Lessons learnt from one-year cold chain support for COVID-19 vaccination in 5 middle income countries of North Africa.

The COVID-19 pandemic demanded rapid scale-up of vaccine cold chain capacity worldwide. With support from the Government of Japan, five middle-income countries in North Africa; Algeria, Djibouti, Egypt, Libya and Tunisia strengthened their cold chain systems between May 2021 and May 2022. This 12-month initiative added 341,146 litres of storage space across 1238 facilities, trained 2850 health staff, and deployed WHO-PQS-qualified equipment worth USD 2.93 million. There were supply and installation delays linked to the equipment and the vaccines. Despite these delays, the investment improved the preparedness for COVID-19 vaccine rollout and strengthened national EPI programmes. Key lessons stressed on the importance of robust cold-chain inventories, service bundle with installation services, alliance with the local service providers, and long-term capacity-building mechanisms. The implementation experience demonstrates how targeted cold-chain investments during emergencies can lead to long-term immunization supply-chain resilience and readiness for future events.