Cold chains, interrupted: The use of technology and information for decisions that keep humanitarian vaccines cool

2.1 The vulnerability of vaccines

Vaccines can only save lives if they remain cool. Most vaccines are developed for a temperature range of 2-8°C (35-46°F), their so-called “safe range.” Although usually heat exposure is in focus, freezing was identified as a problem in an astonishing 75-100 percent of vaccine chains (Lloyd et al., 2015). Vaccines with active ingredients will spoil automatically if frozen, but have generally better heat stability (Matthias et al., 2007). With temperatures higher than 8°C; however, the efficacy of a vaccine decreases (Chen and Kristensen, 2009), and may do harm if not cooled and handled appropriately.

Immunization supply chains were initially designed to manage few, inexpensive and bulky vaccines. Health workers were encouraged to use one vial (i.e. a small container, typically cylindrical and made of glass) per child, although each vial provided 10-20 doses leading to wastage rates of 60-70 percent (Humphreys, 2011). Since the cost of newer vaccines has risen from a few cents to 3.50-7.50 US$ per dose, those vaccines are now typically provided in single or two-dose packages (UNICEF, 2014). While this helps to reduce wastage, it also means that they require more cold chain space (WHO, 2014), significantly increasing the cost for transportation and storage. For instance, for the rotavirus, Wolfson et al. (2008) estimate a cost increase of 60 percent through the new packaging. Overall, immunization supply chains are increasingly stressed by a widening variety of new vaccines and complex immunization schedules, increasingly demanding cold chain requirements, and the rapid expansion of vulnerable populations living in hard to reach areas (WHO, 2014).

2.2 Managing a vaccine campaign – a humanitarian logistics perspective

A typical vaccine campaign has three phases, dedicated to planning, implementation and evaluation respectively. The planning phase is dedicated to the design of the vaccine campaign, including sourcing, network planning and distribution or inventory management policies. Given the long lead times for cooling equipment and vaccines (several weeks or months; UNICEF, 2015a), these planning decisions can typically not be revisited and changed during the ensuing campaign. In the implementation phase, vaccines are transported from national warehouses through a chain of district and regional warehouses until they are distributed (Humphreys, 2011; MSF, 2014; UNICEF, 2015a); cf. Figure 1. The post-campaign phase is dedicated to an evaluation with the purpose to inform advocacy, strategic planning and training.

Figure 1 shows the flow of vaccines from sourcing and the port of entry down to the health posts and eventually administration to the beneficiaries during the implementation. Throughout all cold chain stages, from the arrival at the airport to last mile distribution, vaccines must remain within the recommended temperature range. This implies that vaccines must be stored, packed and transported under cold chain conditions. Cooling systems, however, are typically not standardized. While standards and availability of equipment generally deteriorate deeper in the field, there are different options typical for the respective level (cf. Figure 1).

Cold chain equipment can be categorized into active refrigeration systems and passive cooling devices. Although particularly the passive cooling solutions may seem basic, the cost for setting up the cold chain can amount to almost 50 percent of the total campaign cost (Lydon et al., 2014).

Active systems include mains refrigerators and off-grid refrigerators. Mains refrigerators are cooled by compressors that are powered by the electric grid. Off-grid refrigerators include two main subsets: absorption refrigerators powered by the burning of liquid petroleum gas or kerosene, and solar-powered adsorption refrigerators, which use electric compressors that may be driven from batteries that have stored the power generated by solar panels (solar battery-powered), or directly from the solar panels themselves. For active cooling systems, the reliable functioning of technology and its correct use are essential for keeping the cool; they are more robust to delays and therefore do not require minute planning.

Passive cooling devices include cold boxes and vaccine carriers. Cold boxes are larger devices (6-25 litres), generally transported by motor vehicles, while vaccine carriers are smaller (0.5-3.5 litres), and generally carried by hand or on bicycles or motorbikes. They are called passive because there is no active refrigeration mechanism – the cooling is provided by coolant packs containing phase change material (traditionally plain water) frozen into solid form. To avoid freeze damage to vaccines in passive cooling devices, an extra step of “conditioning” is required, taking coolant packs out of the freezer long enough so that they begin melting before placing them in the device (Robertson et al., 2017). Alternatives include gel packs (often formulated for specific temperature ranges), or other products with sufficient thermal mass to contribute to the temperature control such as frozen meat[3]. In the cold chain stretches, for which passive cooling is used, timing is of the essence, and the cold chain can be disrupted if there are delays.

4.1 Technological innovation case: drones for accessibility

The last mile problem whereby aid supplies reach a central hub but cannot be distributed due to damaged or absent infrastructure is a key challenge for humanitarian supply chains in general. Humanitarian disasters can result in the decrease of the accessibility to particular regions for a long time, thereby causing the resurgence of nearly eradicated viruses (Lemmens et al., 2016). While humanitarian last mile challenges so far have been conceived primarily in the context of rural areas, accelerating urbanization with attendant problems of congestion, safety and infrastructure problems will likely be increasingly come to the fore.

The utility and ethics of so-called “humanitarian surveillance drones” has been the subject of much discussion in the humanitarian community over the last couple of years (Sandvik and Lohne, 2014). More recently talk about the potential of cargo drones to help bridge the last mile to bring vaccines, blood supplies or HIV diagnostic kits to suffering African populations in countries like Lesotho, Malawi, Rwanda or Madagascar has been heavily promoted by the drone industry and has received significant attention from global media (Sandvik et al., 2017)[4]. Despite the experimental and immature state of the technology, proponents of cargo drones present the cargo drone as a “game changer” (Sandvik, 2015) arguing that they can solve the last mile challenge, and address its challenges of effectiveness, efficiency and timeliness in the cold chain with guaranteed delivery in minutes, irrespective of ground conditions (Markoff, 2016). Technology optimists envision that at the point of need, a health worker phones the nearest district store with exact requirements: the drone delivers exactly what is needed, patients are treated, waste is reduced and there is no guesswork. The potential for drones entails savings at local clinic inventory, and increases healthcare capacity. Minimum inventory levels will reduce wastage from wrong, overstocked or expired medication, hence leading to lower costs. In sum, cargo drones promise to make systems responsive rather than predictive. This is particularly significant for cold chains, where storage requires important investments, and transportation needs to be quick to ensure that vaccines remain cool.

However, in the academic literature, very few articles consider the use of drones specifically for cold chain problems. For “humanitarian drone” or “humanitarian UAV” and “cold chain,” there are only three references in Google Scholar, all of them very recent (published in 2016 and 2017). We therefore broadened the scope of the review including technical and pharmaceutical publications on vaccine deliveries. Easterbrook et al. (2017) focus on hepatitis diagnostics and briefly reference the possibility of using drones for healthcare deliveries, including vaccines, to remote locations with poor transport routes. Martini et al. (2016) discuss drones in an urban resilience context, including delivering critical relief items such as medicines. The main focus of their work, however, relates to drones as “resilience building technology,” emphasizing the potential of drones to support the sharing economy. Amukele et al. (2017) investigated the impact of drone transport on the integrity of blood samples. Tatham et al. (2017) published a case study on using drones for transportation of medical maggots in Western Australia. This paper is the only humanitarian logistics publication, and highlights organizational challenges related to the use of drones. The study is situated in a development context, where the challenge is reaching populations in very sparsely populated areas with sporadic demand, opposite to vaccine campaigns with a surge demand across rural and urban areas. In addition, maggots are more robust to changing temperatures[5] than vaccines.

Overall, the literature falls into technical studies (feasibility and integrity), or drones are peripherally referenced as a solution to logistics challenges in disasters. There are no academic studies specifically on the use of drones in vaccine chains, or for densely populated urban areas. Hence, there is clearly a need for studying the use and impact of drones for vaccine chains from a managerial, logistics and operations research perspective.

Cargo drones can potentially solve simultaneously the challenges of humanitarian airdrops (which are costly and ineffective, and medicines are typically not dropped) and the last mile problem. However, so far, experiments indicate significant challenges with respect to airworthiness, durability, energy supply and the problem of absence of weather data, which make navigation difficult (Sandvik and Lohne, 2014). Tatham et al. (2017) emphasize the organizational challenges, but emphasize the feasibility of using UAVs. However, since the context of their work, which is situated in Australia, is different from the setting of many resource-poor countries in the Global South, their findings may not be representative.

From a supply chain perspective, the use of drones crucially depends on human resources in terms of availability of trained staff that runs and maintains the drone system. On a more strategic level, to use drones the efficiently and realize the promise of zero waste, a lean management strategy needs to be implemented, in which warehouses and distribution centers can match the supplies as they are needed locally. Given the current push-based approach for vaccines campaigns with long lead times, this requires a shift of the supply chain strategy to ensure that local demands can be met in real-time. Otherwise, this strategy will only lead to an increase of inventories and eventually wastage at central hubs.

4.2 Technological innovation case: solar refrigerators for power supply

Similarly to cargo drones, solar refrigerators have also been described as “cheap, rugged and game-changing”[6], and construed as having both humanitarian and ecological impact (Proefrock, 2010). For example, in April 2016, the ICRC installed solar panels at 32 healthcare clinics in the Gaza Strip to ensure that vaccines remain refrigerated in “the power-starved territory” (AP, 2016). As a technological fix to cold chain problems, solar refrigerators were introduced already in the early 1980s in the context of the Expanded Program on Immunization (WHO, 1981, Charters and Oo, 1987), and has surfaced intermittently as a potential solution to cold chain problems: for example, by 2006, 50 solar refrigerators donated by ECHO to be used as a power source for immunization cold chain equipment and help insure uninterrupted immunization services were described as being expected to “make an enormous difference in helping […] protect hundreds of thousands of children from deadly and crippling diseases that can be prevented through vaccines, like measles and polio” (UNICEF, 2006).

Solar power is an off-grid technology (Franceschi et al., 2014), and most of the countries urgently needing vaccines are geographically suitable for solar cooling (Santori et al., 2014). In particular, the UN frames solar power as being beneficial to women and children, in ensuring their safety (cooking stoves instead of open fires) or for educational benefits (reading lights) and basic healthcare (Pritchett, 2015). It is argued that solar cooling “could have an important impact on vaccines savings, increasing the number of vaccines available for administration and consequently reducing mortality” (Santori et al., 2014). UNICEF advocates solar refrigerators in a recent report, pushing for replacement of traditional absorption refrigerators that are consuming kerosene or gas, largely because of problems to guarantee access to kerosene/gas, environmental aspects and difficulty of temperature maintenance (UNICEF, 2015b). In addition, there are currently no kerosene- or gas-driven refrigerators that qualify under the minimum standards established by the WHO Performance, Quality and Safety system (McCarney et al., 2013).

Reflecting the maturity of the technology, in comparison with the academic analysis on the use of cargo drones in cold chains, there is a substantial literature on solar refrigerators in humanitarian cold chains. Nevertheless, a recent review on active refrigeration for food chains in humanitarian contexts by Aste et al. (2017) emphasizes that while the feasibility of solar cooling has been widely and often successfully tested under lab conditions, only few devices have been successfully tested on-field in rural areas. Among the successful implementations are a solar-powered adsorption refrigerators in Nigeria (Anyanwu and Ezekwe, 2003) and Burkina Faso (Buchter et al., 2003). However, these contributions focus largely on the technical feasibility and performance of refrigerators. Problems of installation, use and maintenance at the local or community level are not addressed.

Specifically for vaccine cooling, McCarney et al. (2013) review performance of solar refrigerators across a series of use cases. Core problems and relatively high failure rates are related to lacking incentives to support long-term maintenance and repair; system design not considering the local context and conditions; inadequate monitoring of temperature performance; and lack of protocols to manage deviations or disruptions.

Overall, however, the literature is very sparse when it comes to integrating solar refrigeration into humanitarian supply chains. To date, there is insufficient research on the use, maintenance and impact of solar refrigerators in cold chains. Solar refrigerators are still vulnerable: technical problems, problems with spare parts, theft, rain and clouds constitute fundamental problems. Similar as for drones, the success of solar refrigerators depends on local capacities to maintain the system. Moreover, solar power is “weak power” whose presence under the banner of the urgency or difficulty of the conditions of the humanitarian crisis may lead authorities to refrain from having to invest in appropriate infrastructure (Redfield and Robins, 2016).

From a supply chain perspective, the presence of solar refrigerators adds buffer and storage capacity in remote locations independently from access to the power grid. Their efficient use in the cold chain depends on enabling local staff to use and manage this decentralized storage system. To make informed scheduling or routing decisions, for instance, local decision makers need to know where there is spare cooling capacity, if the refrigerator is functioning and if its location can be reached in time to cool vaccines, given the status of the transportation network. Such information needs to be continuously updated and fed into a logistics planning system. Currently, however, logistics information systems suffer from fragmentation, focus on strategic planning and accordingly, long reporting cycles (Comes and Van de Walle, 2016; Laguna Salvadó et al., 2016). We will address the challenges of information and decision making next.

5.1 Technology innovation case: monitoring and tracking systems

Fueled by the rapid developments in information technology, it has become possible to monitor, track and trace goods across the globe. Location-based services have become widespread in the last few years thanks to the mass availability of location chips in every internet-enabled mobile and portable device: smartphones, wearable or embedded devices, and low-cost computing platforms, e.g. Raspberry Pi and Arduino (Schumann-Bölsche and Schön, 2015). Such devices combine motion, location, environmental and physiological sensors that enable advanced location and tracking (Yang et al., 2011).

Besides tracking locations or the movement of humanitarian supplies, monitoring the safety of vaccines is vital. The only reliable way to verify the integrity of the cold chain is continuous temperature monitoring. While it is still common practice in developing countries that thermometers are put into refrigerators and temperatures are checked at given intervals (Thakker and Woods, 1992; Lloyd et al., 2015), only fridge tags, min/max thermometers and vaccine vial monitors can reliably provide information whether the safe range was maintained or breached (WHO, 2014; Trostle et al., 2003). The amount and complexity of vaccine campaigns, however, make vaccine tracking difficult: vaccines are often packed in small containers that cannot individually be monitored due to the high cost and effort in monitoring and updating temperature logs (Carullo et al., 2009). Therefore, the design of cold chain tracking and monitoring systems needs to balance the investment in the monitoring system and the potential gains in terms of reduced waste rates or improved immunization coverage.

The sparse academic literature there is on the topic largely focuses on the results of monitoring in terms cold chain disruptions (see e.g. Lloyd et al., 2015; Matthias et al., 2007; Nelson et al., 2004), Daskalopoulos et al. (2014) being the exception in their presentation of an internet of things approach to develop a seamless monitoring system, which is tested for its ability to detect disruptions of the cold chain.

From a supply chain perspective, monitoring and tracking technologies support data collection that is directly related to the material flows. In this sense, they offer the opportunity to complement existing information flows by reliable information about individual vaccines. However, their impact on supporting coordination and steering the material flows can only be used successfully if they support existing information management practices and systems.

5.2 Technology innovation case: information management systems

Information management covers the various stages of information processing from production to storage and retrieval to dissemination toward the better working of an organization. Increasingly, information technology is playing a key role in enabling effective and efficient information management. Information management systems integrate the technology within the work processes of the humanitarian actors (Van de Walle et al., 2009). Despite its importance, no comprehensive academic attention has been given to the interlinkages between “information management” or “information systems” and “humanitarian cold chain.” In the humanitarian logistics literature, information management is usually referred to as a responsibility of clusters, or as an important skill (Abidi et al., 2015; Jensen and Hertz, 2016). While Schumann-Bölsche and Schön (2015) investigate the use of sensors and Raspberry Pi in medical supply chains in Sub-Saharan Africa, they do not address overall challenges of integration and interoperability within an information system. In a review by Dasaklis et al. (2012) on general epidemics control and logistics considerations beyond the humanitarian context, the lack of information management consideration was considered a research gap.

The humanitarian information management literature, on the other hand, is largely focused on case studies, e.g. for the 2010 Haiti Earthquake (Altay and Labonte, 2014; Van de Walle and Dugdale, 2012), Typhoon Haiyan (van den Homberg et al., 2014; Comes, Vybornova and van de Walle, 2015) or the Ebola Outbreak (Laguna Salvadó et al., 2015; McDonald, 2016; Vybornova and Gala, 2016). Yet, while the contributions emphasize the need to tailor information flows to support specific decisions and problems and the role for ICT in broader logistics operations, none of them specifically addresses the problems of cold chains. The dichotomy between different coordination layers and time frames has been documented for other humanitarian operations and is often reported as a source of friction (Van de Walle and Comes, 2015).

Given the fragmented and emergent state of the literature, there is a need to systematically analyze how cold chain information systems can be designed to serve its three-fold purpose:

1. facilitating coordination and adaptive planning at national or reginal level;

2. enabling local real-time decision making to ensure that vaccines are kept cool; and

3. data collection for evaluations and advocacy.

Introduction of technology can support data collection, but also, in turn, requires data to work efficiently. This implies that any new technology will make information management more complex, and requires systems that facilitate and foster information sharing in a decentralized network respecting the context of the respective users, decision makers or operators.

From a supply chain perspective, information flows are to support coordination and align flows of material (Van Wassenhove, 2006). However, it is still common practice that planning and advocacy dominate information management. Instead of supporting coordination along, the chain data are collected, verified, triangulated and aggregated only at national coordination or headquarters level before redistributing to the field, leading to long information lead times. To adapt to the local and dynamic challenges for cold chains, humanitarian information management needs to refocus and contextualize information to support the core functions of a cold chain, i.e. coordinating a distributed systems and support decision makers detecting and adapting to changing conditions in terms of access, infrastructure, needs or capacities.

7.1 Planning and implementing cold chains under conditions of uncertainty

An important driver behind data collection effort is the need to reduce uncertainty and make evidence-based decisions (Darcy et al., 2013). Acknowledging that the nature of uncertainty in humanitarian disasters is such that they cannot be completely reduced, drones and refrigerators offer different ways to manage uncertainty by providing flexibility and buffer capacity.

Time is a driver of deep uncertainty as it limits the possibilities to collect and analyze data. As such, time determines the approaches that can be taken to manage and model uncertainty. The IFRC’s (2016) World Disaster Report recently advocated scenario planning to consider uncertainties and involve communities. Another popular method in humanitarian logistics is stochastic programming (Özdamar and Ertem, 2015). Both can be applied in the planning phase because there is time for data collection, modeling and simulations, or deliberation and discussion. Moreover, for planning purposes, it is vital to establish an aggregate overview of the campaign including international sourcing decisions to the layout of a distribution network at national level. The time horizon considered will typically encompass the campaign itself, plus longer term strategic considerations and partnerships.

Contrarily, real-time decisions that need to be made at local level during the implementation require only information about (few) locally feasible alternatives. Uncertainties in the implementation phase stem often from gaps, flaws or insufficient updates in data collection. Because of the time pressure, those uncertainties cannot be reduced or fully modeled. Rather, decisions need to be made based on incomplete information, using rapid heuristics, experience or the proverbial gut-feeling of many responders. While most models are deterministic or stochastic assuming that the nature of uncertainties is known (Galindo and Batta, 2013), systems to support real-time decisions need to be developed to acknowledge lacking information and deep uncertainty.

For long-term planning, so-called “Dynamic Adaptive Policy Pathways” have been proposed to address far-reaching uncertainties (Haasnoot et al., 2013). The method is based on two complementary approaches for designing adaptive plans: “Adaptive Policymaking” (planning and identification of early warning signals) and “Adaptation Pathways” (exploring and sequencing a set of alternatives). To fit to the setting of the implementation phase of a vaccine campaign, such methods need to be adapted to take into account real-time scenario construction (as, for instance, proposed by Comes,Wijngaards and Van de Walle, 2015) as well as the impact of shocks on forecasting and decision making (Durbach and Montibeller, 2017).

By using appropriately sourced and field-tested new technologies such as drones or solar refrigerators, the number of options available to safely store and transport vaccines increases, and thus also the flexibility of cold chains. The impact of the increased number of options, however, critically depends on the ability of decision makers at all levels to access, understand and process information before vaccine temperatures exceeds the safe range. This includes the time to note that a disruption may be occurring, the time to adapt the plans and decide, and the time for implementation.

7.2 The role of information in implementing cold chains

Along with the information explosion driven by new technologies, many generic information products are developed, hinting at a growing lack of clarity on whose decisions should be supported (Altay and Labonte, 2014). Indeed, the problem often is the sheer number and heterogeneity of decision makers in the field and the choices they need to make (Gralla et al., 2013). The very set-up of a cold chain provides only a limited and clear set of options to keep vaccines cold within the relatively short time frames available. As such, cold chains constitute a promising case to analyze and model decision makers’ information needs in the field.

The cold chain distribution network and the strict requirements on vaccine temperatures limit the numbers of feasible options at local level. For instance, the number of warehouses equipped with cooling facilities that a transport can reach will, in most cases, be very small. As such, vaccine campaign information systems that support and empower local planning can make use of rapid heuristics, and does not require a global overview of the supply chain. The local information about access, infrastructure, capacity needs to be updated continuously. If such information is not available, at least knowing under which conditions a planned route or schedule leads to a disruption of the cool chain provides an indication of the most crucial information needs and critical thresholds.

Information that is being collected is intended to improve the cold chain implementation and the timely delivery of vaccines to those affected by disaster. Yet, this very information can become a threat endangering these very lives, if it is inaccurate, misleading or falls in the hands of malevolent groups. In the past decade, so-called humanitarian information principles have been identified to guide the processes of collecting, checking, sharing and using information (Van de Walle et al., 2009). Earlier findings from field research in a natural and complex disaster setting indicate that in both disaster types the application of these humanitarian principles can be extremely challenging (Van de Walle and Comes, 2015). In natural disaster response, the processes leading to information products are more “tried and tested” and streamlined. The resulting automation of standard products, however, may reduce the flexibility in tailoring to actual needs, or even prevent the actual verification altogether whether the products meet the needs for which they were generated in the first place. In complex disaster response, information sensitivity and a lack of adequate procedures to handle it may lead to an exaggerated concern for security, and only that information of which one is absolutely certain is considered for the planning and implementation decision processes. More research is needed to elucidate the role of information in disaster settings, natural or complex, in the implementation of cold chains.

7.3 Decision irreversibility in planning and implementing cold chains

Many optimization models assume that decisions are taken at a single point in time and that the events that affect their results can be modeled exhaustively (Altay and Green, 2006). In practice, however, each choice influences the options that can be implemented in future, in other locations, or at another hierarchical level (Comes, 2013). For instance, if vaccines do not reach their destination because the cold chain has been disrupted, decision makers need to arrange for another transport, shifting inventories and re-allocating resources. Hence, decisions should be modeled as a nested series of interdependent decisions that need to be aligned.

One fundamental aspect of restricting future choices, which is particularly relevant in cold chains, is the reversibility of a decision. Although many decisions within a vaccine chain can be irreversible in nature – because vaccines cannot be used any more, or even turn into harmful substances – there is thus far no published research that addresses irreversible cold chain decisions. Even the broader searches of “irreversible” and “humanitarian” in Google Scholar only lead to articles on irreversible evidence and irreversible change, but not of decisions. Henry (1974) defined a decision as irreversible “if it significantly reduces for a long time the variety of choices that would be possible in the future,” while Arrow and Fisher (1974) defined an irreversible action as one that is infinitely costly to reverse. Henry’s phrase “for a long time” is strictly relative. A long time in one decision problem may be a short time in another. This qualification implies that we should be concerned over actions that are costly to reverse within a relevant time frame.

While there has recently been some work on responsive supply chains (Balcik et al., 2015) and related information systems (Laguna Salvadó et al., 2016; Comes and Van de Walle, 2016), the specific conditions of the cold chain requires further research.

Because of the long lead times many strategic decisions in the planning phase are irreversible within the time frame of the upcoming vaccine campaign: it is often prohibitively costly to source and order further vaccines, or to install additional cooling equipment, once a campaign has been announced for launch. The resulting lack of flexibility has important implications for the implementation phase. Theories of flexible decisions in supply chain management emphasize that strategies whose initial decisions limit future options as little as possible have advantages in the uncertain and often chaotic environment of disasters (Charles et al., 2010; Comes, 2013). Intuitively, a flexible strategy should be preferred over a rigid one, for it offers the possibility to adapt upon receiving new information. Therefore, the reduction of lead times and increased flexibility with respect to capacity and facility location planning are important in cold chains to enable operational staff to re-consider, re-evaluate and modify the vaccination campaign’s strategy.

During a vaccination campaign, a series of decisions at operational and tactical level must be made. Given the typical lack of information about infrastructure status or cooling capacity, decision makers will frequently not know whether their decision will be irreversible. For crises, Pauwels et al. (2000) showed that by not taking into account the irreversible nature of a decision, the performance of the operations can suffer. As such, any allocation, scheduling or routing decision should be supported by information about the critical points that can prevent a decision to become irreversible. For instance, this can be the information about back-up cooling capacity that can still be reached on time, or surplus inventories that can be used to replace vaccines if cold chains are disrupted.