International Workshop on COVID-19 Lessons to Inform Pandemic Influenza Response Proceedings of a Workshop (2022) / Chapter Skim
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4 Vaccine Distribution and Supply Chain
4 Vaccine Distribution and Supply Chain
Pages 29-48
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From page 29... ...
Many speakers pointed to the need for equity considerations across the supply chain continuum. UPSTREAM SUPPLY CHAIN CHALLENGES AND DOWNSTREAM IMPLICATIONS Several speakers discussed the various supply chain challenges during the coronavirus disease 2019 (COVID-19)
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From page 30... ...
He also highlighted the long-term challenge of scaling up global supplies to support countries in achieving the necessary "herd immunity." For the Latin American region in particular, he said it would be very important to rely less on a few outside countries that possess the manufacturing capabilities, more regional capacity is needed for both vaccine production and other health supplies.
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From page 31... ...
He continued that the key actors in this environment have been national governments. While they have worked to ensure supply chain and production, they have made less effort to look more comprehensively at the entire supply chain, including the 200–300 ingredients that may go into an individual vaccine and who the suppliers are.
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From page 32... ...
Fundamental to all of this, and to building sustainable and resilient supply chains, Downham continued, is a skilled workforce in key areas, such as chemistry, manufacturing and controls, and regulatory or bio analysis. In summary, he said that there are many moving parts, but the focus is on improving or establishing vaccine manufacturing capacity and capability in regions of the world where needed.
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From page 33... ...
He argued that this should not be seen as a health crisis but more of a national security crisis and include some investments each year in prevention and mitigation efforts. Hansen agreed with Downham on the need to diversify manufacturing capabilities in different regions, ideally during the interepidemic period, but also cautioned that it would be very inefficient if each country tried to set up its own manufacturing sites.
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From page 34... ...
CONTRIBUTING TO BETTER INFORMATION SHARING Challenges in information sharing were a key contributor to the lack of visibility across the supply chain. Rob Handfield, executive director of the Supply Chain Resource Cooperative and professor of supply chain management at North Carolina State University, explained that governments created a lot of funding for vaccine manufacturing, but it became clear that there were many upstream shortages occurring for key supply chain inputs, such as many single-use technologies, bioreactor bags, and filters.
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From page 35... ...
Hansen commented that the largest manufacturers have the least incentive to share data, and hundreds of candidates are trying to enter this space but do not have the visibility of large companies, such as Pfizer and AstraZeneca. He suggested industry associations and governments could work together to mandate or incentivize collaboration of other companies -- for example, to share production data, which they are not doing but could be helpful.
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From page 36... ...
, asked how to switch from current to next-generation vaccine formulations to ensure supply is adequate for various countries depending on their needs. Swann suggested building on the model for influenza, where a multilateral body discusses the most influential strains and can also include more than one strain in a given vaccine.
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From page 37... ...
But key questions will include whether new mRNA platforms can be reproduced in lowresource settings and other delivery systems within the health system can be used to access target cohorts that need priority for certain pandemics, compared to targeting everyone for seasonal influenza. Erin Sparrow, technical officer in vaccine product and delivery research at the World Health Organization (WHO)
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From page 38... ...
Additionally, the influenza market is quite volatile for small vaccine producers, Sparrow noted, with some that enter the market leaving just 2 years later. She agreed with Hasanin on the need for multiple platforms: having a seasonal influenza vaccine infrastructure that can be leveraged during pandemics but also pandemic platform technologies that can be switched on, such as plug-and-play mRNA technologies, to download genetic sequences and quickly be ready for clinical trials.
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From page 39... ...
The most recent analysis from IFPMA shows that 49 percent of the world population received only 5 percent of influenza vaccine doses, she shared. Mazur also highlighted a survey in 2019 conducted to help understand why influenza vaccines are underused in LMICs and outlined several reasons, including access, supply and demand management and procurement, insufficient logistics, unreliable
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From page 40... ...
This potential extended demand is an example of barriers highlighted in their survey, which identified weak alignment between supply and demand of influenza vaccines. This misalignment can be somewhat alleviated by providing demand forecasting support to vaccine program managers so that the suppliers can plan and sustain additional capacity for these markets and other logistics partners can adjust strategies to the specific needs.
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From page 41... ...
Similar to points made by Tippoo and Mazur, John Nkengasong, director of the Africa CDC, shared supply chain challenges from across the African continent throughout the COVID-19 pandemic (see Box 4-1)
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From page 42... ...
Brazil has two large laboratories that retrofit infrastructure for COVID-19 -- Butantan Institute, which also produces influenza vaccine, and Fio Cruz Institute, which makes the AstraZeneca COVID-19 vaccine. They have engaged in the technology transfer process so that FioCruz can produce enough for the Latin American demand.
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From page 43... ...
Handfield highlighted the vaccine shortage and that global actors and decision makers need to make sure that vaccines are distributed much more quickly than they have been, to avoid the risk of variants continuing to grow and explode, he said. This would lead to a new cycle of booster shots and vaccine requirements and an even longer time line for being able to address the crisis.
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From page 44... ...
For example, people in refugee camps use soap and other commodities that are delivered; those supply chains could be leveraged to provide medical products. Adinoyi noted the need for more regionalized production and capacity for vaccines but also highlighted other medical products, such as PPE, ventilators, and oxygen, that are difficult to produce at local levels but still very much in demand.
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From page 45... ...
Mark McKinlay, director of the Center for Vaccine Equity at the Task Force for Global Health, added that another idea from its influenza program is pooled procurement for vaccines, which might be a possibility to increase availability of these needed products. Navigating Vaccine Expiration Dates Limited data initially justified the specific expiration dates with the new COVID-19 vaccines, said McKinlay, and as companies are generating additional data, they are pushing the expiration date further out.
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From page 46... ...
Regardless of the facet of pandemic preparedness, concluded Adinoyi, it will be important to have ownership at the national, subnational, and community levels. If supply chain issues are going to be addressed, she stated that it is necessary to have deep involvement from the end users and beneficiaries.
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From page 47... ...
We need to think about rapid platform technologies that can be leveraged very early on to get a vaccine developed and tested, she said, but the infrastructure and distribution systems need to be put in place to address issues such as cold chain capacity and vaccine hesitancy. Hasanin added that health systems are often a big gap, and while vaccines are a great solution, they are not the first but merely one of the available tools.
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