Based on A Shot in the Arm: How Science, Engineering, and Supply Chains Converged to Vaccinate the World by Yossi Sheffi, published on October 19, 2021 by MIT CTL Media. Copyright © 2021.This article is part of a series in which OECD experts and thought leaders — from around the world and all parts of society — address the COVID-19 crisis, discussing and developing solutions now and for the future. Aiming to foster the fruitful exchange of expertise and perspectives across fields to help us rise to this critical challenge, opinions expressed do not necessarily represent the views of the OECD.
Enduring Lessons from the Race to Deliver Covid-19 Vaccines
In my book A Shot in the Arm: How Science, Engineering, and Supply Chains Converged to Vaccinate the World (MIT CTL Media, 2021), I tell the story of the record-breaking speed and success of the international effort to develop and deliver Covid-19 vaccines. Of the many lessons this epic story has taught us about handling global-scale crises, some of the most important pertain to the supply chains needed to support such an effort.
The manufacturing puzzle
Building on decades of biochemistry and microbiology research, medical scientists developed, tested and gained approval for Covid-19 mRNA (messenger ribonucleic acid) vaccines. As described in the first chapter of my book, the vaccines teach the human body how to recognise coronavirus invaders and neutralise them before they convert the body’s cells into virus factories. The next step requires teams of engineers and supply chain experts to create the manufacturing and supply chain capacities needed to produce hundreds of millions—and then billions—of doses of vaccine worldwide.
Even for the giants among global pharmaceutical companies, it was a significant challenge to design, build, test and operate a manufacturing system for an entirely new type of product on an accelerated schedule. Chaz Calitri, Pfizer’s Vice President of Operations for Injectable Drugs in the United States and Europe, described the stakes: “The weight of the world was on us. We have the manufacturing capability for a solution to the pandemic, and we knew we couldn’t go fast enough”.
Although Pfizer had never manufactured an mRNA vaccine in high volume—no one had—most of the steps for making BioNTech’s mRNA vaccine overlapped with Pfizer’s vast array of pharmaceutical manufacturing capacity for making biologic pharmaceuticals. “We built this out of the Erector Set we had,” said Patrick McEvoy, who oversaw the sprawling 1,300-acre plant in Kalamazoo, Michigan, where much of Pfizer’s US vaccine manufacturing took place.
The pandemic raised trade-off questions between large-scale, centralised production to serve global demand versus decentralised production with sites serving local demand.
Production of the vaccine also required out-of-the box thinking. Another vaccine maker, Moderna, had built some of the most advanced manufacturing facilities in the world. In the book, Paul Granadillo, Senior Vice President for Supply Chain at Moderna, describes how the company created the futuristic plants that played a crucial role in meeting the huge demand for Covid-19 vaccines.
“We needed to be planning this facility like a commercial industrialized manufacturing facility and not clinical lab space”, said Granadillo. First, the facility had the digital processes required for high-volume production. Moreover, the company designed its manufacturing white room for flexibility by having an open space with utilities suspended from the ceiling to make it easy to rearrange the space.
For manufacturing, Moderna chose a strategy based on single-use equipment, such as bioreactor bags, plastic tubing and connectors, rather than traditional fixed, stainless-steel equipment. “Part of the reason we are leveraging so much single-use technology”, Granadillo explained, “is because of the speed that it allows us to proceed forward with, and the flexibility to change the assemblies”. Single-use equipment also avoids the costs, delays and risks of cleaning protocols. Although using single-use plastic bags in manufacturing seems, at first glance, to be wasteful, the disposable bags actually have a lower environmental footprint because using them eliminates all the chemicals and hot water required to clean a reusable stainless-steel vessel after each use. Moderna uses suppliers who can build pre-sterilised assemblies of bags, tubing, connectors, filters and so on to whatever design specifications Moderna needs for the task at hand. The result is maximum flexibility, maximum production speed and a minimum risk of contamination.
Rethinking supply chain strategies
But making the vaccine is only half the challenge; companies also faced the task of transporting and distributing huge volumes of vaccine to locations where it is was injected into human arms.
Finding enough freight-carrying capacity was a major obstacle to overcome. For example, the mass cancellation of passenger flights owing to the pandemic meant that there was less space in aircrafts’ cargo holds to move vaccines. “Prior to the pandemic, about 70 percent of our J&J medical and pharmaceutical products were transported in the bellies of commercial aircraft,” explained Meri Stevens, a global supply chain leader in Johnson & Johnson’s consumer health business. Fortunately, freight transportation companies were willing to prioritise shipments of vaccine when demand for the product was critically high.
The challenges of transporting huge volumes of vaccine also led companies to review their approaches to distributing pharmaceuticals. “The push to buy local-for-local and to shorten supply lines was not something new from the pandemic”, Stevens said. However, the long regulatory approval times required to certify a new facility for a supplier meant that pharmaceutical companies like J&J had to avoid knee-jerk responses when investing in manufacturing capacity. “We’re not rushing to say, ‘Now we’re going to move everything from A to B’, because that’s expensive and that takes time”. In the case of J&J, she continued, “During the pandemic, what we found is that the global nature of our supply chains worked really well—the balance that we have around the world was very good”.
Read more about supply chains: Resilient Trade Starts with Sustainable Supply Chains by Didier Bergeret, the Director of Sustainability at the Consumer Goods Forum
Sourcing and manufacturing site selection strategies for vaccine production also came under scrutiny. The pandemic raised trade-off questions between large-scale, centralised production to serve global demand versus decentralised production with sites serving local demand. At J&J, the supply chain design criteria emphasised reliability and resilience to serve customers and patients in the most effective and efficient ways. That said, Stevens also noted, “We’ll also continuously evaluate the national norms that are going on to see whether or not we have to rebalance”
Another area in which pharma companies had to adjust was in their approach to partnerships. Vaccinating even 70% of the world’s population of 7.8 billion would require nearly 11 billion doses of vaccine (assuming two shots per person, which was a common requirement for the first vaccination campaign of many of the leading vaccines). The potential need for booster shots added to the dosage count. In the quest to vaccinate the world, companies sought partners. “We’re leaving no stone unturned in terms of partnerships”. said Alex Gorsky, J&J’s CEO. “One of the most important lessons of the pandemic is the power of collaboration”.
The race to deliver vaccines also demanded many innovations in logistics. For example, manufacturers learned new lessons in how to keep the vaccine cool while in transit. Covid-19 vaccines required extra careful handing owing to their unique molecular makeup. “Initially it was very much about the science and discovery, but very quickly we were having to create whole cold chains that didn’t exist before”, said Meri Stevens.
Pfizer said it developed a “just-in-time system, to ship the frozen vials direct to the point of vaccination”. That system included packaging for shipping, continuous monitoring of vaccine temperatures to ensure safety, and a means to store the vaccine for up to a month at clinics, vaccination centers and distribution facilities that lacked deep freezers.
An enduring lesson from the vaccine story is one that supply chain professionals have long known: supply chains aren’t about doing one thing well; they are about doing every one of a multitude of things well.
The pharma company worked with SoftBox, a British multinational manufacturer of temperature-controlled packaging, to develop a reusable insulated thermal shipping box that holds 1,200 to 6,000 doses (at the 6-dose-per-vial capacity), and can maintain ultra-cold temperatures for up to 10 days. Moreover, if needed, the dry ice can be replenished every five days to extend storage time for up to 30 days. A small, battery-powered sensor tracks vaccine temperature, when the box is opened, and its GPS location.
Pfizer bought large numbers of deep freezers to set up freezer farms to buffer and distribute the output of its production facilities in Michigan and Belgium. The company also built its own dry ice plant to make the freezing pods that keep the vaccines cold during transit.
Airfreight companies and facilities also prepared for the vaccine distribution campaign. UPS, for example, built its own freezer farms and dry-ice production equipment at key air hubs. Airlines conducted trial runs of vaccine deliveries to both debug systems and ensure the CO2 emissions from the dry ice remained within FAA-required limits.
Having developed highly innovative ways to manufacture and distribute vaccines, vaccine suppliers and supply chain teams had to overcome a long list of challenges. Shortages that began in the product development labs moved into the ingredient supply chains, and then hit the packaging ends of vaccine development and production processes. Shortages also hit capital equipment supply chains as pharmaceutical makers attempted to ramp up their capacity. As the adage goes, supply chains are only as strong as their weakest links.
Even the packaged final product—billions of doses of safe and effective vaccines—wasn’t the end of the challenge. Those vaccines still needed to get to the customers: all people in all the countries of the world. Although modern supply chains have become adept at quickly and accurately making and moving millions of shipments of consumer products per day anywhere in the world, actually getting those doses into people’s arms was a real challenge that tested national and local institutions.
An enduring lesson from the vaccine story is one that supply chain professionals have long known: supply chains aren’t about doing one thing well; they are about doing every one of a multitude of things well. In meeting this challenge, the scientists, engineers and supply chain experts who successfully delivered Covid-19 vaccines to the world have also laid the groundwork for managing and overcoming future global emergencies.
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