Colonel Shiv Choudhary (Retd)
An unprecedented situation throws out unprecedented challenges with an equally unprecedented demand on preparation to meet such hurdles. Supply Chain Management challenges related to the most sought after Covid-19 vaccine are as unfathomable today as the understanding of Covid-19 is even after one year of its first knock in the world. Seeing the speed, reach and efficacy of cure so far of Covid-19 and vulnerability of human being, logistics of much awaited vaccine will be a nightmare for logisticians across world. Simple assumption will be “no one is safe, unless everyone is safe” The world wants a victory through an impactful vaccine mission through unflinching preparedness, ownership and responsibility, not a defeat or ways to save skin.
World population of around 7.8 billion with 220 nations affected by Covid-19, over 8 cr. positive cases, 17 lakh death so far and currently infected cases touching 2.21 cr. (on the day of writing this piece), only reflect the vulnerability of the human being before this deadly virus. Surprisingly, USA with best of health care facilities tops the list with tiny nation like Vanuatu at bottom with just one positive case. One can imagine the enormity of task in hand. Incidentally, the population below 16 years of age and pregnant women are not yet covered under the ongoing vaccine trials. Globally, about 35 percent of the population is under 15 and over 65 years of age.
Developing a vaccine is one thing and correct and timely distribution another. Managing the vaccine supply chain will pose tremendous logistical challenges for health care providers and at all levels of government decisiveness and aptness unparallel for any other pharmaceutical product in the history. The stakes could not be higher.
While the set of challenges like identification of vulnerable groups, priorities, affordability, confidentiality and segregation would be tackled by the concerned governments, an effort is being made here to appreciate the enormous task associated with the supply chain management needed on an unprecedented scale and speed.
No disease or disaster has impacted and scared the world, its medical fraternity and leadership across the world in a manner, the Covid-19 has done. The agonizing wait for the arrival of any cure seems to be getting over. Therefore, the world is likely to witness biggest supply chain management (SCM) effort and challenge ever seen before. The battle involving possible business models, ethical codes, real time updates, reliable networking, smart logisticians, transportations, cold chains, distribution, digital disruptions, spot solutions, end to end understanding, rapid assessment, inter dependency, global visibility, connectivity and integration of human minds and technology till last mile, and final delivery in right quantity and at the right place has just begun.
Pfizer says -70 degrees C storage is projected to be viable for only 10 days after manufacture. Moderna and the others companies also have indicated that their vaccines will require cold storage, but only to the level approx -20 degrees C. Whatever, the vaccine needs to be constantly temperature-monitored to protect and ensure vaccine integrity under all its facets. One may only gauge from a news report published by Eurasia Group that global equitable access to COVID-19 vaccines is estimated to generate economic benefits of at least US$ 153 billion in 2020-21, and US$ 466 billion by 2025, in 10 major economies.
Enough has been said about the capacity of manufactures to produce and stock vaccine with giants like Moderna which can manufacture a billion a year and Pfizer approximately 1.3 billion a year. Limited manufacturing capacity and inflating need just make the life of transporting players miserable. Various nations have funded for speedy production of vaccine but have not spared much wanted financial thought for needed complex and multi resources mechanism to forward move the vaccine. Tasking military is ruled out too being a non feasible solution.
Strategic tie up and partnership seek to provide a speedy and reliable solution for vaccine movements as well as to create a global sustainable cold chain. Vaccine-makers have started planning their own distribution network by engaging with cold chain logistics firms. Highlighting the enormity of logistics challenges associated with vaccine movement, the IATA has noted that if everyone in odd 220 affected nations received a single dose, the medicines would fill 8,000 Boeing 747 cargo aircraft. Similarly, the logistics company DHL estimates the need of some 200,000 pallet shipments and 15,000 flights over the next two years with equipment for precision vaccine cold storage. Governments will need to work out how they can step up capacity. Absence of operational regularity and coordination of estimated 1.6 million drones in the world during 2021 and big delivering players like FedEx, UPS, Amazon and Google need to be tapped in.
SpiceJet in pact with Snowman and Om Logistics, are emerging big players in the transportation in providing with the refrigerated trucks to cover first and last mile, transportation, storage and distribution of vaccines from various manufacturers across India and abroad, under the needed protocols. This arrangement will also handle ground services like packaging, transportation, airports, warehouses and consumption points under controlled temperature both in and outside India.
India is aiming delivery at about 31000 pin code points at present. It has some 20,000 reefer containerized trucks, of which roughly 10-15 per cent may be suitable for vaccine transportation in the frozen temperature range. Cold chain companies are adding over 500 reefer trucks in anticipation of the vaccine surge. In addition, there is 28,000-units cold storage network that is used for the government’s universal immunization programme. Expectantly, none has had the capacity to transport vaccines at temperature colder than -25 degrees Celsius. Finding the requisite workforce for shots to such a humongous population, across unseen geo turf and cold chain logistics for their last-mile distribution in such a vast, hot country will only be too stressing and fatigues.
Supply chain arrangement is not a short term need. Till Dec 2020, more than 10 billion vaccine doses had been preordered by countries, with about half of the doses purchased by high-income countries comprising only 14% of the world’s population. The manufacturers of three vaccines; Pfizer, Moderna, and AstraZeneca predicted a manufacturing capacity of 5.3 billion doses in 2021, which could be used to vaccinate just about 3 billion people against needed two doses for a protective effect. Due to the high demand of preorders in 2020-21, vaccine to people in low-income developing countries may not reach before 2024.
Competition, business cartelization, targeted delivery stations, preferential treatment, N+1 concept, JIT, cost, timelines, regulations, monopolists and local factors throw another set of hurdles for manufacturers, suppliers, transporters and receiptants. Geopolitical issues, safety concerns for vulnerable populations, and producing billions of doses under compressing trial and short circuiting every aspect only showcase the need to control technology strength of one vaccine manufacturer over another.
Post deploying a COVID-19 vaccine during 2021, the world will require the largest worldwide supply chain transport system with more emphasis on containers than contents. Tracking of 10-19 billion vial doses is readily becoming the largest supply chain challenge in history. As of Sept 2020, experts expressed concern that much needed networks for distributing a licensed vaccine with expected volume and urgency are not ready, mainly due to deterioration of resources due to frequent lockdowns during 2020 and downsizing.
Other logistics factors considered internationally during distribution of vaccine demand are visibility and traceability by barcodes for each vial, sharing of supplier audits, custody of each vial from manufacturer to the individual being vaccinated, temperature monitoring, testing, block chain and location intelligence technologies, personal protective equipment, diluents, syringes, needles, rubber stoppers, refrigeration fuel or reliable energy sources to waste-handling and time wasters. A major concern is that resources for vaccine distribution in low- to middle-income countries, particularly for vaccinating children, are inadequate or non-existent. This will need centralized, nationally or regional cost effective procurement.
Vaccines need to be kept cold during transportation since these are inherently unstable during temperature changes. A cold chain must accommodate more than one vaccine with varying temperature sensitivities and local conditions. The cold chain is further challenged by the type and limitations of local and rural transportation access vulnerable populations. This demands dry ice in specifically designed containers using liquid nitrogen. The dry ice is allowed only in limited quantities on airplanes as the gases released via sublimation may be toxic. Thus, maintaining much needed balance is a tricky task. Transporters need to install ultra-cold freezers with UPSs at air cargo hubs. One UPS can manufacture 540 kg of dry ice per hour.
Medicines are the world’s largest fraud market said to be garnering around $200 billion per year. Interpol called it “liquid gold” and warned of an “onslaught of all types of criminal activities”. Widespread demand for a COVID-19 vaccine vulnerable to counterfeit, cyber attacks, theft and scams throughout the supply chain can be a daunting challenge for all the stake holders. Anti corruption, transparency, and accountability safeguards needs to be established. Absence of harmonized regulatory and seamless frameworks among countries, including ineffective capability to identify and track genuine vs. counterfeit vaccines, may be life-threatening. It can potentially cause a COVID- 19 vaccine pandemic.
Tracking technologies for packaging is a must to trace vaccine vials, and digital and biometric tools for security of vaccination teams. Interpol has already warned that organized crime could infiltrate the vaccine supply chain, steal product through physical means, data theft, offer counterfeit vaccine kits and sabotage. Discreet use of GPS system up to the distribution points and RFID technologies must be incorporated. IBM analysts maintain that petro chemical companies are being targeted by hackers due to their central role in producing dry ice. The WHO has implemented an “Effective Vaccine Management System” by constructing priorities of personnel and trained staff to handle time, storage, monitoring, temperature-controlled facilities, equipment, traceability and security.
Border processes, customs and immigration authorities in all individual countries must be on same page for efficient handling and customs clearance to cater for facilitating flights, bottle necks, landing permits, exempting flight crews from quarantine, flexible operations for efficient deployment and granting arrival priority to maintain vaccine temperature requirements without impacting and harassment to normal travelers and cargo. Air cargo of such a sensitive item demands a smooth international coordination for all planned and unplanned terminals and emergencies.
Safe and timely delivery of COVID-19 vaccines will be the mission of the century for the global air cargo industry. Governments need to take the lead in facilitating cooperation across logistics chains so that the needed facilities are ready for the mammoth and complex task ahead. There is a golden chance for sinking airline and hospital industry to get a new lease of life.
Success of Supply Chain Management for forward movement of the universally needed Covid-9 vaccine in right quantity, at right time and at the right place is a very daunting task with an unimaginable safety and health concerns. Success will hinge upon deploying right resources, collaboration, operational efficiency and a flawless coordination amongst all players. Vaccine supplies, staff to implement and people to be vaccinated must be in sync with each other and in place. Any mismatch anywhere, failure is inevitable. The need for supply chain managers to be in the operational loop cannot be over emphasized.
The pace of the COVID-19 cure campaign will be driven by vaccine supplies. Profit and economy should not drive the mission. The government has authority and tools to utilize all available resources and ensure efficacy respectively. If the vaccine supply chain fails, the economic and human costs of the pandemic may be beyond retrieval. There are no bigger challenges, then the ample opportunities the vaccine offers. The entire nation and national machinery need to be on same page of readiness rather than using vaccine as a source of vote bank. Let us all support and stand up to the challenges.
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