Friday , December 4 2020

The world is not ready to introduce a vaccine against covid-19

(CNN) – Vaccines need to be stored cold, just look at the Pfizer version against covid-19, which needs to be frozen. And this will be a problem for developing countries and for rural areas of developed countries.

The “cold chain” is just one of the problems with the spread of vaccines around the world.

There are many others: decisions about priority populations and databases that allow you to track who and where and when received which vaccine. In addition, different vaccines may be more or less effective for different populations; and governments will need public relations campaigns to convince people of the safety of vaccines.

But the logistics of transporting and storing vaccines, delivering them from the factory to the patient’s hand, is very important. And since most vaccines will probably require two doses, the entire chain of needs needs to be repeated in a few weeks.

Unique challenges

The Pfizer-BioNTech vaccine should be stored at about -70 degrees Celsius during transport. It is 50 degrees Celsius colder than any other vaccine currently in use.

Moderna indicates that the vaccine can be stored in freezers, which can usually be purchased at pharmacies, and in the refrigerator for 30 days. But fewer doses of the Modern vaccine than Pfizer are likely to be available next year.

Phase 3 trials have shown that both vaccines are approximately 95% effective, but the results have not yet been reviewed by regulators.

On Wednesday, the CEO of BioNTech, a German biotechnology company affiliated with Pfizer, acknowledged the problem of temperature control.

“We’re working on a recipe that can allow us to supply the vaccine even at room temperature,” Ugur Sahin told CNN. “We believe that in the second half of 2021, we will come up with a recipe comparable to any other type of vaccine.”

But meanwhile, U.S. Secretary of Health and Human Services Alex Hazard believes the Moderna option is “more flexible” for institutions like a local pharmacist. According to him, on Monday Pfizer is better suited for “a large institutional vaccination of, say, an entire hospital, several nursing homes at once.”

Next year, Pfizer plans to ship up to 1.3 billion doses, which requires a large amount of dry ice (solid carbon dioxide of about -78 degrees Celsius) and many insulated boxes. The box contains 975 vials (4875 doses) and can be filled with dry ice for 15 days of storage.

Pfizer is inspecting supply chains in four U.S. states, and CEO Albert Burla said Wednesday that he is “not worried” about cold chain requirements.

But the delivery of such a vaccine can create big problems. Dr Jarbas Barbosa, deputy director of the Pan American Health Organization, told CNN that “rural and urban areas of any country in the world are not ready to introduce this vaccine today.”

So who in the world is ready? Nobody. “

One problem is the presence of dry ice.

The Compressed Gas Association states that its carbon dioxide production capacity in the United States and Canada is about 30,000 tons per day and is confident that its members can meet the demand for dry ice. It says vaccine supply chain employees believe that less than 5% of dry ice production will be needed to support ultra-cold storage of COVID-19 vaccines in the US and Canada.

Others in this area predict bottlenecks. Several dry ice producers in the U.S. told CNN that they had already received offers for their entire production. Buddy Collen of Reliant and Pacific Dry Ice told the online edition of GasWorld: “We are in a dirty state trying to manipulate our manufacturing facilities.”

Sam Rushing, president of Florida-based Florida Cryogenics, told CNN that the U.S. already has a regional deficit.

The main problem, Rushing says, is that during a pandemic there are fewer cars on the roads, which means less ethanol production, a by-product of which is carbon dioxide. European ethanol production has also declined significantly this year.

U.S. officials are confident there will be enough dry ice. Paul Ostrowski, director of supply, production and distribution for Operation Warp Speed, told CNN last week that the UPS courier was committed to “providing dry ice forwarders across the U.S. upon request.”

But Rushing warns that dry ice is not very easy to use and can be dangerous if stored improperly, especially in confined spaces. The Federal Aviation Administration classifies it as a dangerous cargo.

Peter Gerber, CEO of Lufthansa Cargo, told CNN that the need for dry ice “obviously also reduces transport capacity because if you have to carry more ice, you can’t carry that much vaccine. And of course the procedures have to be very special to ensure that it always has such a degree of coldness.

The American DHL courier adapts the distribution plans according to the specifications of each vaccine. David Goldberg, CEO of Global Forwarding US, says “there is a limit to the amount of dry ice used on an aircraft, typically 500 to 1,000 pounds, depending on various factors.”

Once they arrive, Pfizer vials can be stored at 2-8 degrees Celsius for five days until the condition worsens. Pfizer says it has developed “a system that delivers frozen vials directly to the vaccination site in a timely manner.” It will also monitor the temperature of each box supplied.

Julie Swan, a supply chain expert at the University of North Carolina, says large hospital systems, which often have frost freezers, can play the role of distribution centers. But they are not in all the states of the country; Last week in Hawaii it was said that no hospital had such freezers.

Destroying supplies of frozen vaccine to rural areas or small groups of key workers without compromising their temperature would be another headache, Swyon said.

If the vaccine is needed in a few days, vendors should make sure they are ready. “You can’t wait to see who shows up,” Swyon told CNN. “And we still don’t have good data that determines where and who the priority populations are.”

The more links in the supply chain, the greater the risk of deterioration of vaccine temperature. Last month, the U.S. Centers for Disease Control and Prevention (CDC) warned states that “they should limit the transportation of frozen or ultra-cold vaccine products.”

Proshant Yadav, a supply chain expert and senior staffer at the Center for Global Development, said: “It’s a question of how quickly we can start thinking about multiple packaging formats.”

Outside the US

This is what we know about Chinese covid-19 vaccines 1:27

If getting a frozen vaccine for tens of millions of people is difficult in the United States, it is a much bigger problem for the poorest countries.

Transport connections are slower, and medical facilities in developing countries are less equipped. CO2 production is low, and the cost and danger of delivering large amounts of dry ice is also a barrier, Poisons says.

David Gitlin, CEO of Carrier Refrigeration, told CNN last week: “If you look at places like Africa and India, they just don’t have the cold chain infrastructure. The United States spends 300 times more on the cold chain than India.

Peru is one of many countries that have ordered the Pfizer vaccine. In the capital, Lima, where large volumes can be given quickly, this should be effective, says Dr Herman Malaga, a member of a group working on Peruvian vaccine options. But while Lima probably has 30 frost freezers “for the remaining 20 million Peruvians, including the Andes and the jungle, there are none.”

“For the rest of the country, we could use vaccines like the Chinese, which requires 2 to 8 degrees, which is more convenient,” Malaga said.

“It’s about cost-effectiveness, it’s not just the vaccine, but the whole vaccination process,” Yadov said. But if the candidate from Pfizer proves to be the most effective, the demand for freezers with frost will be extremely high.

Barbosa says the Pan American Health Organization is urging member states not to spend large sums on vaccine preparation, but to join a multilateral fund called COVAX, essentially an exchange point for the purchase of vaccines introduced by the Organization. World Health.

In addition to the cold chain, there are other logistical obstacles.

In order to take shots where you need them, you will need a massive air lift. Pfizer, which has production lines in Europe and the United States, says it expects an average of 20 cargo flights a day worldwide.

DHL estimates that over the next two years, 15 million cool boxes will be delivered on 15,000 flights. David Golberg told CNN that the company has set up a high-quality network of cold chains and will add flights between China, Europe and the United States.

Many countries can refer to existing programs as models. Peru’s national vaccination program covers about 75% of the population, Malaga said.

The polio vaccination program is ubiquitous in India: this year it will cover more than 90% of children, according to Gagandip Kahn of the Wellcome Trust Research Laboratory of Christian Medical College in Vellore.

“For polio programs, we used boats and mules and enterprising health workers,” Kahn said. But such programs are designed for less than a tenth of the population, and vaccines against COVID-19 will be prescribed to different groups, he explained.

India will need “a series of waves, each of which will be directed to a different group as the vaccine arrives,” he told CNN.

“Before deciding what to use, we will need to consider the characteristics of other vaccines and the requirements for their delivery,” said Kahn, who is also a member of the World Health Organization’s Vaccine Safety Advisory Committee.

In such a dynamic situation, record keeping becomes critical. Dr Anna Blackney, who is working on a vaccine being developed by Imperial College London, said the US does not have a centralized infrastructure to control who gets what and what it describes as a “really important issue”. .

Poison says that even if the vaccine reaches its destination, it will need to have some flexibility to allow people to receive a second dose elsewhere if they want to. And this requires reliable databases.

Barbosa said outside of supply chains governments “should have a good communication strategy to overcome public skepticism and conspiracy theories about vaccines.”

Blackney agrees. “This process [de desarrollo de vacunas] it happened so fast that it’s no surprise that people are skeptical about reading about safety and possible side effects, ”he said. Blackney is part of an international effort undertaken by researchers to reassure people through social media about safety and efficacy covid-19 vaccine.

Finding enough dry ice is just one of the sequences of the world’s vaccination against COVID-19.

Claudia Rebaza and Fred Pleitgen of CNN participated in this report.

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