Now that one of the new Covid19 vaccines (Pfizer BioNTech's mRNA vaccine) has been approved by a regulatory authority (UK's MHRA on 2 December 2020), attention turns to how to vaccinate the UK and the world.It is important not to underestimate the scale of the challenge. There is no precedent for a healthcare vaccination programme on this scale. It will be the first and not necessarily the last. The stakes are high and we need to get it right.
Put another way, to achieve success, three things need to be in same place at the same time – people and support staff administering the vaccine, the equipment required, and the people being vaccinated (I will call them patients).
This process probably has to happen successfully over 12 billion times (the vaccines require two doses) to achieve global herd immunity. As we do not yet know about how long immunity will last, it is possible that further doses will also be required - so this may have to be repeated …. possibly for years to come.
How's that for a challenge?
Let us consider the key elements for success.
- Logistics. In the broadest sense there are three constituents to organise - Materials, Staff and Patients.
- Materials & Cold Chains. All vaccines require a controlled cold chain. From manufacture to inoculation, vaccines need to be stored at 2-8 deg C and this process includes the need for temperature monitoring as well as control. If the cold chain breaks, the vaccine will likely become unviable. For each of the three Covid vaccines there are different cold chain protocols/ For example, the Pfizer BioNTech vaccine needs to be stored at minus 70 deg C for a period of time prior to administration. The good news is that cold chain management is well understood and widely used. The issue here is one of scale and capacity. However, in parts of Africa, for example, this will present a major challenge as many rural areas don’t have any form of refrigeration. This matters to the whole world as vaccination must be undertaken globally or Covid19 will not be eradicated.
- Materials & Equipment. It's not just the vaccine that needs to be considered. There are syringes, needles, swabs, disposal containers, buildings or shelter, computers, administration supplies, electricity (generators), refrigerators, toilets, water (it's not always on tap everywhere), cleaning equipment, canteens …. the list goes on.
- Reverse Logistics. A brief mention here for the used equipment and refuse - it needs to be recycled or disposed of including from point of use and in transit.
- Staff - Medics & Support. There are the medics of course - large teams of qualified professionals will need to be deployed. Let's not forget the support staff. Patient details need to be recorded, data entered into computers, guidance and education given to patients, media briefings to be needed. And then there are the Local COOs - see below.
- Patients & Planning. As a reminder we have at least 6 billion or so people to organise. That’s a planning requirement of over 6 billion. They need to be contacted, persuaded, transported, looked after, educated ("come back in 4 weeks please"), transported again.
- Patients & Priority. Who gets the vaccine and when? This is a major question that every nation is currently considering. For example, the initial priority in the UK are the elderly, the vulnerable with underlying health conditions, for example, and health care workers.
- Security. Covid 19 vaccine is valuable, highly valuable. Demand far exceeds supply. We had better take security of this seriously …. or else.
- Organisation. It is difficult not to overstate the nature of the organisational challenge involved. Let's consider this nationally and locally.
- National. In supply chains and logistics we sometimes talk about Control Towers. These are hubs equipped with the required processes and technology to organise and control the decision making upon which supply chain and logistics operations rely. A key requirement of such hubs is visibility including demand and stock. It is likely that Control Towers will need to deployed on at least a national basis in most countries.
- Local. No matter how well a Control Tower (or its equivalent) works, local organisation and operations will be key. Each Vaccination Centre will require a full time 'Chief' - let's call them Chief Operating Officers (Local COOs) to make things happen. There will be stock to manage and expedite, crowds to direct, power cuts to cope with, maybe protestors to deal with. In assessing logistics operations for 30 years, the difference between a good operation and a poor one is the local COO. Failure to appoint a competent local Chief …. well don’t.
- Mass Vaccination Centres. It is likely that mass vaccination centres will be widely used to administer the vaccine. These centres will have to cope with large numbers of people arriving at the same time. So attention will need to be given to issues such as crowd management, social distancing, throughput, caring for people who may be waiting for long periods of time in hot or cold weather, etc. Setting up and managing these centres is no small undertaking, especially in remote locations in developing countries.
- Information, Data & Education. To achieve the ambitions of this global programme will require a mastery of information and data at many levels. The following is not an exhaustive list.
- Herd Immunity. The problem is this. Vaccination must achieve two aims - protection of individuals and protection of nations. To achieve the latter and develop herd immunity requires compliance of the former. So ….
- Getting patients there is very important. As vaccination is unlikely to be compulsory in most countries, people will need to be persuaded. Recent polling has indicated that a significant minority in many countries have reservations and may not take the vaccine. The main reasons stated are that it is new and has been produced quickly. While these may be reasonable reservations, if enough people in a population do not get vaccinated, Covid 19 will remain in that population. So governments will almost certainly need to invest in widespread advertising, social media etc, to convince the 'Vaccine Hesitants' within their nations. As if that wasn’t enough of a challenge ….
- Defeat the Anti-Vaxxers. There is already a widespread cohort of opinion fundamentally opposed to vaccination. The movement gained prominence and momentum in 1998 following a paper published by the now discredited Andrew Wakefield et al. They need to be confronted and defeated - not an easy task in a world where fact and the truth has been so distorted in the recent past.
- The Second Dose. The three vaccines to date all require a second dose. Not only will this will require mass education to work, it will also need to be monitored.
- Data demands and management is a long list and another major challenge. For starters: detailed records of who have taken the vaccine; related master data management; discrete data management where integrated data management is not possible, vaccine passports may be introduced to reduce restrictions on those who have been vaccinated; Phase IV Clinical Trials to monitor longer term efficacy and safety of the vaccines, etc, etc. Finally, wherever there is data, there are data security challenges.
At the risk of stating the obvious, all of the above has to be financed with much of the world's population not able to afford it. On which subject I am encouraged by the global COVAX initiative and its aim of equitable distribution of Covid vaccines.
Here at Enchange we have over 27 years of logistics and supply chain management experience and would be delighted to support organisations involved in this most ambitious of undertakings.
Here at Enchange we have over 28 years of pharmaceutical logistics and supply chain management experience and would be delighted to support organisations involved in this most ambitious of undertakings. The Covid19 vaccination rollout will largely be a public sector effort in most countries. I would urge government to consider that there is a lot of established logistics and supply chain best practice within the private sector (i.e. don’t reinvent the wheel) including with respect to sales and operational planning. The latter about getting stuff in the right place at the right time in the best condition. We have a wealth of reference material at Enchange. For starters, you might want to consider the following:
- Sales & Operational Planning (S&OP). S&OP has been the go-to model for operational execution in companies for many decades. As an excellent place to start, government should consider its use to deliver Covid19 logistics success. You can download a copy of the Enchange S&OP e-Book for guidance.
- S&OP Compliance: If you do decide to implement S&OP to guide execution of Covid19, compliance to your ‘Covid Logistics Operating Model’ will be important.
- Logistics Outsource Tendering - Top 7 Hazards: For the due diligence of potential third party suppliers, there are some useful tips here.
- Service Level Agreements (SLAs): These are an important tool in holding parties to account in supply chains and logistics. Here is a light hearted take on them with an important underlying message.
- Resource – Supply Chain Interim Management & Consultancy. If you need to hire interim resource to help with Covid logistics, here are some tips on the benefits of interim management.
- And finally for the folk in charge of Covid19 rollout and the potential role of S&OP, try this - What has S&OP ever done for us? The role of the CEO