Zisis Kozlakidis, International Agency for Research on Cancer, with Erik Steinfelder, Thermo Fisher Scientific, chart the challenges in healthcare logistics in relation to COVID-19
The effects of the coronavirus infectious disease (COVID-19) globally are striking, as the pandemic impacts concurrently social, political, economic and healthcare aspects in many countries. The toll of this pandemic remains to be accurately quantified not simply by human lives and suffering, but also by the psychosocial impact, as well as the wider economic slowdown. The above observations constitute strong reasons to translate ongoing experiences into actionable lessons, and to improve the whole spectrum of population health, as well as healthcare delivery and support. (1)
During a pandemic, there are multiple priorities, including the need to understand the disease, optimise patient care and prevent further transmission. As such, COVID-19 underpinned the central positions of diagnostic testing and mass-vaccination in outbreak control. Ending the pandemic involves the accurate application of diagnostic testing in high volumes and the rapid use of the results to help implement the appropriate therapies, the vaccination campaigns and ultimately, prevent further spread. As the number of COVID-19 cases rose outside of China in February 2020, the first bottlenecks in the global logistics chain became apparent, with healthcare and laboratory supply chains being highly dependent on the unfolding situation in other countries. Here an overview is provided on the challenges in healthcare logistics in relation to COVID-19, focusing on the need for diagnostic tests during the first wave, and the need for vaccines during the second and subsequent waves of the pandemic.
Logistics and diagnostic tests
The supply lines were severely hampered for a few months globally (February to April 2020). Natural disasters, for example, floods and earthquakes, happened previously, and the resilience of healthcare logistics and supply lines had been studied within that context. These included exploring the optimal ways of identifying and deploying parallel logistics service providers and studying ‘temporary facilities’ to cope with the aftermath of such disasters. However, most of the scenarios were for a defined scale and geography, not considering a pandemic, which is much rarer yet more disruptive. The surge in testing demand, combined with the implemented lockdowns posed a great logistical challenge, as the right supplies needed to reach their designated laboratory destinations within a short time frame, and supply chains needed to remain active and then be able to dissipate and be re-activated equally as rapidly as conditions dictated. (2)
The tight interoperability of the supply chain as well as the initial (physical and economic) lockdown of China, representing a low-tier supply base for a large part of the manufacturing operations globally, meant that manufacturing would be directly affected. Therefore, a dual bottleneck emerged early on in the pandemic in terms of sourcing the biological materials as well as sourcing the primary sources for manufacturing. Later on, the transport, storage and distribution of the diagnostic tests formed significant challenges.
Additionally, aspects such as the shelf life of a test, the temperature tolerance of the test components and simple characteristics such as the size and weight of the packages were all important considerations affecting the ease of distribution. These challenges were overcome by many governmental and international responses supporting the necessary adaptations in the healthcare manufacturing and logistics services, as well as emergency funding provisions often deployed to mitigate the impact of the disruptions.
Logistics of vaccination campaigns
It is clear that the entire global population cannot be tested (repeatedly) at the same time nor vaccinated immediately in its entirety, thus choices need to be made to prioritise patient groups or groups at increased risk of being infected (for example, healthcare workers). When these groups have been identified, their logistics need to be designed and implemented. Mass vaccination campaigns have been important mechanisms over the last decades to control and eliminate infectious diseases, especially in low- and middle-income countries. The success of such campaigns was dependent on a number of operational aspects, including the need for publicly available information, the fostering of strong coordination between national and district levels, the timely training of healthcare staff, as well as post-campaign reviews. (3)
The logistics of any mass vaccination campaign is three-fold: the vaccines, the well-defined vaccination sites and the vaccinators. All three of these elements must be in place for a successful vaccine administration to take place. Importantly, vaccine distribution also demands a tight cold-chain management from manufacturer to the vaccinator, which poses a particular challenge for some of the COVID-19 vaccines. (4). The specific storage conditions of some of the leading COVID-19 vaccines that are based on mRNA are additional challenges. The infrastructure to support these from a logistic point of view might be there at the R&D side of the manufacturers, however, it is unlikely to be available already across the entire distribution and point of care chain. Therefore, educated calculations on what the supply will be on the manufacturing side during a certain timeframe, the number of vaccinations and potentially minimal stock are needed to define the actual demand and size during the roll-out campaign.
There are academic networks, societies and private companies that have specialised expertise in this area, such as the International Society for Biological and Environmental Repositories (ISBER), the Society for Cryobiology and others. Thus, the potential success of the mass vaccination campaign would be dependent on coalitions/task-forces of experts being formed, within countries or specific geographic locations. The lessons from the first wave of the pandemic and the ways in which the logistics challenges for diagnostic tests provisions were overcome form a useful blueprint to be followed on and expanded during the second wave and subsequent vaccinations. The cold chain logistics expertise is extant, and needs to be brought on to the fore so that it becomes a central part of the solution.
References
- Jazieh, Abdul Rahman, and Zisis Kozlakidis. “Healthcare transformation in the post-coronavirus pandemic era.” Frontiers in Medicine 7 (2020): 429.
- Vandenberg, Olivier, et al. “Considerations for diagnostic COVID-19 tests.” Nature Reviews Microbiology (2020): 1-13.
- World Health Organization. Global Measles and Rubella: Strategic Plan 2012-2020. World Health Organization 2012. Available. at: https://apps.who.int/iris/bitstream/handle/10665/44855/9789241503396_eng.pdf;jsessionid=3B72D72DB1A61DD74FB714317C2D8E2B?sequence=1
- Russo, Thomas. “Pandemic Policy and the Logistics of COVID-19 Mass Vaccination.” Homeland Security Affairs 16, Article 13 (December 2020). www.hsaj.org/articles/16514
Disclaimer
Where authors are identified as personnel of the International Agency for Research on Cancer/World Health Organization (IARC/WHO), the authors alone are responsible for the views expressed in this article and they do not necessarily represent the decisions, policy or views of the International Agency for Research on Cancer/WHO.
