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The development of multiple COVID-19 vaccines has been an unprecedented scientific accomplishment, but vaccine development is just the beginning of the effort to end the pandemic.
After manufacturing, the vaccines must be distributed to locations around the world, along with a host of ancillary products, and assembled to begin inoculating people. As the first shipments of the COVID-19 vaccines rolled out, the challenges and complexities of getting the vital shipments to their ultimate destination have become clear.
"This could be probably the biggest and most complex use case for supply chain and logistics in history -- certainly in recent history -- and there's unique opportunity to observe this and learn from it," said Dana Gardner, president and principal analyst at Interarbor Solutions, an enterprise industry analysis firm based in Gilford, N.H. "You've got all the major complications with this: It's urgent and it needs to happen fast, there's a limited supply, there's a complex manufacturing process and there's global distribution."
That complexity will affect every aspect of the vaccine supply chain, from demand planning to allocation prioritization to last-mile delivery, supply chain experts said.
The most remarkable aspect of the COVID-19 vaccine supply chain is its scope, both in the number of players involved and in the number of vaccines and that need to be distributed, said Stephen Meyer, research director in Gartner's supply chain group.
The vaccine itself is only one part of the global COVID-19 supply chain, as there are critical ancillary products that need to be manufactured, stored and distributed. Syringes, for example, are vital to the process, Meyer said.
"The global syringe market is only 20 billion units, which seems like a lot. But if you're going to have to dose half the world's population twice, that's eight billion additional syringes we've got to find capacity for," he said. "A lot of manufacturers, whether it's syringe manufacturers, plastic vial manufacturers, alcohol prep pads, don't stand around with that amount of additional capacity laying idle waiting for demand spikes."
More complexity than normal vaccine supply chain
Beyond scope, the COVID-19 vaccine supply chain is also more complex than a typical vaccine supply chain, Meyer explained. Vaccine supply chains are a well-defined, streamlined process from the manufacturer to the primary care physician or retail pharmacies.
"Now it's not only the manufacturer and healthcare providers, but you've also got governments involved," he said.
The government piece is inherently complex, because different governments will take different approaches to distributing the vaccines, Meyer added.
"Planning is the No. 1 issue because demand is going to exceed supply. So you need to figure out what to prioritize, who gets what and how the vaccines are allocated fairly," Robinson said. "You have different governments who have signed contracts with the various companies, but they're still going to have to make decisions."
The governments and manufacturers involved could benefit from scenario analysis techniques to determine what factors should go into making those decisions, Robinson explained.
"For example, if you're going to target a certain population and allow that population to have it first, how are you going to target the areas where the virus is having the biggest impact [within that population]," Robinson said. "Figuring out how to prioritize is going to be one of the greatest challenges straight out of the gate, because we don't have enough vaccine to go around starting off."
Pharmaceutical manufacturers should also shorten the usual supply chain demand planning cycles, Meyer said.
Dana GardnerPresident and principal analyst, Interarbor Solutions
"In a normal situation, like with the seasonal flu, the planning process is usually run on a monthly cycle," he said. "When there's a lot of change in demand like we see now with the COVID vaccine, you need to shorten the planning cycles to make a quicker response time when you see a demand spike or demand drop and you can take that into account in your production and shipping schedule sooner."
Like any complex manufacturing process, all the pieces of the COVID-19 vaccine supply chain must come together at the same time, Gardner said.
"If you don't have the patients, the vials, the syringes, the antiseptic, the swabs, and the person that's able to professionally deliver the vaccine all in the same room at the same time, it doesn't work," he said. "This is a very complex web of variables and you have to do it at scale, because there are hundreds of millions of instances where this has to take place."
Supply chain must account for vaccine differences
Adding to the complexity are the differing storage requirements for the vaccines. The Pfizer vaccine, which has begun distribution in the U.S., must be kept at a temperature of about -100 degrees Fahrenheit, while those made by Moderna, which has been approved for emergency use by the FDA, and AstraZeneca, which has been asked to provide additional clinical data in the U.S., can be kept in regular cold storage.
The Pfizer cold storage requirement presents challenges in the supply chain both in transporting and last-mile distribution, according to Robinson.
"[The Pfizer vaccine] requires a special investment in extreme cold storage, and the lot sizes are about 1,000 doses per box, so to be able to make that useful, you need to be able to consume 1,000 vaccines in a short amount of time," she said. "This is likely not a problem in urban areas, but it will become more of a problem in rural areas."
All three vaccines require two doses for greatest efficacy but have varying intervals between doses, which could create a logistical mess, according to sources.
"You will also need IT systems that can track which vaccine you have, who received the first shot and when, and then track the second shot," Robinson said. "It sounds sort of trivial, but it can be a ridiculously complicated IT optimization problem to ensure that you're matching the same person twice to the same vaccine."
Community mentality is required
The entire COVID-19 vaccine supply chain supply must operate from a community perspective, not an individual one, Robinson said.
"It's not about the vaccine, it's about the vaccination, and the approach must be a community mentality that we're all in this together," she said.
Ultimately, the proof of whether the COVID-19 vaccine supply chain managed this enormously challenging process will be plain to see, as some populations reach immunity -- some faster than others -- and some don't, Gardner said.
"It should be pretty clear as to why those systems, protocols and procedures worked," he said. "And we might find out that the combination of public and private doesn't work optimally and maybe it should be all a public sector activity. We're going to learn pretty quickly whether those are good models or not."