A UNICEF-supported nurse arrives by motorbike at a village in Côte d'Ivoire with a cold box carrying vaccines for routine childhood immunization.
Explainer

What Is a Cold Chain?

A high-quality cold chain allows health workers to deliver lifesaving vaccines to children around the world.

A cold chain keeps vaccines at the optimal temperature from point of manufacture to the moment of vaccination 

Each year, UNICEF delivers nearly 3 billion vaccine doses, enough to immunize almost half of the world’s children

Delivering vaccines to all corners of the world is a complex undertaking. It takes a chain of precisely coordinated events in temperature-controlled environments to store, manage and transport these lifesaving products. This is called a cold chain.

Vaccines must be continuously stored in a limited temperature range — from the time they are manufactured until the moment of vaccination. When temperatures are too high or too low, a vaccine can lose its potency, robbing it of the ability to protect against disease. Once lost, a vaccine's potency cannot be regained or restored.

Learn more about how vaccines save lives

On Dec. 12, 2025, a UNICEF-supported health extension worker prepares a vaccine cold box in Sidama Region, Ethiopia.
On Dec. 12, 2025, health extension worker Melesech Yohannes arrives early in the morning at Adare Health Center in Sidama Region, Ethiopia, to carefully prepare a vaccine cold box. She selects all the necessary supplies and ensures the cold chain is ready ahead of the polio campaign before vaccinators arrive, contributing to the safe and effective delivery of vaccines to children in the community. © UNICEF Ethiopia/UNI925643/Mulugeta Ayene

How do vaccines move along the cold chain?

UNICEF mainly uses air transport to deliver vaccines quickly, with a few shipments traveling by road. All vaccines are shipped as refrigerated cargo directly from the manufacturer to the country, where they will be used. 

To make vaccine deliveries more sustainable and cost-effective, UNICEF is also exploring sea shipping, which could reduce greenhouse gas emission by up to 90 percent and freight costs by 50 percent per shipment compared to air transport. In July 2025, UNICEF successfully completed its first-ever shipment of vaccines by sea, delivering 500,000 doses of pneumococcal 13-valent conjugate vaccines by refrigerated container ship from Belgium to Abidjan, Côte d'Ivoire, paving the way for expanded use of sea transport in future vaccine deliveries.

Once the vaccines arrive in the destination country, they are stored in cold rooms before being distributed to regional and sub-regional cold storage facilities by refrigerated vehicles. 

From storage facilities down to the village level, health workers carry vaccines in cold boxes and  vaccine carriers, traveling by car, motorcycle, bicycle, donkey, camel or on foot to immunize every last child, even in the most remote of villages. 

UNICEF-supported community health workers vaccines in temperature-controlled cold boxes to a fixed vaccination site in Analanjirofo Region, Madagascar.
On Dec. 12, 2025, community health workers carry vaccines in temperature-controlled cold boxes to a fixed vaccination site in Analanjirofo Region, Madagascar. The vaccines were for use during an HPV (human papillomavirus) vaccination campaign aimed at protecting girls ages 9 to 14 from cervical cancer. The campaign was implemented by the Ministry of Public Health with support from technical and financial partners including UNICEF, the World Health Organization (WHO) and Gavi, the Vaccine Alliance, as part of the introduction of the HPV vaccine in Madagascar. © UNICEF/UNI926452/Andriantsoarana

Keeping vaccines safe and effective 

Storage and transport equipment such as cold rooms, refrigerators, freezers, cold boxes and vaccine carriers must comply with performance standards defined by the World Health Organization (WHO). Stock management procedures must also follow WHO guidelines specific to each type of vaccine.

UNICEF procures cold chain equipment and services, and works closely with partners and governments to ensure that the cold chain is unbroken and that systems continue to work efficiently in every country, keeping vaccines for children safe and effective.  

UNICEF staff and partners carry a solar-powered refrigerator up a flight of stairs at a health clinic in Gaza on Nov. 7, 2025.
UNICEF staff and community members carry a solar-powered vaccine refrigerator up a flight of stairs at Sheikh Radwan health clinic in Gaza City on Nov. 7, 2025. The solar-powered units replace refrigerators that were damaged by air strikes. In November 2025, the first round of a vaccination catch-up campaign in Gaza successfully protected over 14,000 children under age 3 against measles, mumps and rubella, diphtheria, tetanus and pertussis, hepatitis B, tuberculosis, polio, rotavirus and pneumonia. © UNICEF/UNI895051/

Right now, the lives of the most vulnerable children hang in the balance as conflicts and crises jeopardize the care and protection that they deserve. Dependable, uninterrupted and effective foreign aid is critical to the well-being of millions of children. Please contact your members of Congress and urge them to support ongoing U.S. investments in foreign assistance.

This story was adapted from unicef.org

 

 

TOP PHOTO: On Feb. 18, 2025, Nurse Didier Coulibaly arrives by motorbike in the village of Kafongo in the North of Côte d’Ivoire, carrying a cold box full of vaccines for routine childhood immunizations. © UNICEF/UNI755345/Dejongh

HOW TO HELP

There are many ways to make a difference

War, famine, poverty, natural disasters — threats to the world's children keep coming. But UNICEF won't stop working to keep children healthy and safe.

UNICEF works in over 190 countries and territories — more places than any other children's organization. UNICEF has the world's largest humanitarian warehouse and, when disaster strikes, can get supplies almost anywhere within 72 hours. Constantly innovating, always advocating for a better world for children, UNICEF works to ensure that every child can grow up healthy, educated, protected and respected.

Would you like to help give all children the opportunity to reach their full potential? There are many ways to get involved.

Donate to UNICEF USA to help kids survive and thrive

Invest in children and their futures

DONATE
A group of smiling UNICEF club members, wearing UNICEF USA t-shirts, stand on a city street and reach their arms out to signify welcoming others.

Tell U.S. Congress supporting kids is critical!

Act Now
UNICEF delivers supplies wherever kids need them most

Help UNICEF get lifesaving aid to children in crisis

SEND SUPPLIES