The final step for the COVID-19 vaccine may well be the most complicated

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Estimated Costs Of Covid-19 Vaccines

The race to find a solution for the  COVID-19 pandemic in the form of a possible vaccine started as soon as the world was under attack by the infection caused by the deadly virus. 

Finally, two companies have announced that their vaccines are prepared and are safe and about 95 percent effective which came as amazing news for the many all around the world. Notable governmental regulators countries such as United Kingdom gave the go ahead for, December 2 which has been marked as the emergency use of a vaccine made by the pharmaceutical company Pfizer and their German biotech partner BioNTech. The first few doses of the new vaccine could be delivered within a few days. The Emergency use authorization and even full approval of the vaccines is probably not far off in countries such as USA or Canada with more countries to soon get the vaccine as well. 

But with one race ending, it seems another has just begun. It is worth noting that, the vaccines will not be successful until or unless enough people have gotten the vaccine which will hopefully stop the spread of the virus and prevent thousands if not millions of more deaths. Just the distribution of the vaccine will be a major logistical challenge on its own, one which companies as well as governments have to prepare for. In normal conditions, vaccines have just a mere 10 percent chance of making it from Phase II clinical trials which in turn, can be tested safely, secondlu, dosing can give hints about the effectiveness of the vaccine. In contrast, on an average, it takes successful vaccines over four years to go from Phase II trials to full on approval. 

Even if the COVID-19 vaccines made by Pfizer or by a biotechnology company Moderna are able to be efficiently distributed in late December under emergency use provisions, keeping in mind that this happened only after one year of clinical trials, they may not be able to get full approval from the U.S. Food and Drug Administration for months, or even years and other countries may also have go account for approval from their governments based upon the policies that they have put in place. 

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Now although, the race to make the COVID-19 vaccine is moving at a rapid pace, it is still far away from ending the pandemic, mentions Robin Townley in Washington, D.C., who currently chairs the special-projects logistics for A.P. Moller-Maersk, a company which is motivated to handle the supply chain logistics and transportation services for many companies all around the world. Townley says that “The vaccine race now is not a race out of the lab. It’s a race to the patient. The  most successful COVID-19 vaccine, will be those made by the companies that pay the most attention to the last mile of the race.”

Presumably the last mile or the last step for the provision of the vaccine’s journey from, say, centralized distribution centers to clinics and finally to patients is not at all related with the distance the vaccine has to make before it is available in countries such Pakistan but rather it is maze of various regulations and supply chains which companies have to navigate through in order to to get their vaccine distributed, eventually to pretty much the whole world, including Pakistan and other developing nations all around the world. The vaccine can not simply be for the most developed countries but have to be provided for to countries with far little resources than the developed countries. Just the scale of vaccinating the world is a major challenge for both the makers and the distributors, the makers have to meet with the demand of the whole world and the distributors have to ensure that the demand is distributed effectively. Most COVID-19 vaccines in development require at least two doses for full effect, there will be a need for roughly 15 billion doses globally, which is a daunting measure to say the very least.

In contrast, the management of the vaccine rollout is a also a major variable in the overall process, at least as important as vaccine efficacy, in the equation determining how well a vaccine will be able to counter the the pandemic, researchers have reported on November 19 in Health Affairs. Researchers took in to account various scenarios, relating to the vaccine effectiveness, the pace at which people could be vaccinated (depending both on delivery systems and public willingness) and how quickly the virus continues to spread. Creating the vaccines is one of the most remarkable scientific achievements in the modern day and age, Schwartz believes, however the technical and logistical challenges of getting the vaccines where they need to go is going to be hail Mary of a task and one which will create a lot of complications. 

One major complication is the fact that, while many of the vaccines in the works will require refrigeration, Pfizer’s vaccine the first fully tested vaccine to get permission for emergency use has to be kept super cold, frozen at –70° Celsius. This vaccine requires ultracold freezers or dry ice for refilling specialized delivery containers. Moderna’s vaccine also requires it to be frozen, but is stable at regular freezer temperatures.

In addition, for distribution, Refrigerated and freezer trucks, planes and trains which are able to transport such chilly goods aren’t available in a very huge supply. “Normal systems are not built to take on this large of a challenge in this short of a time frame,” adds Townley. In contrast, for the vaccine to reach various destinations all around the world while maintaining its effectiveness, trade-offs shall need to be made. Either distributors won’t be able to ship some other temperature-controlled cargoes, or they will need to add more cold-shipping capacity, which is expensive.

Even regular freezers, such as the ones which are needed to store Moderna’s vaccine, may prove to be challenging in some areas. Countries with higher climates may struggle to find effective machines which are able to ensure that the vaccine is maintained at the right temperature. 

In a bid to distribute the vaccine, Pfizer have developed special shipping containers, which they have dubbed as, pizza boxes for the food delivery as they resemble to the food containers used to deliver pizza. These boxes can be recharged with dry ice to keep the company’s vaccine cold in transit and for short-term storage. The U.S. government have stated that they will send one dry ice recharge with each shipment of the COVID-19 vaccine, says Kurt Seetoo, the immunization program manager for the Maryland Department of Health in Baltimore.

However, even that recharge won’t last long, so providers will have  to find local sources of dry ice as well, which may prove to be hard especially in rural areas. Maryland is working with local contractors to make sure that they will be ready supply dry ice when it is needed. Pfizer has also ensured various health officials in the United States that their vaccine can be held up to 15 days in its pizza boxes with dry ice recharges every five days and then spend another five days in the refrigerator before it loses its effectiveness. Still, dry ice sublimates, or turns directly into carbon dioxide gas. The fumes can build up and suffocate people if there’s not enough ventilation, which could make transporting and storing vaccines cooled with dry ice a problem. 

One solution to the storage problem is perhaps the use of devices that have been  developed for transporting cells between laboratories or for moving temperature-sensitive medicines, such as those used in the process of curing cancer or gene therapies, to clinics, says Dusty Tenney, chief executive of Stirling Ultracold, a company which specialize in making portable freezers which can go to temperatures as low as – 80° C. Stirling’s portable freezers — which look like high-tech versions of beach coolers — are being deployed to get COVID-19 vaccine from “freezer farms,” where the vaccines are stored after they come off production lines, to clinics and other distribution sites.

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