How big is the challenge to deliver vaccines to the entire world?

The announcement of a vaccine against COVID-19 initially brought relief across the world. Some of the world’s finest scientific minds are working on the vaccine, and an equally brilliant set of people are working to ensure that jab is administered to you, me and our loved ones.

Despite the breakthroughs, significant challenges remain, and these have been extensively discussed and published by experts.

In this series of four articles, I want to examine the challenges and potential approaches that companies and governments might consider to ensure a greater positive impact for these vaccines. I’m a computer engineer by profession and can’t fully comprehend vaccine type or the research done developing those vaccines. Instead, I’ll focus on the scenarios for the logistics required to deliver the doses.

This table provides a useful overview of the available vaccines and their unique requirements:

Summary of key drugs for COVID (@Source FT.com)

Understanding the magnitude of the problem

The "logistical nightmare" of delivering the vaccine to billions of people is often discussed. We can put those concerns in context to give us a better chance to grasp the enormity of the problem at hand.

For effective vaccination, most of these drugs require two doses administered roughly a month apart. However, the shelf life for some of the most promising vaccines is less than a month. Even without the added headache of cold storage and pandemic protocols, such as socially distancing, this double-dose requirement would ramp up the challenge. But in this crisis environment, it morphs into a gargantuan task.

The focus will be on vaccine delivery by air, since shipping is not practical, and roads will be used only for the "last mile" delivery.

• Overall cargo capacity is down 40%
• 50% of pharmaceuticals are shipped in passenger planes rather than on dedicated freighters
• Global air travel is down over 85%

The average temperature of pharmaceutical cold storage in the supply chain, according to transportgeography.org is between 2 and 8 degrees Celsius. However, they also note that "pharmaceuticals are rarely transported in ISO reefers, but in smaller refrigerated packages for van and air transport."*
*Rodrigue, J-P (ed) (2020), The Geography of Transport Systems, Fifth Edition, New York: Routledge.

These established methods of transport for pharmaceuticals are not geared up to handle the ultra-cold temperatures that are required by some of the vaccines. Just like our traditional medicines did not work against this novel virus, neither will our existing logistics mechanisms meet the challenge without adaptation and innovation. Large, walk-in deep freezers normally used for food cannot be used for reasons of cost, safety and inconsistent power supply across the globe.

Logistic companies like UPS, FedEx and DHL have already started designing COVID-specific delivery chains, and drug companies have begun solving the challenges of storage and transportation. Pfizer has designed reusable cold boxes with dry ice in which to transport their vaccine. Each reusable box can hold between 1,000 and 5,000 doses at ultra-cold temperatures for up to 10 days. Pfizer said its vaccine can be kept for up to five days at fridge temperatures of 2-8°C, but this box can be opened only twice a day and only for up to a minute each time.

In addition, the complexity of the various country-specific regulations and context will demand collaboration across multiple parties, from drug manufacturers and multiple logistics companies to healthcare facilities.

This complexity leads to increased costs to vaccinate the billions of people who need it. Research by the Bill Gates Foundation estimated that an equitable vaccine distribution across the globe could avert 61% of deaths, over only 33% if distributed exclusively to high-income nations. That means the vaccination program would save twice as many lives.

Incredibly, these vaccines have come out in less than 10% of the time of the normal vaccine development process. These are complex projects with the lives of millions of people depending on the outcome, but the complexity doesn’t end with the successful production, testing and approval of a vaccine. That’s just a starting point, which prompts the next project into action – the distribution.

In my next blog, I discuss the role IT has in dealing with the complexity, while reducing cost and risk.