relief launched the Power for Health Initiative to strengthen health systems before disaster strikes.
Through targeted grants for solar arrays, battery storage, and microgrid systems, the initiative enables clinics to:
Maintain electricity during outages
Keep cold chain equipment running
Safeguard temperature-sensitive medicines
Continue delivering care when communities need it most
Across the United States, Direct Relief has funded dozens of solar-plus-storage microgrid systems at community health centers serving vulnerable populations. Globally, the Power for Health Initiative has expanded to 25 low- and middle-income countries, deploying hundreds of resilient energy systems.
For example:
A recent project in Florida installed a 46-kilowatt solar array and 214-kilowatt-hour battery storage system, designed to keep critical clinical systems online for up to 19 hours during grid outages. By powering refrigeration, medical equipment, IT systems, and lighting, the system helps ensure continuity of care when patients need it most.
A solar power system at the Bahai Arugaan ni Maria birthing center in rural Palawan, Philippines, ensures reliable electricity for lighting, ventilation, cold storage, and other critical needs so women from remote communities can access safe, comfortable maternal care.
These installations not only reduce long-term energy costs but also strengthen resilience — ensuring health centers can continue operating safely and reliably when the grid fails.
In 2025, Direct Relief released a three-part report revealing the hidden health consequences of climate disasters—and the urgent need for resilient healthcare infrastructure. Direct Relief surveyed federally qualified health centers (FQHCs) and free & charitable clinics across Florida, Georgia, North Carolina, and South Carolina to understand how power loss from natural disasters disrupts healthcare for the nation’s most vulnerable populations.
Cold Chain Capacity: Every Degree Matters
Covid-19 vaccines for American Indian Health and Services in Santa Barbara are stored at Direct Relief’s warehouse inside of ultracold storage, Oct. 2021. (Lara Cooper/Direct Relief)
Parallel to investing in resilient power is the work of expanding cold chain capacity worldwide, ensuring temperature-sensitive medicines reach the patients who need them.
Cold chain isn’t just about refrigerators. It’s a coordinated system of storage, monitoring, and transport that maintains medicine within precise temperature ranges from factory to patient. Without it, safe and effective treatments can become compromised or unusable.
Strategic partnerships, including a 2025 commitment supporting the deployment of hundreds of medical-grade refrigerators and cold storage systems, are strengthening health facilities in Africa, Latin America, and other underserved regions, helping maintain reliable access to temperature-sensitive therapies.
This work underscores a simple but critical truth: power and cold chain are interdependent. Reliable electricity enables safe cold storage, and cold storage enables effective care delivery, allowing more people to get the necessary care to thrive.
The Invisible Becomes Indispensable
A pharmacist unpacks pediatric cancer treatment medications at Muhimbili National Hospital, Dar es Salaam, Tanzania. (Direct Relief photo)
People may not notice the quiet hum of a refrigerator, the steady spin of a solar inverter, or the locked door of a cold storage room, but these technologies are what keep medicine effective and clinics operational.
Investing in resilient power and advanced cold chain systems is not just an operational strategy. It is a commitment to safeguarding health, ensuring that when medicine is needed most, it works, and care continues.
