How countries can speed up COVID-19 vaccine distribution

A number of developed nations are successfully rolling out the COVID-19 vaccine, with the US finally entering a rapid vaccination push and countries like Israel, the UAE and the UK reaching ambitious targets.

Developed nations have many competitive advantages for rolling out the vaccine, ranging from superior digital and physical infrastructure to a strong negotiated supply of vaccines.

But setting the geopolitics of vaccine purchase aside, the last mile distribution of the Covid-19 vaccine is a particularly difficult one from a logistical point of view and might explain why some developed nations are lagging behind.

In the report Pandemic, Parcels and Public Vaccination, the World Economic Forum and McKinsey & Company explain the core logistical challenges and present some solutions in the mass vaccination effort of Covid-19 in urban areas in developed nations. The logistical challenges in rural and/or developing nations are even more complex and challenging.

Operationally, there are three main steps – (1) operations and planning, (2) movement of syringes, and (3) inoculating the patient. In each of these steps, there are logistical hurdles that vary based on the local context.

Digital infrastructure at the national level helps

Broadly speaking, countries with tight integration of health care with logistics stakeholders seem to show the highest national vaccination rates, 4 months into 2021. For example, Israel has universal insurance coverage and a central, fully integrated, digital public health system, allowing for data-based patient prioritization and timely communication.

Nearly every Israeli citizen and resident belongs to one of four public HMOs, a health care system rooted in the national trade union of Israel's early years. Every Israeli's full medical history – from physician visits to hospitalizations – is accessible to any health provider at the click of a mouse, a repository of digital records going back 30 years.

An efficient digitized system alerted priority groups when and where to go for their vaccines. Similarly, the UK's National Health Service (NHS) has one of the most centralized, streamlined vaccine distribution efforts worldwide. Another surprising leader in vaccine distribution is Chile. In the first three days of the mass vaccination campaign, some 556,000 people were vaccinated against COVID-19, quickly making it a leader in the region.

So why are some countries falling behind?

What are the hurdles seen in developed nations like the United States and European Union and how can they be resolved?

Firstly, good news. Companies like DHL, FedEx and UPS are very well equipped to handle the cold-chain transportation requirements safely and in a time-sensitive manner. These companies have invested more in refrigeration trailers and can cycle from the place of manufacturing to distribution nodes within a day. The challenge comes reaching the underserved communities, such as rural areas while making it cost-efficient and environmentally friendly.

The US and Germany, despite their relatively strong logistical infrastructure, are still facing structural issues:

Fragmented regulations – In the US and Germany, healthcare providers and logistics companies navigate a decentralized, federalist approach and a patchwork of disintegrated IT systems that are manual and inefficient. Countries such as UAE and Israel did well by managing the vaccination with a centralized governance body. The differentiated state-by-state rulings on everything from vaccine eligibility and prioritization to directions for distribution centers make it difficult to predict, replicate and leverage gains from synchronicity. This leads to vaccine wastage and other inefficiencies.

Inefficiencies in connecting demand and supply: While many countries have managed to digitize and professionalize the patient journey – leveraging professional call centers, online registration and digital demand management – many logistics companies complain that the same rigorous approach to central, digital logistics management has not been effectively implemented. We interviewed a leading logistics provider who said, “In many cases, logistics planning happens with the aid of manual Excel files, outdated by the time the data is handed over to route planners and drivers.” Much tighter integration of data flow and physical goods flow is needed in the upcoming weeks and months.

Complex prioritization process: Many countries have decided against a ‘first come first serve’ approach to vaccination. Later this year, after the elderly and immune-compromised population get vaccinated, the prioritization will become more heterogenous and complex as the general groups get in line. This will often be a mix of age, profession, and health status. This increases the need for a central, data-based prioritization strategy and will almost inevitably result in more complexity for logistics players who will face last-minute changes on demand and routing, and potentially need to factor in returns and re-touting of left-over doses from one place to the other.

While an integrated demand and supply system for patient prioritization and vaccination deliveries could increase system efficiency, new and unprecedented risks of cyberattacks and data misuse occur.

Increased unequitable results for the underserved: The vaccine journey from a centralized distribution center to clinics to patients’ arms isn’t only about inefficiencies, but rather an unravelling of the systematic failures of our unequitable society.

Research is showing how minorities and undocumented workers are getting left behind. White as compared to under 10% Hispanic, Black and Asian communities. Many who are already eligible for vaccines – be it elderly or front-line restaurant workers – do not have internet access or much interaction with the health care system.

How can the vaccine laggards catch up?

Technology, technology, technology.

End-to-end unified systems with partners for data integration are needed.

Arguably, developing a central platform at national level will be too complex, too expensive, and too slow in implementation.

Anja Huber, last mile expert and member of McKinsey's Center for Future Mobility argues: "Governments and logistics companies could think about teaming up with players who are experienced in managing very local, capillary demand and with integrating a large number of local retail outlets. Examples include large online retailers, eGrocery giants and technology/platform players."

Unified systems that map out the end-to-end delivery help planners forecast route optimization to supply-chain fluctuations and provide real-time updates. Such a transparent and secure system could help healthcare providers adjust resources on the ground.

Remaining nimble when we stumble upon the unknown unknowns is to be expected. This could also enable more effective communication between driver/logistics player and local health centers, including real-time estimated time of arrival (ETA), automated push notifications as well as dynamic navigation and re-allocation of vaccination supply.

Scenario planning is key to minimizing vaccine spoilage.

Cold-chain storage is complicated. All ecosystem stakeholders should move from reactionary logistics approaches to more proactive planning strategies and the use of scenarios, factoring into their supply-chain strategies certain back-up contingencies.

Home Instead is a US-based company providing care to the elderly population. Given the rampant and dangerous spread in nursing homes, Home Instead was critical in bringing health to home in safe ways. By collecting data on infection rates vis-a-vis human behaviors, they helped governments and companies dynamically adjust the need for COVID supplies and safety protocols around PPEs and distancing.

Traceability and authenticity is key for trust and planning.

Real-time intelligence about every COVID-19 vaccine vial could ensure knowing the provenance of the vaccine, the route it’s travelled and therefore, its authenticity.

It would also allow each healthcare center to predict the number of vials needed per day. By giving a ‘helicopter view’ of every vial of vaccine, real-time intelligence can create a dynamic inoculation system that can resolve the trust in the authenticity of the vaccine. Cloud technology companies such as Evrythng can give real-time intelligence for ensuring provenance of the vials. Henry Schein, a medical supplies company noted that the strength of the medical supply chains is not built for a confluence of crises as that unfolded in 2020.

From shortages in gowns manufactured in Wuhan prior to the outbreak to hoarding of medical supplies, had there been a real-time digital accounting of the PPE, companies could have managed the supply of masks better and curtailed the spread faster.

All intervention will be in vain without trust and inclusivity at a community level.

It’s essential that all of these interventions need to work in tandem with community centers and nodes set up by healthcare service providers at the local level.

Jefferson Health is a network of 14 hospitals on the northeast coast of United States. They recognize that marginalized populations face health disparities and their mistrust of the health system is common in many of communities, which can hinder public health initiatives.

With programs such as the ‘Real Talk’, they are encouraging conversations about the vaccine to overcome hesitancy. One of the biggest concerns is to inoculate the largely undocumented gig economy workers that work in the travel, tourism, and restaurant businesses.

Y-USA, established 175 years ago, are community centers where young or old, rich or poor, access community provisions for health, libraries and cultural services, forming deeply rooted trust-based relationships. Community leaders such Black Doctors COVID-19 Consortium are setting up vaccination centers in the communities that are highest at risk and most reticent to take the vaccine.

The Y-global has a robust footprint in parts of the country where medical centres and pharmacies are not available. As such, for years, it has been the lynchpin that connects community health with its regional healthcare system. It is therefore well-placed to conduct community-based inoculation sites for a new vaccine that requires education, trust-building and urgent implementation.

Optimism awaits

We learnt from polio vaccination programs that with global effort and cross-border learning we can eradicate disease from history. The pandemic has taught us that all interventions will go to waste without innovative partnerships, breaking down bureaucratic barriers and addressing systemic inequities to fight this pandemic.

"As in so many other industries and areas in life, this global pandemic has the potential to fast-forward digitalization of delivery chains by multiple years. In a few months from now we will see which private sector players have used this momentum to leap forward to create strategic distance," Anja Huber notes.

Clearly, much still needs to be done to ensure developed countries overcome and possibly leapfrog operational issues. Mobility transitions should not overshadow an even larger ethical challenge in the context of global north and global south, and possibly – help speed greater equity.