The challenges of the global distribution of COVID-19 vaccines

The fastest developed vaccine ever, but do we feel it’s fast enough?

We continue to see immense efforts going into the development of Covid-19 vaccines by numerous Pharmaceutical companies across the globe. Vaccines typically require years of research and testing before reaching the patient, but in 2020, scientists embarked on a race to produce safe and effective Covid-19 vaccines in record time. Researchers are currently testing 64 vaccines in clinical trials on humans, and 20 have reached the final stages of testing. Two vaccines are approved for full use and eight have been approved for limited/emergency use in the immunization against Covid-19. While this development has been great, the world cannot wait for more vaccines to be available and easily accessible for administration.

We expect to see a handful of approved vaccines by mid-2021, and we have seen the initial mobilization of the first wave of vaccine distribution. As governments and international aid organizations are assessing requirements and options to execute an accelerated global mass rollout there continues to be high uncertainty about where, what and how.

The initial expectation is that the first batches would be transported by air, followed by all other modes of transport. Temperature requirements remain a key as a part of the quality standards to ensure the integrity of the vaccines. Yet, as we get further along the journey we are learning, and I want to share an updated expectation of the distribution logistics as the mapping of supply chain capabilities and potential partners are in full swing.

Demanding logistics needs are still up there

The temperature expectations for the transportation of COVID-19 vaccine addressed in the previous update still holds true. We still see the initial need for Pfizer/BioNTech to transport their vaccine at -80°C and Moderna at -20°C. However, we see that further vaccines released in 2021 will be more stable and require temperature control between 2°C and 8°C.

Considering the vaccines distribution plans, we expect to see two waves approach. The first one will be at speed to the market and we have all seen the excitement with how the vaccine gets rolled out. This rollout will happen by overland transport and air freight and is picking up now.

It is important to note the need for overland transport. As slightly more than 50% of all vaccines will be distributed locally or regionally, where the vaccines are produced, this transportation mode will prove very functional and successful. It is cost efficient, can handle flexible volumes, and one can easily monitor and control temperature via the use of dedicated vehicles. Once the security risk is covered, it can be the perfect distribution mode for the Covid-19 vaccines.

When the industry evaluates the air freight expectations, there are predicted up to 60,000 tones equivalent to 900 dedicated freight flights. This is a best-case scenario, where dry ice restrictions are maximized by best ventilation capabilities. Dedicated aircrafts are likely to be seen later in the distribution waves, as the initial volumes, as they are being produced, will preferably be shipped on passenger flights. Vaccine distribution at destinations will be met with its own challenges; expected shortages for storage and administering hold-up at the last mile. Though, I believe the utilization of ocean temperature containers can serve the purpose of creating sufficient temperature control storage at destination. Ocean freight can support the movement when the vaccine becomes more stable at -20°C and specifically between 2°C and 8°C. Even though global freighter capacity (dedicated planes for cargo) has increased and is currently 20% higher than 2019 levels, overall air freight capacity globally continues to be critical and is at approximately 30% below the levels registered for same period in 2019 therefore confirming the continued impact on airfreight. Air travel restrictions and airfreight market disruptions remain and continue to interrupt and delay the supply of essential health products to many countries. There has been rate increases by as much as 100% to 500% per charter that cannot be afforded by all.

Vaccine Sourcing would benefit some of us more than others

The largest vaccine international distribution will originate from Europe and India, with the largest demand in Africa and Asia. The reason is that the most production facilities are in Europe and India, which also means that most of the European distribution will happen from intra-Europe via trucks due to the short distances and the fact that the EU has signed deals with most vaccine producers. India will be one of the biggest global producers with the Serum Institute of India leading the way with the Astra Zeneca and Novavax vaccine and subsequent domestic distribution in India. The third largest production area is concentrated on the east coast of US, with distribution mostly expected in US, predominantly by road but also air transport. Supply to South America will come from Europe and Asia, supply to Africa will come from Europe and India, South East Asia will self-produce but also receive supply from US, Europe and India. It is expected that in a global context more than 50% of all vaccine distribution will happen on local or regional level. Around the globe there are different infrastructure capabilities, the cost picture can differ from country to country and supply chains for delivering these various vaccine products within Europe and the US versus other global regions may differ hugely.

COVID-19 Vaccine Distribution Challenges are not related only to the vaccine itself

We see the following matters impacting the distribution of the vaccine on a global plan. These are namely infrastructure, admin and the accessories to be in place when the vaccine arrives. In particular:

• Storage refrigerators that will stock the vaccines once they arrive at the destination distribution or administration site. The World Health Organization estimates that there is huge risk of losing vaccines due to cold chain failures and non-functional freezers, as per previous experience. Losing millions of doses of COVID-19 vaccines could be disastrous for getting a handle on the pandemic. That is where Ocean reefers can support in certain geographies.
• Keeping track of who got vaccinated, the vaccine they received and ensuring both and subsequent doses are from the same company will be a challenge.
• The accessories needed around the administering of the vaccine including diagnostics and therapeutics will be six times the volume of the vaccine. These will have to find capacity initially on airplanes but would widely move on trucks and ocean. The accessories are namely: face masks, gloves, gowns, face shields, glasses, needles, syringes, disinfectants, plasters, waste bags and others.

A vaccine for life? - Future Vaccine Demand

No vaccine protects against viruses 100% of the cases. By comparison, for example, vaccines against common seasonal flu can typically pattern an efficiency in a range of between 50%-60%. It is still unknown for how long one would be protected after receiving a Covid-19 vaccine. If enough people are vaccinated with an effective vaccine, the infection rate could be slowed down to such an extent that the Covid-19 virus eventually dies out and then everyone is protected. This is called herd immunity; after about 70% of the population are vaccinated to stop the Covid-19 virus infection completely. The efficacy of the various COVID-19 vaccines administered will lead to different demand scenarios. We anticipate three potential outcomes:

• Enduring immunisation, low demand post-2023: Once administered the effectiveness of the vaccine lasts a lifetime
• Long-term immunisation, medium demand post-2023: The effectiveness lasts many years, after which moderate demand continues 
• Short-term immunisation, high demand post-2023: The effectiveness lasts for a short period of time, leading to considerable demand in the foreseeable future

Vaccine efficacy remains one of the big questions that arises from discovering new variables of the virus, though it is believed the alterations would be handled by the vaccines. The other ones are how, where and when the Covid-19 vaccines reach all of us!