The vaccine is the easy bit; distributing it to everyone is harder

Around the world, there is hope that a vaccine will soon be developed to combat the global pandemic caused by COVID-19. It’s no easy task. The fastest the world has ever produced a vaccine in the past is four years. That was for mumps. I don’t pretend to know what goes into developing a vaccine – I’m not a biochemist or epidemiologist, or any other kind of scientist that needs to be involved. However, what I do know is that once a vaccine is developed, the problems don’t end there. As important as creating a vaccine may be, it’s just as essential to distribute it, and that requires a very specialised form of logistics that has long been neglected.

Immunization Supply Chain and Logistics (ISCL) systems are probably something that few have heard of. That’s not surprising as they were only developed in the 80s. The fact is that successful immunization programs are built on functional, end-to-end supply chain and logistics systems. Vaccines have to be carefully stored, handled and managed. There has to be rigorous temperature control along the way. Your information systems have to be completely up to date. It requires a lot of specialised processes and technology and, unfortunately, for most of the world, these things are either not in place or nowhere as good as they need to be.

ISCL systems are already under stress, and most are not remotely equipped to deal with a new vaccine that has to be distributed to hundreds of millions of people in a matter of a few years. Originally, ISCL systems were designed to manage fewer, less expensive and less bulky vaccines and related supplies. They are not going to be able to keep pace with what is being asked of them without significant investment. Look how quickly we run out of flu vaccines every season. That’s not just a manufacturing issue. It’s a supply chain issue.

Even if a vaccine for COVID-19 is successfully developed, we can expect to see out of stock, administration of ineffective vaccines, wastage, lack of cold-chain capacity and other inefficiencies with coverage, cost and performance implications.

The World Health Organization is acutely aware of the problem, but most governments remain ignorant. Despite the WHO indicating, as far back as 2014, that ISCL systems are limiting the benefits of immunization programmes and need to be much more heavily resourced, we are yet to see significant movement on that front.

National immunization programmes remain disproportionately fixated on the development of vaccines and continue to ignore what’s required to get them to the people who need them. Consider, as a bare minimum, what would be needed to transport billions of doses of COVID-19 vaccine around the world:

• Tens of thousands of flights
• Thousands of liquid tanks
• Hundreds of thousands of pallet shipments with cooling packaging
• Thousands of cooling warehouses
• Millions of cooling boxes with corresponding amounts of cooling bricks or dry ice
• A massive increase in the visibility of relevant data for all involved

None of this currently exists within ISCL systems. Even if it did, there is a lack of suitable cold-chain logistics infrastructure in large parts of Africa, South America and Asia. Right now, we could only easily reach around 2.5 billion of the global population. That means, even if a vaccine is developed, it is unlikely to be available for the other 5.3 billion people any time soon. If you want an idea of what that all looks like, just remember how the world’s wealthiest nations could not even get PPE gear into their hospitals only months ago. Vaccines are a lot harder to shift than PPE gear. We have some serious challenges here.

As much as we all hope the scientists can be successful and as much as we appreciate the resources being dedicated to the vaccine effort, none of that will count if we don’t start paying the same kind of attention to the logistics involved. Our ISCL systems are not up to the task… and time is running out.

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