Kinks in the vaccine supply chain

MARY REICHARD, HOST: It’s Tuesday, the 12th of January, 2021.

Glad to have you along for today’s edition of The World and Everything in It. Good morning, I’m Mary Reichard.

MYRNA BROWN, HOST: And I’m Myrna Brown. First up: vaccine supply chains.

OK, let’s play teacher for a minute and grade vaccine rollouts. France would probably get an F, as in fail. In one week, the country vaccinated just 500 people.

REICHARD: On the other end of the curve, Israel gets an A. The tiny country inoculated 15% of its population in just two weeks, more than 1.6 million people. That’s the fastest pace in the world. 

As for the United States? Well, it’s landing somewhere in the middle.

WORLD’S Sarah Schweinsberg reports.

AUDIO: [Cameras flashing]

LINDSAY: I’m ready. 

SARAH SCHWEINSBERG, REPORTER: On December 14th, New York nurse Sandra Lindsay became the first healthcare worker in the United States to receive a COVID-19 vaccine. 

AUDIO: [Clapping]

LINDSAY: I feel hopeful today, relieved. I feel like healing is coming. I hope this marks the beginning to the end of a very painful time in our history. 

In the month since, 9 million people have gotten their first dose of the Pfizer or Moderna vaccines. That’s about 3 percent of the population.

While the fact that anyone has gotten a COVID-19 vaccine shot within a year of the pandemic’s start is an achievement, these numbers are still far below the Trump administration’s projected goal. 

Dr. Moncef Slaoui is chief medical adviser for Operation Warp Speed. In November, he said 20 million Americans could get the vaccine by the end of the year. 

SLAOUI: We plan to have enough vaccine doses available for use in the U.S. population to immunize about 20 million individuals in the month of December. 

But getting a vaccine from a factory all the way to an arm is proving more difficult than expected. 

David Ding specializes in healthcare supply chains at Rutgers Business School.

He compares the vaccine supply chain to a river, starting with the headwaters. 

DING: So upstream essentially, are the manufacturers.

The upstream supply chain also includes securing the ingredients to make the vaccines and the government regulations to certify them. 

David Ding says the Trump administration helped take care of these upstream issues. 

DING: To help those pharmaceutical companies to speed up the clinical trial process, to find the best candidates for vaccine. And then to also help pharmaceutical companies to secure the raw materials and including the vials and all those different other packaging materials. 

By the end of 2020, Operation Warp Speed had purchased 400 million vaccines. And so far, it’s delivered 25.5 million doses to states.

Ding says the operation is running into more trouble downstream in the states. 

There, vaccines have to flow through the final white water rapids of coordination, storage, and distribution. 

DING: The largest problem we have right now is what we usually call the bottleneck or another term that last mile delivery to administer the vaccine to patients’ arms.

And it’s not really a new problem. Bruce Y. Lee is with the CUNY School of Public Health. 

LEE: We’ve seen this before, where a lot of the focus is in, okay, how do we encourage development of a new vaccine? But then many times, the actual logistics of producing and delivering, distributing the vaccines is overlooked. If you’re not actually delivering it to people, it’s not going to have an effect on the disease. 

There are a few reasons for the current bottleneck. The first is the sheer scope of the task. 

David Dobrzykowski is a supply chain professor at the University of Arkansas. 

DOBRZYKOWKSI: We’re asking healthcare providers and pharmacies to do right now is on a scale that has never been realized previously. 

Dobrzykowski says the second problem comes down to a shortage of manpower. 

Hospitals have to inoculate their own workers while still caring for all of their patients. 

DOBRZYKOWKSI: Hospitals are very, very good at complex care. They are the place to go if you need ICU care for, you know, a COVID condition. But they’re not really organized in a way for vaccine distribution.

The federal government contracted with drug stores CVS and Walgreens to immunize nursing home staff and residents. Pharmacies know how to provide medicine in stores. But delivering it is another endeavor. 

DOBRZYKOWKSI: This is a whole new twist now that we’re asking pharmacies to administer those vaccines outside of the confines of their facility and actually travel to a nursing home for, you know, a larger scale type of vaccinate, vaccination type of, you know, event. 

And there’s something else. 

Rutgers’ David Ding says supply chains rely on demand. And right now, some front line workers, especially in nursing homes, don’t want the vaccine.

DING: There’s a very high percentage of people who refuse to take COVID vaccine.  

In Ohio, more than half the people working in nursing homes refused to get a shot. At a veterans home in Illinois, only 1 in 5 staffers got the vaccine.

Ding, Dobrzykowski, and Lee expect that as time goes on hospitals and pharmacies will find their stride. And demand is likely to pick up as well.

But as distribution widens to the general public, Dobrzykowski predicts new sources of bottlenecks. 

DOBRZYKOWKSI: The challenges that the distribution supply chain faces today, again, in early January, will be very different in early February, March, April, and so forth.

Reporting for WORLD, I’m Sarah Schweinsberg.

(Dan Gleiter/The Patriot-News via AP) Each vial contains five doses of the vaccine. UPMC frontline workers receive the first doses of the Pfizer COVID-19 vaccine at UPMC Pinnacle Harrisburg hospital, December 18, 2020. 

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