Sunday, October 18, 2020

Logistical considerations for global COVID-19 vaccinations

From the Daily Beast’s Rabbit Hole via email: Even When We Have a Vaccine, The Rollout Will Take Years

How long will it take to protect the entire world from the coronavirus?

Only now is it becoming clear that, in the best-case scenario, it will take at least 18 months, beginning early in 2021, for vaccines to reach every part of the world where they are urgently needed.

One measure of the magnitude of the task is that to deliver a single dose of vaccine to the world population of 7.8 billion people would take the equivalent of 8,000 flights by the world’s largest cargo airplane, the Boeing 747.

Can we build a global network that respects vaccine critical temperatures?

The whole program depends on whether there will be enough airplanes to deliver the vaccine doses—and whether the will and means exist to build a global network able to meet the exacting standards required to keep vials of vaccine at critical temperatures, from when they leave the manufacturer to when they finally reach the places where they will be administered, no matter how far and remote.

This infrastructure involves special handling via dedicated warehouses, moving through airports where customs and border controls, a frequent choke point, must allow fast tracking, and similarly secure and dedicated ground transportation.

Make no mistake, this is truly a moonshot moment. A new global airlift for life-saving meds has to be built at a speed that has never before been accomplished. And, once more, the planning has exposed significant disparities in the resources of advanced nations and those of the underdeveloped world.

In North America, Europe, Russia, China and Southeast Asia, the means exist to rapidly ramp up supply chains and safely deliver vaccines to large populations during 2021.

In Africa, Central and South America and the Indian subcontinent, critical infrastructure will have to be created from scratch. (India has no air cargo infrastructure equal to the needs of its 1.35 billion population.)

And experts warn that even in the developed world, there are serious challenges to overcome.

At the heart of these challenges is the cold chain. This is an already well-established system that ensures that vaccines and other temperature-critical medications are maintained at precise temperatures for the entire time they spend in transit, no matter if the journey takes many days and passes through great variations in climate and handling through airports and ground delivery.

The cold chain was initially created because vaccines to treat smallpox, measles and ebola needed to move through it in order to safely and swiftly get where they were needed—indeed, the world eradication of smallpox would not have been possible without it.

This was one of the greatest leaps ever in global infrastructure in the cause of preventing needless deaths, but it is dwarfed by what confronts a world desperate to gain control of the coronavirus pandemic. The cold chain will have to be hugely expanded.

COVAX, an alliance of vaccine producers and international health agencies created to handle the pandemic, aims to produce two billion doses by the end of 2021. This assumes that all nine of the present vaccines being developed and tested in the COVAX program will prove safe and effective. (Six of them are part of the U.S. government’s $6 billion Operation Warp Speed, and two of them are being developed in China.)

Expecting instant success of all of the vaccines is already a roll of the dice. As The Daily Beast has reported, the vaccines have been developed at an unprecedented speed, their long-term effects are still unknown, and testing is far from complete.

And the problem for the cold chain is that there are basically two groups of vaccines in the pipeline. One group has to be kept in very deep freeze, at a temperature of minus 112 degrees Fahrenheit, the other at between 35 and 46 degrees Fahrenheit.

This means that vaccines requiring the deep freeze will likely be confined to parts of the world where such demanding standards of the cold chain can be assured, while the others get directed to places where the handling and distribution systems will be less sophisticated and, in many cases, don’t even exist yet.

Geopolitical hazards

Glyn Hughes, global head of cargo at the International Air Transport Association, IATA, which represents all the world’s airlines, is closely involved in planning the massive airlift. He told The Daily Beast:

“There is no time to be lost. In many of the countries in Africa, Central America and South America you cannot rely on the same infrastructure for a temperature-controlled environment as you can in the developed world. For them, to create what is needed will probably require a combination of commercial and military resources.”

Another gap in the coverage would be the inability to establish secure cold chain infrastructure in “black hole” nations like Venezuela, Yemen, Syria and Iraq, where either war or endemic corruption make it near impossible to carry out safe delivery and distribution.

And there is another specter to watch out for. In countries like Nicaragua, where Daniel Ortega has been the strongman since 2007, or the Philippines, where Rodrigo Duterte rules with an equally iron grip, there is little doubt that the ruling juntas would get priority and perhaps even withhold the vaccines from their opponents, which would amount to biological warfare.

And there is lots more in this report that follows.

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