Coronavirus: Why we need to start planning and preparing for the distribution of vaccine

Assuming the COVID-19 vaccine was ready today, how will it get to you wherever you are? How will it get to your grandma? How will it get to the rural villages and the other corners of the earth?

Are we planning and preparing for the distribution of the COVID-19 vaccine?

It isn’t misplaced optimism to suggest that a slow decline in the dreadfulness of this pandemic is potentially on the horizon, and that is because a vaccine really is coming. It was never a sure-banker but all indications currently suggest it is indeed coming, giving the unprecedented extent of scientific effort and the results thus far. Google it. The only and paramount question is, when?

It is worth noting that experts say having a vaccine in 2020 is a long shot and very less likely to happen. It is almost certain that you will not be injected by a COVID-19 vaccine in the year 2020. When you actually get a dose of the vaccine has much less to do with when it is approved and much more to do with how fast it is manufactured and distributed.

First and foremost, it’s a skill problem.

Shipping and administering one vaccine to one person is not difficult but shipping and administering 5 billion vaccines to 5 billion people is. That is just because, as it stands now, there isn’t enough room in our world’s logistics network to do that. Making it even tougher is the high chance that, based on the current leading vaccines, the first major vaccine to be approved will require two (2) doses administered 21 or 28 days apart.

That doubles the challenge!

Distributing 10 billion or more doses of vaccines would be difficult enough in normal times. I don’t think you need reminding that these are far from normal times. Keep in mind that international travel even just recommenced in Ghana. All over the world, the aviation industry was sitting at more than 90% down, probably still is (I’ve got to check that). Passenger airlines have dramatically cut back their international route.

Ideally, this shouldn’t really be an issue because traditionally, about 50% of pharmaceutical goods are shipped in the bellyhold of passenger aircrafts rather than dedicated freighters, as this can help them get closer to their final destination faster. Also, the world already experienced a massive logistics challenge this year with the distribution of personal protective equipment’s and shipping activities were able to scale up for that reasonably successfully.

There is just one simple reason why it will not be simple this time around: the cold chain.

Vaccines are temperature sensitive

Most of them have to be stored in a highly precise climate controlled environment in order to stay safe and effective. The cold chain is the supply chain suited to shipping goods that need to be kept cold or frozen, such as meat, chemicals and pharmaceuticals.

Off course the difficulty with the cold chain is that everything used has to be specialized. The origin warehouse, the truck, the plane, the warehouse at the final destination. Each of these need to have the proper equipment to keep the vaccines under a specified temperature or the vaccines have to be shipped in packaging that keeps them at the specified temperature. Both options are complicated and compounded by other complications.

This is what makes it a true logistical challenge.

It does not end there though.

One of the leading vaccine candidates is the Pfizer BNT162b2. This vaccine must be stored and transported at -94°F or -70°C. That is far colder than the requirements of most vaccines which can ship at either refrigerator temperature or at a wider range of freezing temperature. A firmer requirement such as this suddenly introduces a whole new level of difficulty into the game. It means that only a subset of the current cold chain can be used, which is already a subset of the overall logistics infrastructure.

Beyond the issue of actually getting such a vaccine to a distribution site, most hospitals don’t even have the infrastructure to keep a vaccine at such temperature, let alone clinics and pharmacies.

That means finding places that can receive this vaccine is a challenge.

Part of the reason why this obstacle has come up is because, traditionally, vaccines are fairly tested to determine the sort of storage and shipping conditions they can endure while still staying safe and effective. With the break-neck pace demanded for the development of this COVID-19 vaccine, they are more likely to not have enough time to conduct this test before distribution.

Let me put it this way: a likely COVID-19 vaccine will need to be shipped through a subset of a subset of another subset of an already strained logistics network to a subset of sites. Also, the vaccination will need to happen many many billions of times. Even if we figure out how to solve these complications, the solutions to these challenges present additional challenges, creating a potential nightmare scenario that needs addressing the earlier, rather than later.

Pfizer, for example, knowing that the unique distribution of their vaccines could limit its commercial success, has developed a partial solution. The partial solution is essentially highly specialized standalone packs that can be used with dry ice to keep the vaccine at the required temperature for up to 10 days. This means that, hypothetically, the vaccines could be shipped through a more traditional logistics network. However, this box has highly specific requirements.

For one, upon arrival, it can only be opened twice a day and not more than 1 minute at a time in order to keep the vaccine at the required temperature. That means the distribution site will need to accurately predict how many doses they will need in a given day before that day.

If they take out too little, they will be slowing the process by not vaccinating everyone they can. If they take out too much, they will have potentially lifesaving vaccines go to waste at the end of the day.

You should see how this can easily get tricky.

Also, this specialised box from Pfizer can only carry vaccines in multiples of a thousand, and keep in mind it can only keep it cold for only 10 days. So how, for example, do you go about getting the vaccine to a clinic that can only vaccinate 50 people in a day, like a real clinic in a small village.

Even if shipping was instantaneous, this aforementioned village can only vaccinate 500 people in 10 days and then after that, half of the vaccines in the specialised box will go bad. Pfizer is apparently developing a smaller temperature controlled box to solve this problem but that means adding a whole new different type of distribution which increases complexity.

Complexity after complexity will slow the process down.

Distributing and administering a complex vaccine like Pfizer’s will already be tough enough in wealthy countries like the United States but just imagine how difficult it would be to get the vaccine from a distributor to Kubongo in the Upper East Region of Ghana or some remote village in the DR Congo, all in 10 days and keeping it at -94°F or -70°C.

When we get to the issue of wide scale distribution, it will be the big corporations, not governments nor non-profits, that will be tasked with doing the job. For them, this presents a massive business opportunity in addition to the positive public relations potential.

If you have read everything here, then you probably have already figured it out that it’s not going to go too perfectly, this vaccination distribution thingie. So right now, it is about doing as much work as possible to make sure the process goes as well as it can go when the time comes. This will come down to making sure that there is much work and planning before a vaccine is approved. By doing that, distribution can be done as fast as possible.

IS GHANA PLANNING AND PREPARING FOR THE DISTRIBUTION OF THE COVID-19 VACCINE???

Now is the time to figure out how and where the vaccine will be distributed. If you are a healthy, relatively young person, you should care tremendously about the distribution process because you are at the back of the line. When you get your shot, when you get to start letting your guard down, has everything to do with how fast everyone in front of you gets theirs. That’s why forward thinking is prudent.

We know that this process will not be perfect and it will be reasonable to ask for perfection giving the complexity of the challenge. But if we truly put every effort into planning and preparing for this now and build the requisite infrastructure together with creating a system that caters to the people by need and not by wealth, we can at least know at the end of this that we did our best.

We can’t go back to normal life until this distribution works.

The full effects of the pandemic, healthwise and in our socio-economic life, will not end until a critical mass of people is vaccinated. That means when we get back to normal life has much more to do with when the last person is vaccinated rather than the first. This is why some experts say that the fast distribution of vaccines will be even a greater challenge than the development itself.

How soon a COVID-19 vaccine is administered will directly correlate to how many lives are saved. We wait for a safe, viable vaccine because we understand that these processes take time, and for good reason.

For our collective consciousness, looking far in the future, this moment will be defined not by when we go back to Shatta Wale concerts or parties or the gym, but rather by how many lives we saved when confronting what is arguably the greatest challenge of this generation.

Let’s rise up to it!