Covid-19: Logistical and political challenges could impede vaccine rollout

By Mason Quah

The new vaccine from Pfizer and BioNTech promises 90 per cent effectiveness, but massive challenges need to be overcome before a vaccine can be distributed globally.

It requires storage at temperatures of -70 °C. This level of refrigeration needs to be maintained across the entire supply chain. Failure to do so could result in the spoiling of the vaccine, which will not be identifiable at the point of use.

Other research conducted using mRNA vaccines have produced products stable with normal refrigeration technology, but it is not yet known whether this could apply to the Pfizer vaccine, certainly in terms of longer-term storage.

Additionally, two doses are needed to achieve effectiveness, doubling the logistical capacity required to immunise a population.

GP clinics and care homes in the UK do not currently possess the freezers required to store the vaccines at an effective temperature.

Two decades ago, similar supply line constraints impeded the ability to distribute Polio vaccines at -50 °C. It posed a logistical nightmare as aging equipment needed repair components from dozens of manufacturers.

Polio demonstrated the importance of cold chain supply lines, beyond the short term needs for whichever vaccine is currently being dispersed. In order to avoid this logistical nightmare from occurring at regular intervals there needs to be broad changes to how we organise medical infrastructure.

This might include standardising equipment and implementing right to repair laws, preventing equipment suppliers acting as a bottleneck. This would also ease the issue of long term maintenance in a field where average equipment lifespan is less than a decade.

Redaction Politics reached out to Pfizer about the concerns of temperature stability.

While Pfizer did not comment on the possibility of producing temperature stable strains of the vaccine, they are confident in their ability to maintain cold chain supply lines during global shipping, verified using GPS enabled temperature monitors on the shipments. This will allow for the identification of any temperature fluctuations that might denature the vaccine.

Pfizer handling instructions claim that the thermal shipping units can be maintained at adequate temperatures for up to 15 days if supplied with dry ice, lower than the 6 months maximum if frozen at ultra-low temperatures. They have also disclosed new stability data suggesting the vaccine is stable for up to five days at regular fridge temperatures of 2-8 °C.

Despite these reassurances, the issue of temperature stability could still sway the decision between the frontrunning Pfizer and Oxford vaccines, as the Oxford vaccine has better stability in normal refrigerators.

This will be easier for use in nursing homes and GP clinics that do not have access to better equipment. The UK has currently agreed to the purchase of 90 million doses once development is completed.

A Russian competitor, Sputnik V, boasts a 92 percent effectiveness but the data has yet to be peer reviewed or published.

There is unlikely to be any singular vaccine that is suitable for global use. Temperature stability is only one variable that needs to be accounted for alongside production capacity, dosage requirements and the impact on pre-existing conditions.

The issue of production capacity has also been raised by Amnesty International, after more than a billion of the first doses of the Pfizer Vaccine have been purchased by wealthy nations in America, Europe and Asia, leaving minimal vaccine capacity for use by less wealthy nations.

Amnesty International’s Researcher on the Right to Health Tamaryn Nelson said: “It is great news that the Pfizer-BioNTech vaccine is proving effective against COVID-19. However, it’s worrying that Pfizer-BioNTech has already struck deals with rich countries for more than a billion doses of its vaccine, leaving less than a quarter of its projected supply for the rest of the world.

“These kinds of bilateral deals risk undermining the potential benefits of scientific breakthroughs. Big Pharma profits must not be prioritised over the health of billions.

“The pandemic will not be over until it is over for everyone.”

UNICEF’s COVAX plan advocates for a rollout of vaccines to maximise impact of each dose, with priority going to health and service workers first alongside vulnerable groups that are liable to have severe reactions if infected.

This would have the greatest impact on reducing the rate of transmission with the lowest number of vaccinations required. A second wave of vaccination could then immunise vulnerable populations.

The strategy is modelled on a production goal of two billion doses by the end of 2021. Without immunising entire populations it can be expected that the vaccine will be rolled out alongside continued use of other protective methods such as social distancing and self-isolation.

There is no medical breakthrough capable of ending the pandemic overnight. We must remember that the goal of any vaccine produced is to complement our existing efforts to reduce transmission.

Featured image: Pixabay

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