Receiving, storage and distribution pose additional challenges
Trucks filled with Covid-19 vaccine vials pulled out of Pfizer Inc.’s Kalamazoo, Mich., production plant on Sunday morning, part of one of the largest mass mobilizations since the country’s factories were repurposed to help fight World War II.
The effort to vaccinate the nation relies on chemists, factory workers, truck drivers, pilots, data scientists, bureaucrats, pharmacists and health-care workers. It requires ultra-cold freezers, dry ice, needles, masks and swabs converging simultaneously at thousands of locations across the country.
To work, every one of the many and complicated links of the chain has to hold.
Challenges of receiving the vaccine
Among the most difficult aspects of delivering the first vaccine to gain emergency approval: the need to keep it at minus 94 degrees Fahrenheit as it travels and awaits use at vaccination sites.
Despite dry runs and contingency planning, a lot can go wrong. Refrigeration problems could ruin doses, and logistical snafus could delay shipments. If hospitals botch the challenge of scheduling a continuous stream of people to get the shots, defrosting doses might go bad. And the pandemic itself could sideline some of the armies of workers involved in the effort.
COVID vaccine distribution is a game of supply chains with multiple players who have to work together. The federal government is coordinating with state governments; state governments are coordinating with local health systems; local health systems are coordinating with pharmacies like CVS and smaller local hospitals; everyone's coordinating in some fashion with logistics companies like UPS and FedEx and, of course, companies like Pfizer, which are actually making these vaccines.
The operational chain of command is more like a spiderweb of decisions. And ultimately it will be up to individual organizations to figure out what to do with disparate advice, which is meant to build flexibility but can also be confusing.
Challenges of storing the vaccine
Once hospitals get their doses, they need to make sure the vaccines don’t spoil before they go into people’s arms, and that none go to waste.
There are also precise procedures for retrieving the vials for vaccinations. Pfizer’s containers can be opened only twice a day, and can’t stay open for more than three minutes at a time. They also can’t be outside ultra-cold temperatures more than once every two hours.
Pfizer has assured health officials that its vaccine can be held for up to 15 days in its pizza boxes (i.e., special shipping containers created to store and transport the vaccine) with dry ice replacements every five days and then spend another five days in the refrigerator before going bad. That gives officials about 20 days to distribute the vaccine once they receive it.
People getting vaccinated must be moved through the line at a steady pace so the doses don’t go bad. Hospitals must stagger appointments to avoid crowding, and keep those waiting socially distanced. A missed appointment could leave hospitals with unused doses that must be thrown out.
Challenges of distributing the vaccine
At this point, each state isn’t sure how many vaccines it will get from the federal government, which makes it hard to determine how many doses the state will get for healthcare workers and people in long-term care homes who will be first in line to get the vaccine. And, each state has their own vaccine distribution plan.
In addition, the two-dose requirement for most COVID-19 vaccines adds to the supply problems—unless doctors, pharmacies and other providers are sure they’ll have a steady supply of vaccine, they will need to save half of a shipment to give people booster shots three weeks to a month after the first shot.
Keeping track of who got vaccinated, which vaccine they got — both doses need to come from the same company — and when people are due for a second dose is another potentially daunting logistical challenge. Databases used to manage patient data or to order and ship medical supplies aren’t well integrated among vaccine providers and local, state and federal government agencies. Existing databases may need to be enhanced and given new ways of managing information.
Hospitals will face unprecedented staffing, spacing, and logistical hurdles throughout this vaccine rollout—but there is no industry better suited to lead this charge than our heroes in healthcare.
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