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Newswise – Delivering a vaccine for a global pandemic that has caused nearly 1.5 million deaths and infected more than 64 million people in early December 2020 will require an extraordinarily complex logistical effort.
In the following questions and answers, Johns Hopkins Carey Business School Associate Professor Tinglong Dai provides insight into the COVID-19 vaccine administration process in the United States and elsewhere in the world. Dai is an expert in operations management and business analysis, with a focus on the healthcare industry.
QUESTION: We know that some vaccines must be kept in extremely cold temperatures. What are the different temperature requirements of the first three candidate vaccines? And what are the supply chain implications?
TINGLONG DAI: The three main candidate vaccines, from Pfizer / BioNTech, Moderna and AstraZeneca / Oxford, have very different temperature requirements.
If you’ve heard people talk about a vaccine that needs to be stored in arctic winter temperatures, that’s the one from Pfizer. Pfizer vaccine can be stored at minus -70 degrees Celsius (minus -94 degrees Fahrenheit), plus or minus 10 degrees Celsius, for six months. Needless to say, that is a very strict temperature requirement that few hospitals or pharmacies can offer. Essentially, you would need to purchase an ultra-cold freezer, each of which can cost up to $ 20,000 and contain over 100,000 doses. That’s why Pfizer has built a heat carrier that can be stored at room temperature and keep vaccines ultra-cold for up to 10 days. You can only open the sender at most twice a day. After 10 days, you will need to add dry ice to those shippers every five days. Once you take a vaccine out of the package and put it in a regular refrigerator, you will need to use it within five days.
If you mentally think about how difficult the Pfizer vaccine is to distribute, you will greatly appreciate the other two vaccine candidates. Moderna vaccine can be stored between 2 and 8 degrees Celsius (36 and 46 degrees Fahrenheit) for 30 days. That is what a normal refrigerator can offer. It can be stored for up to six months at minus -20 degrees Celsius (minus-4 degrees Fahrenheit) in a household or medical freezer. It can also be stored at room temperature for 12 hours.
And the AstraZeneca vaccine is another improvement. Basically, it requires refrigerated storage, not cold. It can be stored between 2 and 8 degrees Celsius (36 and 46 degrees Fahrenheit) for six months. This is really a very, very basic requirement. For this reason, the AstraZeneca vaccine is considered by many to be the one that will be widely distributed around the world.
When a vaccine is available, who do you think should get it first?
CDC’s Immunization Practices Advisory Committee just voted on December 1 that healthcare workers and nursing home residents will be first in line to receive COVID-19 vaccines. We have about 17 million healthcare workers and 2 million nursing home residents. So in total it gives just under 20 million people. We are expected to have around 40 million doses available by the end of December. Suppose we administer the doses in order of arrival, we would have some doses for other groups. The next in line would be the first to respond, people with various underlying conditions, school teachers, prisoners and the homeless. The next would be healthy adults, children, and others. Then there are certain people, like those with rare diseases, who cannot get vaccinated for safety reasons. We will have to vaccinate them indirectly by vaccinating members of their household.
What should policy makers do to ensure equitable distribution of COVID-19 vaccines?
The name of the end of the COVID-19 pandemic is not a vaccine; this vaccination. It is important to think about the institutional realities of vaccine administration. Simply giving people a certain number of vaccinations does not make it fair. A rural clinic can be assigned tens of thousands of doses of Pfizer vaccine, but if it cannot meet the ultra-cold temperature requirement, it will not be able to use them. Another problem is that many places simply don’t have enough healthcare professionals to administer COVID-19 injections on a large scale, so it is important to ensure not only that vaccines are assigned, but also that what is needed for the vaccination is there.
What should hospitals do to prepare for the distribution of multiple vaccine brands in the coming months?
Large and urban hospitals may consider adding some cold and ultra cold capacity so they have the means to service all the vaccine brands that will be available. Small and rural hospitals should begin to develop and test their information systems to allow people to register for vaccination and be notified of when and where to receive vaccines. Regardless of the size and nature of a hospital, its leaders, physicians, and supply chain professionals should have regular meetings in the war room to discover potential logistical limitations and bottlenecks that can make it difficult to vaccinate people.
Will there be particular challenges in vaccinating people in rural areas of the United States?
The key challenge is that they don’t have the economies of scale to invest in ultra-cold freezers. Additionally, each Pfizer “pizza box” (the nickname for Pfizer’s secondary packaging) has 975 doses. It may not always be possible to use almost 1,000 doses in five days in rural areas. So Pfizer may not be a desirable option for rural areas, unless they can find a way to match supply and demand efficiently, essentially creating a kind of just-in-time COVID vaccine clinic. Moderna and AstraZeneca are much more tolerant of temperature requirements, but rural areas can still face other constraints, such as staffing, stable electrical grids, and PPE.
Beyond the US, what will be some of the challenges of vaccinating people in other parts of the world, especially in regions with limited resources?
Ensuring an equitable vaccine allocation will be the first challenge. The United States has the most serious pandemic in the world, so it deserves a high priority to receive vaccines. However, unless the rest of the world is vaccinated, we also cannot assume that we will be safe at home. Many countries do not have the operational transportation and storage infrastructure needed to carry out this large-scale vaccine distribution operation. Vaccinating billions of people in a matter of months is not something we have much experience with, not to mention that there is very little room for error. There’s also a demand-side problem: even if you get the shots and everything else needed for vaccination, people can choose not to get vaccinated. Vaccine doubts are not a national problem; it is a global problem. To put it all together, it is perhaps not an exaggeration to say that the COVID-19 vaccine will present one of the greatest logistical challenges in human history.
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