The story of a time and temperature indicator that has dramatically changed the course of vaccine
management practices as well as shaped the future of the cold chain.


We may ask ourselves where humanity might be without some of the greatest inventions that have come to pass. Great ideas have continuously changed the path of human civilization over time with vaccination being widely considered one of the greatest medical achievements of modern civilization. Many commonplace and preventable childhood diseases are now increasingly rare because of vaccines. The concerted human effort to bring the vaccines to the ones who need them at the right time is remarkable.

Just one example of the dedication and self-sacrifice involved was the 1925 ‘Serum Run’ between the settlements of Nenana and Nome in Alaska also known as the Great Race of Mercy. This involved a famously grueling winter expedition across the frozen Alaskan interior using dog-sled relays to take diphtheria antitoxin to the beleaguered township of Nome where an outbreak of diphtheria was threatening around 10,000 local Alaskan natives who had no natural immunity to this lethal disease. The epic journey took 20 mushers and about 150 sled dogs just five and a half days to cover the 1,085 km route. This display of bravery and was how the small town of Nome and the communities surrounding it were saved from an incipient epidemic. Balto, the lead sled dog on the final leg into Nome, became the most famous canine celebrity of the era. Balto’s statue became a popular tourist attraction both in New York City’s Central Park and downtown Anchorage in Alaska.

The vaccine vial monitor (VVM) is one of the most important inventions of the last century; one that has dramatically changed vaccine management practices and continues to shape the cold chain. In 1996, when VVMs started to get to countries with the OPV, I was the health officer for the UNICEF Central Asian Republics and Kazakhstan Area Office. I remember one particularly cold night going to the airport in Almaty at 03.00 am to receive the very first shipment of OPV with VVMs. For years, I was a humble VVM user and advocate in the field. Things started to change when I was hired by the WHO Headquarters ‘Access to Technologies’ team in 2001 and VVM became one of my prime responsibilities. That was at a time when vaccine manufacturers were dragging their feet about incorporating VVM onto vaccines other than OPV. My brief was to overcome this resistance from the manufacturers, an objective that formed the basis for my plans for the historic 2002 VVM technical consultation meeting.

In 2007, I immensely enjoyed organizing the event to celebrate the 10th year anniversary of VVM introduction. Visiting Niger, Indonesia and Vietnam for the shooting of the Five Senses video is full of cherished moments.

Towards my retirement in August 2018, I conceived the idea of writing this book. I was one of the few people who had actually witnessed the decades-long programme of VVM development from its birth to its maturity. I had worked with sweat and tears for to get VVMsonto all vaccines as well as tirelessly helping vaccine managers and health staff to excel in using the VVMs to their utmost potential. Today, it is a great pleasure to see one of my e-VVM based vaccine management course graduates (2015) Junaidu Adamu Barde from Nigeria, working for the Clinton Health Access Initiative, using the course materials to duplicate efforts in his country.

I had originally wanted this book to be a concise, structured, globally-relevant manual that provided comprehensive information on a wide scope of issues; in other words, an ‘A-Z of VVM’. In the event, it turned out to be more voluminous than I thought. I did not want to restrict myself when there are so many clever, dedicated and selfless individuals that have made have this near miraculous innovation a reality and in doing so contributed to saving, literally, the lives of millions.

So, I am happy that it became a celebration of all the efforts of individuals, organizations, agencies, donors, and manufacturers involved in development, scaling it up, applying, advocating for it, enforcing, helping health workers to excel in their practice, and using it.