V for Vaccine

By Nazery Khalid,

Nazery Khalid looks at the challenges to supply chains in facilitating the production, distribution and administration of Covid-19 vaccines worldwide 

Vaccines to the rescue 

The development of vaccines by several pharmaceutical companies provides a huge sigh of relief to a world still reeling from the impacts and uncertainties of the Covid-19 pandemic a year on since its outbreak. 

The production of vaccines by several manufacturers – the major ones including Pfizer from the US (and its German partner BioNTech), Astra Zeneca (UK), Sinovac and CanSinoBIO (China), Gamaleya (Russia) and World Health Organization (WHO) Covax facilities – is going at a breakneck pace to meet the huge in-country demand where they are produced and also worldwide.    

Starting in December 2020, the countries where the vaccines are manufactured, and other countries have begun mass vaccination programmes targeted at their populations.  All countries around the world are eager to start the vaccination program in a race against time to protect their population against this deadly virus.   

On the day this article was written, international news agency AFP reported that 201 million coronavirus vaccine doses had been administered in at least 107 countries and territories worldwide (excluding statistics from China and Russia) since the first shots were given in late 2020.  This was against a backdrop of 111 million active cases and 2.4 million deaths globally to date, according to World Health Organization figures.   

Here in Malaysia, the Government has already laid out a vaccination roll-out plan to attain immunity for at least 80 percent of its population or 26 million people within a year.   As is the case in other countries, Malaysia has put protecting its people from the deadly virus as a matter of utmost priority.   

Immunising its citizens is a crucial first step towards kickstarting the recovery of its economy which has stalled to its worst level in two decades arising from the movement control order (MCO) introduced to curb the spread of Covid-19 and from the worldwide economic recession triggered by the pandemic.      

The first consignment of 312,390 doses of Pfizer-BioNTech vaccine landed at the Kuala Lumpur International Airport on 21 February 2021.  This paved the way for the deliveries of more vaccines in the coming weeks. They will be administered to targeted recipients under the National Covid-19 Immunization Program (NCIP) in three phases as follows: 

Phase 1 (from Feb 26 – April 2021) for frontliners 

Phase 2 (April 2021- August 2021) for high-risk groups 

Phase 3 (May 2021- February 2022) for adults aged 18 and above 

The pressure is on for the NCIP to be carried out effectively as the number of daily new infections and deaths in the country remain uncomfortably high and the groups which are most vulnerable to Covid-19 need to be protected quickly.  These include the millions of foreign workers in the country whose dwelling places make up a big percentage of Covid-19 clusters here.   

This is despite the numbers showing signs of decline since the implementation of the latest round of MCO in parts of the country announced on 16 February 2021 lasting until 4 March 2021, following the third wave of the spread of the virus.   

As manufacturers ramp up the production of vaccines and their availability increases, national health authorities will recommend more groups to be vaccinated.  The ultimate objective of governments around the world, including Malaysia, will surely be to administer the vaccination to their entire population as soon as large enough quantities of the vaccines are available. 

Challenges along the chain  

Supply chain management and logistics practitioners and watchers are keenly tuned in to the vaccination programs around the world to evaluate how the supply chains perform to facilitate the immunisation programs.  As with most undertakings of this scale and extent, its success will depend greatly on the supply chains facilitating the vaccine’s production, storage, distribution, and administration. 

To underscore the importance of supply chains, the roll-out of the vaccine in the US was hampered by problems along the supply chain of Pfizer’s production, the first manufacturer which announced the production of a workable vaccine.   

The key hurdle was the raw materials used in the production of its vaccine not meeting standards.   This impeded the roll-out target of the company, which gave credence to earlier concerns expressed by US health authorities that the early supplies of the vaccine would be likely limited due to obstacles along supply chains. 

From a supply chain management perspective, the critical success factors for the immunisation programs to be carried out efficiently and sufficiently are:  

  1. Adequate supply of the vaccines. The pressure is on for manufacturers to produce their vaccines in the amount that can satisfy the urgent global demand without compromising on their safety and in full satisfaction with regulatory requirements of health authorities.   

Demand for these life-saving items has already reached stratospheric levels as countries around the world scramble to roll out their national immunization programs, despite niggling concerns over the after-effects of the vaccines.   

Already, there are grouses amongst developing and under-developing countries about ‘vaccine nationalism’.There is genuine fear amongst them that the developed, rich nations are hoarding vaccines for their population and leaving little to others.  Of the 201 million jabs given thus far worldwide, an estimated half of them took place in high income, wealthy countries belonging to the G7 group which accounts only a mere ten percent of the global population.  Although this is not a supply chain issue, it could soon become one if surging demand for vaccines is not met.   

Failure to meet this demand quickly would put the manufacturers in bad light and expose them to accusations of colluding with governments of vaccine-producing countries to hoard these coveted life-saving item.  

  1. Good planning and effective coordination / execution of the immunization programs.  The success of the extremely challenging and complex task of immunizing as many people globally as possible rests squarely on the efficient coordination of all stakeholders involved.  They encompass vaccine manufacturers, logistics services providers, health care sector, governments (federal, state, and local) and communities, among many others.   

There has to be close coordination among all parties every step of the way in the production, distribution and administration of the vaccines, the preparation of venues for immunisation, informing the public about the details of the immunisation programs, and recording information about and monitoring the effects of the immunisation.  Without close cooperation, collaboration and cooperation of all parties involved, it would be difficult to achieve the lofty target of achieving immunity to the majority of (if not the entire) populations. 

  1. Adequate personnel to handle the logistics of the vaccine supply chains.  They include truckers, warehouse / distribution center personnel, logistics practitioners, medical frontliners and even sanitisation workers.  Without adequate highly skilled and well-trained personnel playing these critical roles in the processes involved in the immunisation programs, the vaccines will not be delivered on time and in the right volumes and desired conditions to the impatient global population, and will not be dispensed properly and according to the predetermined targets and timelines.   
  1. Availability of data related to all aspects of the immunization initiatives against Covid-19.  It is essential that comprehensive, accurate and updated data – from the point of production of the vaccines to their distribution and administration – is collected and shared with all parties involved in the programs.  These include data on information of the vaccines (covering information on their production, transportation, storage and administration), recipients of the vaccine (including their personal information and when they are vaccinated), the venues of the vaccines being administered and those involved in administering them (physicians, nurses, clinicians, cleaners, food delivery personnel etc), among others. 
  1. Visibility of data across the supply chains.  The date collected must be shared and easily tracked and accessed by everyone along the supply chains at all times, from the point of production (the vaccines manufacturers) to the point of consumption (the targeted population). 
  1. Adequate storage facilities for the vaccines.  These time- and temperature-sensitive items need to be stored at low temperatures.  Handling certain types of the vaccines may require custom-built freezers with special features which regular freezers do not have.  Storage facilities in sanitized conditions are also needed to stock ancillary items needed to administer the jabs such as syringes and also PPE such as gloves and masks for frontliners.  The supply chain must have adequate supplies to store the vaccines in the desired conditions until they are distributed to the target groups.  The challenge will mount as the vaccination programs expand to rural areas where freezer storage facilities are not as easily available as in major cities.  
  1. Adequate transportation capacity and capabilities to deliver the vaccines from factories to the people.  Several challenges test the resolve of players in the transportation section – on land, in the air and at sea – to deliver the vaccines to the target recipients in good time and acceptable cost, without compromising on health, safety and environmental interests and in full adherence to all national and international rules and regulations.  It will be especially challenging to deliver the vaccines to remote and rural areas where transport infrastructures are lacking.  Solutions such as retrofitting vans into deep-freeze mobile units may have to be explored.   
  1. Robustness of the supply chains to ensure zero or minimal disruptions of their production, transportation and distribution.  Given the long and complex supply chains between the vaccine manufacturers and global markets, it is pivotal to ensure the chains do not break and the flow of the vaccines from their production centers to populations are not impeded.  Contingencies must be in place to ensure disruptions arising from bad weather, strikes, breakdown of equipment / systems, human errors, geopolitical turmoil, inadequate facilities / capacity to handle the vaccines’ production, distribution and administration, and even hostile acts such as sabotage, counterfeiting and theft are dealt with, if not altogether prevented.  The supply chains facilitating the immunization programs must be resilient in the face of these disruptions and beyond. 
  1. Proper disposal of wastes post-vaccination and of spoiled vaccines / damaged vials or equipment.  This aspect requires meticulous planning and management as wastes not disposed of properly can cause health and environmental hazards.  In addition, there could be severe repercussions arising from people carrying out unscrupulous activities such as recycling the vaccines to be sold in the black market and filling vials with counterfeit vaccines, if the wastes are not handled properly.     
  1. The application of technologies in facilitating the logistics end of the immunization programs.  In all the processes listed above, technologies must assume center-stage to ensure they are carried out effectively and in full compliance of rules and regulations while meeting the end objectives and expectations of all stakeholders.  The full array of technologies and solutions offered by Industry 4.0 – artificial intelligence, Big Data Analytics, blockchain technology, cloud computing, Internet of Things, systems integration / interoperability and virtual reality, among others – should be used optimally to ensure the immunization programs are successful and the mammoth task of eradicating Covid-19 globally is achieved.   

Spotlight on supply chain 

Immunising their populations as fast as possible has become a matter of topmost priority to governments around the world as the number of infections and deaths show no signs of abating and as economies continue to suffer from the impacts of the pandemic. 

The authorities in charge of dispensing the vaccines in all the world’s countries depend on the smooth planning, running and execution of their roll-out plans to reach as many people as possible within a reasonable amount of time and at reasonable cost.   

Attaining this gargantuan target hinges on the smooth running of the supply chains to ensure the uninterrupted production, transportation, storage, distribution and administration of the vaccines to first the targeted recipients and eventually to entire populations.    

The challenges discussed are just several of many more facing those involved in the supply chains of immunisation programs to ensure adequate quantities of vaccines are produced, distributed efficiently and administered quickly to rid the world of this deadly pandemic. 

This massive undertaking will test the resolve of all the parties across supply chains.  Covid-19 does not discriminate and is a global health issue, hence no one should be left out in the process to eradicate it.  Time is of the essence, and cost is also a certainly a factor in this very challenging fight against this killer virus.   

Nazery Khalid is an avid commentator of supply chain and the logistics and maritime industries.  He welcomes comments at [email protected] 

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