It's broken...but don't throw it out!
One of the Kenya lab staff said to me, “You are the first ones to help us with these machines. They give to us and we try, but don’t know how to use (the machines).” Poor equipment maintenance and understanding of the machines is a reality in the African vaccine labs. The end result is the machines sit idle, deemed broken, and potentially cause vaccine production delays.
The labs typically run equipment to failure. In other words, they run until they no longer can run; and then try to figure out how to fix them. The maintenance staff makes routine visual inspections, but rarely performs preventative maintenance on equipment.
By Western drug production standards, some of the old lab equipment would have been decommissioned already. However, the African labs do not have the resources to purchase new replacements; therefore, the maintenance staff is challenged with trying to figure out how to fix the broken equipment. In the Kenya labs, the lyophilizer for freeze drying vaccines was broken for more than 6 months. Freeze drying is critical to several of the vaccines, and the lab was not able to produce certain vaccines because of the broken lyophilizer. The staff tried but lacked the technical expertise to get the lyophilizer running. Current Fellow with GALVmed as well, Seamus Pender, an engineer from Pfizer Ireland, joined me in Kenya and helped the maintenance staff troubleshoot the problems and got the system running again. In the Ethiopia labs, the fermentor agitators were repeatedly making excessive noise due to corrosion and breaking down. The staff’s broken English caused communication troubles with the supplier and the supplier did not respond. I assisted the maintenance staff by explaining the technical issues once again to the supplier and identified the required spare parts. The bigger problem was getting the spare parts to make the fix. The parts must come from overseas. The lead time, coupled with an inefficient procurement system, significantly delayed fixing the agitators.
Maintenance is not just a problem for old machines, even fairly new equipment was found sitting idle because the lab staff thought the equipment was broken. Caps were flying off and not crimping properly on the automated vial filling and capping machine in the Kenya labs. The machine was only a few years old but “never worked properly,” according to the production manager. The staff manually capped and crimped the vaccine vials instead of using the machine. After a thorough inspection of the unit and watching it run, several recommendations were made to the staff to fix the system: obtain consistent quality from caps supplier, adjust the machine alignment, reinstall original machine component, lubricate the capping cylinders, and draft a comprehensive set-up and operations procedure.
In conversations with NGO employees working in Africa, the consensus regarding equipment maintenance is that it is a real problem for the local people. Fred, who has worked on many UN projects, pointed out that the people sometimes fear or have no interest in new equipment because they have no practical experience with the machines. Gabrielle, who works on ILRI projects, said that there are warehouses in Africa full of new equipment unopened and donated by foreign agencies. Both Fred and Gabrielle were making a common statement that the machines are of no use to the recipients if the donors don’t assist with equipment integration, operation, and maintenance.
GALVmed had proactively identified and addressed this known problem through the VACNADA project. They pay for suppliers to install new equipment, commission, and train the African lab staff. Spare parts were purchased for many machines. The labs are also supplied with follow-up maintenance service plans with specific OEM (original equipment manufacturers). Seamus and I were recruited to train the maintenance staff about equipment preventative maintenance and record keeping. We work with other VACNADA supported consultants to integrate new systems into existing vaccine process. The equipment knowledge and continued technical support will ensure that the machines keep running and the recipient labs will keep on producing quality vaccines.