While the global COVID-19 pandemic put medical front liners and hospitals in the spotlight, the supply chain that delivers life-saving pharmaceuticals also needs attention. COVID-19 is creating a rising demand for better life-saving supply chains. How can pharmaceutical cold chain logistics be improved?
Behind the scenes of frantic doctors and medical professionals attending to patients worldwide, the same urgency ensues in the cold chains. Inefficient supply chains disrupt the storage, transport, and delivery of vaccines and put lives at risk.
Reece Armstrong Editor of European Pharmaceutical Manufacturer wrote that :
Since Covid-19 has spread to almost every corner of the globe, if and when a vaccine is produced, the challenges don’t stop there’. Logistic providers will face the daunting task of transporting time-sensitive Covid-19 vaccines in different parts of the globe.European Pharmaceutical Manufacturer
Transporting and delivering vaccines isn’t a simple process. It involves data, monitoring systems, and cutting-edge technology to ensure that medical goods are preserved from any contamination and corruption until reaching the end-users.
Besides having well-trained storage and delivery personnel, cold chain companies must comply with stringent industry standards and certifications. Biopharmaceuticals have extreme sensitivity to the temperature that the slightest deviation from its thermal requirement could lead to spoilage.
Unfortunately, most developing countries are still using cold chains dating back to the 1980s. These antiquated storage and delivery systems are obsolete and dangerous since they threaten patients’ safety.
Vaccine research and development have leapfrogged over the years resulting in the doubling of many diseases cured through vaccination. More vaccines are now available to more age groups in high-population regions.
However, weak supply chains are incapable to cope with the demand and lead to recurring long-term problems like high wastage rates, inaccurate vaccine delivery data, and inventory shortage. These unresolved or poorly addressed cold chain problems put medical patients in peril like children that need immunization, vaccines for women, and medicines that cure life-threatening diseases.
In a study made by Ashvin Ashok, Michael, and Yann LeTallec entitled Improving Cold Chain Systems: Challenges and Solutions, the author writes:
In many low‐income countries, vaccine delivery systems have remained largely unchanged due to challenging contextual factors that have limited their ability to meet immunization program requirements. Structurally, the scale and geographic spread of cold chain systems have been demanding, given the need to consistently reach the whole population. Kenya, with a yearly birth cohort of nearly 1.5 million children, currently provides immunization services at nearly 6000 facilities equipped with cold chain storage capacity.
Furthermore, diverse population settlements (e.g., urban, semi-urban, rural) present unique challenges that test cold chain capabilities and response. For example, road and main power access are challenging for over 70% of health facilities in Uganda, with limited road networks further complicating access to ‘off-grid solutions like gas.
Furthermore, the authors of the study state:
cold chain performance is often limited by lack of performance management systems’.
cold chain systems lack regularity and fall short in providing efficient day-to-day management.
Ironically, the oversupply of vaccines is causing problems for the immunization program of the World Health Organization. Storing vaccines in the long-term means added costs and wastage. Vaccines get damaged when they remain in stock beyond their expiry date and weak cold chains alter the effectiveness of the pharmaceuticals.
“We want to have a little buffer stock as possible,” said, Project Optimize Director Michel Zaffran, “but still we want to have enough vaccines to vaccinate the children.”
He emphasized that cold chains should have information systems and technologies in place to give managers real-time vaccine monitoring data through a country. The integrity of the pharmaceuticals must be maintained during storage and transport.
The World Health Organization expounds on this issue in their website:
In 2005 Turkey needed only 2600 m2 of cold storage in order to accommodate its stocks of vaccine. When they introduced the first generation of pneumococcal vaccine in 2008, Turkey’s storage space requirement jumped (four times) to 11 400 m2. They had to rent cold storage space.” Turkey found a solution, but not every country does.
For Zaffran it is not too strong to describe the situation faced by many countries as a crisis.
Countries are postponing the introduction of these vaccines because they do not have the capacity. Some countries are actually delaying the time when the vaccines arrive, even when they have been paid for by others because they do not have the capacity either at the central level or in the country.
The kind of problem faced by Turkey is also causing people to rethink the use of the cold chain, the temperature-controlled supply chain, which has traditionally been used for virtually all vaccine delivery. “Most vaccines are stored at a temperature of between 2 and 8 degrees Celsius,” explains Cheyne, referring to guidance that is described on the vaccine packaging.
In the context of the current pandemic, the need to modernize and improve the cold chain is increasing. It should have regular monitoring performed by certified professionals, cutting-edge cooling systems, and strict compliance with government standards to have efficient and reliable supply chains. These are the factors needed for optimal cold chain storage and delivery.
Pinar Keskinocak, Ph.D. and Evren Ozkaya, Ph.D. in their article entitled US pharmaceutical Supply Chain Unprepared for COVID-19, write:
Pandemics encumber the supply of medications needed to fight them and also the supply of other critical pharmaceuticals with potentially grave consequences for public health.
Pandemics do this by disrupting global supply chains in general, and pharmaceutical supply chains are particularly vulnerable. America’s medical supply chain is not prepared for this. But the government and industry can help it cope if they react rapidly.”
Keskinocak and Ozkaya suggest that rationing, increased access to online healthcare, maximized use of current manufacturing capabilities, flexible manufacturing, clamping down on fake drugs, and increased supply chain digitization and visibility are the solutions to current supply chain issues during the COVID-19 pandemic.
These are industry terms for knowing how much of each medication we have in the supply chain and where it is at any given moment.
The Drug Supply Chain Security Act (DSCSA) requires drugs in supply chains to be better identified and tracked. Manufacturers, distributors, and dispensers should be enabled to share real-time data when necessary, which is currently not the case and needs upgrading.
We need to champion this advocacy for better medical cold chains, especially in developing countries. Vaccines borne out of years of research and testing are useless if they cannot be delivered efficiently to their end-users.
Drug supply chain disruptions due to COVID-19 a very high concern: Poll
How Covid-19 is affecting the pharma supply chain
Improving Cold Chain Systems: Challenges and Solutions
US pharmaceutical supply chain unprepared for COVID-19