Logistics of the COVID-19 vaccine: a lot left to work out

We’ve heard a lot about the race to develop a safe and effective COVID-19 vaccine, which hopefully will be ready for approval around the end of this year. However, just because there is a vaccine doesn’t mean it will be widely distributed right away. Most of us will not have access to a vaccine until at least the middle of next year.

There are many reasons why it will take much longer than we all hope, including the fact that much of the distribution planning can’t even begin until we know which vaccine candidates will be approved. A further complication is that the various vaccines have different handling requirements.

The CDC (Centers for Disease Control and Prevention) will coordinate U.S. distribution. The plan is to allocate vaccines to all 50 states, with the state health departments responsible for overseeing distribution from there. So far, states have responded quite differently to the pandemic. We can expect their distribution approaches to be widely disparate as well.

While the manufacture of leading candidates is beginning even before government approval, distribution will not ramp up as quickly. Most will be handled by current medical supply chains, which will expand some, but what is required is still light-years beyond their capacities. It’s unlikely that supply chain infrastructure not already associated with established and trusted medical channels will be incorporated into the distribution of the vaccine. Few distributors will invest in infrastructure they won’t use once the pandemic subsides.

A key factor is that at least two of the leading candidates require that vaccines remain at -70º C (-94º F) at all times. Even our current medical distribution models aren’t equipped for this. For instance, most of the doctors’ offices, pharmacies, and clinics that routinely distribute flu vaccines cannot maintain vaccines at these temperatures.

Such stringent requirements will limit the scale of distribution. And scale is a huge problem. There are 330 million Americans and 7.6 billion people in the world, all needing a vaccine. Most of the vaccines will require two doses. We don’t even know yet how long a vaccine is effective. Will we all require a yearly vaccine as with the flu shot? These are many of the unknowns that affect supply chains.

Actual distribution will follow allocation guidelines developed by the National Academies of Sciences, Engineering, and Medicine. There will be four phases, with initial doses going to health care workers, first responders, and those with serious health issues or living in nursing facilities. The second phase targets teachers, those in prisons and homeless shelters, essential workers, and people with other underlying conditions. Most Americans will not receive a dose until Phase 3 or 4.

It’s a simple matter of demand exceeding supply and capabilities. Don’t expect much change in our lives for quite some time yet.