Ultra-cold Storage Requirements Just Tip of the Iceberg, Says OIS Prof. Nichalin Summerfield

Business Professor Nichalin Summerfield
Asst. Prof. of Operations and Information Systems Nichalin Summerfield says the "last mile" of COVID-19 vaccine distribution will be the most tricky.

By Ed Brennen

Now that pharmaceutical companies have developed COVID-19 vaccines in record-breaking time, another unprecedented challenge awaits: delivering doses to billions of people around the world as quickly and efficiently as possible.

Nichalin Summerfield, assistant professor of operations and information systems in the Manning School of Business, researches supply chain management and health care analytics. Like many, she’s been following the progress of drugmakers such as Pfizer, Moderna, Johnson & Johnson and AstraZeneca in their race to develop vaccines that will help to end the global pandemic.

Summerfield has also been thinking about what will arguably be the biggest and most complex supply chain challenge in history — one that requires coordination and cooperation among private industry, health care, transportation and government agencies at every level.

“I’ve been following it with great interest,” says Summerfield, who is teaching Operations Management to undergraduates remotely this semester, as well as an online course in Statistics for Predictive Analysis in the Master of Science in Business Analytics program. “There will be many case studies coming out of this pandemic in terms of the supply chain management, not just for vaccines, but also for everyday consumer products like paper towels.” 

We asked Summerfield about the supply chain challenges of getting the COVID-19 vaccine into the arms of billions of people around the world.

Q. Let’s start with the big picture. Who is overseeing the vaccine supply chain? 

A. On a global scale, the World Health Organization (WHO) has done a lot of good work. They’ve created an alliance called COVAX, which will be a centralized force in terms of procuring all these vaccines and distributing them to its member countries based on a formula that the WHO dictates. Unfortunately, the U.S. is not part of COVAX or the WHO. In the U.S., the CDC (Centers for Disease Control and Prevention) is the centralized force in procuring orders from various manufacturers. The CDC has contracted McKesson, one of the largest medical and pharmaceutical distributors in the country, to distribute all vaccines that do not require ultra-cold storage. Pfizer, which makes an ultra-cold vaccine, will handle its own distribution. They will deliver directly to hospitals from their distribution center in Kalamazoo, Michigan. 
“With supply chain, you need to know the parameters of the product. And given that the product parameters are still uncertain, designing an optimal supply chain is difficult.” -OIS Asst. Prof. Nichalin Summerfield

Q. How do those extremely cold temperature requirements you mentioned complicate the vaccine delivery and storage? 

A. There are more than 50 vaccine candidates right now in play, which can be separated into three groups in terms of their temperature requirements for delivery. The vaccine that must be kept at minus-94 degrees Fahrenheit, which is the Pfizer vaccine, requires ultra-cold chain logistics. The vaccine that must be kept at minus-4 degrees Fahrenheit, which is the Moderna vaccine, requires regular cold chain logistics. And then there’s the refrigerated type, which can be kept at 36 to 46 degrees Fahrenheit.

A lot of countries have already decided that they’re not going to use the ultra-cold vaccine because they don’t want to deal with the storage requirements. But for the other types of vaccine, even poor countries already have cold chain infrastructure in place to transport and store them, so that’s not a problem. They can be transported with dry ice, although there is a limited amount that can be put on a plane because it generates a toxic gas. But there are a lot of new freezers being developed that allow you to transport vaccines more efficiently.

Q. The ultra-cold Pfizer vaccine has already been approved in the United Kingdom and is first in line for approval by the Food and Drug Administration here in the U.S. Is the supply chain ready for it?

A. Supply chain management covers everything from the raw materials, to manufacturing, to distribution — all the way to the consumer level, or what they call “the last mile.” The challenging part is handling the last mile, where it’s delivered to the patient. Generally, for a flu vaccine, you go to your primary care physician or CVS, or your town sets up a vaccination site. So that takes the strain away from the major hospitals, which are now drowned by COVID patients. But not all these facilities have the capability to handle the ultra-cold vaccine. There is a U.S. company, Stirling Ultracold, that produces freezers that can keep the product at minus-94 Fahrenheit for a long time, using a regular power outlet. They’ve already collaborated with UPS Healthcare to provide freezers for the vaccine delivery. We will have to wait and see how such freezers will be used in the last mile.  

How that last mile works is still unclear. I think they are going to learn how the distribution will work from the first group that is vaccinated: the health care workers. Then, the next round, they’ll be able to improve the process and probably do better. By the time you and I will probably receive the vaccine in the fourth or fifth round, I believe the problems will be smoothed out.

Q. How is this vaccine supply chain different from the supply chain for, say, an iPhone?

A. Most of the research I’ve done is on decentralized supply chains, where each stakeholder is doing what is best for themselves. But for vaccine distribution, this is a centralized supply chain, where you want to maximize the benefit for the whole chain. You’re not looking for one company to make as much profit as it can. There is also a branch in operations management called humanitarian supply chain, where profit is not the key goal. If there’s an earthquake somewhere, how do you transport water and health supplies to that place? It’s a field that evolved from military operations management, which is a centralized way we transport materials efficiently to different military bases around the world.

Q. Besides temperature, what are the other complicating factors?

A. There are several parameters that determine what the supply chain should look like besides temperature, such as the safety and efficacy of the vaccines, their shelf life, and the number of required doses. If it can be one dose, that would be great. Both the Pfizer and Moderna vaccines require two doses, however, which complicates things because they have to have the tracking in place to make sure the patient comes back for their second shot. 

A lot of things are still up in the air because other vaccines are still being developed. Maybe a newer and better vaccine will come out soon, and then all these parameters may not be that important anymore. It may be a one-dose vaccine that can be transported at regular refrigerated temperature. With supply chain, you need to know the parameters of the product. And given that the product parameters are still uncertain, designing an optimal supply chain is difficult. 

Q. Finally, how do you think supply chains have been holding up in general during the pandemic?

A. Given the lockdown, I think the supply chain has done a great job this year getting products to the consumer at the right time. We don’t see a lot of shortages in our grocery stores after the initial panic buying — not to the point where it’s not acceptable. Overall, I think the supply chain has proven pretty resilient.