NORWELL, MA. – January 6: CVS Pharmacist Faisal Ibrahim gives Norwell Firefighter Jeff Jacobson a … [+]
MediaNews Group via Getty Images
On December 14th, vaccinations began in the US. As of January 6th, five and a half million doses had been administered. The initial goal for the US was 20 million vaccines by the end of 2020. Operation Warp Speed has been anything but.
Why was the performance so poor?
The Pfizer Vaccine
The Pfizer vaccine distribution plan involves the use of “specially designed, temperature-controlled thermal shippers utilizing dry ice to maintain recommended storage temperature conditions. Pfizer’s plan utilizes strategic transportation partners to ship by air to major hubs and then distribute by ground transportation to dosing locations. FedEx
FDX
MCK
The Pfizer vaccine needs to be kept cold – very, very cold. For long term storage, this vaccine must be stored at ultra-low freezing temperatures, about -100 degrees Fahrenheit. That is well below what standard freezers can accommodate.
If at a point of use, there are freezers that can accommodate this kind of storage, then the supply chain becomes easier to administer, although not any quicker. Different states have different priorities when it comes to vaccination: In Massachusetts, healthcare workers doing direct COVID patient care have first priority. This is to be followed by workers and residents in nursing homes; first responders; homeless shelters and prisons; and then other lesser prioritized groups until finally the general population can get vaccinated. If ultra-cold storage is available, then there is no “use it or lose it” problem.
But because most point of use sites do not have the ability to do ultra-cold storage, one supply chain turns into three supply chains. The other two supply chains depend upon the freezer capabilities at the point of use.
The Pfizer thermal shippers, in which doses will arrive, can be used as temporary storage units by refilling with dry ice every five days for up to 30 days of storage.
Refrigeration units that are commonly available in hospitals can refrigerate the vaccine at 2-8°C. This allows for five days of storage. Once thawed to the 2-8°C temperature range, the vials cannot be re-frozen and used subsequently.
The Moderna Vaccine
Moderna has partnered with Lonza Ltd. for vaccine production. McKesson is serving as a centralized distributor of the Moderna vaccine and the associated supply kits. FedEx and UPS will work in partnership with McKesson for the transportation.
Moderna’s COVID-19 vaccine is said to be stable at 2-8 degrees Celsius, the temperature of a standard refrigerator, for up to 30 days. Moderna’s vaccine offers great advantages based on its efficacy rates and ease of storage. Ideally, states will be sending Moderna to areas with refrigeration constraints.
The issue with Moderna is that the company has no real manufacturing track record and has never produced or sold a commercial drug to date.
The Partner Problem
The biggest problem with vaccine distribution is the partner problem. The upstream supply chain partners – companies like FedEx, UPS, and McKesson – have experienced supply chain personnel, proven processes, and good technology.
But once you get to the downstream portion of the supply chain – the supply chain that includes state planning and edicts, and then down to the supply chains associated with hospitals, clinics or even doctor’s offices – that domain expertise becomes increasingly spotty.
It is tough enough for big, sophisticated companies to work out with their supply chain partners the joint processes, the hand offs, and ways to measure service and hold the responsible parties accountable. That shakeout process can take months for much simpler supply chains even during the best of times.
At the state level, states need to be using network planning tools to understand how many of a prioritized group are in a vaccination coverage area, whether that site should get the Moderna or Phfizer vaccine based on refrigeration constraints, and use or lose it timelines with contingency plans in place if not enough of the prioritized group show up to be vaccinated in a timely manner.
Final Thoughts
So why did the US not achieve its vaccination goals? Because those goals were never possible to begin with! This is a case of rampant overpromising.
This is a complex supply chain. There needed to be suitable shakeout period. We will see vaccinations ramp up as learning curves kick in.
Finally, because the planning and expertise being done at the state level differs greatly, we will also see various states held up to ridicule for poor performance; some governors are going to face tough reelections.
