GAVI estimates that billions of doses of Covid-19 vaccines are required to achieve herd immunity. Past vaccine campaigns show that generating demand, allocating and distributing vaccines, and verifying coverage are key to successful vaccination.
Storage and Distribution
Between 10% and 20% of vaccines are wasted due to temperature and shipment related issues, especially in-country (BioPharma Reporter, 2020).
“Between 10% and 20% of vaccines are wasted due to temperature and shipment related issues, especially in-country.”
Of the 48 candidate vaccines currently under clinical evaluation, 11 are in phase 3 trials (GAVI, 2020). In November, Pfizer and Moderna announced vaccines that require two doses about a month apart and are 95% and 94.5% effective, respectively (Pfizer 2020; Moderna, 2020). Moderna’s vaccine can be transported and stored long term at -20°C for up to 6 months and now be stored at 2° to 8°C (36° to 46°F) for 30 days. Upon thawing, the vaccine is viable for up to 12 hours at room temperature. Meanwhile, Pfizer’s vaccine requires subarctic storage temperatures (WHO, 2020).
An estimated 15 billion deliveries in cooling boxes; 200,000 movements by pallet shippers; and 15,000 flights across various supply chain setups (see archetype 3 of figure 1) are required for global reach assuming 10 billion doses being needed over 2 years (DHL, 2020).
Figure 1: Three archetypes of end-to-end logistics solutions for COVID-19 vaccination distribution (Source: DHL 2020)
A report by PwC (PwC 2020) suggests existing gene therapy and mRNA trial sites as skeletons for cold-chain distribution in the US (see Figure 2). However, this is not feasible in the developing world in the Global South, where such facilities are non-existent.
Figure 2: Gene therapy centres, mRNA trial sites as a skeleton for cold chain distribution.
George Fenton, senior operations advisor of the Humanitarian Logistics Association, in an interview with Cov360, noted some countries in the developing world still rely on bicycles or foot for last mile delivery.
“Some countries in the developing world still rely on bicycles or foot for last mile delivery.”
Pfizer has designed cool boxes with an outer layer of dry ice that may be suitable for such journeys. However, the temperature within the boxes is affected by the ambient temperature. Transport to remote areas over long distances at high temperatures may not be viable even with cooling bags.
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Figure 3. President Kagame along with Zipline CEO Keller Rinaudo watch the drone take off for delivery | Muhanga, 14 October 2016
Figure 3. President Kagame along with Zipline CEO Keller Rinaudo watch the drone take off for delivery | Muhanga, 14 October 2016
An insulated cylinder – called Arktek – was used to distribute Ebola vaccines at -70°C in the DRC during the 2014 Ebola epidemic. It can hold more than 500 doses, is small enough to be carried on a motorbike, can keep its contents cold for up to a week without external power sources, and is reusable. However, scaling up its use across countries will be challenging.
“Drone technology, used in hard-to-reach areas in Rwanda, may be a solution.”
Lyophilized or freeze-dried versions of the vaccine may be easier to transport if viable, but reconstitution on-site may pose challenges. Fenton notes that drone technology (Gavi, 2020), used in hard-to-reach areas in Rwanda, may be a solution.
Verifying immunization
Verifying immunization is key to global herd immunity. In low- and middle-income countries (LMICs), immunization services are predominantly targeted at children. Local registries are not designed to track healthcare workers and at-risk adults for Covid-19 vaccination, owing to fragmented health systems and lack of government prioritization (Privor-Dumm et al., 2020; Weintraub et al., 2020). Furthermore, the lack of tracking technology in developing countries requires alternate means to reach target populations.
“The lack of tracking technology in developing countries requires alternate means to reach target populations.”
Fenton suggests mobile technology as an option in places like Somaliland, as 90% of the population use mobiles. However, this is a challenge in places like the Middle East where data protection and security issues are present.
Generating Demand
Governments already burdened by conflict are unlikely to prioritise a COVID-19 vaccination campaign strategy. Additionally, vaccine hesitancy, lack of awareness, and culturally low emphasis on adult health can contribute to low demand (Weintraub et al., 2020).
The following measures are recommended to address the impending logistical challenges:
- Concerted, well-coordinated, well-communicated strategy, as well as widespread public health communications campaigns.
- Government collaboration with international agencies, local networks, and their population. The international aid and humanitarian system need to be aligned.
- An impartial global platform that supports strategic logistics planning to ensure effective vaccine distribution.
22 December 2020
By Iman Hameed
A contributor and member of the Public Health Pathways team.
With special thanks to George Fenton of the Humanitarian Logistics Associations who provided insights to help prepare this report.
