Health and Healthcare Systems

Is the world up to the challenge of mass COVID-19 vaccination?

Small vials of the COVID-19 vaccine.

The COVID-19 vaccine's inclusive, safe and sustainable distribution to health workers, at-risk groups and eventually everyone will test global supply chains. Image: Unsplash

Margi Van Gogh
Head, Supply Chain and Transportation Industry, World Economic Forum
Ludwig Hausmann
Partner, McKinsey & Company
Christoph Wolff
CEO, Smart Freight Centre, Amsterdam, Honorary Professor Economics & Social Sciences, University of Cologne
Detlev Mohr
Senior Partner, McKinsey & Company
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Vaccination

  • More than 12 billion vaccine doses have been announced by all manufacturers for release in 2021 – in case all vaccine candidates succeed in clinical trials.
  • The first wave of vaccines for the 92 low- to middle-income COVAX countries represents two to three times UNICEF’s yearly routine vaccination program.
  • The magnitude of the task requires bold collective action from multinational organizations, governments and industries.

In a year that has seen a pandemic that has left few unaffected, where consequences resulting from attempts to contain the spread of the COVID-19 virus has seen the lives and livelihoods for millions across the globe impacted, the most dire impacts cannot be over stated. In the worst cases, impacts on the livelihoods of those most vulnerable has led to rising poverty levels, with Oxfam reporting that up to 12,000 people per day are facing starvation in 2020.

The inclusive and efficient distribution of safe vaccines is imperative for restoring economic recovery protecting lives. And now that the first COVID-19 vaccine has been administered to a 90-year-old woman in the UK, the world awaits the roll-out of a mass vaccination program after several pharmaceutical companies announced promising vaccine trial results in recent weeks.

The Pfizer/BioNTech vaccine was authorised for emergency use by the UK’s medicine regulatory authority before decisions by the US and Europe. While the first wave will only vaccinate 400,000 of the highest-risk group, the UK has bought 40 million doses of the vaccine, which was recently shown to have 95% efficacy after the second dose. After been granted Emergency Use Authorization, the US has also begun the rollout of the vaccine, with deliveries arriving in distribution centers this week.

As vaccine capacity ramps up , we face a task of unprecedented scale to ensure an inclusive, safe and sustainable distribution to reach frontline healthcare workers, at-risk groups and eventually all people around the world.

The logistical planning involved will push any modelling and supply channels previously used to new limits. More than 12 billion vaccine doses have been announced by all manufacturers in total for release in 2021, in the best case of all candidates succeeding in trials. In this ideal scenario, six to seven billion doses will be shipped in the first wave of pre-ordered vaccines, after which many countries are expected to reach the World Health Organisation’s minimum target of 20% immunization.

Projections show largest intercontinental flows of vaccine to Asia (except India and China) and Africa.
Africa and Asia (excluding India and China) are expected to be the largest importers of the vaccine. Image: World Economic Forum

COVAX, the initiative co-led by the World Health Organization, Gavi, the Vaccine Alliance and the Coalition for Epidemic Preparedness and Innovations, is working with UNICEF to coordinate the distribution of vaccines to a raft of low to middle-income countries.

To put the scale of the task into perspective, the first wave of vaccines for the 92 countries in the COVAX scheme represents two to three times UNICEF’s yearly routine vaccination program – but up to four to five times its current monthly flows if the vaccines get distributed in a six-month period.

Since March this year, the World Economic Forum Supply Chain and Transport Industry team has convened 35 leading companies across the logistics and transportation ecosystem, who, with support from McKinsey & Company, have been working collaboratively to identify priorities and help address the logistical challenges of the pandemic and the distribution of the vaccines. We have identified a number of key factors that will play crucial parts in a successful roll-out process.

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The first relates to the geographies involved in the production process. More than 90% of all COVID-19 vaccine doses are expected to be produced in the US, Europe, India and China, while Africa and Asia (excluding India and China) are expected to be the largest importers. According to a joint scenario model of the World Economic Forum and McKinsey, the largest exporters, Europe and India, are expected to ship approximately 1 billion doses each in the first wave (to reach 20% immunization globally), of which around 600 million could go to Africa and 1,100 million to Asia, apart from India and China.

Ten percent to 20% of the vaccines – i.e., the Pfizer/BioNtech vaccine with announced production capacity of 1.3 billion doses in 2021 – will likely require ultra-cold supply chain facilitation at -70°C, but these will mostly be applied within Europe, North America and Japan, which have or can dedicate resources to build the necessary capabilities.

Although all countries have their own logistical challenges, countries in the global south will need more support to successfully distribute the vaccines. Intercontinental shipments will be affected by constrained air cargo capacity, with an overall reduction of 20-25% expected in the first and second quarters of 2021 (see exhibit below). However, charter flights could solve this if adequate funding is made available.

Logistics capabilities vary among countries in the global south, but are also generally lower for any kind of cold chain logistics than in the mature economies. Particularly challenging are operations in relation to airport handling, warehousing, dry ice facilities (to handle vaccines with deep frozen temperature requirements) and the “last mile” in rural areas.

Graph shows air cargo capacity is down in all continents around the world.
Charter flights could counteract the constrained global air cargo capacity if funding is made available. Image: World Economic Forum.

There is also a higher risk of deviation and counterfeiting requiring security solutions involving serial numbers, tracking and potentially blockchain technology in southern countries. Lastly, the distribution of high volumes of ancillary vaccine supplies, such as syringes, needles and PPE kits, that greatly exceed the volume of the vaccine vials in number and tonnage, will also require effective co-ordination and collaboration to ensure timely delivery across the transport ecosystem to these locations.

Taking these challenges into account, how can the supply chain and transport community safeguard the vaccine distribution to get us all out of this pandemic?

We see four avenues for collective action:

  • Engage with governments, customs authorities and NGOs to enter private-public partnerships that ensure fast and safe global movement of vaccines. This means arranging pre-clearance, airspace clearance, documentation and training.
  • Encourage asset sharing, where indicated and as appropriate, to resolve bottlenecks and fill potential gaps in the vaccine supply chain, namely consolidating air cargo volumes, deploying reefer containers, sharing re-icing facilities and warehouse spaces or consolidating last-mile volumes.
  • Assign non-competitive expertise to support governments, where indicated and as appropriate, to advise on solutions related to on-the-ground vaccine distribution planning.
  • Support COVAX in its coordinating role and respond to its requests for information, resources, assets or emergency calls for action.

We believe that the unprecedented magnitude of the pandemic requires innovative and bold collective action from multinational organizations, governments and industries to deal with the effects and support the return to a new normal. With lives and livelihoods of millions across the globe depending on our ability to harness the power of such collective action – whether in the field of health delivery, goods delivery or humanitarian service delivery, we all have to ask ourselves, are we ready to do what it takes? Are we ready to act inclusively to protect the lives of those most vulnerable and in so doing ensure no nation and no vulnerable community is left behind?

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Health and Healthcare SystemsSupply Chains and Transportation
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