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The logistics nightmare that awaits Covid-19 vaccine

Pfizer Inc. and BioNTech have announced that their mRNA-based vaccine candidate, BNT162b2, against SARS-CoV-2 has demonstrated evidence of efficacy against COVID-19 in participants without prior evidence of SARS-CoV-2 infection, signaling hope that the search for Covid-19 vaccine was finally bearing fruits. The results were based on the first interim efficacy analysis conducted on November 8, 2020 by an external, independent Data Monitoring Committee (DMC) from the Phase 3 clinical study.

“Today is a great day for science and humanity. The first set of results from our Phase 3 COVID-19 vaccine trial provides the initial evidence of our vaccine’s ability to prevent COVID-19,” said Dr. Albert Bourla, Pfizer Chairman and CEO.

“We are reaching this critical milestone in our vaccine development program at a time when the world needs it most with infection rates setting new records, hospitals nearing over-capacity and economies struggling to reopen. With today’s news, we are a significant step closer to providing people around the world with a much-needed breakthrough to help bring an end to this global health crisis. We look forward to sharing additional efficacy and safety data generated from thousands of participants in the coming weeks.”

But even as the the world is celebrating the good news, experts are worried that the vaccine if finally given greenlight, may not reach the people who need it most.

“Safely delivering COVID-19 vaccine will be the mission of the century for the global air cargo industry. But it won’t happen without careful advance planning,” says Alexandre de Juniac Director General and CEO of International Air Transport Association.

Vaccines must be handled and transported in line with international regulatory requirements, at controlled temperatures and without delay to ensure the quality of the product. While there are still many unknowns (number of doses, temperature sensitivities, manufacturing locations, etc.), it is clear that the scale of activity will be vast, that cold chain facilities will be required and that delivery to every corner of the planet will be needed.

Stringent temperature requirements (up to -80°C) are likely to be imposed for certain vaccines to ensure that their efficacy is maintained during transportation and warehousing, according to DHL/McKinsey & Company white paper report.

The distribution venture will also require availability of temperature-controlled facilities and equipment – maximizing the use or re-purposing of existing infrastructure and minimizing temporary builds, availability of staff trained to handle time- and temperature-sensitive vaccines and Robust monitoring capabilities to ensure the integrity of the vaccines is maintained.

Another challenge that faces the vaccine is security during the entire transport chain.

“Covid-19 vaccines will be highly valuable commodities. Arrangements must be in place to keep ensure that shipments remain secure from tampering and theft. Processes are in place to keep cargo shipments secure, but the potential volume of vaccine shipments will need early planning to ensure that they are scalable,” De Juniac observes.

In general, says Dr Seth Berkley, CEO of Gavi, the Vaccine Alliance, 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.

“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,” he said.

But with few aircrafts still operating, due to a drop in passenger numbers transporting the vaccine will prove to be a real nightmare for countries.

The severe downturn in passenger traffic, airlines have downsized networks and put many aircraft into remote long-term storage. Now the global route network has been reduced dramatically from the pre-COVID 24,000 city pairs.

The WHO, UNICEF and Gavi have already reported severe difficulties in maintaining their planned vaccine programs during the COVID-19 crisis due, in part, to limited air connectivity.

“The whole world is eagerly awaiting a safe COVID vaccine. It is incumbent on all of us to make sure that all countries have safe, fast and equitable access to the initial doses when they are available. As the lead agency for the procurement and supply of the COVID vaccine on behalf of the COVAX Facility, UNICEF will be leading what could possibly be the world’s largest and fastest operation ever. The role of airlines and international transport companies will be critical to this endeavour,” said Henrietta Fore, UNICEF Executive Director.

The potential size of the delivery is enormous. Just providing a single dose to 7.8 billion people would fill 8,000 747 cargo aircraft. Land transport will help, especially in developed economies with local manufacturing capacity. But vaccines cannot be delivered globally without the significant use air cargo.

“Even if we assume that half the needed vaccines can be transported by land, the air cargo industry will still face its largest single transport challenge ever. In planning their vaccine programs, particularly in the developing world, governments must take very careful consideration of the limited air cargo capacity that is available at the moment. If borders remain closed, travel curtailed, fleets grounded and employees furloughed, the capacity to deliver life-saving vaccines will be very much compromised,” said de Juniac.

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