2020 has been the year of COVID personal behavior. When COVID-19 appeared, the only way to slow its spread was to convince everyone to change their personal behavior in terms of hygiene, distancing and mask-wearing. In other words, our societal response was defined by the sum of individual responses and actions. Some people are responsible. Some are not. Some are well-led by their authorities. Some are not.
We now understand the virus enough to know that this challenge will persist until a safe vaccine is administered en masse.
So 2021 is shaping up to be the year of COVID vaccine logistics. If scientists can develop and test vaccine candidates that are effective and safe, the vaccine doses must be mass-produced and distributed around the globe. That’s a supreme logistics challenge. It may be the biggest challenge that any supply chain professional has ever faced. If you want to dive into the spectrum of complexities, I recommend a few readings:
Disclaimer: I’m NOT an expert on the mechanics of vaccine distribution. I’m a retired (Emeritus, Auburn Univ.) Assoc. Prof. of Operations and Supply Chain. I have 2 or 3 decades experience reading industry and technical literature, talking to experts, and interpreting them to university Business grads and undergrads. FWIW, those are more like general laypersons than one might hope.
Volume
The planet has about 6 Billion people who are potential targets of COVID. As of this writing, 6 Million are known (through testing) to have already contracted the disease. There are probably at least that many more that were asymptomatic or suffered through it without getting a definitive test. That leaves nearly 99 percent of the global population that still have no immunity. Herd immunity, if it is even possible, is a long way off.
Depending on the vaccine and the level of protection desired, it appears that most of the vaccine candidates will require either one or two injections. That is just for the first round of vaccination. Since we don’t know how long immunity lasts and we don’t know if COVID will mutate, it’s possible that this will be an annual endeavor.
We would need somewhere around 5 to 8 Billion doses to vaccinate a decent majority of the world’s population in 2021. Then, we might have to repeat it every year thereafter. Realistically, that almost certainly won’t happen. People in remote parts of Africa, Asia and South America are unlikely to get many doses next year … and a lot of people live in those areas.
So let’s say we only need 3 or 4 Billion doses next year.
That’s a massive amount of stuff and high-volume manufacture of vaccines is not an operation you can set up in your garage. The factories will have to be incredibly high tech, insanely clean, and managed within an inch of their lives. Anything less and we will hear horror stories about badly made vaccines hurting people in random parts of the world.
Distance
The vaccine units must be transported from a small number of factories to clinics and doctors and individuals across the globe. This arrangement arises because the manufacturing equipment is specialized, the knowhow is concentrated in relatively few people, and both tend to exist in relatively few locations. The only sane approach is to build or adapt big factories (the bigger the better) around those people in those locations and ship the product to where it is needed.
I’m quite confident that the experienced supply chain knowledge and technology exists to get it to its destination. The challenges hinge on the surge in scale, the need for combined effort and the urgency.
The Cold Chain
If you tell an executive at UPS, Amazon, USPS, FedEx, McKesson, or Cardinal that you want to ship 3 or 4 Billion units of a small, light product all around the world over the course of a calendar year, their first reaction would probably be to yawn. They’ll salivate at the size of the contract, but the logistics won’t give them pause.
Mention that the items are fragile, valuable and delivery is very time sensitive. They’re now paying closer attention.
Add that you demand foolproof tracking and security every inch of the way, recognizing that any mistake or loss could cost lives. I think that’s sweat I see on their brows.
Finally, they all need to be kept frozen. The supply chain industry refers to a distribution system like this as a “cold chain”. You’ll see some frantic calls to company cold chain experts.
The anticipated vaccines fall into two categories (not yet sure how much in each):
- Normally Frozen: The vaccine must be maintained at near 0 Degrees Fahrenheit over the entire journey and throughout any storage. All of our current vaccines (flu, etc.) are in this group and many of the COVID-19 candidates are expected to reside here also. However, most of these candidates aren’t front-runners for early approval.
- Deeply Frozen: The vaccine must stay close to minus 80 Degrees Fahrenheit from start to finish! Unfortunately, the vaccine candidates that are hoped for soonest are from Moderna and Pfizer and they are both in this category.
The normally frozen version is technically routine. If you bought frozen wild-caught salmon at the grocery, it arrived through a cold chain that would generally meet the requirements. Phamaceuticals and vaccines get a lot of extra tracking and attention, but the temperature limits are similar.
The deeply frozen version is a whole other deal. As we speak, UPS is investing in two giant freezer farms in Louisville and the Netherlands to store vaccine at this temperature. Moderna and Pfizer are also working hard to establish that their vaccines can be stored at normal freezing temps for a while at the end of their journey. In other words, they’re hoping the vaccines can stored for 2 to 4 days in a standard freezer immediately prior to injection. Every day they gain will be huge.
Our existing supply chain isn't configured to handle sudden, massive volumes at those low temps. Any glitch and the vaccines may become inactive. You're vaccinated and act accordingly, but you're actually unprotected. That’s a life and death problem.
I suspect that Dr. Fauci deeply understands all of this. Yet, his rhetoric about scheduling has tended to downplay these aspects. Instead he has focused on vaccine development and testing and reiterated the need for personal responsibility because that's what people can do right now. Nonetheless, I am sure he knows that logistics will ultimately drive the result.
The Last Mile
I live in downtown Atlanta, a 20 min drive from the largest airport in the world. I have three first-rank hospitals within a 45 min walk. No matter what happens with the COVID vaccine, I will do better than most. For huge numbers of other people on the planet, getting the vaccine will either a huge ordeal or an impossibility for most of next year.
Distribution professionals always talk about the difficulties of the “last mile”. With frozen COVID vaccine, the last mile will be a special challenge. If you live in a remote area, you might do without a lot of wild-caught salmon, but you should still want to be vaccinated. Somehow the vaccine cold chain must be made to extend that far.
For normally frozen vaccine, the challenges won’t too hard. A refrigerated local delivery truck can probably make the trip fairly easily. Pharmacies are increasingly set up to provide the local storage and injection, so this will be like a higher intensity flu shot distribution program. However, the normally frozen vaccines may not show up until later in the year.
The first vaccines may need the deep freezing. Those won’t be coming to a nearby CVS or Walgreens any time soon … if at all. The only way to distribute those in rural areas will be to stage large-scale vaccination events. Bring in special reefer trucks and shipping containers and commandeer the community center for two days. If you miss the vaccination event, be prepared to drive a few hundred miles to some other town … or to a nearby city. If the vaccine isn’t used in the 2 or 3 days around the event, it may have to be discarded.
Another factor will be time of year. This year, parts of Texas and the Southwest experienced summer temperatures well over 110 F. If a deep frozen vaccine requires -90 F and it’s +110 F outside, the cold chain system must maintain a 200 degree F differential!
I haven’t even addressed the need to ration supplies to different risk groups early in the distribution period. How do we ensure that a rural long term care residence gets it first? Their risk will merit it, but they’re at the far end of the cold chain.
Again, the expertise and knowledge to pull this off is well established in the US, but the overall system must expand and get a lot better integrated for the results to be timely and fair.
The Rest of the World
The advanced countries in Europe and East Asia are similar to the US with comparable skills and facilities. They will be stretched and I expect things will get hairy from time to time, but the overall outcome doesn’t worry me. Africa, Latin America and most of Asia far more worrisome.
These areas have much weaker cold chain systems for normally frozen product. It is very unlikely that they will be able to handle deep frozen vaccines at all. Most likely they will have to wait for the normally frozen candidates to be approved and then struggle to get those out to their populations.
Normally, Americans and Europeans tend to ignore problems in the hinterlands. With COVID, that may be a bad idea. These are areas with large populations in remote areas that will be very hard to vaccinate. There is a high likelihood that they will be ongoing petri dishes for the virus, posing a continuing threat to spread it to other locales.
Even after I am vaccinated, it’s going to hurt to read about ongoing suffering and death in many regions and know that logistics are much of the cause. Plus, I want to travel to places that I expect to be quite late to the party. Even if I’m protected, their society may be stressed and my experience will be conflicted and bittersweet. Also, if a sizeable fraction of the US population decides to forego vaccination, they will remain vulnerable to imports by visitors and that, in turn, could delay our collective return to normalcy.
It’s going to be hard to watch how slowly the vaccine will filter out to impoverished parts of our planet.
Loss and Counterfeiting
The IATA slide deck linked above has a stunning statement on slide 16. Today, about a quarter (25%) of all vaccines are rendered unusable in the shipping process and air transport is one of the worst offenders. The transportation method that can distribute vaccines farthest and fastest has the worst performance in maintaining a stable cold chain.
According to IATA, many of the problems occur at the airports between the aircraft and ground transportation. Guess what? Most airports around the world are owned and operated by local governments. That’s also where government bureaucracy like customs and security are critical links in the chain. Governments with corruption or competency issues have a perfect opportunity to muck things up.
Finally, there are many flavors of security threat. Think about dozens, hundreds and thousands of hermetically sealed containers being rushed through customs and security. What can go wrong? Could a drug cartel slip in some apparently authentic containers that actually contain Fentanyl or Cocaine? Could someone pilfer the real vaccine vials and reseal the box with faked vials. If they can fake the seal, no one will check until the boxes are opened and the vaccines are injected. Even then, the recipients may not know they are being vaccinated with tap water.
These things won’t happen much in the US, where experienced companies like McKesson have mature systems, but they can happen a lot of other places. Some of the world’s biggest vaccine factories are in India. The factories may be secure, but what about the journey from their door to the plane?
Whatever its other foibles, the US has the most sophisticated logistics profession and industry in the world. Our industry leadership can be pivotal to achieving an early end to COVID disruption. If we are well-organized, let our experts lead, and nurture alliances with the rest of the world, I'm personally convinced that our existing supply chain system can be adapted and deployed to rise to the occasion. The question is whether they can bulk up fast enough and whether their partners in transportation can climb up with them.
For many places elsewhere in the world, however, it’s going to be a painful thing to watch.
What Matters to Us
When I look at all of these challenges, I have two main takeaways:
- This is stuff that lots of experts and companies know how to do. It’s just that they have never had to do it on such a huge scale and under such a high level of urgency.
- There is no single company solution or logistics silver bullet. It will require a massive team effort, with all-hands-on-deck commitment and powerful, astute leadership to pull it off.
Almost all of this will take place after November. Most will occur after January 20, in the first year of the next administration. That leads to THE question:
Do I trust the current administration to be creative, effective, disciplined and competent to lead the country and the world toward the best possible solution to this problem?
It seems blindingly obvious that Trump.Will.Screw.It.Up
I have hundreds of reasons to support Joe Biden and Democratic candidates. But this one reason towers over the others for me. Whatever reservations people may have about him, I’m confident that he will empower and support the best experts to solve this challenge the best way they know how.
That’s all we can ask.
I want my life and future to return to normal.
