Learning from the Covid-19 vaccine supply chain

Mar 1, 2022

When the world became aware that the spread of the Covid-19 (SARS-CoV-2) virus had officially become a global pandemic in 2020, there was no real indication about if and when an immunization would be available. The race was on to harness international knowledge on vaccine development for an infectious disease that was not going away. Luckily, messenger RNA (mRNA) vaccine technology already existed in healthcare. This kind of vaccine allowed the creation of a mechanism which gives genetic instructions to the body’s cells to reduce the spike protein – the characteristic of coronaviruses – thereby catalyzing a natural immune response.    

To add to this, research teams based at the Oxford Vaccine Centre in the UK, combined their knowledge and skills to rapidly create a DNA vaccine. The Oxford-AstraZeneca vaccine utilized ChAdOx1 technology, which had been developed by the Jenner Institute and optimized over the ten years previous to the novel coronavirus appearing. This particular type of vaccine technology had been tested for use in vaccines for other diseases such as influenza (flu) and middle east respiratory syndrome (MERS), which is also a type of coronavirus. It may have seemed that the new vaccines were created and underwent clinical trials rapidly, however, the technologies that were utilized had been in existence for decades.

The main Covid-19 vaccines approved by EU regulators were:

  • Pfizer/BioNTech
  • Moderna
  • AstraZeneca/Oxford
  • Johnson & Johnson
  • Novavax

CureVac was a vaccine which only achieved 47% efficacy in Phase III trials, so development and production was abandoned.

Once an effective vaccine had been formulated, regardless of which pharmaceutical lab had developed them, the challenge was to manufacture in vast numbers and to organize vaccine distribution. Most vaccines are required to be kept at a stable temperature – not too hot and not too cold. For Covid-19 vaccine doses, it’s vital that they’re kept cold but not freezing, which led to an extra hurdle in the rollout: the need for a vaccine cold chain. This is a global network of cold boxes, freezers, refrigerators, and cold rooms for last-mile delivery and storage of the vials.

The Novavax vaccine is a regular protein-based vaccine which it is hoped will help allay public health fears of side effects, encouraging people to get immunizations if they originally did not want to risk a reaction to mRNA or adenovirus vaccines. Due to supply chain and rollout issues, there have been shortages of Novavax, but it is now on-track to be widely available. The Novavax vaccine also does not need cold storage with dry ice which makes it much easier and less costly to transport. It will be of great benefit to developing nations where vaccines have not always been readily available and where cold transportation and storage have been an ongoing issue. 

The emergence of Covid-19 vaccine supply chains

The urgent need for the rapid manufacture of effective vaccines in the Covid-19 response required a different approach to any that had been seen before. The Covid-19 pandemic was and continues to be the first global pandemic where vaccine technology has been available. Despite estimates in February 2022 stating that 10.6 billion doses have been given globally and that 55.7% of the worldwide population has been fully vaccinated, there are still many more doses to be procured and administered.

In August 2021, the nonprofit, Peterson Institute for International Economics, released an objective analysis of the Covid-19 vaccine supply chain to begin answering two questions:

  • Could more vaccine doses have been manufactured faster?
  • Could alternative policy choices have made a difference?

It describes the tricky process through which companies at nearly 100 facilities across different geographic hubs united to scale up global manufacturing. It’s thought that some major pandemic policy interventions and initiatives – including the USA’s Operation Warp Speed – are likely to have affected the timing and formation of those vaccine supply chains.

Pfizer/BioNTech had relatively large in-house capacities from the start which allowed it to proceed with all drug production, formulation, and fill-finish on its own sites from the end of December 2020. As demand increased, partners such as Dermapharm, Thermo Fisher, and Sanofi bolstered the US and European supply chains. However, production outside of these two markets was much slower to begin with. It wasn’t until May 2021 that BioNTech announced a manufacturing facility in Singapore. At the same time, Shanghai Fosun Pharmaceutical acted on its March 2020 agreement to implement a joint venture in China.

The AstraZeneca/Oxford vaccine had separate supply chains for the UK, the USA, Europe, India, Australia, Japan, Latin America, Brazil (still to be finalized at the report’s publishing), and Southeast Asia. Each region utilized up to four companies, but the full supply chain also included 15 other companies outside of AstraZeneca and Oxford Biomedica.

Equitable supply chains and sustainability

Initiatives like COVAX aim to accelerate vaccine manufacturing and guarantee fair and equitable access for every country. COVAX is co-led by the Coalition for Epidemic Preparedness Innovations (CEPI), Gavi, and the World Health Organization (WHO) with UNICEF as a key delivery partner. The African Vaccine Acquisition Task Team of the African Union and the COVAX consortium are hoping to secure 720 million doses of Covid-19 vaccines to achieve 60% coverage in Africa by June 2022. Partnerships like these will help increase manufacturing capacity and support international interdependencies.

The vaccine supply chain as outlined on the WHO website is a continuous cycle containing the following steps:

  • Daily records
  • Monthly reports
  • Monthly analysis
  • Request for supply
  • Vaccine arrival
  • National store
  • Subnational store
  • District store
  • Service-delivery point
  • Vaccine administration

Data from daily records and monthly analysis have been crucial to supply chain management. From the procurement of raw materials like lipids for vaccine production to circumnavigating bottlenecks, decision making on vaccine production numbers that fulfill allocation, but avoid waste, the data is key to coordinating efforts across stakeholders.

The WHO’s Immunization Agenda 2030 (IA2030) sets an ambitious global vision and strategy for vaccines and immunization for the current decade up to 2030, based on what has been learnt in the Covid-19 pandemic. Supply chain and logistics is a key area to ensure that immunization programmes for current and future virus outbreaks are an integral part of primary healthcare so that worldwide health coverage can be achieved.

Be at the cutting-edge of supply chain management

Supply chains continue to be in the headlines as geopolitical, economic, and environmental shifts impact manufacturing, trade, and logistics. Stakeholders all along the supply chain are looking for ways to streamline and improve systems that are straining to adjust, whether in the pharma sector, in consumables, or in the manufacture and transportation of any other time-sensitive product.

Be part of this rapidly-changing sector by studying a 100% online MBA with Supply Chain with Alba Business School, The American College of Greece, and develop skills that could shape the business landscape of the future.

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