The real challenge of vaccinating everyone against covid19 begins AFTER the vaccine is invented

This time last year, we never expected that vaccines, trials, medical journals, and scientific evidence would become dinner table conversations in our families soon.

I am writing this post – drawing from the opinions, articles, pieces by sector experts1 – to say that, by this time next year, our dinner table conversations might shift to issues like cold chain storage and vaccine trackers. Our lives will literally depend on the logistical challenges coming up next.

Let us try to look at the complexity of this problem. As we know, billions will need a COVID vaccine. Currently, 8-10 vaccines are in Phase 3 of the clinical trial2, that is, the last stage of testing before launch. It is expected that we will have a vaccine in early 2021. However, hold that sigh of relief. Here are some complications that begin after the vaccine(s) clear Clinical Trial:

Source: World Bank Photo Collection

The first question will be – Who gets the vaccine first?

After healthcare frontline workers, how does a government differentiate between its citizens? Should senior citizens with co-morbidities who are the most vulnerable get it first? Or the young, who are the ones who have to step out of their homes to make a living, get it first? Or should children be a priority so that education can get back on track soon? Should the rich who can afford it – and do not need government subsidies – get it first so the earnings can cross-subsidize vaccines for the poor? Or the poor who can’t bear the financial cost of falling sick? Should it be first given to people in major cities? Or priority should be given to the most back-of-beyond and hard-to-reach areas since it will take time to reach them? There are good arguments on every side and the governments of the world have some tough decisions to make.

When you come to logistics, the biggest challenge will be the vaccine cold storage chain.

Most vaccines currently under development need sub-zero temperatures and start going bad if the low temperatures are not maintained. Out of the three leading COVID19 vaccines in the world currently in Phase 3 trials, the Moderna vaccine needs to be stored at minus 20 degree celsius and the Pfizer vaccine needs to be stored at minus 70 degree celsius3. In poor countries like India, where power supply is a basic we cannot assure even in the capital city, how will we develop pharma warehouses, airport cargo storages, trucks, lorries, trains that come equipped with the high technology required to maintain these temperatures? The toughest challenge will be the last mile. When the vaccine reaches the hands of an ASHA worker in a rural hamlet in Bihar, where will she get the equipment to maintain a sub-zero temperature for the vaccine when she doesn’t yet have a facility to keep milk stored overnight? A study from 2019 estimated that 25% of vaccines are degraded by the time they arrive at their destination4. Building the kind of infrastructure we need will take a lot of time, resources, planning and investment. Governments around the world need to act fast and act NOW to work this out.

Will the vaccine be an injectable one or a nasal spray? 

An injectable vaccine will be a lot harder to administer than, say, a vaccine that can be administered at home through a nasal spray, because the number of healthcare workers who can administer it will be a limiting factor.

How do we track who got the vaccine and who didn’t?

Even for a nasal spray vaccine, a system will be needed to track who got the vaccine and who didn’t. Countries with what is called a de-duplicated citizen identification number, such as the social security numbers in the US or aadhar card numbers in India can use these numbers to do the tracking. However, countries that do not have such a system in place will have to quickly come up with a system to keep track.

How will we combat counterfeit vaccines and the vaccine black market?

The vaccine, when it appears in the market, will have a demand that outweighs supply many times over. This is going to lead to a quick black market / counterfeit vaccine market that will sprout up and will have to be dealt with by governments to protect citizens’ health and money.

A potentially order of magnitude addition to the complexity

It is possible, at this stage, that the vaccine that works might need to be administered in a double dose, which means double all the problems listed above and square the complexity.

If you are feeling more despondent than ever after reading this, there is hope. We are nothing if not a resourceful species. Companies are ramping up capacities in storage and transportation as we speak. For example, the leading logistics companies like UPS and DHL are setting up vaccine hubs in the US with the required cold storage capabilities5. Governments are considering options like having the military6 take over vaccine transport where they are present in enough numbers and capacities. Technology today is at an unprecedented level of advancement which means that techs like blockchain7 can enable real-time tracking of vaccines and provide a solution to the counterfeit vaccine problem.

I am far from an expert on the matter and am linking the rabbit hole of articles I went down from which I got a lot of insight into the vaccine logistics challenge and led me to writing this piece. 

To summarize, the challenges of getting everyone vaccinated against COVID19 only begin with the invention of a vaccine that works. Our species has its work cut out out for us. It might be at least another year before the vaccine reaches you and your family.

So sit tight at home, hold your children close, hug your parents, and wear those masks. Most importantly, keep generously giving to charities and campaigns for the worst-hit communities because we are all going to be here a while.



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