When the cold chain breaks, the vaccine is stopped where it is: it is not administered, distributed or destroyed. For Ministry of Health vaccines in Turkey, the decision on usability is made by a provincial or district evaluation commission. In wholesale distribution, the TİTCK Good Distribution Practice guide requires a temperature excursion during shipment to be reported to the distributor and the recipient, and the product to be handled through a risk assessment.

The emergency plans and workflows published by provincial health directorates (Adana, 2024-2025) follow this order:

  1. If the refrigerator drops below +2 °C, the door is opened and the vaccines go into a vaccine carrier; if it rises above +8 °C, the door stays shut, ice packs are conditioned and, if the temperature does not recover, placed in the refrigerator without touching the vaccines.
  2. The facility's vaccine and cold chain officer informs the provincial or district officer; if the cold chain cannot be maintained, the vaccines go to the district vaccine store in a carrier.
  3. The report includes the highest and lowest temperatures and exposure times from the Vaccine Tracking System, the temperature chart, photos of the VVM and freeze indicator, and the printout of the second logger.
  4. The commission decides between usable, destroy or lost, based on the vaccine's heat sensitivity, the temperature reached and the duration.

For many vaccines freezing does more harm than mild warming. Turkey's Expanded Programme on Immunization circular (2008/14) states that DTaP-IPV-Hib, Td and hepatitis B vaccines and diluents must never freeze, and that a shake test alone does not show a vaccine is usable. WHO notes that the VVM records cumulative heat but not freezing; with sub-zero readings the logger data is what counts.

Once the decision is on file, the root cause is recorded: a deformed door seal, frost thicker than 0.5 cm in the freezer compartment, a generator that failed to start, or a thermostat turned colder after a power cut. The circular singles out that last mistake, because it can freeze the sensitive vaccines.