An effective vaccine against COVID-19 has largely been viewed as a primary solution to the pandemic that has left an indelible mark on the year 2020, causing over 1.3 million deaths globally, 55 million cases and widespread economic hardship. The race to develop a vaccine against the SARS-CoV-2 virus kicked off in early January when researchers at the Pasteur Institute in France released the virus’ genetic sequence to the global scientific community. Since then, an army of pharmaceutical companies and biotech labs have been working to develop vaccine candidates that can do the job.
Two leading vaccine candidates from Moderna and Pfizer have preliminary results showing over 90 percent effectiveness and could be ready for deployment soon as other candidates continue through the development process. While these milestones are obviously essential, what may be less apparent are the upcoming challenges in distributing these vaccines around the world and subsequently administering them to 7.8 billion people.
The distribution of COVID-19 vaccines will occur against a backdrop of a global supply chain still reeling from the effects of the pandemic itself, which has hampered many industries and slowed the flow of goods around the world. While some level of recovery has occurred since the height of the shelter-in-place orders that took place earlier this year, the effects are still present and may worsen as infections are on the rise.
Yet beyond preexisting supply chain issues, the logistics of global distribution of these vaccines are incredibly complex. The most salient issue at the forefront is that Pfizer’s vaccine must be kept at minus 100 degrees Fahrenheit (minus 73 degrees Celsius) to remain effective. Even in places with advanced medical facilities, the supply of ultracold freezers isn’t adequate to store the number of vaccines needed. However, Moderna’s leading candidate does not need to be kept in such extreme conditions; for its vaccine candidate, storage between 36 and 46 degrees Fahrenheit (2 and 8 degrees Celsius) will suffice. This would allow rural medical clinics in the U.S. to keep the COVID-19 vaccine in stock, as they rely on standard refrigerators to keep vaccines at the proper temperature.
“We believe that our investments in mRNA delivery technology and manufacturing process development will allow us to store and ship our COVID-19 vaccine candidate at temperatures commonly found in readily available pharmaceutical freezers and refrigerators,” said Juan Andres, chief technical operations and quality officer at Moderna. “We are pleased to submit these extended stability conditions for mRNA-1273 to regulators for approval. The ability to store our vaccine for up to 6 months at ˗20° C including up to 30 days at normal refrigerator conditions after thawing is an important development and would enable simpler distribution and more flexibility to facilitate wider-scale vaccination in the United States and other parts of the world.”
Despite the extreme temperatures required for its storage, Pfizer’s vaccine is a major player because a single vaccine cannot serve as a panacea for the disease. It’s likely that many different vaccines will be needed. Danby Appliances, based in Ontario, is gearing up a new line of ˗80 °C freezers for hospitals and pharmacies across Canada. While promising, production will take about 120 days and the units will cost between CAD$8,500 and $20,000. However, even with a ramp-up of production of such freezers, it will be difficult to narrow the supply-demand gap given that the pandemic has already taken a huge toll on the distribution of standard refrigerators and freezers.
Although the Moderna vaccine temperature parameters are less stringent compared to Pfizer’s, the reality is that it still poses great hurdles for many parts of the world where there are little to no refrigerators or freezers. It’s estimated that 3 billion people could be at risk of not getting the vaccine. Places such as a rural clinic in Burkina Faso that lost vaccines for tetanus, yellow fever and tuberculosis due to a broken refrigerator are not currently equipped to store any COVID-19 vaccines. Furthermore, in many rural parts of the world, families sometimes must walk tens of miles to reach the nearest medical clinic. Clinics that receive allotments of multidose vaccine vials will be on a tight schedule of administration as opening a vial immediately reduces its shelf-life. Such time lines could result in wasted vaccines and missed vaccinations if residents can’t get to a clinic in time.
Beyond the temperature-controlled storage challenge, distribution and administration of COVID-19 vaccines will take a high level of coordination among medical suppliers, hospitals and specialized delivery companies. The coordination will also extend among governments of nations, international nongovernmental organizations (NGOs) and small medical clinics around the globe. The vaccines will require needles and syringes for injection, alcohol swabs to prepare the injection site, and proper hazardous waste disposal of these medical items. Trucks or aircraft that carry the vaccines will need to provide sterile environments, and very large amounts of dry ice may be needed to keep the vaccines at the right temperature en route to their distribution locations. There’s also ample concern that a temporary breach in required temperature conditions could cause some vials to become tainted. Manufacturers have proposed a heat-sensitive label on the packaging that would change color as an alert if the vaccines have been exposed to temperatures higher than the requisite ones.
Richard Wilding OBE, professor of Supply Chain Strategy at Cranfield University in the UK called the deployment of a COVID-19 vaccine “one of the biggest logistical challenges we have faced this century.
“A successful rapid deployment of any proven vaccine doesn’t just rely on the amount of vaccine that can be produced. It relies on multiple factors such as infrastructure, information systems and having a workforce that can administer the vaccine,” he told Logistics Management.
Wilding said that an initial piece of the puzzle is to create demand by convincing the general population that the vaccine is necessary. Then logistics and supply chain practices will follow to fulfill that demand. Another challenge is the special infrastructure needed for manufacturing and distribution such as ultracold storage, which will affect the speed and quantity of distribution. Wilding recommends that governments and health professionals listen to pharmaceutical supply chain experts as well as those in industries such as technology and food who are experienced in deploying products quickly.
Militaries may end up playing a role in the monumental effort to vaccinate the world. In the U.S., the Department of Defense has launched Operation Warp Speed to accelerate the testing, supply, development and distribution of safe and effective vaccines to counter COVID-19. While U.S. military personnel won’t be administering vaccines, the plan is for them to help with logistics such as transporting needles, syringes, swabs, bandages, dry ice and trucks. Part of this will entail setting up operation centers similar to those used during natural disasters and coordinating with the Centers for Disease Control and Prevention, states and local governments. The last piece—getting vaccines to health centers in local communities—will be a critical part of the challenge. In the U.S., many of the centers have been underfunded for decades and will require federal aid to successfully conduct such a widespread and immediate vaccination program.
Logistics company DHL estimated that 15,000 cargo flights would be required to vaccinate the entire world against COVID-19. The question still lingers about whether sufficient infrastructure and materials are available to carry out this feat. One important aspect will be supplying the world’s most rural medical clinics with solar-powered refrigerators and freezers in time to store adequate quantities of the vaccines.
COVAX, an initiative spearheaded by the World Health Organization and the Gavi vaccine alliance, has been putting resources toward the equitable distribution and administration of COVID-19 vaccines since it was created in April. The ethos behind COVAX is the idea that “no one is safe until everyone is safe” given how widespread and easily transmissible the virus is. But if fierce competition for vaccines ensues between nations, many could be left behind.
To combat this, the COVAX Facility was devised to maximize the chances that people in participating countries will get access to COVID-19 vaccines as quickly, fairly and safely as possible. So far, 78 higher-income countries are participating. The facility is incentivizing manufacturers to expand their vaccine production. It’s also using the collective purchasing power of the participating countries to negotiate vaccine prices with manufacturers in hopes that they will be affordable to recipients.