Vaccine Handling Management in Korea, Japan, and Taiwan: A Comparative Study of Storage Standards, Implementation Practices, and Regulatory Approaches.

BACKGROUND: Robust vaccine cold-chain management safeguards potency and public trust. Korea, Japan, and Taiwan share core practices (2-8°C storage, continuous monitoring, first-expiry-first-out [FEFO] stock rotation) yet differ in implementation and governance. We compared standards and real-world practices across the three systems to identify actionable improvements for Korea. METHODS: From March-July 2025 we conducted structured interviews and onsite observations at public health centers, hospitals, and clinics in Korea, Taiwan (National Taiwan University Children's Hospital), and Japan (Kyoto University Hospital, Katsura Hospital, and multiple Osaka/Mie sites). We reviewed the latest national guidance and synthesized findings across four domains: 1) storage facilities/equipment, 2) temperature monitoring and excursion response, 3) inventory management/disposal, and 4) governance/compliance. RESULTS: All three countries uphold core cold-chain principles, but system design varies. Taiwan applies centrally coordinated, de facto mandatory standards: government-supported data loggers with alarms, immediate excursion reporting, regular checklist-based inspections, regional backup storage, and a differentiated wastage policy (reimbursement for unavoidable loss; penalties for preventable waste). Japan employs a trust-based, decentralized model, where the widespread use of purpose-built refrigerators and continuous monitoring is common practice rather than a national legal mandate. This system is governed by professional norms, provider-borne financial liability for waste, provider-led excursion decisions (discarding if viability is uncertain), and local-level stock redistribution networks. Korea's evolving hybrid model provides detailed technical guidance (since 2021), promotes automated monitoring and FEFO, and encourages contingency planning; however, requirements are largely advisory, inspections are ad hoc, and formal redistribution and incident-reporting systems remain under development. Comparative tables highlight stricter equipment mandates and enforcement in Taiwan, Japan's reliance on professional norms and financial incentives, and Korea's partial implementation gap. CONCLUSION: To strengthen reliability and reduce waste, Korea could 1) confer regulatory status on key standards, 2) institute routine audits and incident reporting, 3) formalize regional backup/storage networks, 4) enable systematic stock redistribution, and 5) align incentives with a differentiated compensation scheme. Drawing on Taiwan's enforcement/support model and Japan's local-level redistribution networks can help Korea achieve uniformly high performance while maintaining operational feasibility.