The Cold Chain Assurance Act took effect on 1 August, requiring clinics and pharmacies that store insulin and vaccines to install certified medical refrigerators with temperature logging. A study of 1,086 outlets across 12 Ukrainian regions says 18% ran out of refrigerated insulin for at least one day during the law’s first month.
Researchers estimate that about 41,000 patients in the surveyed areas experienced a missed or delayed pickup. They attribute the disruption partly to the compliance deadline: medical-grade refrigerators rose from an average ₴31,000 (about €633) to ₴44,000 (about €898), a 42% increase, as suppliers struggled to meet demand.
A deadline, then empty shelves
The study, led by Paweł Malinowski-Cieślak of the Centre for Cold-Chain Health Studies, was published in the Eastern Health Review. Researchers compared daily temperature logs and stock records from 1 August to 31 August with the same outlets’ records for May, before the equipment requirement was announced.
They found that 14% of the outlets temporarily stopped dispensing insulin, compared with 3% in May. In 62% of those cases, the outlet had closed its refrigerated-medicine cabinet while waiting for a certified unit or for technicians to install it, the paper says. Researchers cautioned that other supply delays may also have contributed.
“The law was meant to protect medicine, but the deadline left thousands of people travelling farther or coming back another day,” said Malinowski-Cieślak. The team used clinic catchment registers to estimate the number affected; it did not track individual patients, and said the total should be treated as an estimate rather than a headcount.
The deadline left thousands of people travelling farther or coming back another day.
Paweł Malinowski-Cieślak, study lead
Clinics count the extra cost
In a Cherkasy district, Salvador Santos said he made two trips to collect his prescription after his usual dispensary paused refrigerated sales for four days. The 58-year-old said the replacement outlet was 19 km (12 miles) away. “I got the medicine in the end, but the bus fare and the lost workday mattered,” he said.
The research team found that patients in affected districts travelled an average of 23 km (14 miles) farther for a replacement pickup. Seija Vilkkula-Hakala, a family doctor who reviewed the paper, said the result showed why equipment rules need a transition plan. “A safe refrigerator is essential, but closing a dispensing point is not a safe outcome,” she said.
The health ministry said it had received the findings and would allow a 60-day grace period for outlets that had ordered certified units before 1 August. Emil Krupa, a ministry adviser, said a reimbursement scheme covering up to 70% of equipment costs would open on 15 October, with priority for rural clinics.
The study says that step may help, but warns that the initial rush drove up prices for units also sold through general appliance suppliers. It recommends staged deadlines, temporary shared storage between nearby clinics and a public list of outlets with insulin available. The authors say they will repeat the survey in November to test whether stock and travel distances improve.
