The Biggest Issues Facing Covid-19 Vaccine Distribution

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While many are hopeful that the delivery of Covid vaccines will offer them some relief from the current social and economic conditions, it may be a long road back to normal if some of the vaccine delivery options proposed by the CDC are true.

Cold Chain Delivery

The logistical complexities of cryo storage and cold chain delivery are two obstacles that are difficult even in normal times, with as much as 25% of vaccines going to waste due to improper storage and cold chain delivery. David Galton, President and CEO of Carrier (CARR), is one of many industry leading experts working with companies like Pfizer and Moderna to build a reliable distribution network, but in an interview with CNBC, David says “with Covid, distribution becomes eminently more complex.” Approximately 1 billion people worldwide receive flu vaccines, but according to Galton, 10 billion doses will be needed to effectively treat the global population.

While 10 billion is a large number in any context, the problem becomes much larger when you consider that these 10 billion doses need to be stored at temperatures ranging from -20° to -70° Celsius. To address this problem, Carrier, a long time manufacturer of refrigerated shipping containers and trucks, is developing a plan to distribute vaccines using a combination of dry-ice packed boxes and refrigerated containers, but with only 1.2 million of these refrigerated containers and trucks globally, Carrier says they will need to scale up in a big way to meet the demands of Covid.

Vaccine Storage

The other major obstacle in the supply chain is how to store the vaccines once they reach their destination. The CDC has issued storage guidelines for both of the current vaccine candidates, and while shelf life varies from 24 hours to 7 days when stored at temperatures of 2°-8° Celsius, neither of them can be exposed to room temperatures for more than 6 hours. See Figure 1. for storage guidelines.

Figure 1.

Retrieved from: https://www.cdc.gov/vaccines/acip/meetings/downloads/slides-2020-08/COVID-08-Dooling.pdf

Candidate A Could be a Big Problem

If you’re like the majority of people, you’ve been around long enough to see major disappointments at the hands of government-led initiatives that seem to be better at writing policy than executing a well hashed out plan. So, while we have 2 candidates for vaccines that seem to be effective, Candidate A, as seen in the figure above, could be a disastrous option for medical personnel if it becomes the ONLY option. 

The Issue of Time

Candidate A begins it’s shelf life in Cryo storage at -70° Celsius, which lasts for 10 days per CDC guidelines, and then moves to a 30 hour combined refrigerator/room temperature shelf life once it’s taken out of cryo storage. In highly populated regions, like LA county, the 30 hour shelf life option will not be efficient enough to treat LA county’s 10 million residents when you consider that it could take between 2 and 4 minutes to treat each patient. While the 20-40 million minutes required to administer these vaccines in LA county alone is a major issue in itself, significant vaccine losses (losses presumably higher than the current industry established 25%) will only add to confusion and even worse, could result in delivering ineffective vaccine treatments to patients, further exacerbating the problem.

The Issue of Infrastructure

According to the table in Figure 1., the CDC has established guidelines for vaccine Candidate A to ship only to “large admin sites” with existing cryo storage units; however, this only accounts for a handful of facilities in most major regions, like LA county, and for the facilities that do exist, their cryo storage units were not designed to store millions of vaccines doses. While companies like Carrier are concerned with the cold chain delivery of the vaccines, hospitals and “admin sites” are left picking up the pieces when it comes to facility storage. Kyle Black, President and CEO of MGI Inc., a company that builds the medical gas systems necessary for cryostorage, says “building enough cryogenic storage units to house all of these vaccines would take a of couple years, there simply aren’t that many biomedical engineers or medical gas installers in the country to do the work, and most of us are already on clinical projects installing medical gas systems for covid patients.”

The Issue of Personnel

While most of these issues address vaccine Candidate A, both vaccine candidates address a deeper more fundamental problem: who will be coordinating all of this on the ground? Doctors, nurses, and even nursing assistants who will be administering these vaccines on the front lines are not trained in supply chain management. Even for individuals in supply chain management that work at the larger facilities, the task of managing the distribution of millions of vaccine doses is not something anyone has had experience with. Although vaccine Candidate B will offer much more flexibility in storage, distribution, and administration, there will still be major hurdles with its distribution, and when you add in a changing political landscape, the timing could prove even more problematic.