The latest issue of Vaccine, an Elsevier journal with open-access content, devotes 177 pages to one theme: how today’s global vaccine supply chains function, and how they can be improved. Vaccines are notable in that many (but not all) require 2-8°C temperature control—and that stability in out-of-range temperatures can quickly be lost, deactivating the drug. While the bulk of the issue’s content is devoted to public-assistance efforts in the developing world, there are notable lessons for anyone operating supply systems for any temperature-controlled drug. Moreover, as four authors from UNICEF point out in a meta-study of recent vaccine projects, one-third of vaccine inventories are exposed to below-specification temperatures in “wealthier” countries; and an even higher proportion—38%—are overly cooled during shipping. Both of these figures are higher than those seen in less-developed countries, a condition the authors attribute to the possibility of more temperature monitoring activity (i.e., better identification of what had been there all along).
Today’s vaccine supply chain grew out of efforts that began in the 1960s to address smallpox (a successful eradication eventually) and then polio (an ongoing campaign). Along the way, vaccines were essentially handled in their own supply chain, with refrigerated depots, insulated containers and specialized logistics processes distinct from the range of general healthcare product deliveries. There are now efforts to integrate vaccine shipments with other healthcare products, but the same time, the volume and types of vaccines have grown by 50% since 2007. (The fact that an increasing number of biopharma drugs also require refrigeration seems to be outside the scope of the studies.) A common figure in the activity is that 40% of the cost of a typical vaccination program is taken up by the vaccines themselves. A 1% reduction in vaccine wastage is estimated to save $50 million by 2020. And, like commercial drug deliveries in some parts of the developed world, temperature monitoring is only a sometimes thing in vaccines in the developing world.
In “Gavi eligible” countries (Gavi, the Global Vaccine Alliance nonprofit, has selected some 55 underdeveloped countries that meet its application criteria), the state of cold chain equipment is poor: 50% depend on early-generation refrigeration equipment that often freezes vaccines; 20% have little or nothing and another 20% have significant breakdowns, leaving only 10% with the latest technology. McKinsey & Co. has worked with Gavi on a Cold Chain Equipment Optimization Platform since 2015 to improve this situation. Advances such as using solar direct-drive refrigeration will replace earlier, fuel-burning or “ice-lined” refrigerators (set up to deal with intermittent electrical power). Electronic temperature-monitoring equipment will also become more widespread.