Israel COVID-19 vaccination program
Look to Israel for a Measure of How the US Vaccine Supply Chain has Failed
In this article we will explore the differenc between the US and Israel COVID 19 vaccination programs. With the COVID-19 vaccine production in full swing this year, planning and implementation are crucial to a successful vaccination program. This vaccine has been referred to as liquid gold and pharmaceutical companies worldwide are focusing their efforts on producing it. Anytime there is something that’s of high value, there’s a likely chance for some level of nefarious.
There are many security issues around the transfer points at each point in the vaccine supply chain. Potential risks include theft, sabotage, and counterfeiting. For example, how to dispose of the vaccines that are potentially damaged? If not properly disposed of, they will end up in the black market by unscrupulous individuals.
The COVID-19 Vaccine Supply Chain: Potential Problems and Bottlenecks
The pressure is now beginning to mount for these vaccines to be distributed and administered quickly. Covid-19 patients are overwhelming hospitals in various countries; state and local decisionmakers are working to make vaccinations available for each segment of the population as soon as possible.
1. Shortage of Personnel
The first potential problem is that it doesn’t account for vaccinating the vaccinators.
By not vaccinating the people administering the vaccine, there is a greater risk for the elderly and other patients contracting the virus before getting the vaccine. These people should be included in phase one as well. There should be an assurance that key supply chain personnel will stay healthy. These include the thousands of people that all have critical roles – all the way down to the cleaning personnel people. These personnel matters because vaccine manufacturing, distribution, and administration will completely shut down if they’re not there.
Governments should also address the anticipated shortage of trucks. Even if production ramps up, there may not be enough personnel needed to drive the deliveries where they need to go.
2. Lack of Coordination
A strategic plan refers to collaboration on micro-plans at the local and state level, few details are provided, but it seems that effective planning has not yet been done. It’s unclear how the vaccines will be distributed on the ground – and how they’ll allocate who’s in the first, second, and third waves of distribution. It’s also unclear whether people will be notified about the second dose of the vaccine – and whether they will be told which vaccine to get. Those who’s worked in supply chains know that with no plan, it will not work.
3. Shortage of Supplies
Though the pharmaceutical companies have begun production of the vaccines, they are still experiencing severe bottlenecks due to a lack of critical materials – including vials and rubber stoppers for the vials. There’s also been a shortage of natural rubber, which is a challenge because rubber gloves are recommended for administering the vaccine. Lack of access to these raw materials for the vaccine kits would mean disruption and halting the production. There are some suggestions to look for alternative suppliers or substitute materials, but that requires getting FDA approvals, which can take weeks if not months in some cases.
4. Limited Capacity
On the production line, one of the biggest concerns is what they call fill-finish capacity. This is the ability to take the liquid vaccine and put it into vials. Each vial carries a limited number of doses. Another limitation is freezer capacity. While the Pfizer vaccine needs to be stored in a freezer at -90°C, most freezers weren’t designed for that level of cold – most are set for -20°C. Taking these factors together, there’s extremely limited capacity.
There are other risks – equipment breaking down from being overrun, new equipment not meeting regulatory requirements, etc. These are possible risks that could potentially shut down the production process.
There is also a potential shortage of skilled personnel. It’s crucial that enough skilled personnel are healthy and able to work in these fill-finish capacities and storage facilities.
5. Vaccine Spoilage
Depending on the length of the route, dry ice packing has to be re-examined. Each time the vaccine packages are opened, there is potential for temperature excursions, damaging the vaccines. There should be a limit of two repacks.
In rural and geographically challenging areas, there is more opportunity for the supply chains to break down. It’s important to ensure that the cold chain and supply chain supporting freezers are able to prevent temperature excursions and prevent large shipments of the vaccine from spoiling.
Why the cold chain supply is often neglected and underappreciated in the United States
Getting decision-makers’ attention hasn’t quite been successful. They often assume that vaccine delivery is the easy part once the vaccines reach the market and are paid for.
This is where the US failed in its vaccine distribution program. A vaccine supply chain is the complex system of manufacturing transportation, equipment, personnel, locations, and processes involved in getting vaccines from where they are made to the people who will receive them.
In mid-December 2020, the US blundered in one of the biggest leadership failures in the modern era. After heroic science and huge government funding to deliver the new vaccines in record time, the US botched the Covid-19 vaccination campaign’s roll-out.
To see how the US failed in its attempt to inoculate its population, let’s compare the US to that of Israel.
By comparison, Israel has been vaccinating 150,000 people a day or about 1.7% of its 9 million people since the end of December 2020 – 10 times that of the US rate per capita. At this pace, Israel will take a little over 80 days to achieve herd immunity (when 70% of the population are vaccinated twice). This month, Israel said that every Israeli citizen over the age of 16 will be vaccinated by the end of March 2021.
In the US, it may take about two and a half years of confusion, death, and economic ruin to reach herd immunity.
Many of the US’s problems are entrenched in the country’s vaccine supply chain, especially the “last mile” segment that delivers serum to its citizens. As any practitioner will quickly observe, this supply chain is poorly prepared and managed.
Vaccine supply chain management hard but not impossible
Supply chains function around three paths:
To achieve the highest levels of performance, the participants must plan and coordinate these three paths. To minimize delays and optimize vaccination rates, planners need to cooperate with manufacturers, logistics providers, local governments, healthcare providers, and citizens so that everyone knows what to do and has the tools they need to expedite the vaccination process.
US government officials knew for more than seven months since announcing the vaccination program that millions of citizens would have to visit one of the numerous inoculation centers to receive the vaccine. While the Israeli administration planned for such a vast and complex operation, the current US administration did not plan properly in this crucial planning and coordination phase.
Besides, a lack of information hindered the US effort. States and health care providers did not know when they would get which vaccine in what quantities ahead of time. As a result, mayors and governors cannot inform the public about the roll-out. This information vacuum created suspicion among citizens and dread among local hospitals and clinics.
Here are some examples of where these failures hampered the vaccine supply chain.
- Leadership. Israel’s Prime Minister Netanyahu planned ahead and prior to the vaccine program’s started talking to CEOs of pharmaceutical companies, buying vaccine doses, cajoling stakeholders, and using private connections as well as economic incentives to get the vaccine supplies. President Trump played golf during the crucial initial stages and ranted fake facts about the election he lost.
- Planning for vaccinations. Israel imported the first shipments of the Pfizer vaccine even before the US FDA approved it. The Israelis factored in the costs and risks that come with buying an unapproved vaccine which is cheaper than the costs and risks by delaying orders for the drug and vaccinations. Israel’s months of pre-planning included training volunteers to handle extensive phone banks, developing management systems, enlisting army medics and retired healthcare professionals, preparing and qualifying vaccination centers.
Compared to that in the US, Operation Warp Speed did not factor in vaccination drives in its planning. The country missed the distribution portion of its original year-end goals by 30%. It distributed only 14 million of the 20 million doses needed. Even worse is the operation’s performance on inoculations. Only 2.73 million people were vaccinated by the end of 2020 – which is more than 85% short of the original goal.
- Coordinating with patients. Israel has an appointment system to efficiently raise the rate of vaccinations while minimizing the spread of Covid-19 when citizens go to inoculation centers. The country’s planners know that vaccination is a “numbers game” when the goal is to inoculate the highest number of people as efficiently as possible. The Israeli government, like other governments, established priorities designed to minimize the future number of deaths, the burden of cases, and the economic results of the pandemic.
While in Israel, the administration called to every citizen 62 years of age and older to see their primary care physician clinic. Once a person arrives for their appointment, it only takes 3-5 minutes to get inoculated. If there are surplus vaccines in that assigned area, the neighborhood residents, regardless of age, are invited to receive the vaccine without an appointment. Thus, nothing is wasted.
Whereas the US is too focused on finding the “right” priorities when creating its vaccination program. This strategy is already failing because, for example, many healthcare workers who were not exposed to Covid-19 patients were assigned as a high priority. And when a uniformed state tried to vaccinate a large number of people, the result was endless lines of elderly citizens waiting many hours for vaccination, with brawls erupting as people cut the line thus having a potential virus superspreader events.
- Eliminating paperwork. In Israel, vaccination is free. In the US, although the vaccine itself is free but administering the vaccine costs about $45 per shot. This system raises health insurance coverage issues, imposes deductibles and co-pays, and adds paperwork to the process.
Additionally, recipients must sign a legal waiver absolving vaccine administrators and makers of liability. The extra bureaucracy means potentially life-threatening delays in vaccine administration, less productivity at centers, and reduced inoculation rates.
- Fighting anti-vaccine rumors. After spending months undermining medical experts’ assessments of the pandemic, US President Trump created an anti-institutional culture in the US. Further, as the vaccines neared approval, the President seems to be more concerned with his re-election bid than defeating the disease.
The Israeli government took a different approach. They contacted Facebook to remove content that spread fake news or falsehoods about the vaccine. This effort was part of a massive social media campaign to get citizens vaccinated.
One of the key areas to a successful distribution in any supply chain plan is awareness — awareness of all the possible things that could go wrong. Supply chain logistics providers should consider every scenario that could hinder the deliveries of the vaccines to those who need them the most.
When it comes to planning how Covid-19 vaccines will be delivered to the people who need them, it is hoped that hindsight is used to learn from the past and the U.S. and other countries won’t fall into the same problems with vaccine supply chains encountered in the past.
Some detractors may say that comparing Israel and the US is inconsistent given the huge disparity in the sizes of respective countries. The argument here is that the US is massively richer and can bring more per capita resources to bear. In a small country like Israel, they were able to pull it out. Why can’t the US use the same tactics? As the saying goes; “Too many cooks spoil the broth.” The same applies here.