Mission of the century

posted on 15th September 2020
Mission of the century

Air freight’s capabilities will be crucial to the quick and efficient transport and distribution of COVID-19 vaccines, but will not happen without careful advance planning, IATA warns

The International Air Transport Association (IATA) has urged governments to begin careful planning now with logistics and life sciences industry
stakeholders and international agencies to ensure full preparedness for when vaccines for COVID-19 are approved and available for distribution, warning of potentially severe capacity constraints in transporting vaccines by air.

IATA stressed that air cargo plays a key role in the distribution of vaccines in normal times through well-established global time- and temperature-sensitive distribution systems. And this capability will be crucial to the quick and efficient transport and distribution of COVID-19 vaccines when they are available, but “it will not happen without advance planning, led by governments and supported by industry stakeholders”.

Stating that safely delivering COVID-19 vaccines will be “the mission of the century for the global air cargo industry”, IATA’s director general and CEO Alexandre de Juniac said “the time for that careful advance planning is now”, adding: “We urge governments to take the lead in facilitating cooperation across the logistics chain so that the facilities, security arrangements and border processes are ready for the mammoth and complex task ahead.”

Facilities, security, borders, capacity
In a message coordinated with key representatives from key global vaccine players including UNICEF and Gavi, the Vaccine Alliance, IATA highlighted four key areas needing urgent consideration: facilities; security; border processes; and capacity.

On facilities, IATA stressed that vaccines must be handled and transported in line with international regulatory requirements, at controlled temperatures and without delay, to ensure the quality of the product. “While there are still many unknowns – number of doses, temperature sensitivities, manufacturing locations, etc. – it is clear that the scale of activity will be vast, that cold chain facilities will be required and that delivery to every corner of the planet will be needed,” the association said.

Priorities for preparing facilities for this distribution include: availability of temperature-controlled facilities and equipment – maximising the use or repurposing of existing infrastructure and minimising temporary builds; availability of staff trained to handle time- and temperature-sensitive vaccines; robust monitoring capabilities to ensure the integrity of the vaccines is maintained.

Valuable commodity
On security, IATA emphasised that the Covid-19 vaccines “will be highly valuable commodities”, highlighting: “Arrangements must be in place to
keep ensure that shipments remain secure from tampering and theft. Processes are in place to keep cargo shipments secure, but the potential volume of vaccine shipments will need early planning to ensure that they are scalable.”

Looking at border processes, IATA stressed that “working effectively with health and customs authorities will be essential to ensure timely regulatory approvals, adequate security measures, appropriate handling and customs clearance. This could be a particular challenge given that, as part of COVID-19 prevention measures, many governments have put in place measures that increase processing times.”

It said priorities for border processes include: Introducing fast-track procedures for overflight and landing permits for operations carrying the COVID-19 vaccine; exempting flight crew members from quarantine requirements to ensure cargo supply chains are maintained; supporting temporary traffic rights for operations carrying the COVID-19 vaccines where restrictions may apply; removing operating hour curfews for flights carrying the vaccine to facilitate the most flexible global network operations; granting priority on arrival of those vital shipments to prevent possible temperature excursions due to delays; and considering tariff relief to facilitate the movement of the of the vaccine.

Capacity challenge
On top of the transport preparations and coordination needed, IATA said governments “must also consider the current diminished cargo capacity of the global air transport industry”. It warned that, with the severe downturn in passenger traffic, airlines have downsized networks and put many aircraft into remote long-term storage.

“The global route network has been reduced dramatically from the pre-COVID 24,000 city pairs,” IATA stressed. “The WHO, UNICEF and Gavi have already reported severe difficulties in maintaining their planned vaccine programmes during the COVID-19 crisis due, in part, to limited air connectivity.

The association stressed that the potential size of the vaccine delivery operation “is enormous”, noting that “just providing a single dose to 7.8 billion people would fill 8,000 B747 cargo aircraft. Land transport will help, especially in developed economies with local manufacturing capacity; but vaccines cannot be delivered globally without the significant use air cargo.”

De Juniac added: “Even if we assume that half the needed vaccines can be transported by land, the air cargo industry will still face its largest single transport challenge ever. In planning their vaccine programmes, particularly in the developing world, governments must take very careful consideration of the limited air cargo capacity that is available at the moment. If borders remain closed, travel curtailed, fleets grounded and employees furloughed, the capacity to deliver life-saving vaccines will be very much compromised.”

Henrietta Fore, executive director of UNICEF, commented: “The whole world is eagerly awaiting a safe COVID vaccine. It is incumbent on all of us to make sure that all countries have safe, fast and equitable access to the initial doses when they are available. As the lead agency for the procurement and supply of the COVID vaccine on behalf of the COVAX Facility, UNICEF will be leading what could possibly be the world’s largest and fastest operation ever. The role of airlines and international transport companies will be critical to this endeavour.”

Dr Seth Berkley, CEO of Gavi, the Vaccine Alliance, commented: “Delivering billions of doses of vaccine to the entire world efficiently will involve hugely complex logistical and programmatic obstacles all the way along the supply chain. We look forward to working together with government, vaccine manufacturers and logistical partners to ensure an efficient global roll-out of a safe and affordable COVID-19 vaccine.”

COVAX global initiative
More than 170 countries are engaged in discussions to potentially participate in COVAX, a global initiative aimed at working with vaccine manufacturers to provide countries worldwide with equitable access to safe and effective vaccines, once they are licensed and approved.

Co-led by the World Health Organization (WHO), Gavi, and the Coalition for Epidemic Preparedness Innovations (CEPI) – working in partnership with vaccine manufacturers – it is the only global initiative working with governments and manufacturers to ensure COVID-19 vaccines are available worldwide to both higher-income and lower-income countries. The WHO describes COVAX as the world’s largest and most diverse COVID-19 vaccine portfolio, including nine candidate vaccines with a further nine under evaluation and conversations underway with other major producers.

IATA’s global head of cargo Glyn Hughes said that because of the scale of the challenge, the association was already “working across many fronts” to help co-ordinate air logistics preparations for Covid-19 vaccine deliveries, noting: “We have already commenced a large number of meetings with various UN agencies; we participate on a weekly call with the World Food Programme and UNICEF and other aid agencies with regards to the logistic cluster; we’ve engaged with numerous pharmaceutical manufacturers and associations – so we can assess the status and the readiness as it’s progressing.

“We’re also working with our airlines, in terms of global facilities, and with ground handlers and with airports about readiness.” He said IATA is also  encouraging local air freight community initiatives, highlighting that the Frankfurt Airport community has “already commenced local coordination with regards to what they feel they need there as well – because the scale of this doesn’t just impact developing nations, it impacts all nations”.

Meanwhile, individual airline groups, such as Air France KLM, “have instigated a significant amount of work – looking at their African network, for example”, Hughes noted.

“So, I would say we’re encouraging discussions at all levels, and we are trying to facilitate the questions at this time that need to be answered; what needs to be in place? And then we can, collectively as an industry and as a community, see how it’s best addressed.”

Final-mile delivery challenge
Like with e-commerce, he anticipates that the biggest challenge with vaccine delivery will be “the final mile”, particularly in some developing countries and regions.

“That is where we, in our initial assessment, would see the need for greatest focus,” Hughes noted. “The airline industry, together with its freight forwarding and airport partners and ground handling partners, have already got a very well established cool-chain solution or controlled environment. It has a programme called CEIV; but there’s also GDP, and there’s other validations or verifications in place.

“A lot of the equipment manufacturers – Envirotainer and others – have some great equipment to ensure that the cargo can be transported in a safe, temperature-controlled environment, from factory to airport from airport to airport. So, right up to the point upon clearance at destination, we feel that there are good or adequate procedures in place.

“We do need to scale those up, because right now they do not adequately cover the entire planet; but at least we’ve got a good basis to look at how we could build, as an industry, hub and spoke components to that particular part of the transportation.”

Hughes continued: “The challenge will really be once the cargo is cleared at destination, and through to where it needs to be finally distributed. If you take Africa, where cargo would probably traditionally be about 90% moved on passenger aircraft, international passenger services have been so dramatically curtailed during the current crisis. If a vaccine were to be distributed today, there would just be no way of distributing it throughout the
continent; the continent is too large; too many borders; you can’t use road transport, you can’t use ocean transport.

“So, it does require a very intricate, well-planned logistical operation – almost to military precision – to look at where the cargo can arrive in safe conditions, and put the preparations in place.

“Now those preparations – and this is just an early assessment – would require core facilities at various staging points throughout the continent. It could be regional; it could be national; it could be based on geographical location of populations and demographics.

“But you would certainly need to have a big network of cold storage facilities, which then would be used in the distribution of the pharmaceuticals, so that they ultimately could move from cold storage facility to cold storage facility, until they would need to be dispersed and distributed on a very local level. So, that is our initial assessment of one of the most significant challenges that needs to be overcome.”

DHL conclusions
IATA’s observations are broadly consistent with some analysis published in September by DHL. Working with McKinsey & Company as its analytics partner, its white paper highlighted that with the first emergency use authorisations for COVID-19 vaccines expected to be effective in the last quarter of 2020, logistics providers and their customers face a challenge to rapidly establish medical supply chains to deliver serums of unparalleled amounts of more than ten billion doses worldwide.

It notes that currently, more than 250 vaccines are being developed and trialled. And as COVID-19 vaccines have leapfrogged development phases, “stringent temperature requirements (up to -80°C) are likely to be imposed for certain vaccines” to ensure that their efficacy is maintained during transport and warehousing.

“This poses novel logistics challenges to the existing medical supply chain that conventionally distributes vaccines at around 2 to 8°C,” the paper notes.

The paper also highlights that “the scope of this task is immense”, noting: “To provide global coverage of COVID-19 vaccines, up to 200,000 pallet shipments and 15 million deliveries in cooling boxes as well as 15,000 flights will be required across the various supply chain setups.”

Katja Busch, chief commercial officer at DHL, commented: “The COVID-19 crisis emerged with an unprecedented breadth and impact. It required governments, businesses, and the logistics industry alike to adapt quickly to new challenges.

“To protect lives against the pandemic, governments have moved towards a more active role in medical supply chains. Over the past few months, we have demonstrated that sufficient planning and appropriate partnerships within the supply chain can play a key role as governments work to secure critical medical supplies during health emergencies such as this.”

Public-private partnerships
Since the outbreak of the pandemic, bringing medical supplies from their distant sources to use at the frontline has been one of the most crucial activities in pandemic response management in the first phase of the health emergency, DHL notes, adding: “For PPE specifically, inbound logistics were a major challenge due to geographically concentrated production, limited air freight capacity and a lack of inbound quality checks. To ensure stable medical supply in a future health crisis, a comprehensive setup of public health crisis strategies and structures needs to be established by governments, with partnerships from both public and private sectors.

Framework for cooperation
To “kickstart the dialogue among the different actors and improve pandemic resilience in medical supply logistics”, DHL said it was providing “a framework for the cooperation of logistics companies with authorities, politicians, NGOs as well as the life sciences industry”.

It said the framework would help “to establish measures to ensure the most stable and safe supply chains possible. Besides an emergency response plan, this includes a partnership network, strong physical logistics infrastructure and IT-enabled supply chain transparency. Lastly, a response unit with a clear mandate should be put in place to implement all critical activities at short notice.”

The DHL analysis notes that once a safe and efficacious vaccine is approved for use, “transport and logistics promises to be the next challenge in the fight against COVID-19 due to the sensitivity of vaccines to environmental conditions”. It said the exact logistical requirements for transport and storage will differ between different vaccines or technology platforms, as well as between the different supply chain steps. “Nevertheless, it is important to plan ahead and understand in detail the potential temperature requirements and their implications for logistics.”

Temperature requirements
Stressing that when vaccines enter the market for emergency use – potentially as early as Q4 2020 – “a potential lack of stability data might mean stricter temperature requirements for the vaccine supply chain”; whereas in a less-stringent scenario, requirements for emergency use are not likely to differ fundamentally from today’s standard vaccines logistics.

Stringent vs conventional requirements
Looking at the so-called Stringent scenario, it notes that “out of caution, producers of certain vaccines and their logistics providers can choose to adhere to extreme temperature requirements (as low as -80 °C)to ensure that the efficacy of the vaccines is maintained during storage and transport. These conditions are in line with the ones used for certain COVID-19 vaccine clinical trials today.”

However, health authorities, producers and logistics providers “would strongly prefer to begin large-scale transport and distribution under the conditions prevalent in pharmaceutical supply chains today (+2 to 8°C or even higher), as long as stability is not compromised.”

In preparation for vaccine distribution – in particular in the stringent logistics scenario – the DHL study said it was “important to map out the logistics requirements and identify potential bottlenecks along the key supply chain steps of intermediate transport, intercontinental shipment, warehousing, downstream distribution and final short-term storage at the point of use”.

Different challenges
It added: “Our analysis suggests different challenges at each step along the supply chain. We can expect intermediate transport of the drug substance and intercontinental shipment of the drug product to be manageable given the intact logistics infrastructure available at production sites – predominantly in industrialized regions in Western Europe, North America, and India. However, high variance in process duration or customs clearance can pose a challenge given the consistent cooling requirements.”

It noted that the physical handling of ultradeep- frozen shipments requires special equipment, such as gloves, and processes to avoid injury. This means that a large number of couriers and consignees need to be informed or trained.

Air freight capacity
Given the urgency of the pandemic, the DHL study noted that “vaccines will likely be transported via air freight for longer distances”, adding: “To ensure global coverage for the next two years, some 200,000 movements by pallet shippers on 15,000 flights may be needed. In downstream distribution, accommodating the stringent temperature requirements will be even more challenging, though for a different reason. While process duration is much more plannable and consistent here, the lot size decreases substantially.”

This poses three operational challenges. “First, the sheer number of shipments – imagine almost 15 million cooling boxes in an exemplary supply chain – paired with the required volume of cooling bricks or dry ice.

Packaging bottleneck
“Dry ice production does not seem to be a bottleneck for vaccine distribution. But even under aggressive assumptions, both the availability of suitable packaging as well as the maximum-allowed quantities of dry ice in air cargo transport could potentially limit shipment possibilities in certain cases if the preparations are not made in time.”

Geographic view
The study highlights that while pharmaceuticals production happens mainly in countries with a modern and intact logistics infrastructure, downstream distribution cannot be limited to these regions.

“Given that temperature requirements are likely to be the main challenge, regions with a particularly warm climate and those with limited cold-chain logistics infrastructure will pose the biggest challenge in a stringent vaccine distribution scenario,” it notes.

“Furthermore, in-country logistics capabilities must be considered when targeting downstream distribution of vaccines globally. Especially under stringent logistics scenarios requiring dry ice for cooling, bottlenecks are likely to arise at the destination due to centralised dry ice production, especially if refilling is required after 3-5 days. Transportation under stringent temperature requirements – when shipping frozen vaccines, for example – may require extraordinary measures to reach people outside the ~25 countries with the most advanced logistics systems, which are home to just one third of the world population. Currently, large parts of Africa, South America and Asia could not be readily supplied at scale due to lack of coldchain logistics capacity suitable for life science products.

“Governments and NGOs would need to implement special measures to ensure vaccine distribution. Capacity would have to be increased and scaled in order to reach the global population.”

Conventional transport requirements
However, executing the last mile in line with conventional transport requirements – assuming sufficient shelf life at +2 to 8°C – “is much more feasible; it allows for a more efficient distribution to end users globally since transport can rely on available capabilities and capacities, as well as prior experience and knowledge,” the study notes.

“However, even when leveraging existing infrastructures, the share of the world’s population with good access to a vaccine only increases to around 70%, reaching a total population of around 5 billion in about 60 countries.

“Feasibility for supplying substantial parts of Africa remains low due to high outside temperatures and limited cold chain infrastructure. It is therefore important to consider innovative and specialised transportation modes to reach populations in less accessible regions.”