Cuba: Strengthening the cold chain for safe vaccination

The country has renewed equipment at around 70 percent of its vaccination sites and acquired a cold storage chamber for José Martí International Airport, with support from PAHO and Canada.

Havana, March 2025

It’s Monday, and Nelisa Cecilia García is getting ready to take her 10-month-old daughter, María Elena, to the vaccination point in Habana Vieja, the neighborhood she has lived in for three years. It is one of the most densely populated areas in the capital. Before leaving, Nelisa makes sure to attend to every detail needed to prepare her little one. She has been waiting for this moment for days, knowing how important it is for María Elena’s well-being. "It’s a relief to make sure the children don’t get sick," says Nelisa, holding her daughter in her arms. "The nurse called me, and I came immediately, but first, I bathed her and got her ready."

Between games and laughter, mother and daughter make it through the wait, while the nurse gets ready to administer the vaccines. The father enjoys the moment too, awaiting the nurse's call. For María Elena, today is the day she will receive another vital jab to protect her health.

Havana is a city with one of the highest vaccination rates in the Americas. At the "Antonio Guiteras" Polyclinic, where María Elena will be vaccinated, refrigerators prequalified by the World Health Organization (WHO) safeguard the vaccines received by children, adults, and families as part of Cuba’s immunization program.

These high-tech units arrived at the institution through a cooperation project between the Pan American Health Organization (PAHO) and the Canadian government, focused on providing access to COVID-19 vaccines for vulnerable populations in the Americas.

According to nurse Pierrette Patricia M´baloula, the change has been highly beneficial. "We’ve seen many advantages with this prequalified refrigerator. It has been very important for vaccine preservation, as the temperature remains stable. The refrigerator is very efficient and ensures maximum safety," she says.

A sustainable cold chain

Between 2021 and 2022, the first prequalified refrigerators were placed within Cuba's vaccination network to update the country’s cold chain technology.

In response to the COVID-19 health emergency, the Canadian government collaborated with 25 countries and territories in the Americas. Cuba received $1.3 million to secure the cold chain for vaccine storage and distribution, as well as to enhance other program components, including surveillance of events supposedly attributable to vaccination or immunization (ESAVI).

The contribution enabled the purchase of refrigerators and spare parts, costing over $1,400 per unit, as well as temperature control devices (with or without external reading sensors), vaccine transport coolers, and other supplies, such as computers to support the digital transformation of ESAVI monitoring.

Other UN agencies, like UNICEF, have also made contributions, funded by Japan and other donors. Thanks to these efforts, Cuba now has 1,065 prequalified refrigerators, 1,000 1.5-liter vaccine transport coolers, 4,000 cold packs to maintain the appropriate temperature during transport and storage, and nearly 2,000 temperature monitors with internal or external sensors.

The PAHO-Canada project also included the installation of a cold storage chamber at the Aerovaradero terminal of the “José Martí” International Airport in Havana, with a storage volume of 63 cubic meters, ensuring the safe storage of all vaccines entering the country.

Protection from day one

Amelis Díaz, grandmother of a baby awaiting immunization at the newborn vaccination point at the "Abel Santamaría Cuadrado" Provincial Hospital in Pinar del Río, in western Cuba, comments: "Having these donations from various organizations gives us great peace of mind. For him (her grandson), it’s a blessing. It’s not just about having the vaccine and the necessary supplies to administer it, but also the physical conditions to ensure the optimal quality of that vaccination".

In Consolación del Sur, a municipality in the same province, the arrival of the modern equipment has marked a significant change. Dr. Talía Batista, deputy director of medical assistance for the region’s health department, highlights the impact in hard-to-reach areas.

“With an area of 1,113 square kilometers, 12 popular councils, and a population of 86,000, Consolación del Sur is already benefiting from the operation of these units to preserve and maintain vaccine quality in the cold chain,” she says.

Effective vaccine management

In Matanzas, Cuba's second-largest province, Ricardo Valdés praises the vaccination strategies implemented by local health authorities. He is in his early 30s and works in the city. "For me, the vaccine means peace of mind, strength, and hope," he says.

His words carry deep meaning. In Matanzas in 2021, the SARS-CoV-2 virus had a huge impact pm the population. As the epicenter of the COVID-19 pandemic in Cuba, the province reported the highest numbers of confirmed and suspected cases during several weeks. As in the rest of the country, vaccination played a key role in controlling the epidemic.

Ricardo and his wife, Yenisel Estupiñán, visit the "Samuel Fernández" Polyclinic vaccination point to receive their COVID-19 vaccinations. Currently, this site serves more than 51,000 residents from the 46 clinics located in the city center.

Matanzas received around 90 of the prequalified refrigerators, which have been distributed across hospitals, vaccination centers, and pharmacies in all health districts.

To ensure the proper conservation and use of this technology, PAHO/WHO coordinated the purchase and installation of the units in healthcare centers. Additionally, the Organization provided technical advice, coordination, and leadership in the effective vaccine management (EVM) process.

"In Cuba, PAHO has provided technical assistance through training courses for health personnel on this tool (EVM) and its version 2.0, based on new quality standards, to ensure that vaccines stored, distributed, and handled maintain their potency until they reach the final user," explains Nora Lucía Rodríguez, PAHO/WHO cold chain specialist.

Canada: A bridge of solidarity through PAHO

Dr. Duniesky Cintra, PAHO/WHO consultant in Cuba, is familiar with every detail of the management and installation of the new refrigerators and is well-acquainted with their benefits.

"The term 'prequalified' means that the quality, efficiency, and safety have been verified, ensuring that everything stored inside these units offers guarantees for use with populations," Dr. Cintra says. "They were specifically purchased for vaccines, ensuring they maintain the right temperature during storage and don’t lose efficacy," he adds.

Marelys Sandoval, a PAHO/WHO procurement assistant with extensive experience in Cuba, emphasizes that the support provided for purchasing the refrigerators focused on guaranteeing proper documentation and communication flow with the PAHO headquarters in Washington, DC.

Before the purchase process, specialists in biomedical engineering and nurses working at vaccination points received training on the use of these units and the data collected.

PAHO/WHO Representative in Cuba, Dr. Mario Cruz Peñate, underscores Cuba’s advantage in being able to develop its own COVID-19 vaccine, a highly recognized achievement. However, strengthening the cold chain was necessary to increase the capacity to manage more vaccines through the national immunization program.

For Cruz Peñate, Canada is one of PAHO's main partners in strengthening health systems in the region. Canada is also one of the main contributors in areas such as equity, gender equality, ethnicity, and human rights.

In an interview at the Canadian embassy in Havana, François Picard, Canada’s cooperation advisor, remarks: "Canada’s partnership with PAHO has grown significantly in recent years, expanding into areas like vaccination, health system strengthening, pandemic preparedness, sexual and reproductive health, and vaccine production. Canada is PAHO’s second-largest contributor, behind the United States."

Cuba has an expanded immunization program that applies 20 different vaccines, for both children and adults. Among the newest immunogens included are those produced by Cuba’s pharmaceutical industry against COVID-19, explains Dr. José Raúl de Armas, head of the Ministry of Public Health's Department of Infectious Diseases.

In remote areas, vaccination points bring this technology to the most isolated populations, ensuring the country maintains immunization levels above 95 percent. This has allowed Cuba to eliminate diseases such as rubella, congenital rubella, measles, and other health issues that no longer pose a significant threat.

"Cooperation projects ensure that a proper vaccination system is developed, directly impacting maternal and child health and, above all, the survival of our children," says Dr. De Armas.

This progress in cold chain infrastructure and equipment, supported by PAHO and Canada, underscores Cuba’s commitment to maintaining the quality and effectiveness of its immunization programs, ensuring that vaccines are delivered and preserved across all regions of the country.

Cuba

Immunization

Vaccine Safety