Suresh Acharya, Professor of Practice at the University of Maryland’s Robert H. Smith School of Business, lays out the challenges of creating an end-to-end supply chain that can produce and distribute millions of doses of a vaccine for COVID-19.

The vaccine supply chain can be broken up into three distinct stages: production and manufacturing, distribution and logistics, and delivery to ultimate point of care. The first requires complex coordination of materials and parts, sourced from multiple locations. Assigning priority to production of a COVID-19 vaccine could cause other materials and drugs to be put on the back burner, Acharya acknowledges. Still, he believes that the manufacturing side is relatively well prepared for the surge of production that will be required, once a vaccine is approved. “This needs a lot of collaboration,” he says, “but I believe that if there are issues, they can be rectified more easily.”

The middle stage of distribution carries its own set of challenges, including the need to book sufficient numbers of trucks and planes. Here, too, Acharya believes that a well-established capability is in place to address issues that might arise, provided that carriers and distributors are able to maintain the cold chain that’s necessary to transport the virus safely, at temperatures well below those of perishable food and other types of drugs.

The “last-mile” stage of the vaccine supply chain presents the most serious problems, Acharya says. The manufacturing and logistics sectors tend to consist of a limited number of large players who are well-positioned to address any problems that might arise. That’s less the case with final distribution, where the cold chain is most apt to break down. The World Health Organization estimates that around half of certain vaccines end up going to waste for that reason.