Pfizer Inc.'s experimental COVID-19 vaccine has emerged as the leading candidate to halt the pandemic but distributing it or any other vaccines poses massive logistical challenges that will test Canada’s health supply chain infrastructure and expose its weaknesses in the days and months ahead.
McKesson Corp., a leading health care distributor in North America, is warning Canada’s existing public and private vaccination delivery systems aren’t ready for a successful and widespread vaccination program. It says the special handling and storage required for the most promising vaccines and the sheer volume of doses to be distributed threaten to “overwhelm existing infrastructure.”
In the United States, the government has dispatched the military to oversee the rapid distribution of a vaccine as soon as one is ready, tapping its vast logistics power to ensure the co-ordination of private sector suppliers and freight transportation companies. In Canada, the federal government is taking the lead on sourcing and transport planning but it will fall to the provinces to ensure their citizens get the vaccine and any additional follow-up shots that are required.
Canada has struck supply agreements with seven pharmaceutical manufacturing groups to secure one or more vaccines that will allow the country to begin mass immunization. It has also begun preparation work on how to distribute the vaccines, a critical piece of the puzzle that has to be in place for quick and widespread treatment once a vaccine is approved by Health Canada.
“This will likely be the largest vaccination program ever and it will be rolled out in a very condensed time period,” said Sam Tarantino, head of logistics at Mississauga-based BioScript Logistics, a specialist in moving pharmaceuticals and medical devices that is vying for a piece of the work. “No one company or government will be able to manage it alone.”
Based on updates it has received from manufacturers including Pfizer, AstraZeneca and Moderna, the Trudeau government is working on the premise that a vaccine could be ready for distribution starting in early 2021 with a vaccination program running through to the second quarter of 2022. It has drafted a list of requirements for supply chain logistics and is now short-listing potential companies to provide the transport, handling and security from end to end. It is encouraging companies to partner with one another.
The challenges involved are unprecedented.
Providing one and likely two doses of a vaccine to 35 million Canadians in all corners of a vast country within the space of a few months has never been accomplished. Even the largest public flu vaccination campaigns tend to distribute only about 15 million doses a year. In the case of COVID-19, the government is working toward providing 75 million doses.
Although the International Air Transport Association has warned that the air transport industry’s diminished cargo capacity could complicate efforts to distribute COVID-19 vaccines, that could be the lesser challenge. Maintaining the vaccine at consistently low temperatures throughout transit and repackaging could be far more difficult.
Some of the vaccine candidates need to be kept as cold as -80 C from the moment they’re made until they’re ready to be administered, which might happen days or even weeks later.
“There’s no airplane, or any boat or truck that can maintain -80 C for that length of time,” said Aaron Mitchell, chief executive of Human Logistics, an air charter brokerage working on a joint bid with partners. “People do not transport things at that temperature range every day, in our industry or many others.”
There’s also a major security risk. The federal government has made clear in public procurement documents that it considers COVID-19 vaccines to be “high value assets and high value targets for criminal elements” that will need to be kept safe.
“We don’t typically think of that in the day-to-day shipment of pharmaceuticals or food products but in this case it’s a real concern,” said Peter Evans, chief executive of Victoria-based Cryologistics, a Victoria-based refrigeration technology company that is involved in the process. “It could be stolen, it could be contaminated, it could be supplemented with a fraudulent product, which is not uncommon."
Among the federal government’s requirements, logistics companies have to be able to pick up frozen vaccines from international manufacturers by plane, bring them to Canada and then control vaccine inventory in warehouses for distribution. They’ll be expected to parcel out emergency orders anywhere in Canada within 48 hours, including to the most remote hamlets. They will also be required to ensure doses get to the thousands of Canadians serving abroad. The chosen providers will have to prove they can start work on the project by Dec. 15.
Companies are jostling behind the scenes to form alliances as they ready offers for their services. Among the corporations attending an Oct. 30 bidders conference were Air Canada, Brink’s, CargoJet, DHL and Shopper’s Drug Mart. McKesson’s Canadian arm is also in the mix.
McKesson has been tapped by the U.S. government as the centralized distributor of future COVID-19 vaccines and ancillary supplies such as syringes. McKesson is building four new centralized distribution centres to fulfill its mandate.
The company released a white paper in September titled Is Canada’s Supply Chain Ready for a COVID-19 Vaccine? Authored by Dimitris Polygenis, president of McKesson Canada Pharmaceutical Solutions and Specialty Health, it says the company is “most concerned” that two of the vaccine manufacturer frontrunners with whom Canada has supply agreements require either frozen (-20 C) or ultrafrozen (-80 C) storage and transportation conditions.
“The existing public and private vaccine supply chains in Canada are not equipped to support frozen and/or ultra-frozen COVID-19 vaccines at scale,” Mr. Polygenis said in the paper. “And even if the vaccine is refrigerated, the sheer scale of doses to be distributed will overwhelm existing infrastructure, particularly if there is a desire to push all these doses in a matter of months, and/or if there is any overlap between COVID-19 vaccine and seasonal flu vaccine distribution.”
McKesson estimates that Canada will need 1.7 million cubic square feet of frozen or ultrafrozen warehousing space for 75 million vaccine doses if the country adopts a protocol to provide every Canadian with an initial shot and a subsequent booster. It says that space doesn’t currently exist in the volumes needed. Liquid nitrogen is required to maintain the coldest temperatures.
McKesson itself has no ultrafrozen infrastructure in Canada and only one single refrigerator-sized freezer worth $10,000 in one of its distribution centres. The company says pharmaceutical-grade freezers or liquid nitrogen-powered freezers could be needed at all points of immunization – whether it be pharmacies, doctor’s offices or hospitals.
Pfizer says it has developed shipping units for its vaccine that can maintain recommended cold temperatures for up to 10 days during transport. The units can also be replenished with dry ice and used for temporary storage at destination, spokeswoman Christina Antoniou said. Pfizer recommends -70 C for its vaccine. Once taken out of ultralow-temperature storage, the vaccine vial can be stored for up to five days at refrigerated conditions, she said.
Quebec insists it has many of the potential logistics problems in hand. The province has purchased 60 special freezers that will be deployed at strategic locations and it is working on a plan for who should be vaccinated first, Health Minister Christian Dubé told reporters Tuesday during a news conference.
Kuehne+Nagel, another company that attended the bidders' conference, regularly ships medicines at ultralow temperatures, often for use in clinical trials.
Robert Coyle, senior vice-president of pharma services in Raleigh, N.C., said the company uses temperature-controlled trucks carrying vaccines in specialized packaging to maintain -80 C using gel packs, dry ice or active refrigeration.
Some COVID-19 vaccines require such low temperatures, he said, because the regulatory approval process is moving so rapidly. Normally, manufacturers have several years to test a product’s stability, so that by the time they bring it to market, they know its shelf life and how it reacts in different storage conditions.
But there hasn’t been enough time to collect stability data for potential COVID-19 vaccines yet, so lower temperatures are required to assure quality is maintained. Given more time, manufacturers may acquire sufficient data to support moving the product at more normal temperatures.
Skelton Truck Lines, which also attended the bidders' conference, distributes vaccines throughout Canada, including flu shots. Mike MacDonald, director of North American sales, said that by the end of October, 44 per cent more flu vaccine had been distributed in Ontario compared with the same period last year. “There is the capacity to ramp up the vaccine network,” he said. “You just need to have the actual vaccine to be able to deliver.”
The United States is ahead of Canada in planning, he added, and that will help this country. “They’re going to be distributing these drugs sooner than we are. And I think Canada’s going to be able to learn some lessons from that.”
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