In recent weeks, Pfizer and Moderna announced that their vaccine candidates were more than 94% effective, with AstraZeneca achieving an efficacy rate of 70%. Once vaccines are approved for distribution, what does this mean for medical supply chains?

Medical supply chains the world round have always been critical to providing equipment and resources to healthcare workers, but they’ve never before faced a global pandemic like COVID-19. Roughly nine months after the first outbreak, medical experts now fear that their supply chains could face even more strain this winter, as hospitals, medical centers and doctors race for proper storage, delivery and distribution of vaccines, once approved by the U.S. Food and Drug Administration (FDA).

Many questions need to be answered. What can we learn from history, to build up our medical supply chains for the immediate future? What strains could the manufacture and delivery of these vaccines create? Which transportation sectors will be at the forefront of this monumental task? And what’s the current global status of our medical supply chains?

Below, we break down the answers to these important questions, and explore the big picture.

What can we learn from history about the deployment and development of vaccines? How can this knowledge help current medical supply chains?

The current crisis can be compared to the deployment and development of penicillin in the 1940s. There have been gains in global manufacturing since then, with Pfizer reportedly expecting to produce 50 million vaccines in 2020, and ramp up to 1.3 billion in 2021. This potential feat doesn’t even account for the capability that exists if the company shares its formulas with competitors for a negotiated rate.

Healthcare suppliers have also relied on lessons learned from previous vaccine-distribution efforts such as the H1N1 influenza pandemic, including the need to build flexibility into distribution plans when supply is unpredictable, and tailor messages to many different populations. States are in varying stages of readiness in terms of distribution planning. Health systems take this responsibility seriously, and are striving to achieve significant improvements in their own preparations.

How important will passenger airlines be to the global transport of COVID-19 vaccines, especially with the need for controlling temperature? What’s the supply-chain impact of air versus sea, train or truck?

Passenger planes typically haul approximately 50% of air cargo, so any remaining commercial planes will be essential to the vaccines' movement. Suppliers face the issue of limitations on commercial traffic, especially international travel. Additionally, any commercial aircraft that’s temporarily converted for freight purposes will become an essential link in transport of the COVID-19 vaccine. Air cargo generally provides the fastest transit option, especially for critical cargo like vaccines. Temperature is the real constraint and challenge, but logisticians have a history of solving problems with innovative solutions, maintaining temperatures of -80 degrees Fahrenheit in labs today. This capability is being developed on a monumentally larger scale.

Controlling temperature is difficult for all modes, but there has been significant growth in sea trade with modified refrigerated containers. Millions of perishable goods are shipped in adverse conditions into tropical areas daily with ocean containers.

Regardless of mode, strict temperature guidelines must be followed. According to Scientific American, Moderna’s vaccine has to be shipped at -4 degrees Fahrenheit, and can be stored at that temperature for six months. Once thawed and kept in a refrigerator at between 36 and 46 degrees Fahrenheit, it’s good for up to 30 days. Pfizer’s vaccine, by contrast, must be kept at -94 degrees Fahrenheit — a much greater challenge. Once transferred to a refrigerator, it must be administered within five days.

Existing supply chains manage factors like temperature and refrigeration, but not at this scale and difficulty. Validating control and viability after use could be a real challenge. Supply-chain executives will continue to ask themselves throughout this pandemic:

• Can production of these items be ramped up to support supply?
• Will the production allow some room for inefficiency?
• How do we manage sensitive factors, such as temperature, for massive shipments?

Deploying a logistics supply chain as complex as this one is no small task. But practical applications exist today, involving multiple recycled boxes by a plethora of labs.

Will the need for glass vials slow the distribution of a COVID-19 vaccine? What kind of complexities must airlines deal with to enhance their vaccine cargo capacity?

Government intervention will likely occur to ensure a supply of the raw materials necessary to make glass. If returned containers also contain recycled vials, they will not face biohazard complications due to sterile needles and contact controls. An effective sterilization and contamination prevention process seems feasible, but agreement on viable standards by government officials would have to be fluid before supply-chain leaders could move forward.

Existing air capacity can supply freight containers, including for cold storage, necessary for transport of the vaccine. Demand for the vaccine could lead to the utilization of many furloughed or out-of-work pilots.

With medical supply chains having mostly recovered from the first outbreak of COVID-19, how are they now? How should suppliers prepare for another challenging outbreak, anticipated this winter?

From where we started in late March to the present day, supply-chain coordination within the healthcare field has greatly improved. It has led to the formation of strategic partnerships and better collaboration, for access to needed supplies. According to Dr. Prakash Mirchandani from the University of Pittsburgh, the COVID-19 outbreak exposed significant glitches in healthcare supply chains, which are complex and highly fragmented. Healthcare consists of five categories of products: pharmaceuticals, personal protective equipment, medical devices, medical supplies, and blood. Each has a distinct supply chain, and the failure of any one of them can wreak havoc on the healthcare system.

The challenge of balancing products overwhelmed the global medical supply chain at the beginning of the pandemic. Most suppliers showed improved resilience during the summer and fall, but there are signs of more struggle as we head into winter. Health systems continue to see increased pressure from not having visibility into their supply chains. The pandemic has made it clear that creating transparency and building a clinically integrated supply chain will be key strategic priorities for health systems this winter.

Johnathan Foster is a principal consultant with Proxima Group.