Vaccines: The Logistical and Safety Challenge After Distribution

On the eve of the start of the inoculation against Covid-19 in the United States, Army General Gustave Perna, commander who oversees the logistics of the federal vaccine program, he referred to the distribution of the drug produced by the North American Pfizer and the German BioNTech as “D-day.” “There are people who have interpreted it as the day of distribution,” Perna said at a press conference about efforts to bring the vaccine to every state in the country. “Actually, in the Army, ‘D-day’ marks the day a mission begins. ‘D-day’ was a turning point in World War II. It was the beginning of the end. And that’s where we are now ”, added the director of operations of the Operation Warp Speed, the Donald Trump administration program for the development of the vaccine.

And that “D-day” took place on December 13. Workers at the Pfizer plant in Kalamazoo, Michigan, applauded as the first truck loaded with vaccines left the facility that day, kicking off the long-awaited cast. UPS and FedEx employees helped package the 2.9 million doses that would be distributed to 636 locations in all 50 states of the country for the start of the inoculation campaign the following day.

But the distribution of the Pfizer vaccine involves logistical challenges, basically due to the need to keep the drug at -80 ° C, which is the temperature necessary for its components not to degrade. Because it is based on a new messenger RNA technology that requires doses to remain frozen until they are used, the caps of the vaccine containers are equipped with a GPS tracking system, temperature monitoring devices and a barcode that is scanned upon receipt.

And one of the trucks transporting these doses to California experienced these challenges. As the vehicle snaked its way through interstate highways, a team of analysts monitoring almost every aspect of its journey in real time detected that the temperature of two of the vaccine trays, one destined for Napa and one for Sonora , it was falling below the accepted threshold of -80 ° C.

As revealed by Time magazine, a call was made to the truck driver to stop and keep the trays in the vehicle. “They never left the truck,” General Perna said. “We immediately returned them to Pfizer and sent immediate shipments to replace those two trays,” he said.

As with this shipment, if the vials (vaccine vials) get too hot or cold or the doses deviate from their target destination in each of the 41,689 U.S. ZIP codes, company officials and the government receives an immediate alert on the problem. Information flows to the Vaccine Operations Center in Washington, where the military, Health Department officials and US Marshals monitor the logistics of the federal vaccine program.

The companies in charge of distribution themselves have taken their safeguards. FedEx is using a new monitoring program in collaboration with Microsoft, called Surround, which uses historical data around the logistics company’s routes, weather and mapping data, and analytical capabilities to speed delivery. “To illustrate how this works in practice, imagine if a pallet of vaccine was destined for transportation from Michigan to California and external data showed a high probability of delay due to weather,” writes FedEx executive Judson Althoff. “In that scenario, an alert would go off to customer service agents and operations planners, who could then put the shipment on another flight.”

And it is that although the first local shipments have been through trucks, industry experts estimate that as more vaccines are approved and distribution is launched at full speed, approximately half of the doses that are transported all over the world they will go by plane. “It really will start in January,” Dorothea von Boxberg, executive director of the cargo unit at Deutsche Lufthansa AG, which is bidding for contracts to transport vaccines globally, told The Wall Street Journal. He said he expects air shipments to peak in the second quarter of 2021.

The International Air Transport Association (IATA) estimates that the equivalent of 8,000 loads will be required on a 110-ton capacity Boeing 747 freighter for the airlift, which will take two years to deliver some 14 billion doses, or nearly two for every man, woman and child on Earth, details the Bloomberg agency. It is a difficult task, given that about a third of the world’s passenger fleet is still inactive, according to data from Cirium, one of the expert consultants in travel data analysis. “This will be the largest and most complex logistics exercise ever conducted,” said Alexandre de Juniac, IATA’s Director General and CEO.

Pfizer plans to ship 1.3 billion doses of its vaccine by the end of next year. Moderna will produce around 500 million. AstraZeneca has a manufacturing capacity of 2 billion doses, half of which go to low- and middle-income countries.

Hani Mahmassani, director of the Northwestern University Transportation Center, highlights as one of the main challenges of the global distribution of the vaccine the “large scale, magnitude and urgency of the deployment”, according to Third. Also, the expert warns about the “difficulty to reach remote areas while maintaining the handling requirements, especially for the Pfizer vaccine, in terms of freezing temperatures.”

Another vaccine, made by Moderna, requires storage and shipping at -4, a temperature that most drugstore freezers can reach. The rest of the vaccines, which do not develop messenger RNA technology, have minor restrictions on cold storage. “There are no freezers everywhere,” said Adar Poonawalla, CEO of the Serum Institute of India Ltd., the world’s largest vaccine manufacturer. “These frozen vaccines, which are very unstable, developers must work to stabilize them,” Poonawalla told Bloomberg.

But Mahmassani also warns that the great variability in local capacities for vaccine management “can lead to poor management, as well as possible misuse.” “In fact, there is concern, especially since the vaccine is being shipped to parts of the world where security can be lax, or where authorities can turn a blind eye ‘to criminal elements,” he adds.

Indeed, last Monday, the general secretary of the International Criminal Police Organization (Interpol), Jürgen Stock, warned that there will be a “significant” increase in crimes during the transfer of vaccine doses. “We are going to witness robberies, looting of warehouses and attacks during the transport of vaccines,” the German policeman told Wirtschaftswoche magazine.

“The vaccine is the liquid gold of 2021. It is the most valuable thing that will be distributed next year. The mafia and other criminal organizations are already prepared. As vaccines roll out, crime will increase dramatically. We will see thefts, break-ins and raids on vaccine shipments; corruption will be rampant in many places to get to valuable material faster. By the way, even before the vaccine was approved, criminals were distributing counterfeit vaccines, ”Stock admitted.

At the beginning of December, Interpol issued a global alert on possible criminal activities related to counterfeiting, theft or illicit advertising of vaccines, “in a context in which the pandemic has already unleashed unprecedented predatory and opportunistic criminal behavior.”

The possibility of tampering, production of counterfeit doses, and even attempts to disrupt distribution are also a concern, according to IATA. Pharmaceuticals have responded by requesting end-to-end security escorts, Dominic Kennedy, managing director of cargo for Virgin Atlantic Airways Ltd., told Bloomberg.

In Germany, for example, the federal police will be in charge of transporting the vaccines, which will be stored in secret places, France Presse reported. “In the US, there is military tracking of the main transportation from the plant / warehouse to key locations in the various states,” Mahmassani notes. However, he acknowledges, “once local authorities are in possession, capacities may be more limited.”

Filippa Lentzos, a biosafety researcher at King’s College London, tells Third that also “some European countries are discussing the implementation of additional security measures in vaccination centers in case of anti-vaccine demonstrations.” This is the case in Spain, where there is fear within police intelligence circles that actions by radical anti-vaccine groups may take place that may carry out some type of sabotage both in transport, warehouses or the vaccination points themselves, he highlights the newspaper La Vanguardia.

Even just before hundreds of thousands of doses arrived in the country, the Canadian Security Intelligence Service warned logistics companies that malicious foreign agents could threaten the largest inoculation program in Canada’s history by targeting their workers, among other tactics. “They are targeting people who already work within companies that have vulnerabilities or that could be neglected by the tight deadlines we have to bring the vaccine to market,” Pina Melchionna, president of the Canadian Institute of Traffic and Transportation, told CBC.