Moving vaccines a complex challenge
Feds want distribution system in place by Nov. 1
Operation Warp Speed – the White House-led partnership for COVID-19 answers – is pushing its partners to be ready to distribute a coronavirus vaccine by Nov. 1.
The date is the first concrete goal set for companies working with Operation Warp Speed to deliver vaccines to doctors and hospitals, said Wes Wheeler of the delivery giant United Parcel Service.
Wheeler said UPS and other partners will conduct test delivery runs in September. “We’ll be ready. We have to be ready,” he said. “The world is watching. We can’t fail.”
Operation Warp Speed includes federal agencies such as the Centers for Disease Control and Prevention, the Food and Drug Administration and the Department of Agriculture. The initiative aims to expedite the rapid production of COVID-19 tests, treatments and vaccines. Its goal is to produce and deliver 300 million doses of vaccine by January.
UPS is a consultant to Operation Warp Speed, Wheeler said. UPS expects to be involved with the government and drug manufacturers in the logistics of distribution and storage.
President Donald Trump has repeatedly said he expects a vaccine to be released “very soon.”
The FDA and other top government scientists have said only science and data will be taken into account when deciding whether a vaccine is accepted. Thursday, Peter Marks, director of the FDA’s Center for Biologics Evaluation and Research, told Reuters he has faced no political pressure to release a
vaccine without sufficient data on safety and effectiveness and he would resign if that happened.
The FDA said it might consider releasing at least the first vaccine under what’s known as an Emergency Use Authorization rather than the full licensing process, if it has sufficient data on safety and efficacy.
“We have to balance the need to see a biologics license application ... (which has) thousands of pages with a lot of different analyses, many of which will not be directly relevant for a decision of whether or not to make the vaccine available,” Marks told journalists attending National Press Foundation training Aug. 13.
No one can say with certainty when the FDA will approve a SARS-CoV-2 vaccine because it’s not known when the results of large clinical trials will be available or whether those results will meet the agency’s requirements for safety and effectiveness, said Kelly Moore, associate director of immunization education and the Immunization Action Coalition.
“Nonetheless, those preparing to distribute a SARS-CoV-2 vaccine are aiming to be ready to begin distribution as soon as a vaccine is approved,” said Moore, a professor of health policy at the Vanderbilt School of Medicine in Nashville, Tennessee.
The logistics are daunting. The U.S. government is investing in at least seven potential vaccines. At least one of them needs to be stored and transported at -112 degrees Fahrenheit, a temperature at which antifreeze freezes and rubber shatters. Three others have to be stored at -4 degrees Fahrenheit, the temperature ice cream is shipped at.
The candidate vaccines are produced and stored at manufacturing sites across the country. If they prove safe and effective, and are approved by the FDA, they will be released for use. Any candidate vaccines that don’t will be destroyed.
Two waves of vaccine delivery
Delivery of the vaccine to sites where it can be administered will happen in two waves, an early one, when supplies are limited and the military will be involved in logistics, and a later one, when the vaccine is plentiful and can be distributed through regular channels.
“That plan is that in Phase 1, we will have 10 million doses distributed in November and 20 million doses in December,” said Wheeler, president of UPS Healthcare.
Because the initial doses will be in limited supply, the focus is expected to be on getting high-priority recipients – probably health workers – fully vaccinated first, Moore said.
“I get the sense the Centers for Disease Control, the Department of Defense and the states will target a limited number of locations where they can easily reach people determined to be top priority,” she said.
Once more vaccine becomes available, probably within several months, the second wave of distribution would go through the routine vaccine distribution program, probably using the national Vaccines for Children program as a backbone, she said.
That’s when vaccinations would probably become available at major pharmaceutical chains such as Walgreens and CVS. Both companies plan for that, they told USA TODAY.
Complexity upon complexity
Experts presume more than one vaccine may be ready early on, meaning there could be as many as seven different vaccines administered nationally at the same time, each with a different temperature storage requirement.
Some vaccines might work better for one group and others for another. That’s an enormous transportation complication, Wheeler said.
“They’re going to try to match effect with patient population,” he said. “So if one of the vaccines looks as if it will work best with young, healthy people, then you divert to that population; if another works better with the elderly, then it would go to that population specifically.”
Operation Warp Speed wants the doses shipped with a matching vaccination kit containing personal protective equipment for the person giving the shot and leaflets about that particular vaccine, Wheeler said.
UPS is involved in distributing doses of several of the candidate vaccines being tested in clinical trials, in which 30,000 volunteers are given either a candidate vaccine or a placebo shot.
“There is not one single vial to spare, not one. We have 24/7 GPS tracking on every shipment,” he said.
Keeping vaccine cold
As it gears up for the work, UPS is building a “freezer farm” at its Louisville, Kentucky, air operations headquarters, as well as a COVID-19-specific operations center. The freezer farm building will be filled with hundreds of ultra-low temperature freezers, each about the size of a large home refrigerator, that can hold materials as low as -85 degrees Celsius.
“About half the freezers are already in place, and they’re being validated now,” Wheeler said.
The company has similar freezer farms in the Netherlands at its international air transit hub.
Vaccine that must be kept at -80 degrees Celsius will be transported in boxes topped off with dry ice, which can be replenished as it boils away, Wheeler said.
Air transportation requires another level of planning at these temperatures because there are limits on the amount of dry ice that can be loaded onto planes under FAA regulations. As it sublimates to gaseous carbon dioxide, there is a danger the oxygen content of the air would fall too low, incapacitating the crew.
Keeping vaccines at their proper temperature is crucial to keeping them effective, said Jaap Venema, chief science officer for U.S. Pharmacopeia, a public standard-setting organization for drugs.
As much as 25% of vaccine globally is lost because of cold chain issues. As the world works to create enough coronavirus vaccine for everyone, such loses are unimaginable, he said.
“That’s keeping me up at night,” he said.
Vaccine developer Pfizer said it has detailed logistical plans and tools to support transportation of its candidate vaccine, which must be kept frozen at -80 degrees Celsius.
“We have specially designed, temperature-controlled containers that would allow the maintenance of storage conditions up to 10 days,” said Pfizer’s director of media relations, Steve Danehy. “We are confident of our capability to deliver and store doses to the destinations governments designate, according to requirements at -80.”