A vaccine is only as effective as the cold chain logistics that get it from A to B – from manufacturer, to end user. Get that wrong, and you run the risk of your vaccine losing some, or all of its efficacy. Why? Because most COVID-19 vaccines will require either 2°C to 8°C refrigeration, or between -20°C and -80°C deep freezing from bottling to application.

In what has recently been described by Pfizer’s Supply Chain Vice President as their ‘biggest ever vaccination programme’1, and as one of ‘the biggest civilian projects in history’2 by UK Health Secretary, Matt Hancock, the scale of the COVID-19 vaccine delivery only serves to complicate what is already a delicately balanced series of events that get vaccines from manufacturer to end user.

With unprecedented investment into COVID-19 vaccine development and stockpiling, the ongoing damage to global economies caused by lockdowns, and the cost to human life, effectively connecting the links in the vaccine cold chain is under more public and professional scrutiny than ever.

‘When are we getting it?’, ‘who gets it first?’, and ‘how effective is it?’ are just some of the questions being asked in the aftermath of the successful BioNTech-Pfizer, Moderna, and now Oxford-AstraZeneca phase 3 trials. For perhaps the first time in human history, large numbers of the general public are seeking to obtain a detailed understanding of how a vaccine cold chain works.

The answers to those questions rely on numerous things: manufacturers gaining licences to produce and deliver their vaccines, vaccine production capacity, and the ability of global logistics networks to function at an unprecedented scale. At Intelsius, we offer packaging solutions and expertise throughout the vaccine cold chain, however this article will focus on the last of several vital steps to getting vaccines from manufacturers to end users: the last mile.

 

What is last mile delivery?

Pfizer have already published their approach to delivering their COVID-19 vaccine around the world, stating that it will be distributed from its own centres in the US, Germany and Belgium, and will need to, ‘travel both on land and by air, face potential storage in distribution centres in between stages, and the final hurdle will be local delivery to clinics, surgeries, pharmacies, hospitals – anywhere the vaccine will be administered.’3

The ‘final hurdle’ they mention is what’s known as the ‘last mile’ – the final link in the cold chain prior to vaccines being administered to end users.

 

As the above infographic illustrates, once vaccines arrive at national and regional distribution hubs they will be distributed to numerous institutions and vaccination centres where healthcare workers and members of the public will receive their vaccine. This last and crucial link in the cold chain will see local, regional, and national couriers delivering small and medium size packaging solutions containing numerous does of a vaccine, with the temperature of these packaging solutions needing to remain stable until the vaccine can be administered.

 

The last mile is the hardest

Research and development companies, drug manufacturers, and major logistics providers have the benefit of purpose built deep frozen and refrigerated storage facilities on an industrial scale. As reported by The Guardian, ‘Pfizer’s COVID-19 production site in Puurs, Belgium, has hundreds of large freezers in which to store the vaccine before shipment.’4 In cases where these organisations don’t have the requisite cool storage capabilities to meet the unprecedented COVID-19 vaccine demand, they’re building them from scratch, with logistics giant DHL reportedly committing $160 million to new COVID-19 vaccine storage facilities.

Shipping vaccines from one established, well-funded, and well-equipped distribution hub to another, while still taxing on the scale required to vaccinate 7.8 billion people, involves large-scale, existing logistics networks and providers with decades of cold-chain experience between them. However, localised, last mile vaccine logistics are – at the scale required to overcome COVID-19 – an altogether different prospect.

A recent Financial Times article suggested that, ‘two-thirds of the world are unlikely to have easy access to vaccines requiring frozen storage’5. This inability to reach the majority of people seeking vaccination is in large part due to lack of sufficient cold chain capabilities, with the article going on to say, ‘research by DHL and consultancy firm McKinsey has found that insufficient “last mile” cooling facilities in the final delivery stages and a lack of storage at clinics in large parts of Africa, Asia and South America would “pose the biggest challenge” to delivering a vaccine at scale.’5

The recent phase 3 trial breakthroughs from Pfizer, Moderna, and AstraZeneca have all been met with worldwide acclaim, but issues with deep freezer storage and distribution look set to significantly impact the likelihood of certain vaccines reaching all corners of even the world’s most developed nations, with a recent Reuters report stating: ‘… the vaccine’s complex and super-cold storage requirements are an obstacle for even the most sophisticated hospitals in the United States and may impact when and where it is available in rural areas or poor countries where resources are tight.’6

 

‘Warm vaccines’

Despite there being a global lack of suitable frozen storage on the scale required, hope is available with recent AstraZeneca and Gamelya vaccines only requiring refrigerated or 2°C – 8°C temperature control. This still poses a challenge, but greater levels of infrastructure are currently in place to transport vaccines within these temperature parameters in Africa, Asia and South American regions.

As recently reported by The Guardian, scientists are exploring novel ways to bypass traditional cold chain networks in order to deliver COVID-19 vaccines to regions without the expensive cold chain hardware, and established logistics hubs and networks: ‘Scientists are exploring whether future Covid-19 vaccines could be in the form of inhaled vapours, powders, tablets, oral drops or intranasal sprays, for which the only delivery requirements could be a mailing address.’7

An important aspect of these novel solutions is that they can survive in extremely warm temperatures, eliminating the need for complex cold chains. The article went on to say: ‘Researchers at the Indian Institute of Science in Bengaluru believe their “warm” vaccine against Covid-19 could survive at 100°C in powder form, and 70°C in a solution – withstanding the searing summer temperatures across India.’7

Despite potentially novel approaches to future COVID-19 and other vaccine development and distribution, the fact stands that the majority of the vaccines becoming available in the coming months will require a monumental cold chain effort from governments, manufactures, and logistics specialists around the world.

 

The end of a long road

The last mile comes at the end of a potentially long and demanding journey with packaging exposed to a variety of external temperatures. This only adds greater emphasis on the ability of your packaging to keep your vaccine payload at the right temperature for long enough to complete the cold chain without losing vaccine efficacy.

As previously mentioned, while many well-established and well-funded cold chain locations have the requisite facilities to effectively handle temperature-sensitive biologics (industrial freezers capable of -80°C, and industrial size refrigerators), regional and local cold chains are far less equipped, and less capable of ‘restarting the clock’ on the temperature inside your chosen shipping systems.

The packaging solution you choose to get vaccines from national and regional distribution hubs, to a clinic, hospital, temporary vaccination centre, or care home needs to give you temperature-stability, and enough time to ensure your vaccine arrives with time to spare, before losing its efficacy.

 

ORCA Solutions: a COVID-19 vaccine last mile delivery solution

ORCA solutions are a range of connected, temperature-controlled packaging systems capable of 120 hours protection against the most extreme temperature profiles. Qualified against ISTA 7D standards, and available with dry ice for vaccines requiring deep frozen temperatures or refrigerated at 2 to 8°C using advanced phase change materials, the entire ORCA range uses superior vacuum insulated panels, ensuring a longer and more stable temperature profile.

Available with payload volumes of between 4.5L and 50L, and with an easy-to-use, simple design, ORCA solutions can meet the requirements of last mile, COVID-19 vaccine delivery.

ORCA Connect solutions offer real-time tracking, so you never lose sight of your payloads, even during its last mile delivery. ORCA Connect allows for the usage of various tracking solutions for your temperature critical payloads. Not bound by a specific hardware, ORCA Connect provides the freedom to utilise the optimum tracking solution for your requirements, ensuring you are always connected.

You can read a full features and benefits breakdown of all our ORCA solutions here.

To discuss your cold chain requirements, or to find out more about how Intelsius is providing COVID-19 vaccine distribution solutions, get in touch with your local branch.

To read our previous article on COVID-19 vaccine transportation – The Role of Dry Ice click here 

External references

1 – Lloyds Loading List (2020) –  Pfizer in ‘mega’ logistics operation for COVID-19 vaccine 

2 – BMJ (2020) – Covid vaccine: GPs need more clarity on logistics and planning, say leaders

3 – BBC (2020) – Covid vaccine: How will we keep it cold enough?

4 – The Guardian (2020) – Pfizer and BioNTech’s vaccine poses global logistics challenge

5 – Financial Times (2020) – Covid-19 vaccine delivery faces problems, warns DHL

6 – Reuters (2020) – Why Pfizer’s ultra-cold COVID-19 vaccine will not be at the local pharmacy any time soon

7 – The Guardian (2020) – Scientists race to find ‘warm’ Covid vaccine to solve issue of cold storage

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