The race against the virus

IT HAS been more than a year since the world woke up to the news of the new SARS-COV-2 virus. What followed was the largest global health crisis in 100 years. The disruptions to every aspect of society have been profound. Logistics and supply chain management have played a vital role in pandemic management right from the start to ensure the availability and distribution of key pandemic management tools: medicines and medical supplies, such as vaccines, test kits, ancillary supplies, treatments, and personal protective equipment (PPE). 

With over 200 million doses of all approved vaccines distributed to over 120 countries and 9,000 operated flights in which more than 350 DHL facilities were involved, DHL was part of the response strategy from the beginning. Over 50 bilateral and multilateral collaborations with partners in both the pharma and public sector and several new dedicated services were created to stem this task. The recently published DHL white paper on Revisiting Pandemic Resilience takes one step back and sheds light into what the sector has learned from the race against Covid-19 to be best prepared to handle public health emergencies in the future.

There are important achievements across research and development, production, and supply chain management as well as policy that will help us get through the crisis as a global community. The foundation of this was laid by research and development by developing a vaccine five times faster than any other vaccine in history and ramping up production in record time – quadrupling pre-Covid vaccine production capacities. Together with logistics and supply chain, they were able to get the life-saving vaccines to patients worldwide. Although unprecedented cold chain requirements of up to -70 deg C had to be met, logistics were able to roll out the distribution three times faster than usual. Furthermore, multilateral action by public health and policy actors has provided a conducive framework for rapid vaccine development and deployment.

Collaboration key

For high levels of immunisation, around 10 billion vaccine doses are required globally by end of 2021. However, only four countries have achieved vaccination rates >50% to date and many of the remaining countries and territories have less-developed infrastructure, making the rollout more difficult. To speed up vaccine distribution, the following areas need to be looked at:

• Industries and nations must foster collaboration, paying special attention to building strong partnerships and a supportive data backbone.
• For safe inbound supply flows, proactive transport-capacity management and sustainable return flows for packaging are needed. This is particularly critical as more than 95% of global Covid-19 vaccine doses are produced in just eight countries and need to be delivered worldwide.
• Also locally tailored last-mile, ground distribution models should be put into place with a focus on strategic location of warehouses, the synchronisation of vaccines and ancillaries flow as well as the number and location of vaccination points.

The set-up of logistics infrastructure and capacity should be kept on that level, as in the coming years a further 7-9 billion doses of vaccines are necessary annually to keep (re-)infection rates low and slow down the pace of virus mutations – seasonal fluctuations not counted.

Among the building blocks for successful vaccine roll out was securing inbound flows of the product. 

Transport

Transportation capacity management was important. Capacity limits (particularly those related to air freight and dry ice) can lead to bottlenecks that delay vaccine delivery, compromise vaccine quality, and even endanger aviation workers. Accurate prediction and management of transportation capacity can ensure the timely and safe delivery of vaccines to destination countries.

The DHL Ice Tracker forecasts and monitors dry ice amounts, adapting the network as necessary to ensure both flight crew safety and product quality.

Packaging

Many of the vaccines approved today have cold or ultracold storage temperature requirements, for which special packaging systems are required. These can be quite expensive – up to EUR 400 per container. Streamlined return logistics and multisupplier relations can ensure packaging and equipment capacity, sustainability, and circularity, with packaging being refurbished (as needed) and reused. Well-functioning return logistics can reduce packaging waste by 50 to 60%.

Strategic warehousing

Just-in-time or direct shipping models are not always suited to serving a large number of vaccination points or countries with largely remote populations. At the same time, up to 70% of health facilities in low- and middle-income countries do not have the capacity to store large volumes of Covid-19 vaccines at 2 to 8 deg C or –20 deg C. Taking into account the time, cost, and utilisation of large-scale cold-chain storage and warehousing, national governments should explore the option of setting up appropriate storage at local or regional levels.

The signatories of the UNICEF and World Economic Forum charter on Covid-19 vaccine delivery have stepped forward to offer pro bono support in the form of specialist logistics personnel for global logistics coordination, and operational assistance for warehousing and cold-chain solutions at regional and national levels. At the same time, many countries have issued vaccine exemptions such as removing import barriers at their borders, speeding up transportation.

Active loggers enable location and temperature tracking of each vaccine shipment in near-real-time. The DHL Quality Control Center predicts shipment schedules, identifies anomalies, and triggers solutions. In the case of Pfizer, vaccines enter the country and are shipped and stored at delivery points. There is no need for cross-docking or repackaging.

Examples of effective hubs include a cross-regional hub in Dubai for the UN World Food Programme. Foreign governments commission vaccines and ancillary supplies for combined shipment. Once these shipments clear customs at the hub and destination country, each point of use receives one combined shipment.

An example of a local hub is in Rwanda: The country has cold-chain warehousing close to an international gateway. Each point of use receives vaccines and ancillary supplies as needed.

Synchronised flow of goods

In addition to vaccines, the transported volume of ancillary supplies, such as needles, syringes, diluents, and hazardous waste containers, needs to be ramped up to ensure that enough are available to administer every vaccine. Vaccines and ancillary supplies should be shipped and stored either jointly or separately, depending on the local infrastructure, timeline, IT capabilities, and availability of medical supplies. In the mountainous kingdom of Bhutan, vaccines and ancillary supplies were combined upon arrival in the country and then delivered to remote locations by foot or helicopter. Over 95% of the adult population has received their first shot.

The future

Planning for the future it is essential to identify and prevent health crises early through active partnerships, expanded global warning systems, an integrated epidemic-preventions agenda and targeted R&D investments. It is also recommended to expand and institutionalise virus containment and countermeasures (e. g. digital contact tracing and national stockpiles) to ensure strategic preparedness and more efficient response times. To facilitate a speedy rollout of medication (i. e. diagnostics, therapeutics and vaccines), governments and industries should employ “ever-warm” manufacturing capacity, blueprint research, production, and procurement plans, as well as expand local deployment capabilities.

To read the white paper, visit www.dhl.com/pandemic-resilience