Vaccine

Getting the jab

It’s possibly the greatest logistical challenge ever faced by humankind: distribution of temperature-sensitive vaccines at unprecedented speed and scale. ANTHONY SHARPE delves into the challenges facing South Africa’s roll-out plan

South Africa’s COVID-19 vaccine programme is underway in fi ts and starts, with the AstraZeneca option fi rst being rejected, and the subsequent Johnson & Johnson roll-out paused and then resumed.

And while procurement has been centralised in the hands of the National Department of Health, experts in the logistics market need to be involved in the distribution process, says Daniel Dombach, Director EMEA for

Industry Solutions at Zebra Technologies.

“That’s what we’re seeing in the majority of countries. Most governmental organisations don’t have the knowledge or infrastructure. The police and army can play an assisting role but should leave track-and-trace and cold chain monitoring to the experts. “Transportation of pharmaceuticals has been happening for a long time, so most countries have an existing infrastructure of logistics providers, many specialising in the cold chain, who are adept at handling vaccine transport,” says Dombach.

Thankfully, South Africa is well equipped in this capacity, asserts Mohammed Akoojee, CEO of Imperial Logistics. “There’s no lack of warehousing capacity or transport expertise in the private sector to handle a project of this scale.”

What will determine the success of the endeavour, says Akoojee, is coordination at the front end because rapid mass vaccinations require supply chain effi ciency. “To enable effective coordination, there needs to be good information fl ow between the point of vaccination and warehousing, distribution and logistics.”

Distribution points

Mass vaccinations also require a massive number of vaccination points. “Authorities around the world have set these up in major sports arenas, parking garages, concert halls or repurposed exhibition halls,” says Dombach, “with some places even offering drive-through vaccinations.

“Doctors’ offi ces will play an important role, but if you

VA-VA-VOOM VACCINES

Vaccines usually take years to develop, prompting concern among some about the safety of those being rolled out with such relative speed. These development cycles have been enabled by unprecedented funding and global sharing of nancial risks.

The COVAX initiative for example, which provides vaccines to the developing world, has the support of 190 countries. Such development cycles are also not unprecedented: a vaccine was developed for the 2009 H1N1 swine u pandemic in just six months, and one for the Zika virus took just two weeks more than that.

Source: Gavi, The Vaccine Alliance

Mohammed Akoojee

want mass vaccinations of as many people as fast as possible, you’ll fi nd the logistical challenges of delivering to individual doctors are greater than those of delivering to a larger venue.”

Akoojee estimates there are presently around 50 centres across the country doing phase one vaccinations for healthcare workers, adding that this needs to be amped up signifi cantly.

“Transportation of pharmaceuticals has been happening for a long time, so most countries have an existing infrastructure of logistics

providers.” – Daniel Dombach

“The good news is the private sector distributes to thousands of points, ranging from pharmacies to public hospitals,” says Akoojee. “We can use those points of care to expand the vaccination network.” He says that while these will need to have the right infrastructure, as well as trained medical staff, if the public and private sectors cooperate effectively this should be feasible.

Anthony Diack, MD of healthcare for DSV South Africa, says the company alone delivers to 14 depots and another 500 direct delivery points around the country, including state hospitals, clinics and correctional services facilities under contract to the National Department of Health. “In excess of 7 800 public sector orders are processed and more than four million packaged units are delivered each month.”

Working together

Akoojee believes government engagement with the private sector at both a planning and execution stage is on track. “The interaction between the public and private sectors is good. The formation of the Presidential Coordinating Council enabled business and government stakeholders to engage around planning this properly. Our experience with the National Department of Health has historically been pretty good – we’ve worked with them on the roll-outs of antiretrovirals and childrens’ vaccines – and our engagements have been positive and constructive.” The tender for distribution of vaccines was a result of these engagements.

Unfortunately, where there are tenders, there’s a chance of corruption. but Akoojee believes there is reason for optimism. “The risk of corruption is limited because of the type of product and the regulations around distribution. It’s stricter than PPEs. To deal with vaccines, you need the right South African Health Products Regulatory Authority approvals, you need the right sort of warehousing. It’s not something every logistics provider can do.”

Precious cargo

While South Africa may have plenty of experience in vaccine distribution, those developed for COVID-19 present their own unique challenges.

“What’s different now is that some vaccines, for example the Pfi zer-BioNTech one, need to be transported at arctic temperatures of -70 to -80°C, and others need special care,” says Dombach. “For this reason, it’s essential to monitor the temperature corridors at which vaccines are transported, which requires additional technology.”

To this end, Zebra employs its Temptime temperature-sensitive labelling monitoring solution. “We have data loggers that can monitor the temperature of a product on its journey, in the range of 200 to -200°C,” explains Dombach. “At the point of arrival you can read all the data from this device through a Bluetooth connection to a handheld terminal or smartphone, and immediately see which shipments are or aren’t in good shape.”

Diack says DSV can accommodate both Johnson & Johnson and Pfi zer vaccines. “J&J vaccines are stored and distributed between 2 and 8°C and present no challenge outside of DSV’s existing cold chain service. Pfi zer vaccines are stored long-term at -70°C. We’ve invested in ultra-cold freezers to store these, which are augmented by passive KryoTrans storage locations, with dry ice validated at -70°C.”

Diack says DSV’s end-to-end cold chain service makes use of a range of passive packaging solutions validated for up to 144 hours. “Product integrity is ensured because there is no break in the cold chain at all, from source of product or vaccine to OR Tambo International Airport, on to our cold chain facilities and then via our vehicles to the destination.”

DEFENCE VECTORS

The Johnson & Johnson vaccine is what’s known as a viral vector vaccine. This works by injecting a patient with a harmless adenovirus that has been modi ed to include instructions for creating SARS-CoV-2 spike protein. When the patient’s cells read this instruction and create the spike protein, their immune system responds by producing antibodies against them, protecting them in the event of future exposure to COVID-19.

Source: US Center for Disease Control

Keeping it safe

In this process, as with any modern logistics operation, visibility throughout the supply chain is key. Akoojee says government has put out a tender for a validated solution to maintain supply chain visibility and product integrity. He says control tower solutions – which function like the control tower at an airport, monitoring and controlling the fl ow of traffi c in and out – are applicable here.

Visibility is also essential for security. While thefts and counterfeiting have plagued supply chains around the world (not least of all in South Africa) throughout the pandemic, the vaccine presents an extraordinarily tempting target for nefarious activities.

“We’re a logistics company operating in Africa, so it’s part of our business to ensure security through satellite tracking, armed escorts, spot checks and technology like control towers that helps identify where the product is at all times,” says Akoojee.

Dombach says the fi rst counterfeit vaccines have already been discovered. “Serialisation plays a very important role here – being able to identify each and every box, or even vial, because they’ve been marked with a unique serial number or barcode sticker that can be read and checked to see it’s not a duplicate of another number somewhere in the world.”

VACCINATION ROLL OUT SIGNALS DISTRIBUTION SUCCESS

DSV’s investment in -70°C cold chain helps South Africa’s fight against COVID-19

The mass roll out of vaccinations against COVID-19 started in mid-May this year. DSV Healthcare was awarded the tender (jointly with The Biovac Institute) by the National Department of Health (NDoH) to distribute the -70°C vaccines – jointly developed by Pfizer and BioNTech – to multiple private and public vaccination sites around the country.

There has been much debate around South Africa’s capability to distribute vaccines at -70°C, and while the challenges are many, DSV has been working successfully in this space for 20 years. DSV was so keen to contribute to the fight against COVID-19, that it bought nine highly specialised ultra-cold freezers on risk – there would have been no time to boost capacity once the tender was awarded.

The turnaround time from the first delivery of the vaccine to DSV to DSV’s first delivery to a vaccination site was 10 days (this includes the seven-calendar day stability testing process). This is testament to DSV’s forward planning and the commitment and efforts of the NDoH planning team.

For DSV, success means staying true to the standard operating procedures that have been specifically developed for the NDoH and which factor in four variables that make this project like no other: 1. Risk mitigation planning. Storing and transporting product that must remain consistently at a temperature of -70°C involves high risk. To counter this, every risk has to be understood and a primary and secondary risk mitigation plan developed. 2. Scale. DSV will distribute high volumes over a sustained period, which requires meticulous planning. 3. Time. Due to the urgency of getting the product to vaccination sites, receiving and sampling timelines have been halved and a white glove delivery service put in place. 4. Accuracy. It is critical to get the right amounts to the right place at the right time to support each site’s daily vaccination plan. For risk mitigation, DSV’s planning includes a product recovery process should a delivery fail for whatever reason. In this instance, DSV would use its national footprint of cross-dock hubs to re-ice the consignment, thereby enabling 72 hours to return that product to DSV’s main storage hub.

These critical success factors are woven into the three processes – warehousing, distribution and DSV’s control tower – which have been recalibrated to make sure the vaccinations are received as scheduled.

The first order of Pfizer vaccines – packed and ready for dispatch from DSV on 12 May 2021. From left to right: Back row: Daniel van der Linde, Tracy Frank, Lavelle McAnda, Eben Zandberg, Jeffrey Nkonyane, Mishell Mathipe, Nishan Ramsamy, Dudley Saunders, Christel Lupton Front row: Ralton Moses, Carine Labuschagne, Adrienne Youell, Ravina Govender.

WAREHOUSING

Warehousing involves receiving, sampling, storing, picking and packing, dispatching, and inventory control. Each step is time-critical.

Storage solutions include nine ultra-cold freezers with overflow product moving to Kryotrans containers with dry ice, should the need arise. There is a dedicated dispatch area, the cross-dock hubs have dry icing capabilities, and stock will be counted twice a year with weekly cycle counts taking place.

Warehousing insight: A vaccine is allowed no more than five minutes outside of frozen storage status and requires two hours at -70°C before it can be handled again.

DISTRIBUTION

Distribution includes delivery to NDoH appointed vaccination sites, collection of cold boxes and temperature monitors and a returns process.

CONTROL TOWER

DSV’s control tower is responsible for inventory management, reporting, monitoring and assessment and order management.

DSV is the largest private distributor of cold chain products to the public and private sectors in South Africa. It has the experience and capabilities to support the national vaccination initiative countrywide. DSV has one of the largest GDP-compliant cold rooms in the Southern Hemisphere and an extensive range of passive cold packaging solutions are validated to up to 144 hours.

Reporting insight: Compile and distribute intra-day, end of day, weekly, monthly and KPI reporting to stakeholders.

For more information:

www.dsv.com/en-za