As the COVID-19 pandemic continues to infect communities worldwide, people need immediate access to the available vaccines; but, unfortunately, vaccines need special handling and storage. Needless to say, these unique needs require the global supply chains to function with the utmost efficiency.
All over the world, countries have routine immunization systems. But, with the demand for COVID-19 vaccines, the pre-existing systems are strained. In other words, supply chain systems are under extreme pressure to deliver vaccines immediately and have to work with more efficiency than ever before as millions of lives are on the line.
What Supply Chains Need
According to the World Health Organization, the global supply chains need to have the right mix of factors to move the vaccine worldwide effectively. To inoculate the world, supply chains need enough of the vaccines kept in the proper conditions. They need to move vaccines to the correct location, in an appropriate amount of time, at an affordable cost.
Logistics systems must keep vaccines at the appropriate temperature, which is often sub-zero. If movers cannot keep the vaccine at the correct temperature, the vaccine cannot properly function and is wasted. Ideally, the global supply chain must move the vaccine from the manufacturer to pharmacies, hospitals, or clinics without any glitches.
Cold-Chain Management
The struggle for many logistics companies is the temperature requirements. The first approved vaccine - the Pfizer-BioNTech vaccine - in the United States must be stored at frigid temperatures between -80°C and -60°C.
Before releasing the COVID-19 vaccine, Pfizer was already a global vaccine producer and supplier. The company makes more than 200 million doses of other vaccines. They work closely with supply-chain companies to move their vaccines around the United States and Europe, but cold-storage requirements of the COVID-19 vaccine added a new challenge.
The frigid temperatures forced Pfizer to use what they called a “just-in-time” system to move vaccines directly to the sites where injections are to occur. Pfizer produces the COVID-19 vaccine in Kalamazoo, Michigan, so they use road and air to ship the frozen vials within 24 and 48 hours.
To help transportation companies get the vials safely to their destinations, Pfizer provides innovative packaging solutions. Their thermal shippers use dry ice to keep the vaccines in the temperature range for up to 10 days, as long as the shippers remain unopened.
Pfizer logistics experts rely on GPS-enabled thermal sensors to track the temperature and location of each shipment. If temperature issues arise, Pfizer can inform recipients whether or not to use the vaccines.
As every dose matters, shipping companies need to deliver the vaccines within the allotted time frame. Once the vials arrive, the recipients can do one of three things:
- Store the vaccines in an ultra-low-temperature freezer for up to six months.
- Store the vaccines in the Pfizer shippers, replacing the dry ice every five days, for 30 days.
- Store the vaccines in hospital refrigerators at temperatures between 2-8°C, then use all vials within five days.
Recipients Relying on Timely Deliveries
Timely deliveries are not only for the vaccine manufacturers. The vaccination sites expect vaccines to arrive on time. When health-care providers become informed that a vaccine is on the way, they let patients make appointments in their communities. If the vaccines do not arrive on time or arrive in a less-than-ideal quality, they must cancel all of those appointments.
Health-care providers already have struggled with community members questioning the vaccines. Having to schedule, cancel, and reschedule appointments can add to suspicions or doubts. Slowing vaccination schedules slow the goal of herd immunity.
Managing vaccines at the injection sites involves more than scheduling patients. Health-care providers need to be on-site to give the injections. Security personnel help with parking and managing queues. Refrigeration needs to be available. When the supply chain fails, even at just one site, vaccines can be wasted, and costs increase.
Security Issues
People all over the world know the vaccine as a precious commodity. As demand increases, supply cannot keep up. This problem can lead to people taking advantage of a potentially lucrative situation, which could result in national security problems.
There are several points of transfer in vaccine production and distribution. At any point, theft, sabotage, or other nefarious behaviors can affect supply chains. The vehicles that move the vaccine need to be protected, so criminals do not try to take the precious cargo or harm the drivers.
Along with protecting the vaccine and the movers, security issues occur at the injection sites. Vaccine vials, syringes, and needles all need to be disposed of properly, as someone could steal the medical waste and try to sell the vials as counterfeit vaccines.
Keeping the Supply Chain Movers Healthy
If the logistics personnel get sick, the speed of vaccine movement slows. Everyone involved in manufacturing, packaging, and moving vaccines needs to be inoculated as they are front-line workers.
To get millions of doses to vaccination sites around the globe, the world needs truck drivers. In the United States alone, there aren’t enough truck drivers. As production increases, vaccines will sit until someone can drive them to their destinations. If those truck drivers get sick, vaccines move slower.
Coordinating Supply Chains
Having truck drivers, pilots, and manufacturers isn’t enough to get the vaccines around the world. Logistics companies need coordination at federal and global levels.
Current local and state level plans work at the local and state level, but only if the vaccines arrive on time and in the correct condition. As companies must move vaccines across state lines, federal involvement is necessary.
Unfortunately, more extensive coordination is minimal. States need to coordinate with the federal government, and governments need to coordinate with each other. Vaccines won’t be effective unless people all over the world can get them.
Without a coordinated national and global effort, vaccines are at risk.
- Hackers can get into exposed systems.
- Several problems can delay vaccine delivery.
- Shortages can occur.
With appropriate coordination, global access to the vaccine becomes a reality.
A coordinating nightmare occurs with the fact that some vaccines need two doses to be fully effective. This means that patients cannot mix their vaccine brands.
Manufacturers and logisticians need to track where vaccines are delivered to ensure that the second doses arrive by the time patients need dose two, usually three weeks after receiving dose one. Those second doses need to arrive at the correct location because patients cannot get their second dose somewhere else.
The Pfizer-BioNTech requires two doses. If vaccination sites cannot store the second doses for three weeks, they need to receive a shipment in time for the second doses. People who received the first dose of the Pfizer vaccine cannot get a Moderna vaccine for the second dose.
Not being able to move patients to other sites or give them other vaccine brands creates a logistics nightmare for underprepared sites. Unfortunately, many health-care providers are using pre-existing systems to track and manage dosages and brands. Often, these systems aren’t robust enough to handle the coordinated vaccine effort.
To coordinate supply chains locally and federally at all stages of the vaccine movement, IT infrastructure needs to exist. At this time, they do not. At the end of the line, vaccinated people only have a vaccine card with the nurse's initials and hand-written dates as proof of vaccination. Those little cards can create chaos. Consider these questions:
- Will those paper cards be accepted as proof of immunization before getting on an international flight?
- What happens if someone loses their vaccination card?
- What if the handwriting is illegible?
- Will people create counterfeit cards?
Logistics includes more than simply moving the vaccine to the correct site. It also involves knowing who has had the vaccine, especially if proof of vaccination becomes necessary for public transportation and air travel.
Supplying the Supplies
Vaccines don’t move in a vacuum. They must come in medical-grade vials, and those vials need rubber stoppers. Global supply chains need to move the materials required to package the vaccine. Unfortunately, manufacturers are also using natural rubber to make PPE that health-care providers wear when giving vaccines.
Medical-grade glass is also in limited supply. The materials used to package vaccines have to be FDA-approved, so replacing them with new materials can take months. As soon as the packaging supplies become available, transporters must move them to the vial manufacturers. Then, the vials need to be safely moved to the vaccine manufacturers.
Supply chains not only have to work around a lack of materials, but they also have to work around employee health issues. Weather disruptions can slow production, too. Consider what a three-day power outage can do to a manufacturer trying to get vials to a pharmaceutical company that needs to get second-dose vaccines to an injection site.
Rural and Urban Issues
COVID-19 is a global problem, not just a big-city problem. A significant challenge for global supply chains is getting the vaccines to big cities and rural communities. All areas of the world have issues with refrigeration space, health-care provider availability, and patient transportation. People who are homebound cannot get to vaccine sites.
Rural issues create even more challenges. Many rural communities do not have any medical facilities, so there is literally nowhere to send vaccines and no one to inject them into arms. With Pfizer and Moderna vaccines needing cold storage, any vaccines going to rural areas need to be injected immediately. In the remote Western states, no cold storage exists.
To get rural communities vaccinated, shipping companies need to coordinate with roaming health care providers. They also need to coordinate with public health systems to notify people in the community to show up to vaccine sites. If vaccines do not arrive on time, chaos will ensue.
Capacity Issues
Supply chain experts have to understand capacity issues. Cold-storage facilities have limited space for vials. Health-care centers have limited parking and limited employees who can give injections.
You cannot overfill a freezer, so sending too many doses can waste vaccines. If parking spaces are not available, people will go home, and vaccines go to waste. If no one is available to inject a vaccine, vaccines become useless. Supply chains need to coordinate with several organizations to ensure that the vaccines get into arms and not a drop is wasted.
At vaccine sites, skilled personnel must be healthy and able to give vaccines. Part of the problem with global supply chains is the lack of employees at all levels. These capacity issues slow the entire process of moving vaccines from the manufacturers to the arms that want them.
Learn From Past Mistakes
In 2009 during the H1N1 flu pandemic, vaccine distribution was heavily flawed. Vaccines were delivered to hubs, then moved to vaccination sites. Unfortunately, some areas received too many vaccines, while others did not receive enough. Logistics companies have learned about getting vaccines where they need to be, but that’s only one part of the struggle.
In the past, bottlenecks occurred when storage space, personnel, and transportation failed. Doses of vaccines had to be discarded, which led to deaths and financial issues. Vaccine distribution from the manufacturer to the arm is a matter of infrastructure. Many supply chains are not robust enough to get hundreds of millions of doses into arms at the desired rate.
To remedy the past flaws, logistics experts need to analyze what didn’t work to determine what will.
Final Thoughts
Strong global supply chains need to work together to get vaccines distributed effectively, but they cannot do it alone. They need to coordinate with public health departments, hospitals, and pharmacies.
Supply chains need to work in urban and rural settings, so non-traditional connections need to be made with political officials, faith-based leaders, essential workers, and educators to get vaccines safely into communities all over the world.
Relying on pre-existing systems is a start, but most supply chains need to create new infrastructure to effectively get the raw materials to the pharmaceutical companies. In other words, time is of the essence.