By Alex Ababio
ACCRA, Ghana — The phone buzzed after midnight. Nurse Afua Boahen rubbed her tired eyes and read the message from her district director: by 10 a.m., a shipment of Pfizer COVID-19 vaccines would arrive at her Community-based Health Planning and Services (CHPS) compound in Sewhi, Western Region. It was July 2021, and Ghana, like the rest of the world, was rushing to vaccinate its people against a deadly virus.
Her chest tightened, not from fear, but from the same old frustration. The compound had only one solar-powered refrigerator, humming at a safe 2°C. But these new mRNA vaccines demanded something nearly impossible in her setting: a chilling -70°C.
“We were told to improvise,” Afua recalls. Her voice still carries the heavy memory. “Improvise with science that requires perfection. They said, ‘Use dry ice.’ But where? How? The nearest reliable source is five hours away on terrible roads. So, we waited. We prayed. And when the vials arrived, we packed them in thermoses with ice packs we froze in our own deep freezes. We watched the clock, knowing the vaccines were melting away with the ice.”
That desperate improvisation was repeated by health workers across Ghana. It was a painful warning of the larger test ahead. In 2022, Ghana was chosen by the World Health Organization (WHO) to host Africa’s first mRNA vaccine technology transfer hub. The project carries a bold dream: to make Ghana a pioneer in cutting-edge vaccines for Africa.
But a detailed investigation by Ghanaian Watch—based on budgets, audits, and more than a dozen interviews with scientists, health workers, and logisticians—shows a dangerous gap. Ghana’s health infrastructure, especially its cold chain system, is far from ready. The country may soon have the factory, but not the nationwide system to deliver the vaccines safely to its own citizens.
The Glaring Gap: A National Cold Chain Audit
The hub, housed at the Vaccine Manufacturing Unit of the National Vaccine Institute (VaccMed Ghana), is presented as a symbol of independence. Director Prof. William Kwabena Ampofo explains proudly: “This is about health security and sovereignty. We will not just be consumers of technology but innovators, developing vaccines for diseases like malaria and Lassa fever. This is our moment.”
But the very technology that brings hope also brings a massive logistical problem. mRNA vaccines are extremely fragile, needing storage at ultra-low temperatures (ULT), far colder than what normal vaccine refrigerators can provide.
An internal 2023 Ghana Health Service (GHS) Cold Chain Inventory Report, obtained by Ghanaian Watch, paints a worrying picture:
Out of 4,500 health facilities that store vaccines in Ghana, only 12 facilities—all teaching hospitals in Accra and Kumasi—own working -70°C freezers.
Around 60% of district-level health facilities suffer from unreliable electricity, depending on diesel generators that often break down or lack fuel.
Nearly 25% of normal vaccine fridges (+2°C to +8°C) were not working during the audit, damaged mostly by power surges or poor maintenance.
“The gap is not just in equipment, but in the entire ecosystem,” says Dr. Priscilla Sereboe, a cold chain logistics expert who once consulted for Gavi in Ghana. “A -70°C freezer is not something you just plug in. It uses huge amounts of power. It needs special technicians, and those are almost non-existent outside big cities. Running one generator for a single ULT freezer in a rural district can cost more than the facility’s whole monthly budget.”
When asked about this, Prof. Ampofo did not deny the challenge. “The hub itself will have world-class storage. The broader cold chain expansion is a parallel project. It is work in progress,” he said. He pointed to government promises of future investment.
The Billion-Cedi Question: Who Pays the Bill?
That “work in progress” comes with a shocking price tag. An independent 2022 feasibility study, commissioned by the Ministry of Health, estimated the cost of upgrading regional and district hospitals with ULT storage and backup power at $120 million USD (over 1.4 billion GHS). And that figure does not even cover annual maintenance, training, transport, or the massive electricity bills.
But a careful check of the 2023 and 2024 National Budget Statements raises alarms. Yes, funds are earmarked for constructing the vaccine factory itself. But there is no specific line for rolling out the national cold chain system needed to carry the vaccines across Ghana.
A Finance Ministry insider confirmed the weakness. Speaking anonymously, the source explained: “The hub is seen as a flagship project. The cold chain is treated as a general health problem. Money comes in bits—some from health, some from energy, some from donors. There is no single, costed national plan being funded. The assumption is it will be figured out later.”
That assumption drives logisticians like Kofi Mensah, a retired GHS manager, to despair. “It’s like building a magnificent factory to make the best chocolate, but with no trucks or roads to deliver it,” he says. “It will spoil before it gets to the shops. We draft nice policies and secure big grants, but when it comes to execution—the difficult part—we fail again and again.”
“We Are Set Up to Fail”: The Human Toll of Systemic Neglect
For frontline workers, this failure is not theory. It is daily pain. Back in Sewhi, Nurse Afua opens her logbook. She points to entries from July 2021:
“During the COVID rollout, we lost power for 18 hours. The generator had no fuel. We watched the vaccine temperature rise to -20… then -10. We had to decide: Do we inject people with possibly spoiled vaccines? Or do we throw them away?”
The answer broke her heart. “We discarded them. Twenty doses. I cried that day. Not just for the waste, but for a system that sets us up to fail. They give us a Rolls-Royce task but only a bicycle toolkit.”
Her case is not rare. Health workers across the country face the same impossible decisions.
A Path Forward: Beyond Hope to a Plan
Experts say hope alone is not enough. Ghana needs a clear, urgent plan. Dr. Sereboe suggests three steps:
1. A national ultra-cold chain master plan with its own budget, linked to the energy ministry.
2. Heavy investment in solar-powered, off-grid ULT freezers for rural areas—technology that now exists and works.
3. Immediate training of a new group of biomedical technicians across all 16 regions to maintain the machines.
If these are not done, the consequences could be absurd. Ghana may end up with a world-class hub in Accra, producing vaccines, only for them to be flown abroad for safe storage—a new form of dependency. Or worse, vaccines could sit unused in warehouses while Ghanaians wait in line.
As the day ends in Sewhi, Nurse Afua closes the clinic’s humming fridge—the one that holds only routine vaccines. She reflects on the coming hub with both pride and doubt.
“I hear about this great thing coming. I am proud. Truly proud,” she says softly. “But my question is simple: when the first vaccine is made, will someone like me, in a rural place, have the tools to give it safely to a mother’s child? Or will we still be improvising with ice packs?”
The answer will decide if Ghana’s great leap forward in science becomes a success—or stumbles on the last, cold mile.