Relationship Between Knowledge, Attitude and Motivation of Officers in Managing the COVID-19 Vaccine Cold Chain: A Systematic Review


  • Sudarto Edi Hartono 1) Magister of Public Health, Universitas Ahmad Dahlan, Yogyakarta, Indonesia; 2) Sleman Health Office, Daerah Istimewa Yogyakarta, Indonesia
  • Solikhah Solikhah Faculty of Public Health, Universitas Ahmad Dahlan, Yogyakarta, Indonesia
  • Sulistyawati Sulistyawati Faculty of Public Health, Universitas Ahmad Dahlan, Yogyakarta, Indonesia



Vaccine, Cold Chain, Knowledge, Attitude, Motivation


Background: Vaccines are an important tool in preventing serious infectious diseases. Cold chain management is essential to maintain vaccine quality, including storage, transportation, and distribution at appropriate temperatures. This study aims to investigate the relationship between knowledge, attitudes, and motivation of health workers responsible for cold chain management of the COVID-19 vaccine.

Method: This was a systematic literature review study by searching through databases: Google Scholar, PubMed, Semantic Scholar, and Frontiers, using some keywords. 76 relevant previous studies were found. After filtering for publication year (post-2019), they reviewed 19 articles' abstracts. However, 10 articles lacked information on vaccine officers' knowledge, attitudes, and motivation in cold chain management. Thus, only 9 articles were included in the review.

Results: The results show that adequate knowledge, training, and understanding of guidelines significantly influence desired vaccine cold chain management practices. These studies also highlight the importance of understanding guidelines, efficient implementation, and sustainability aspects in vaccine management.

Conclusion: This research concludes that to increase the effectiveness of vaccination programs, efforts are needed to increase knowledge, training, and implementation of guidelines among health workers responsible for the vaccine cold chain. Efforts to understand and implement sustainable practices are also crucial. The conclusions from this research can help decision-makers improve vaccine cold chain management to ensure the success of the vaccination program.


Petersen E, Ntoumi F, Hui DS, Abubakar A, Kramer LD, Obiero C, et al. Emergence of new SARS-CoV-2 Variant of Concern Omicron (B.1.1.529) - highlights Africa’s research capabilities, but exposes major knowledge gaps, inequities of vaccine distribution, inadequacies in global COVID-19 response and control efforts. International Journal of Infectious Diseases. 2022; 114:268–72.

Khodaee V, Kayvanfar V, Haji A. A humanitarian cold supply chain distribution model with equity consideration: The case of COVID-19 vaccine distribution in the European Union. Decision Analytics Journal. 2022;4(July):100126.

Kusumadewi A, Lestari AD. Gambaran sistem pengelolaan rantai dingin vaksin di beberapa Puskesmas Kecamatan di Wilayah Jakarta Timur Tahun 2019. Medical Sains : Jurnal Ilmiah Kefarmasian. 2020;4(2):153–62.

Duijzer LE, van Jaarsveld W, Dekker R. Literature review: The vaccine supply chain. European Journal of Operational Research. 2018;268(1):174–92.

Roden RBS, Stern PL. Opportunities and challenges for human papillomavirus vaccination in cancer. Nature Reviews Cancer. 2018;18(4):240–54.

Schoenmaker L, Witzigmann D, Kulkarni JA, Verbeke R, Kersten G, Jiskoot W, et al. mRNA-lipid nanoparticle COVID-19 vaccines: Structure and stability. International Journal of Pharmaceutics. 2021; 601:120586.

Feyisa D, Jemal A, Aferu T, Ejeta F, Endeshaw A. Evaluation of cold chain management performance for temperature-sensitive pharmaceuticals at public health facilities supplied by the Jimma Pharmaceuticals Supply Agency. Advances in Pharmacological and Pharmaceutical Sciences. 2021;

Fahrni ML, Ismail IAN, Refi DM, Almeman A, Yaakob NC, Saman KM, et al. Management of COVID-19 vaccines cold chain logistics: a scoping review. Journal of Pharmaceutical Policy and Practice. 2022;15(1):1–14.

Yulia M, Luthfi F, Armal K. Profil Penyimpanan Vaksin Covid-19 Di Seluruh Puskesmas Kota Bukittinggi. Journal Pharmacopoeia. 2023;2(1):41–53.

Onyango JO. Supply chain solutions for essential medicine availability during COVID-19 pandemic. Journal of Humanitarian Logistics and Supply Chain Management. 2023;

Xie X, Xie B, Xiong D, Hou M, Zuo J, Wei G, et al. New theoretical ISM-K2 Bayesian network model for evaluating vaccination effectiveness. Journal of Ambient Intelligence and Humanized Computing. 2022;14(9):12789–805.

O’Dea RE, Lagisz M, Jennions MD, Koricheva J, Noble DWA, Parker TH, et al. Preferred reporting items for systematic reviews and meta-analyses in ecology and evolutionary biology: a PRISMA extension. Biological Reviews. 2021;96(5):1695–722.

Pangalo P, et al. Knowledge, Attitude, and Implementation of Cold Chain Management in Boalemo District, Gorontalo, Indonesia. Journal of Health Policy and Management. 2020;5(2):139–45.

Feyisa D, Ejeta F, Aferu T, Kebede O. Adherence to WHO vaccine storage codes and vaccine cold chain management practices at primary healthcare facilities in Dalocha District of Silt’e Zone, Ethiopia. Tropical Diseases, Travel Medicine and Vaccines. 2022;8(1):1–13.

Ergetie FS, Kassaw AT, Sendekie AK. Vaccine cold chain management practices in primary health centers providing an expanded immunization program in Northwest Ethiopia: self-reported and actual practice observational study. Frontiers in Public Health. 2023;11:1–10.

Mohammed SA, Workneh BD, Kahissay MH. Knowledge, attitude and practice of vaccinators and vaccine handlers on vaccine cold chain management in public health facilities, Ethiopia: Cross-sectional study. PLoS ONE. 2021;16(2 February):1–12.

Gebretnsae H, Hadgu T, Ayele B, Gebre-Egziabher E, Woldu M, Tilahun M, et al. Knowledge of vaccine handlers and status of cold chain and vaccine management in primary health care facilities of Tigray region, Northern Ethiopia: Institutional based cross-sectional study. PLoS ONE. 2022;17(6):1–16.

Tri Amelia Rahmitha Helmi, Lintang Dian Saraswati NK, Udijono A. Gambaran kondisi rantai dingin vaksin imunisasi dasar di Puskesmas Kota Semarang. Jurnal Kesehatan Masyarakat (e-Journal). 2019;7(1):228–35.

Setiawan A, Saraswati LD, Adi MS, Udijono A. Gambaran kualitas pengelolaan rantai dingin vaksin meningitis di Wilayah Provinsi Daerah Istimewa Yogyakarta. Media Penelitian dan Pengembangan Kesehatan. 2021;31(2):97–108.

Prasetyo SD, Vidia Ningrum BC, Irianingrum EH, Oktarini FT, Nizza I. Tingkat pengetahuan petugas pengelola vaksin dan evaluasi pengelolaan Vaksin di Puskesmas Kabupaten Sleman. Majalah Farmaseutik. 2021;17(2):249.

Asamoah A, Ebu Enyan NI, Diji AKA, Domfeh C. Cold chain management by healthcare providers at a District in Ghana: A mixed methods study. BioMed Research International. 2021;

Gelaw A, Belyhun Y, Wondimeneh Y, Kokeb M, Dagnew M, Amare A, et al. Knowledge and associated factors of healthcare workers on measles vaccine and cold chain management at health institutions in Gondar, Ethiopia. Asian Pacific Journal of Tropical Medicine. 2023;16(1):26–32.

Yassin ZJ, Nega HY, Derseh BT, Yehuala YS, Dad AF. Knowledge of health professionals on cold chain management and associated factors in Ezha District , Gurage Zone, Ethiopia. Hindawi Scientifica. Scientifica. 2019;1–8.

Mukherjee S, Baral MM, Chittipaka V, Pal SK, Nagariya R. Investigating sustainable development for the COVID-19 vaccine supply chain: a structural equation modelling approach. Journal of Humanitarian Logistics and Supply Chain Management. 2023;13(2):199–215.

Manurung O. Hubungan pengetahuan ibu tentang imunisasi dengan kepatuhan ibu membawa balita imunisasi di Dusun V kecamatan Tanah Jawa kabupaten Simalungun. Excellent Midwifery Journal. 2022;5(1):9–25.






Review Article