gloved hands holding a vial of vaccine

The monumental challenge of delivering a vaccine globally

9 min read

02 Jun 2021

Text

Lorelei Yang

Nikhil Sivadas

Photo

123RF

9 min read

02 Jun 2021

Text:

Lorelei Yang Nikhil Sivadas

Photo:

123RF

The number of COVID-19 vaccines being approved is rising, but the delivery and distribution of these vaccines promise to be logistically complex, straining both public and private sector resources.

A year ago, the world was grappling with the emergence of a novel and highly contagious virus, COVID- 19. As the virus led to a pandemic, enormous amounts of time resources and efforts were pumped into developing a vaccine. But few were hopeful that we would have anything ready within a short period of time. 

But now, at the start of the second quarter of 2021, at least seven different vaccines have been rolled out across the world with another 200 in development. Humanity has made it through its first challenge in battling the pandemic, which was to find a way to prevent its spread. The next challenge is to distribute these vaccines quickly and at great enough scales to slow down and eradicate the virus. 

“This vaccine introduction program is unlike any ever before in any country around the world. There is no program like this in its speed, its dimension, its worldwide, simultaneous nature,” says Dr Katherine O'Brien, Director of the Department of Immunization, Vaccines and Biologicals at the World Health Organization in an interview in February 2021. 

When demand outstrips supply

Even before promising vaccines were developed, governments across the world placed multiple orders on different vaccine candidates to cover entire populations. The extraordinary demand has made it difficult for vaccine manufacturers to scale up production and fulfil these commitments, leading to global vaccination efforts falling short of targets. Adding to the problem is the sheer logistical challenge involved in keeping these vaccines safe as they are transported across borders.

“Developing a vaccine is one thing. Distributing it is another,” says Sarah Rathke, co-author of Legal Blacksmith: How to Avoid and Defend Supply Chain Disputes. “Managing the COVID-19 supply chain will pose tremendous logistical challenges for health care providers and at all levels of government unequalled for any other pharmaceutical product in history – and the stakes could not be higher.”

Bruce Lee, a professor at the City University of New York Graduate School of Public Health and Health Policy, notes that decision-makers too often assume that merely putting vaccines on the market and paying for them is sufficient to ensure these vital products’ delivery to patients. However, this is not the case.

Authorities are having to grapple with problems as far-ranging as a lack of proper cold storage units causing vaccines to spoil, insufficient supplies of masks and syringes, and even shortages of trained personnel. Without these, it will be impossible for countries to store and administer vaccinations, or even keep track of which sections of their population have received the vaccines. 

“Vaccines are just one piece of the puzzle: UNICEF also aims to deliver up to 1 billion syringes and 10 million safety boxes for their safe disposal in 2021,” said Margi Van Gogh, Head of Supply Chain & Transport, World Economic Forum and Etleva Kadilli, Director, Supply Division, UNICEF.

A gargantuan logistical challenge

Late in 2020, the International Air Transport Association (IATA) indicated that at least 8,000 Boeing 747s would be needed to ship vaccines around the world. And while those numbers have had to face up to limited supplies from vaccine manufacturers, it only underlined the monumental challenge the undertaking would be.

“There is no doubt that, in the post-pandemic world, air freight but also more than ever, ocean freight will continue to be widely utilized and will undoubtedly play a critical role as part of a more shock-resistant, multi-modal freight logistics for Pharma & Healthcare,” explained Hristo Petkov, Global Head of Pharma & Healthcare at A.P. Moller – Maersk in a LinkedIn blog. “There is a need for an integrated approach to pharma logistics, especially for Covid-19 vaccine distribution, where all the stakeholders are partnered and strategically aligned.”

In order to prepare for global vaccine storage and distribution, the logistics industry has begun gearing up and coordinating with various governments to help make the process as smooth as possible. Depending on the geographies involved, decisions are being made to either adopt a centralised, devolved or hybrid model of distribution that gets the vaccine to the right people. For instance, in many parts of Africa where transport links are limited, hybrid hub-and-spoke models are being considered to reach larger sections of the population at once. 

The global supply chain is also undergoing a massive burst of digitalisation with companies investing in high-tech warehousing capabilities, ore sophisticated digital inventory methods and tracking abilities to ensure that supplies of different material are accounted for. These trends are expected to accelerate as they are being influenced not just by the vaccine, but also by the global surge in e-commerce that has been caused by the pandemic This spate of digitalisation has also led to the use of technologies such as IoT, Fleet Management Software, end-to-end temperature recording, smart sensors to monitor shocks, moisture and the viability of the vaccines to prevent spoilage. 

A problem of disparity

Some countries are getting creative to administer COVID-19 vaccines despite healthcare worker fatigue. “In the United Kingdom, they’re deputising private citizens to be trained as vaccine administrators,” Rathke points out. The UK’s National Health Service has received tens of thousands of applications from people volunteering to be non-registered/non-healthcare vaccinators, with selected members being trained to deliver safe and effective service for the mass delivery of the COVID-19 vaccines alongside regular staff. This is also feasible in the U.S. where the National Guard could be used to fill in gaps in the existing healthcare system. Therefore, for developed countries, “the supply chain glut isn’t necessarily the problem; it’s really a lack of qualified personnel to administer the vaccine.”

South Warwickshire NHS Foundation Trust, which administers four hospitals in central England, has begun using a digital ledger technology akin to that underpinning several cryptocurrencies to track Covid-19 vaccines. The Hedra Hashgraph system allows the hospital system to track whether Covid-19 vaccines are being stored at the correct temperatures. 

However, the experiences of the United States and the United Kingdom are not representative of developing countries’ Covid-19 vaccination challenges. “The cold supply chain is a challenge in Africa,” says Rathke. However, the continent has some experience with delivery of the Ebola vaccine, which required a super-cold supply chain. 

A turning point for the drug supply chain

At a high level, the pandemic has raised awareness of the need for more resilient drug supply chains that remain able to deliver products with minimal disruption even during extraordinary global crises. The Center for Infectious Disease Research and Policy (CIDRAP) has called for the USA to create a federal-level plan to anticipate, respond to, and prevent shortages of critical medications. The organization also calls for the U.S. Congress to authorize and fund a federal agency to monitor the pharmaceutical manufacturing landscape and the prescription drug supply chain. While CIDRAP’s suggestions are at the U.S. domestic level, their basic concepts—that governing bodies must understand pharmaceutical supply chain constraints and seek to mitigate them—are applicable in all policy contexts and even globally. 

For the Covid-19 vaccine to be successfully delivered to enough patients to enable a return to normalcy this year, it will be critical both for nations to address their unique distribution and administration challenges and for nations to plan ahead for the next health crisis. Learning from this year’s challenges will make governments more able to protect their citizens in future, helping them be more prepared for the next pandemic or similar global event.