‘Challenging task’ of delivering billions of vaccine doses

Getting a COVID vaccine to the entire country — and perhaps the entire world — will present a unique challenge, according to Tao Lu.

“It's the first time you are trying to do such a huge job in such a short time frame,” he said.

Lu is an assistant professor at UConn’s School of Business, specializing in supply chain management and logistics.

He said development of a vaccine — there are currently two coronavirus vaccine candidates on the fast track for worldwide distribution — is just the first problem.

“The next challenging task is how to deliver the vaccine to every single person in the nation, or in the world,” he said.

In fact, Lu said that, assuming vaccine efficacy is similar in each candidate, supply chain logistics will determine which vaccine comes to a pharmacy near you.

“We should not only consider the effectiveness of the vaccine itself, but also consider the fact whether it's easier to store and transport,” he said.

From factory to shelf

Lu explained that the supply chain consists of every step a product, in this case a vaccine, must take from the moment it’s formulated until it is injected into your arm.

The supply chain, Lu said, is the journey a vaccine must take, “from the manufacturers, to logistic providers, like trucks and warehouses, all the way down to the end users such as hospitals and drugstores.”

The first problem is capacity. Millions if not billions of doses must be manufactured and distributed. Connecticut has developed a phased approach , which builds in time to ramp up vaccine production.

“In Phase 1 of the COVID-19 mass vaccination initiative, initial doses of vaccine will likely be distributed in a limited manner and with the goal of maximizing vaccine acceptance and public health protection while minimizing waste and inefficiency,” that plan says.

During that initial phase, vaccine doses will be specifically administered to health care personnel “likely to be exposed to or to treat people with COVID-19,” people over the age of 65 and with underlying medical conditions, and other essential workers, according to the state’s mass vaccination plan.

The approach then expects a period where there is a huge demand and sufficient supply of vaccines, followed by a third phase when demand slows.

The problem of temperature

The vaccine candidate being developed by Pfizer presents two specific issues with regard to the supply chain, according to Lu.

When there isn’t an ongoing pandemic, Lu’s research focuses on the transportation of perishable food, and he said there is a lot of similarity between the problems inherent in that realm and with Pfizer’s vaccine.

The first problem is the cold.

Pfizer’s vaccine requires the use of “ultra-low” freezers that can maintain temperatures close to 100 degrees Fahrenheit below zero.

The company is actually building so-called “freezer farms,” one in Kentucky and one in the Netherlands for distribution in Europe. In Connecticut, the special freezers needed to store the vaccine can be purchased by health centers and hospitals — they retail for more than $ 10,000.

But Lu explained that those low temperatures must be maintained throughout the supply chain, and Pfizer’s cooling boxes can only be used for 10 days at a stretch unopened.

“What we should do is to identify the potential bottlenecks along the supply chain. We should check. Do we have enough freezers, cooling boxes, to store and transport the vaccines?” Lu said. “Once the vaccine is out for delivery, it can last at most 10 days. So it's going to be super challenging to deliver a vaccine to the end users within 10 days.”

When it comes to perishable food, Lu explained that logistics companies use “the internet of things” to verify that conditions within a shipping container are appropriate for transport. That’s not as easy with a vaccine.

“People can deploy some sensors inside the container so that we can monitor the temperature or humidity inside the container in real time. So that once there is something wrong inside the container, we can make some contingency plans,” he said. “It's not that easy to tell whether a vaccine becomes invalid because of some temperature disturbance.”

The Pfizer candidate is also a two-dose vaccine with 21 days in between the doses, which creates additional problems with regard to capacity.

“This will make the delivery distribution more challenging,” Lu said. “You have to guarantee people get sufficient supply for the second dose.”

One for urban, another for rural

The vaccine being developed by Moderna is also nearing distribution, and that one does not require anything colder than a standard commercial freezer.

But the vaccines are not mutually exclusive. Lu said that, assuming health concerns are similar, both could be employed to ease capacity issues.

“It could be a good idea to make use of a combination of vaccines,” he said.

That may mean people in more accessible locations would get a Pfizermade vaccine, while people in more rural areas would get one made by Moderna.

“For the Pfizer vaccine, it’s difficult to store, but if we can deliver it to very huge cities, as long as we get one distribution center equipped with these super freezers, then we can get so many people vaccinated,” Lu said. “For some rural areas, people who are leaving small towns, maybe the Moderna vaccine is more suitable for that area because it's easier to transport and distribute.”

That has particular meaning for developing countries.

“If you're talking about more developing countries, like countries in Africa, it must be much more challenging,” Lu said. “Remember, the cooling boxes can last only 10 days. Okay, how can we get the vaccine delivered within 10 days to a village in Africa?”