Covid-19 vaccine is here, but supplies will be tight

The Pfizer-BioNTech vaccine is here, approved by FDA under an emergency use authorization (EUA) on Dec. 11. The Moderna version (also based on mRNA technology, and from a company that has never had a commercially approved product) is expected to have an FDA public hearing on Dec. 17; if the Pfizer-BioNTech pattern holds, that product could be approved the next day.

Extraordinary excitement—and no little anxiety—has built up over how the vaccine will be delivered to the US population quickly. But the realities, at this point, appear to be that a) distribution providers—wholesalers and third-party logistics providers like UPS and FedEx—are well-adapted to delivering the temperature-controlled products; b) there won’t be much flowing through the system initially.

According to press reports and FDA statements, only 2.9 million doses of the Pfizer product will be on hand for administration, starting Dec. 14. And while it’s possible, at least in the near term, to administer all of those to patients immediately, the health officials will administer only half, pending later deliveries, to ensure that patients get the second dose three weeks later. (Moderna’s vaccine calls for a second dose after four weeks.) By comparison, there are 21 million healthcare workers, and three million long-term care patients—the two groups tagged as first in line for vaccination—nationally.

President Trump issued another executive order on Dec. 8 claiming priority for supplying vaccines to Americans first, but given that the Pfizer vaccine is already being supplied to the UK, Canada and Bahrain, and Moderna has commercial agreements with the EU, Canada, Japan and other countries, Trump’s action is more symbolic than substantive. Together, Pfizer and Moderna hope to deliver 25 million doses in the US by the end of the year.

On Dec. 8, the White House’s Operation Warp Speed program held a Vaccine Summit (the relevant comments begin around 1:18 into the video) at which representatives of McKesson, UPS and FedEx presented. McKesson is responsible for delivering vaccines other than Pfizer’s (although there is coordination going on with the company) as well as the kits containing supplies for vaccine administration. UPS is handling, mostly, the US east of the Mississippi, and FedEx the western portion. UPS Healthcare’s president, Wes Wheeler, demo’d the materials the company will use: insulated boxes from Softbox and Cold Chain Technologies, an end-to-end tracking device (for location and environmental conditions) from Controlant, and its own RFID tag, and Sentry GPS system, that is read at UPS way stations. FedEx is using its own SenseAware device for location and environmental monitoring, and FedEx Surround, a predictive analytics monitoring system. UPS is also preparing to send supplemental dry ice, alone, through its network, from dry ice production capacity it has installed.

There have been numerous statements to the effect that the vaccine-distribution process is a monumental undertaking (The New York Times called it “a challenge of staggering proportions”), but the delivery companies pooh-poohed these concerns. UPS’ Wheeler noted that while hundreds or thousands of vaccine parcels might be in transit soon, the company handled 34 million packages through its network on Dec. 7 (the day before the Summit). FedEx’s Richard Smith, regional president, allayed concerns that there are enough cargo aircraft available; his own company could, in theory, manage delivery to the entire world itself in a short period of time (of course, many other carriers are and will be involved). Deliveries on this scale “is what we do every day,” he said.

State-level efforts

Operation Warp Speed and the CDC are deciding how to allocate vaccine shipments among 50 states and territories, but after that, most of the decisions will be made at the state and local level, including what priority is given to which citizens. Fifty states have 50 plans (Kaiser Health News consolidated all these plans, as of mid-October, here).

At least one state—Louisiana—is relying on an in-state wholesaler for local distribution for certain categories of dispensing locations. Paul Dickson, president of Morris & Dickson, says the company is handling delivery to 200 medical facilities that are not major hospital locations. It has installed sufficient ultra-cold storage for 750,000 doses of the Pfizer vaccine, and contracted with a local dry ice supplier to provide up to 4,000 lb of dry ice weekly. It will be able to receive vaccine from Pfizer and deliver to facilities the same or next day. (Morris & Dickson operates in 18 states across the Southeast and Midwest, but so far, no other state has asked it to step in.)

Like the UPS and FedEx representatives, Dickson is bullish that vaccine distribution will proceed smoothly. “In our everyday business, we’re tracking 30,000 products being delivered daily across a wide region,” he says. “We have our part to do, and we plan to do it well.”

12/15 UPDATE: On Dec. 14, Cardinal Health announced that it has been selected by the Ohio Dept. of Health to deliver Covid-19 vaccines to 350 locations within the state. The company, which is headquartered in Dublin, OH, but operates nationally, will be using its OptiFreight Logistics service to make these deliveries; OptiFreight is tailored to the needs of healthcare sites. Last month, the company announced that it has an agreement with CDC to be a network administrator for Phase 2 deliveries, when a wider portion of the US population will be served after the Phase 1 deliveries for healthcare providers and long-term care residents.