Special delivery: the logistics of curing Covid-19

When it comes to the Covid-19 pandemic, a vaccine remains the holy grail. Once a vaccine is released, the most vulnerable in society can be protected and some form of population immunity can be reached, without the need for mass infection or damaging lockdowns. 

At the time of writing, more than 170 candidate vaccines are in development, 11 of which are in phase III. With positive trial data from Pfizer and interim results on the efficacy of other candidates expected soon, plus news that the US Food and Drug Administration plans to lower its requirements for authorisation, it is conceivable that we could have a vaccine approved by Christmas. This would be the news that so many of us are desperate to hear. 

That said, the approval of a vaccine won’t automatically spell an end to the pandemic. Exciting though it will be, the authorisation won’t make much difference unless the vaccine can be rolled out on a mass scale. Here is where a different set of challenges come in; specifically, the enormous logistics challenges associated with delivering a medical product to billions of people.

In September, the International Air Transport Association (IATA), urged governments to begin planning for vaccine delivery, working with industry stakeholders to make sure they have capacity in place. 

“Safely delivering Covid-19 vaccines will be the mission of the century for the global air cargo industry. But it won’t happen without careful advance planning. And the time for that is now. We urge governments to take the lead in facilitating cooperation across the logistics chain so that the facilities, security arrangements and border processes are ready for the mammoth and complex task ahead,” said IATA’s director general and CEO, Alexandre de Juniac, at a teleconference.

It’s clear that air cargo constraints present a major obstacle. IATA has noted that, if everyone in the world received a single dose, the medicines would fill 8,000 Boeing 747 cargo aircraft. Similarly, the logistics company DHL estimates that we will need some 200,000 pallet shipments and 15,000 flights over the next two years. 

Unfortunately many airlines have downsized their networks, with whole fleets grounded since the pandemic started. This has caused problems for organisations like UNICEF and Gavi, which have struggled to main their regular vaccine programmes. 

Governments will need to work out how they can step up capacity again, not to mention removing employees from furlough; opening borders to air cargo; and exempting airline staff from quarantine restrictions. 

Beyond that, not every airport is certified to receive pharmaceuticals, and there is a shortage of dedicated facilities throughout the distribution chain. At this stage, we don’t know what kind of handling requirements will be necessary for a Covid vaccine, but they could be relatively stringent. Some vaccines need to be kept at temperatures as low as -80^oC, posing huge challenges for regions with limited cold chain infrastructure. 

As a result, many airlines, airports and logistics companies will need to make specialised investments. Airport operator Fraport (which operates Frankfurt International Airport) is preparing to open another 6,500 sq ft for pharma logistics. Lufthansa Cargo has opened dedicated pharma storage centres in Munich and Chicago, while Air France-KLM has invested in temperature-controlled infrastructure in Paris and Amsterdam. 

Pharmaceutical freight firm Yusen Logistics has opened a new branch in Sunderland, UK, designed specifically for Covid-19. And the logistics company Kuehne+Nagel has two new pharma hubs in Brussels and Johannesburg, which will facilitate storage at different temperature ranges. 

Yngve Ruud, overseer of air logistics at Kuehne+Nagel, said: “Today, new pharma and healthcare products tend to be more valuable, more temperature-sensitive and have additional requirements for storage and transportation conditions. 

“Such capabilities and facilities are not easily available globally. The new hubs in Brussels and Johannesburg will ensure that our pharma and healthcare customers can fully rely on K+N to handle [these] specific challenges.”

While the difficulties should not be downplayed, the last few months have shown us exactly what medical logistics providers can achieve in times of crisis. Since the start of the pandemic, the healthcare supply chain has dramatically scaled up the procurement and distribution of personal protective equipment. 

We have also seen a widespread rollout of the drugs used to treat Covid-19 patients. Gilead has invested significant capital to ensure large-scale supply of remdesivir, while dexamethasone production has been ramped up to meet the surge in global demand. 

The same applies with medical devices. Contract manufacturer Flex works with 17 of the top 20 med tech companies globally via its Health Solutions business. 

Among other achievements, the company supported delivery of a customer’s nebuliser system, produced ventilators for major global brands, delivered diagnostics to China and helped scale up production of antibody test kits, all while making millions of masks for its own factory workers. 

“We increased our inventory levels and did a number of spot buys of materials – around ten times the number we normally do,” says Amy Boyle, vice-president of marketing in Flex’s Health Solutions division. 

“We found new regional suppliers so that we didn’t get stuck in a situation where everything was shut down, and then we worked with some of our customers to establish additional production at their request. We were able to start some additional lines inside 60 days, which is really something.”

She adds that information sharing was key to their success. Issues that, in the past, might have taken a week to resolve were dealt with in hours or even minutes. Even when Flex didn’t manufacture a specific product, it was sometimes able to augment companies’ supply chains by securing supply from elsewhere – something that wasn’t previously in its remit.   

“It’s really amazing what comes out of people in a crisis,” she says. “We were able to make decisions very nimbly, bottlenecks were called out and since everyone had a very proactive approach to problem solving, nothing was left to fester. It was about keeping the whole ecosystem going. That kind of partnership and collaboration made a huge difference in how our customers were able to respond to challenges.”

To a large extent then, preparing for vaccine distribution will mean learning from what’s been achieved so far. 

“I think some of it has to do with modelling – you can do a lot of simulation around production and distribution logistics,” says Boyle. “You can plan some ‘what if’ scenarios, at least identifying where the weaknesses are in the system and what kind of stressors would bring down parts of it. Then when you start to see the stressor, you already know it’ll cause a breakdown in the system and you already have a contingency plan.”

In practice, this might mean implementing a regional strategy with some redundancy in the supply chain, giving back-up if a certain country ends up in lockdown.

“Everybody wants to operate at minimum inventory levels and maximum cost efficiency levels, but we’re asking now ‘where does lean become too lean?’” says Boyle. “The risk profile of that position has changed and people are going to be re-examining some of their goals. It’s about ensuring resilience of the supply chain and working out what level of risk you’re willing to take.”

With the first vaccines in sight, it is time for logistics providers, governments, airlines, and many more to begin their preparations in earnest. As the speakers emphasised at the IATA teleconference, this is an enormous undertaking that requires careful planning from every stakeholder. 

“Delivering billions of doses of vaccine to the entire world efficiently will involve hugely complex logistical and programmatic obstacles all the way along the supply chain,” said Dr Seth Berkley, CEO of Gavi, the Vaccine Alliance. “We look forward to working together with government, vaccine manufacturers and logistical partners to ensure an efficient global roll-out of a safe and affordable Covid-19 vaccine.”