All in this together?

Supply chain limitations may scupper the developing world’s early access to a vaccine. DHL and McKinsey say in the Delivering Pandemic Resilience white paper that an early vaccine may come at a cost of lack of stability at ‘conventional’ temperature ranges. As Covid-19 vaccines have leapfrogged development phases, stringent temperature requirements (up to -80°C) are likely to be imposed for certain vaccines to ensure that their efficacy is maintained during transportation and warehousing.

Given that temperature requirements are likely to be the main challenge, regions with a particularly warm climate and those with limited cold-chain logistics infrastructure will pose the biggest challenge in a stringent vaccine distribution scenario. Furthermore, in-country logistics capabilities must be considered when targeting downstream distribution of vaccines globally. Especially under stringent logistics scenarios requiring dry ice for cooling, bottlenecks are likely to arise at the destination due to centralised dry ice production, especially if refilling is required after 3-5 days.

Transportation under stringent temperature requirements – when shipping frozen vaccines, for example – may require extraordinary measures to reach people outside the ~25 countries with the most advanced logistics systems, which are home to just one third of the world population. Currently, large parts of Africa, South America and Asia could not be readily supplied at scale due to lack of cold-chain logistics capacity suitable for life science products. Governments and NGOs would need to implement special measures to ensure vaccine distribution. Capacity would have to be increased and scaled in order to reach the global population.

In contrast, executing the last mile in line with conventional transportation requirements (assuming sufficient shelf life at a more conventional temperature range of +2–8°C) is much more feasible; it allows for a more efficient distribution to end users globally since transport can rely on available capabilities and capacities, as well as prior experience and knowledge. However, even when leveraging existing infrastructures, the share of the world’s population with good access to a vaccine only increases to ~70%, reaching a total population of ~5 billion in ~60 countries. Feasibility for supplying substantial parts of Africa remains low due to high outside temperatures and limited cold chain infrastructure. It is therefore important to consider innovative and specialised transportation modes to reach populations in less accessible regions.

Vaccine scenarios

First emergency use authorisations for Covid-19 vaccines expected to be effective in the last quarter of 2020, and logistics providers will be challenged to rapidly establish medical supply chains to deliver more than ten billion doses worldwide, says DHL and McKinsey.

Currently, more than 250 vaccines across seven platforms are being developed and trialled. As we’ve seen: Covid-19 vaccines have leapfrogged development phases, stringent temperature requirements (up to -80°C) are likely to be imposed for certain vaccines to ensure that their efficacy is maintained during transportation and warehousing. This poses novel logistics challenges to the existing medical supply chain that conventionally distributes vaccines at ~2–8°C. 

The scope of this task is immense: To provide global coverage of Covid-19 vaccines, up to ~200,000 pallet shipments and ~15 million deliveries in cooling boxes as well as ~15,000 flights will be required across the various supply chain set-ups.

There are two scenarios with major supply chain implications, which some indications suggesting that the least favourable in supply chain terms, may be the first to produce a viable vaccine.

Stringent scenario: Out of caution, producers of certain vaccines and their logistics providers can choose to adhere to extreme temperature requirements (as low as -80 °C) to ensure that the efficacy of the vaccines are maintained during storage and transport. These conditions are in line with the ones used for certain Covid-19 vaccine clinical trials today. These stringent requirements might be lifted over time if 1) vaccine efficacy at higher temperatures is proven by stability testing or 2) formulations are improved and additional manufacturing steps are added to increase stability.

Conventional scenario: However, health authorities, producers and logistics providers would strongly prefer to begin large-scale transport and distribution under the conditions prevalent in pharmaceutical supply chains today (+2–8°C or even higher) as long as stability is not compromised. The certainty of success of a conventional approach partially depends on the vaccine platform. While these less stringent transport requirements have been trialled and tested for a protein-based vaccine, applying a conventional transportation approach to certain current frontrunners (developed on RNA platforms, for example) is riskier and based on less experience and stability data. 

In any scenario, Covid-19 vaccine supply chains will also differ based on the utilised technology platform and individual vaccine. If things go extraordinarily well, the first vaccine that proves to be safe and clinically efficacious could in theory be the ideal candidate, i.e. not only efficacious, but also allows for scalable production and manageable distribution at standard temperatures. However, the announced production capacities are particularly high for vaccines of the novel RNA and viral vector types, and the RNA platform, in particular, presents a higher probability of extreme logistics requirements. As a result, under the stringent scenario, pharmaceutical companies, governments, NGOs and logistics providers need to prepare to handle these requirements.

Challenges in detail

Challenges include the sheer number of shipments – imagine almost 15 million cooling boxes in an exemplary supply chain – paired with the required volume of cooling bricks or dry ice. Dry ice production does not seem to be a bottleneck for vaccine distribution. But even under aggressive assumptions, both the availability of suitable packaging as well as the maximum-allowed quantities of dry ice in air cargo transport could potentially limit shipment possibilities in certain cases if the preparations are not made in time.

In addition, ensuring consistent temperature management (in a way that avoids damage to the precious shipments throughout the last-mile network) is much more complex for ~50 boxes/parcels than it is for one pallet shipper. The physical handling of ultra-deep frozen shipments requires special equipment (such as gloves) and processes to avoid injury. This means that a large number of couriers and consignees need to be informed or even trained.

Learning from Covid-19 response

The height of the first wave of Covid-19 infections revealed several logistics-related challenges in two links of the supply chain – inbound logistics and distribution. Particularly as related to personal protective equipment (PPE), product-quality issues, constrained transportation capacity, complex customs processes and regulations increasing the risk of delays, warehousing challenges, and limited transparency regarding stock levels all posed significant problems.

Even a product as simple as hand sanitiser, for example, requires careful handling due to its alcohol content, especially for longer-term storage. Moreover, products shipped on a push-based approach from various suppliers lacked standardisation in terms of SKU formats and shipment information, which also led to inefficient warehousing operations.

Second, limited real-time transparency on warehouse stock levels significantly limited options for orchestrating an effective last-mile delivery network. This also made it difficult to make reliable promises to end users and created friction in planning processes. Transportation planning and managing multiple carriers posed additional challenges that governments had not faced before.

DHL and McKinsey says the same issues could come into play when distributing a vaccine. DHL advocates IT-enabled supply chain transparency, alongside a strong infrastructure, including a pre-established network of warehouses and transportation capabilities.

The white paper suggests to respond effectively to the next public health crisis, governments need to start putting strategies and structures in place today, rather than relying on reactive, ad hoc measures when the crisis hits. 

To kick start the dialogue among the different actors and improve pandemic resilience in medical supply logistics, DHL provides a framework for the cooperation of logistics companies with authorities, politicians, NGOs as well as the life sciences industry. The framework helps to establish measures to ensure the most stable and safe supply chains possible. Besides an emergency response plan, this includes a partnership network, strong physical logistics infrastructure and IT-enabled supply chain transparency. Lastly, a response unit with a clear mandate should be put in place to implement all critical activities at short notice.

To read the white paper, visit https://bit.ly/332aZzo