One of the more poignant features of life during the pandemic is the publication of daily sets of numbers related to Covid-19. The number of hospital admissions, number of new cases, number of deaths and, now a new one in recent weeks, the number of people who have received the vaccine.
All these are key indicators and are studied with both great interest and great concern. For the first time in the UK we are towards the top of a positive global table (third behind Israel and the UAE in numbers per thousand citizens who have had the vaccine). This is at last for us good news, having previously been amongst the world leaders in the spread and impact of the virus.
For us as logistics and transport professionals, we can see that success here is driven by a number of key supply chain capabilities and metrics alongside the professionalism of the health care industry. There is of course the subject of equitability of vaccine provision globally and how the richer countries will take a lead, but at present we will instead focus on the logistics of the operation, and how we can learn from current experiences.
Experience in the UK is changing and developing daily. The learnings here are already informing the global distribution task ahead. There is in fact a strong case for starting in a country with a well-developed supply chain and medical structure before moving to more inaccessible parts of the world. The UK has in recent weeks experimented successfully with phasing the first and second injections of the vaccine over a much longer period – 12 weeks or more – to enable the maximum number of people to receive the first injection and therefore some immediate protection. This last week has seen the opportunity to experiment with mixing vaccines – having one dose of one followed by a second of another. In the UK the population have been so badly hit by the virus there is a much more favourable view from individuals to have the vaccine, which is a major consideration.
The recent weeks have led to a general realisation that the supply chain starts with the product itself, the capability to manufacture and control its quality, and the procurement contracts set up. The recent EU battle with one of their suppliers indicates an immediate failure to get sensible procurement contracts set up. It also illustrates to most seasoned supply chain professionals that if you are talking litigation with your supplier in the early weeks of supply, some fairly basic procurement principles on both sides have been neglected.
However, if you think only in terms of procurement initially, you invite failure as you then consider how to quickly and effectively vaccinate individuals. For this to work well the first stage to consider is the manufacturing process, then the transportation, then the storage and secondary distribution, and finally the delivery in batches to the actual vaccination locations. At this point the logistics become even more critical in ensuring you have the correct number of patients ready to administer the quantity of vaccine that you have delivered, without wasting a dose. Each vial of the Oxford Astra Zeneca vaccine in the UK should give 10 doses but there becomes an efficiency challenge if a 10% improvement can be made on each vial, as you can get 11 doses rather than 10 out of each. If this succeeds nationwide there is a huge potential saving and benefit.
In manufacturing, the general pattern is to manufacture the vaccine in one location and then move in bulk to a finishing plant. Currently only the manufacturer and owner of the license are carrying out both tasks, but we are already seeing Pfizer working with Sanofi in France to enable another competitor to manufacture under license. This can and will be extended to open up global capacity. Capacity is a key initial issue so watch out how that is dealt with globally, as with current manufacturing capacity limits the timeline to vaccinate everyone globally will take at least until the end of 2022. Another critical factor in manufacturing is the availability of the glass vials themselves which require a partnership and a manufacturing capability with a supplier close to the finishing plant.
In distribution from manufacturing to the country or region, one of the key factors is the vaccine itself and the conditions with which it must be held to ensure it can be delivered safely for use at the vaccination point. This is where some vaccines have major limitations, as we know with the Pfizer vaccine which has extreme temperature requirements that can only be met by very sophisticated supply chains. These requirements can, and are being met, but as distribution extends into more remote areas then other vaccines will win out.
Security of supply is another factor to ensure that when stored or transported, theft or tampering is not allowed and the vaccine properly monitored and managed. Public confidence is critical in the coming months and if there is a threat to that in any shape or form then that threat has to be considered carefully and removed quickly. Again, as supply chain professionals, we are used to these type of threats and we can neutralise them through careful planning.
Entry and exit from countries across borders and the ease of that transit is another critical issue. The world is watching as countries seek to create barriers rather than expedite transit and, alongside that, there is a need to ensure data exchange is facilitated through good electronic methods and processes.
Then, of course, there is the last mile where we as professionals know failure occurs most frequently. How do we ensure individuals are ready to receive the dose, that that dose is recorded, that repeat dosages are properly managed, and that the person to administer is ready? For most of the population this can be done through existing medical facilities or specially created ones. In the UK my local centre is our local cathedral and in other places it is the local football stadium. However, things become more complex when reaching out to the disadvantaged and those who are not mobile.
For a very comprehensive document written before the first vaccines were ready, do read this paper published by the Logistics and Supply Chain Management Society.
For a view on the lessons so far from Covid in the health logistics supply chain please read these two short abstracts co-authored by our very own CILT Global WiLAT Chairperson, Gayani de Alwis.
This is an example of international industry analysis which we are sharing as part of our global best practice resource to help you think about and determine appropriate responses locally.