Getting a coronavirus vaccine around the world
The COVID-19 vaccine developed by Germany's BioNTech (with the help of US company Pfizer) may well herald the beginning of the end of the pandemic.
The race to develop a vaccine has required an unprecedented global mobilization of scientific know-how and pharmaceutical resources. But that was only the first part of the battle. Getting the vaccine out into the world will require a massive corraling of transport and logistical resources.
Get approval, ramp up production
Regulators have not approved the vaccine yet. However, given the extremely promising trial results, that is not expected to take much longer.
Many analysts believe the US will approve it on an emergency basis by the end of the year. The European Medicines Agency will likely follow a similar timeframe.
BioNTech has contributed the vaccine technology but it requires Pfizer's vast resources to scale up manufacturing. By October, Pfizer had already made several hundred thousand doses at a manufacturing facility in Puurs, Belgium.
Various countries have already done huge deals for distribution. This week the EU finalized a deal to buy around 300 million doses of the two-dose vaccine, enough for around 150 million people.
Pending approval, Pfizer says it expects to start deliveries before the end of 2020. It hopes to have around 100 million doses available around the turn of the year, with more than 1 billion doses to follow in 2021.
Waiting in very, very cold storage
The vaccine needs to be stored at temperatures of minus 70 degrees Celsius and once thawed, it can only survive for around five days at temperatures of 2-8 degrees Celsius. No other existing vaccines require this kind of deep freeze storage, as this vaccine has a novel scientific basis.
Consider the complexity not just of transporting billions of doses of the vaccine around the world, but doing so with such extreme storage requirements.
Existing "cold chains"— supply chains which specialize in low temperatures from production to consumption — are not capable of maintaining such extreme temperatures.
As a result, Pfizer has come up with its own short-term solution. It has developed its own "thermal shippers," each one about the size of a suitcase and capable of storing up to 5,000 doses of the vaccine. Packed with dry ice, they will be able to keep the vaccines at the right temperature for about 10 days, if left unopened. The boxes themselves can be stored at temperatures of 15-25 degrees Celsius.
Even with the thermal shippers, the vaccine will have just 10 days to reach a vaccination center, such as a hospital or doctor's surgery, and after that it must be used within five days unless its final location is capable of storing it at minus 70 degrees. In that case, it could last for an additional six months before being thawed and used within a few days.
Give me your tired, rich, huddled masses
Ultralow freezing technology is not commonplace in hospitals and surgeries, and not at all in low-income countries.
"Nowhere on the planet does the logistical capacity exist to distribute vaccines at this temperature and volume without massive investment," said Toby Peters, Professor of Cold Economy at the University of Birmingham, in a statement.
"The problem is particularly acute in the Global South where many rural villages don't even have a working vaccine fridge."
For richer countries, it appears that the problem can be overcome, even if it is logistically challenging. Puurs and another Pfizer center at Kalamazoo, Michigan have massive deep-freeze storage capacity, which will be complemented by the use of so-called freezer farms, such as one in Karlsruhe, Germany.
Pfizer's special boxes are fitted with GPS and the company hopes to be able to move around 7.5 million doses daily from its centers in Puurs and Kalamazoo to airports.
Various logistics and delivery companies have been preparing as well. UPS has built two freezer farms in the Netherlands and the US while DHL has opened a new cold storage facility in Indianapolis.
Ultralow temperature freezers are commercially available albeit expensive, costing between €10,000 ($11,800) and €20,000. Germany plans to equip around 60 vaccination centers with such freezers.
Aviation companies have also been getting ready. Joachim von Winning, CEO of the Air Cargo Community, told Reuters this week that his industry has been preparing to deliver vaccines by plane since March.
Poorer countries wait on other vaccines
However, as feared at the outset of the vaccination race, such capacities are beyond all but the richest countries.
"Most of these vaccines need minus 70 degrees, which we just can't do in India, just forget it," T. Sundararaman, a New Delhi-based coordinator of the People's Health Movement, told Bloomberg.
At the release of its third-quarter results, BioNTech said it was working on developing a more stable version of its vaccine that could survive in a conventional fridge for longer. However, even such an outcome would not dramatically change the existing logistics requirements.
A possibly more realistic hope for lower-income countries lies in the many other vaccines which have shown promising results in late stage trials. Many of them will not require the same deep-freeze storage technology and some may not need to be frozen.
For this first vaccine though, the logistical requirements of getting it from production to a patient's arm are uniquely exacting. And even with the huge investment required to equip logistics networks with the required tech, there will still be the inevitable, uncontrollable hiccups: power cuts, trucks breaking down, ice melting.
However, just as the virus spread around the world much quicker than many expected, a vaccine, or vaccines, may end up doing the same.