What History Can Teach Us About Distributing The COVID-19 Vaccine

SCOTT SIMON, HOST:

Last night, the Food and Drug Administration authorized a second COVID-19 vaccine for emergency use. This one is made by Moderna, and it's been found to be 94% effective. Here's FDA Commissioner Stephen Hahn.

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STEPHEN HAHN: This is another crucial step in the fight against a global pandemic that is causing vast numbers of hospitalizations and deaths in the United States every day.

SIMON: While approval is welcome, getting the vaccine into the arms of hundreds of millions of people is a vital and daunting logistical challenge, with doses already in route to Maine, to Alaska, as well as Hawaii and American Samoa. Bruce Y. Lee is the executive director of the Public Health Informatics, Computational, and Operations Research team. PHICOR, as it's known, develops computer models to understand and improve global vaccine supply chains. Dr. Lee is also a professor of public health at City University of New York. Thanks so much for being with us.

BRUCE Y LEE: Thanks for having me, Scott.

SIMON: Delivering hundreds of millions of doses of coronavirus vaccine isn't exactly like delivering boxes of cornflakes to millions, is it?

LEE: Yeah, it poses specific challenges that are unique to this operation. We've never had a situation where we've had to deliver so many vaccines to so many people in such short periods of time. You know, people only pick up cornflakes when they need it. And it's not something that you have to make sure as many people as possible get cornflakes. So it's a different situation.

SIMON: Well, help us understand some of the challenges and the daunting nature of this enterprise.

LEE: It's a complex operation that needs to get the vaccines from where they're produced and manufactured all the way to central locations where they can then be distributed to different states. And then this is a series of storage locations, personnel, storage equipment, vehicles, transport devices and different processes that have to handle the vaccines and keep them safe, especially if you're talking about vaccines that require the deep-freeze storage requirements. The places where the vaccine will actually be delivered are very heterogeneous. They range from clinics to hospitals to potentially nursing homes, places of employment, schools, you know, even potentially door to door. So a lot of people are involved. A lot of things are involved, and they have to be all coordinated. You have to also deliver the accessory devices, like the syringes or needles or whatever you're going to be using to deliver the vaccines. And plus, people have to be properly protected with PPE when they're actually delivering the vaccines, too.

SIMON: You've been, I understand, doing supply chain modeling for a number of vaccines, including H1N1, over the last 15 years. What kind of mistakes can we learn from, do you think?

LEE: So the first thing is many times there can be a tendency to focus on, OK, developing the vaccine first. And of course, that's important. We have to have a vaccine in the first place. So there's a lot of attention that was focused on that. But what can often happen is once the vaccine reaches the market, you're like, OK, great, the complex, difficult parts are done. But we can't underestimate the complexities that are involved in doing so. Other vaccines need to be delivered. You have other products. You have other things competing for the space and the transport and then the personnel as well. So you're not going to necessarily have dedicated personnel just to delivering the vaccines.

Another is assuming that the existing supply chain can actually handle this new vaccine introduction. We've seen many cases where even smaller new vaccine introductions can hit bottlenecks. If you have limited storage capacity or limited vehicle capacity at one level, at one place, like, that can clog up the entire supply chain.

SIMON: And, for example, a snowstorm could do that, right?

LEE: Exactly.

SIMON: Or a mudslide or road construction. I can't help but think now - I mean, this has got to be the busiest time of the year for deliveries anyway.

LEE: Of course. Yeah, definitely. I mean, all of those things - or there's going to be accidents. There's going to be situations in which products will be broken, some boxes left out, power outages. And, you know, things could go bad. Equipment could go bad as well.

SIMON: Dr. Lee, how do you recommend tracking people to make certain that they receive both doses of the vaccine?

LEE: That's another challenge as well. So you need to have a coordinated information system in place as well, and it has to also account for the fact that people may be moving during the time. So they may be in one state when they get first dose, in another state the second dose, et cetera.

SIMON: The whole notion of tracking anyone, it upsets a lot of people. What kind of system do you recommend?

LEE: Yeah, that could be a challenge. Any time you use the word surveillance, that's not a great word for people to hear. So we have to strike the balance between, you know, making sure that the information is there so you can know whom to vaccinate and whom to repeat the vaccination with. But also, you don't want to spook people. You know, in actuality, every time you go to a supermarket, your sales are being tracked and recorded and those things like that. So it's not too unusual, but you have to communicate it in a way that's not threatening to people, that people realize this is why you're doing it. And, you know, it's not for any other nefarious purposes.

SIMON: Bruce Y. Lee is executive director of PHICOR and a professor of public health at City University of New York. Thanks so much for being with us.

LEE: Thanks, Scott.

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