The greatest challenge of this era: Logistics of COVID-19 vaccines
COVID-19, a virus orders of magnitude smaller than a grain of dust, has turned everyday life on earth into something deeply unknown. In the ten or so months after it first appeared, the epidemic settled at a constant rate of killing 5,000 people per day, or almost a million. The global economy has wreaked havoc, plunging the global into the worst economic recession since World War Two. Potentially, we are reaching the beginning of the end, meaning we may be at the end of the middle now. We are possibly far from halfway through the pandemic in terms of time, but the gradual deterioration in dreadfulness is potentially on the horizon. The culmination of this epidemic will take much longer than the beginning. This is because there is a vaccine coming. There has been a time of uncertainty previously as to whether a successful vaccine will be made, which is not a sure shot, but all signs currently show that it is indeed coming.
Right now, in September
2020, the late-October, early-November timeline is the focus of all attention.
This is the first possible moment that any of the leading vaccines, from large
manufactures such as AstraZeneca, Pfizer, and Moderna, may be subject to
regulatory scrutiny. If all the details confidently show that the vaccine has
an appropriate level of safety and effectiveness experts say that having a
vaccine in 2020 is a less-than-long-shot possibility. However, it is almost
certain that you will not be injected by a COVID-19 vaccine in the year 2020.
It can be described as
the most challenging and consequential single logistical undertaking ever to
get the majority of the world's population vaccinated. The stakes were never
higher, but the challenge was never greater either.
It's a problem of scale,
first and foremost. It is not difficult to ship and administer one vaccine to
one person, but to ship and administer 5 billion vaccines to 5 billion people
is. That's because our world's logistics network doesn't have enough space to
do that. Making it much harder, depending on the latest leading candidates, two
doses offered 21 or 28 days apart would be needed for the first big vaccine to
be accepted. That doubles the challenge. Distributing 10 or more billion doses
of a vaccine would be difficult enough in normal times, but these are far from
normal times.
With international
travel all but non-existent, more than 90 percent of passenger airlines have
significantly decreased their international route networks. Today, this is a
problem since about 50% of pharmaceuticals are usually delivered in the
passenger aircraft's belly-hold rather than on dedicated freighters. Total
cargo capacity is about 30 percent down with minimal passenger operation, while
cargo demand is just about 15 percent down, meaning there is still a supply
shortage. This has led to existing dedicated freighter aircraft being used
more, additional dedicated freighters coming into service, but still, due to
constrained supply, a dramatic increase in shipping costs.
Pharmaceutical producers had to come up with different techniques to export their products before the COVID vaccine reached the global logistics network, such as flying their product to where shipping costs are cheaper and delivering them to their ultimate destination or chartering private planes and shippers were willing to scale up fairly for that, but there's one basic explanation why it won't be easy Vaccines are sensitive to temperature. Most of them have to be stored in a highly precise, climate-controlled environment to stay safe and effective. So, the cold chain is the supply chain suited to shipping goods that needed to be kept cold or frozen, such as chemicals, and pharmaceuticals. The trouble with the cold chain is that everything used must be specialised, each having the origin and the final destination to have the equipment to hold them at the specified temperature. Both solutions are difficult and complexities compounded by other complexities are what make it a real logistical challenge.
A thermal requirement
like it is an entirely new ball game, and it ensures that only a portion of the
cold chain infrastructure, which is already a portion of the total logistics
infrastructure, will be able to be included. Many hospitals do not even have
facilities to hold a vaccine at such a temperature, beyond the problem of
simply getting such a vaccine to a delivery centre. Part of the reason why this
obstacle has come up is that traditionally, vaccines are thoroughly tested to
determine what sort of storage and shipping conditions they can endure while still
staying safe and effective.
Consequently, to repeat, now, a possible vaccine would only be able to be distributed to a subset of a subset of an already overloaded distribution network, to a subset of locations, and that would have to happen several billion times, but even the answers to these problems present additional challenges. For example, Pfizer, knowing that their vaccine's particular delivery criteria could limit its commercial success, has created a partial solution. This means that, hypothetically, the vaccine could be shipped through a more traditional logistics network. Upon arrival, it can only be opened twice per da. That means that a distribution site would need to accurately predict how many doses they would need in a given day before that day
They could only
vaccinate five hundred people in ten days, even if shipping was instantaneous,
meaning half their vaccines would go bad. To solve this problem, Pfizer is
designing a smaller temperature-controlled package, but that means adding a
slightly new form of distribution, which adds complexity, slowing down the
operation.
In its scenario planning, the American CDC mapped out a distribution process for if both Pfizer and Moderna’s vaccines are approved and, if this happened, the Pfizer vaccine would be directed to only large distribution sites that would either have the facilities for ultra-cold storage.
The sequence of
operations for distribution is another challenge that needs to be met.
Coronavirus affects multiple individuals in various ways. This suggests that
the first person in line should be the one who is most vulnerable to COVID-19
if we want a vaccine to save as many lives as possible, and the last person in
line should be the one who is the least susceptible. One set of research modelled
two scenarios—the first where, of the first 3 billion doses available, 50
high-income countries buy up 2 billion of them. The second was where the first
3 billion doses were distributed to countries proportionally based on their
population, regardless of wealth. In this model, twice as many people died
overall with the first scenario—the wealthy countries first scenario—than the
equitable, proportional approach. However, for vaccination purposes, it is the
least wealthy countries, arguably those that need the vaccine most, that are
toughest to distribute to. Poor countries tend to have limited cold chain
infrastructure, let alone normal logistics infrastructure, poorly-funded healthcare
systems.
In prosperous nations such as the United States, the delivery and administration of a sophisticated vaccine such as Pfizer's would always be tough enough. With assurance, a day's delay will lead to more death and despair. The manufacturers are working as fast as they can, they are already producing millions of doses of their vaccines before they’re approved so they can be distributed as fast as possible, and regulatory agencies have been preparing for months for an unprecedentedly fast review process, so it is now truly down to every member of the global logistics network to save lives, many of those that will be involved, especially once we get to wide-scale distribution, will be companies, not governments or nonprofits, and for them, this presents a massive business opportunity.
As well as the positive
prospects for public relations. To be able to manage more of the rise in
demand, DHL and FedEx are currently dramatically upgrading their cold-chain
systems, while other lesser-known logistics firms are also. Ultimately,
however, finding someone in-the-know who does not admit that shipping is going
to be a bottleneck is challenging. This will come down to making sure that as
much planning work as possible is done now before the vaccine is approved so
that distribution can happen as fast as possible.
When that does happen? Now is the time to work out how the vaccine
can be distributed and when. If you are a good, comparatively young person who
thinks selfishly, the delivery process should take better care of you, because you
are at the back of the line. If we can make an effort now to organise and train
for this, to build a framework that directs people by obligation rather than
money, we will at least realise that if only the vaccine came to them sooner,
no lives could have been lost. In facing what is the biggest global obstacle of
this generation, hopefully.
References:
https://blogs.worldbank.org/opendata/understanding-depth-2020-global-recession-5-charts
https://www.iata.org/en/iata-repository/publications/economic-reports/air-cargo-markets-july-update/
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