Covid vaccine delivery: Applying the lessons learned

posted on 9th June 2021
Covid vaccine delivery:  Applying the lessons learned

Although some of last year’s initial concerns were overstated about the capacity of the sector to meet the vaccine logistics challenge, air freight’s role will continue and expand in the coming months as vaccine production ramps up further, reports Roger Hailey

An armada of ‘flying freezers’ with life-saving doses criss-crossing the world. That was the initial fevered forecast of air freight’s logistical role when the first Covid-19 vaccines were available.

In 2020, there was much industry talk of 10,000 freighter movements dedicated to Covid-19 vaccine shipments, while the first available vaccine, made by Pfizer BioNtech, needed to be kept at minus 80°C – colder than an Antarctic winter. Other vaccines required minus 20°C. That could mean a mountain of dry ice, a problem both for safe aircraft operations and a challenge for dry ice production and handling.

Fortunately, it gradually became clear that a much smaller number of freighters and cargo-only passenger aircraft are needed, with many vaccines in the US and Europe moving by truck from local production centres. And importantly, air freight’s long-established pharma packaging, with a few tweaks and innovations, has proven up to the cool chain task for vaccines.

For the early forecasters, there were many unknowns in March 2020 about future vaccines which were to be created in record time. But a lot of hard work, collaboration and teamwork across air freight’s entire vaccine cool chain made sure that millions of doses are being delivered safely. And although the majority have so far been delivered by road, air freight’s role will continue and expand – given the basic facts that some 95% of COVID-19 vaccines are produced in only eight countries but need to be distributed to 220 countries and regions around the world.

Julian Sutch, manager for global accounts – Pharma Industry Solutions – at Emirates SkyCargo, says: “When we first started, there were some massive numbers put out about how the world’s air freight capacity was going to be taken up by vaccines, but it did not happen.”

Dubai-based Emirates moved the first shipments for vaccine trials in October last year. Says Sutch: “From December onwards we saw live shipments whizzing around. In terms of challenges, initially there was quite a scare that the world’s active containers were going to be used up, but we have actually seen very little use of active containers.

“There is no aircraft in the world capable of handling any temperature below zero. As an airline, we fly 2°C to 8°C or 15°C to 25°C temperature ranges and it is always the responsibility of the packaging to maintain either -20°C or down to -80°C if that was needed as well.

“Pfizer were very quick to the game and knew that you needed a packaging solution that can last at -80°C for 10 days, requiring 23 kg of dry ice, and that is exactly what they have done so far.”

Only 5% moved by air
Marc Claesen, senior vice president commercial EMEAA at global ground handler WFS, estimates that only 5% of the forecast vaccine volumes have actually moved by air, and that the figure will rise to a maximum of 15% at its peak in the coming months. He also makes the point that air freight professionals, in the first months of the pandemic, had very little real data to assess what the vaccine volumes and production sites would be. It, therefore, made sense to prepare for the worst case.

Claesen adds: “From the beginning of the crisis there were concerns about warehouse capacity and the deep-frozen transport of vaccines and dry ice on aircraft. By December last year those issues were resolved.”

He says that there are now usually four to five pallets per flight with vaccines, which is very manageable. Vaccine producers like Pfizer deliver on a planned last-minute schedule, which does not strain warehouse capacity, and the packaging requires dry ice within acceptable limits.

Dry ice dangers
“We had an average 23 kg of dry ice net per box on-board,” he notes. “But some of the newer challenges that came were the safety of staff handling the products. If you have a large amount of dry ice in a single cooling facility, then you need to have meters measuring the oxygen levels inside. Using dry ice can be very dangerous and the danger is underestimated.”
Air transportation of dry ice – the solid form of carbon dioxide – is strictly controlled under dangerous goods regulations as it becomes CO2 gas upon evaporation, hence the limits onboard freighters and in warehousing.

Claesen says that a 15% increase in vaccine volumes this year and further ahead will not affect the transport of non-virus pharmaceutical traffic: “It has never been an issue. There is sufficient equipment in the market to handle those volumes,” he notes.

Other critical pharmaceuticals
Sutch of Emirates agrees: “Another focus of ours has been to make sure that the critical pharmaceuticals for all other diseases keep moving. Just look at the cancer drugs that we move all day, every day. We cannot stop shipping those. We also move food products,
but pharmaceuticals and these vaccines are number one for us.”

It is estimated that 99% of non-Covid pharma moves at 5°C, and that while most clinical trials shipments are frozen for the sake of stability, the final end product moves in the normal range for airfreighted pharma.

Deep frozen is not always the answer, as the Moderna and Johnson & Johnson vaccines cannot go below a certain temperature.

Andrea Gruber, head of special cargo at IATA, told a webinar audience in early May that 1.18 billion vaccine doses have already been administered worldwide, while 12.1 billion doses have been secured globally. Of those, some 4 billion doses had by early May been secured and optioned through COVAX, the World Health Organization-led international alliance to provide equitable access to COVID-19 diagnostics, treatments and vaccines to countries, regardless of their wealth. Gruber said that IATA and the major global airlines have assisted in providing transparency on cargo capacity, connectivity and expected requirements.

Vaccine distribution planning
Global freight forwarder Kuehne + Nagel (K+N) is among the major leading pharma logistics specialists that was already playing an important role in vaccine distribution prior to the Covid pandemic. Terrence Sell, global pharma product manager within K+N’s Air Logistics business, says in the early days in assessing Covid-19 vaccine logistics “the biggest issue was lack of information, but it forced us into a positive direction. We formed our own task force, did a lot of research and benchmarked with some of our consulting partners.”

He continues: “We started off with a strategy that is still intact today. We had a good idea where vaccines would go and where the critical mass points were, from a population perspective. We knew who would deal with it themselves and who would have to go to different foundations like UNICEF and Gavi or Hope. We did not wait, we built options for our customers early in the process and worked with them to refine.”

K+N set up its hyper-care team specifically for Covid vaccines and trade-related products of a critical nature: “This team engages from end to end, to ensure that we have operational execution of the highest level based on zero tolerance for failure,” he notes. “That is the goal for us and our customers.

“In combination with the hyper-care team, our technology increases visibility because customers want to know, within minutes and not hours or days, where things are and what the next step is.”

Special handling codes for vaccines
Many airlines now have special handling codes for vaccines. Some airlines have two codes, one solely for vaccines, and a second for Personal Protective Equipment (PPE) or other Covid-19 related products such as syringes.

Emirates has one code, Covid priority shipment (CPS), which makes sure that the shipment is on the right flight, connects quickly with another flight and is kept in temperature-controlled dollies or in airside pharma storage. Sutch says that Emirates kept to one code because “it is all very nice having vials of vaccine, but if you don’t have a syringe, then it is useless”.

The US and Europe already have syringes and PPE in situ, but for the developing world – a special area for Emirates – this is often not the case.
However, there is a large stock of syringes kept in Dubai, says Sutch, adding: “That is critical for us. We are in a great strategical location to fly the vaccines and syringes on one flight.”

Influx of smaller syringes
Claesen of WFS reports that there has been an influx of smaller syringes from China, so that a greater number of medically approved dosages can be extracted from one vial.

India and Africa concerns
One of the main areas of concern is India, where millions of people have contracted the virus. India’s pharma industry is a major producer of Covid vaccines for worldwide distribution, but the government has stopped exports, including those destined for Africa. The WHO has warned that the risk of a new wave of COVID-19 infections in Africa remains high, due to Africa-bound vaccine doses from the Serum Institute of India being delayed for the foreseeable future, slow vaccine rollouts, and new variants making inroads.
Delays and shortages of vaccine supplies are driving African countries to slip further behind the rest of the world in the COVID-19 vaccine rollout. As of early May, Africa accounted for only 1% of the vaccines administered worldwide, down from 2% a few weeks earlier.

Meanwhile, the turbulence and fast-changing environment in the procurement of vaccines, with some countries going directly to manufacturers, creates logistical problems for other essential Covid-related goods, for example if vaccines are flown in but the syringes and PPE arrive by ocean freight. Furthermore, in a volatile environment, the air freight booking will have to be made on an ad hoc basis at the prevailing market rate rather than through a block space agreement at an agreed rate level.

Lessons learned
But 12 months, there have been various lessons learned from the early days of uncertainty on when the vaccines will arrive, where they will be produced and in what temperature range they will need to travel.

Says Sutch of Emirates: “We created a team within our airline to give priority to these vaccines, we created a task force, and within that task force we have been speaking with governments and forwarding partners and vaccine manufacturers to see how we as an airline can help distribute these vaccines especially to the developing world. That is why we also became a partner in the Dubai vaccine alliance, which uses the combined capabilities of Emirates and DP World and Humanitarian City – which all have their own infrastructure and capability around the world.

“When projects come up, we can get those vaccines to the developing world, which is very, important. In the US and Europe, all these things can be trucked, no problem; but there are very many other areas in the world that need them.”

Claesen of WFS says: “First of all it was very clear that, in a very traditional business, new and updated infrastructure is still key and that it contributes to the strategy of the pharmaceutical handlers to invest in decent infrastructure. We need to be able to handle all the pharma, not just the vaccines but also the general cargo, and it is clear that digitisation has to be rolled out throughout the chain with digital checks.”

Example of good forecasting
Claesen adds: “We also realised the importance of good forecasting, to control the volumes that came in. If we get more alignment throughout the chain on forecasting, for example what can be expected and combined with good communications, this is also an example for general cargo throughout the industry and we can benefit from that.”

Gruber of IATA said one element of the top three challenges for vaccine distribution was the uncertainty in not knowing exactly what was required, noting: “This is where communication was exceptionally important. Manufacturers were developing their vaccines, not really knowing where from, where to, and in which circumstances.”

The second was the temperature control environment for the vaccines and having the appropriate infrastructure to ensure the integrity of the product is maintained throughout transport and distribution.

Security matters
The third element was security, gaining from the PPE experience of March 2020 over the threat of goods being stolen: “Those lessons were definitely learned and applied to a very sensitive product about its safety,” she notes.

K+N’s Terrence Sell emphasises the innovative thinking and rapid response of the industry, noting: “What companies have learned is that we need to be more agile, especially in planning, and to make sure we have the appropriate team that can mobilise quickly as needed.

“The increasing collaboration and communication are making sure that all stakeholders understand the situation. It is important that we are aligned to all assumptions – even if they change – as this will impact our success.”

Sell does not believe that we are yet in the stabilisation phase for the vaccines. Agility, communication and collaboration will be needed, including with airline partners as the vaccine volumes and general cargo steadily increase in 2021, he says. The model that K+N built working with Seabury and BCG has been fairly accurate, he says – so as expected, the volumes will grow as we move to more heavily populated areas of the globe.

Competition for space
As volumes pick up in existing vaccines and new vaccines appear, a greater percentage of global consumers will come out of lockdown and start a spending spree that will see air freight volumes surge, probably in the third and fourth quarters, air freight stakeholders anticipate.

But air freight capacity for vaccines and ‘normal’ pharma will remain a priority in the competition for still-constrained space.