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There are many! We talked about some of these challenges earlier this year.
Some people talk about the scale. For example, it will take approximately 500 million doses to vaccinate a significant portion of the US adult population, because most vaccines require two doses. For comparison, we had a supply of 198 million doses of influenza vaccine this year, and the response to the H1N1 pandemic distributed more than 100 million doses in emergency settings. So the scale is impressive, but not insurmountable, especially since the systems will build on previously used practices.
One challenge is the cold chain required, especially for a vaccine like Pfizer’s, which currently must be stored at -70 degrees Celsius (-94 degrees Fahrenheit). That is much colder than our freezer temperatures. Pfizer has developed a special thermal shipping box to which dry ice can be added every five days for a total of 30 days. Once thawed, it should be stored at 2-8 degrees C (refrigeration) for no more than five days. The shipping box contains around 1,000 to 5,000 doses, so it is likely more appropriate for cities or locations that will host mass vaccination clinics.
Moderna vaccine can be stored at -20 degrees C for months or 2-8 degrees C for up to 30 days. Those shipments will contain a minimum of 100 doses each, so it may be appropriate for smaller locations, including rural ones. Fortunately, from the initial available data, those two vaccines have similar profiles in terms of safety and efficacy.
A third challenge is managing and using the information throughout the system. Our public health system is decentralized, with multiple decision-making entities. There are several information systems that have different functions and not all of them communicate with each other. On a daily basis, the public health system does not need to have a robust information system that tracks millions of products to their final destination in order to respond quickly to changing supply and demand. Some new information systems are also being implemented; this could be helpful or it could increase complexity.
Another challenge is the people. I mean, how do we reach people, even fairly and equitably? How do we ensure that people have reliable information on safety and efficacy?
We are already seeing disinformation campaigns, and there are documented concerns around questions about vaccines. People who manage logistics systems must remember that humans are the end consumers. That means logistics must include humans in the loop in multiple ways to support equitable and fair outcomes that take patient input into account.
