Cold Chain

Issues & Solutions

The Covid-19 vaccination effort spotlights the global cold-chain network’s collective shortcomings–a sobering fact extending far beyond Covid-19, as most medicines under development are temperature-sensitive.

19 April 2021 – Muhimbili National Hospital, Paediatric Block, Dar es Salaam, Tanzania – Ezekiel Tunduje, a pharmacist, organizing drugs in a cold room at Muhimbili Hospital built through donations from Direct Relief through Tumaini La Maisha.

In Brief

Limited cold-chain distribution capacity creates an obvious, practical barrier to people obtaining access to medications and therapies – even when they are free.

These shortcomings, if unaddressed, will only intensify the gap between haves and have-nots, and the profound advances being made in health will fail to reach people who are poor or in poor areas.

For these reasons, Direct Relief is working to improve cold-chain systems at the national and local levels in countries around the world and expand its cold-chain capacity to deliver increasing volumes of temperature-sensitive medication.

The Humanitarian Supply Chain for Temperature-Sensitive Medications

Increasingly, new medications and vaccines approved by the U.S. Food and Drug Administration (FDA) come in a form that requires some level of consistent end-to-end cold handling and storage from the point of manufacture to the patient.

On the one hand, this means more potentially lifesaving medications are becoming available. On the other hand, access is distributed unevenly between developed and developing countries — often due to lacking cold chain infrastructure, insufficient capacity to handle such medications.

The challenge loomed long before the Covid-19 pandemic, but the global race to vaccinate against Covid-19 has brought it into stark relief.

Developing nations struggle to compete with developed countries to secure Covid vaccines. Still, even when they get them, they often lack the cold chain infrastructure, power, and systems required to handle them properly.

While 1 billion doses of Covid vaccines are manufactured monthly, wealthy countries edge closer to vaccine targets while the challenge for the developing world is shifting from a supply issue to a vaccine logistics issue.

Boosting Access to Cold-Chain Medication Globally

Direct Relief Pharmacist Alycia Clark prepares Covid-19 vaccines for patients at a Santa Barbara Neighborhood Clinic-run vaccination clinic at Direct Relief's headquarters. The event was the first of several that will be held in order to vaccinate the clinic's patients, many of whom are low-income or uninsured. (Photo by Tony Morain for Direct Relief)


The organization is helping equip healthcare providers in the US and globally with emergency medical resources including vaccines, antibody therapies, and other critical medicines.

Temperature sensitive therapies are staged at Direct Relief's warehouse. (Lara Cooper/Direct Relief)

Rare Diseases

Direct Relief provides critical therapies to patients with certain rare diseases in countries where these lifesaving therapies are otherwise unavailable.

Cold shipping containers are staged at Direct Relief's warehouse. (Lara Cooper/Direct Relief)


Direct Relief partners with leading cancer institutions around the world to source and deliver lifesaving treatment drugs.

Journées d'éducation thérapeutiques organisées par l'ONG Santé Diabète à la Maison des Jeunes de Bamako


Direct Relief provides critical medicines and supplies for patients with diabetes to its network of health facilities worldwide.

Direct Relief has significantly expanded its cold chain capacity in recent years, increasing its ability to provide temperature-sensitive medications to healthcare providers globally. The organization distributed $577 million in cold chain medications in its 2021 fiscal year — free of charge.

A cold chain, however, is only as strong as its weakest link. Without the capacity to store and handle temperature-sensitive medications, communities go without essential vaccines and therapies.

For this reason, Direct Relief works to improve cold chain systems at the national and local levels in countries around the world through financial grants, donations of refrigeration equipment, and expertise.