As pharmaceutical companies conduct phase 3 vaccine trials, air cargo transporters are cautious about the logistics involved in the mass distribution of a Covid-19 vaccine. A recent survey found that less than 30% of air cargo companies felt prepared for the job ahead. Developing the vaccine is only the first step. Getting that vaccine to the population will prove as difficult.
Vaccines are difficult to distribute in part because of their delicate structure. Most vaccines need to stay cool to maintain effectiveness. Moderna and Pfizer’s Covid-19 vaccine candidates need temperatures of -15 and -70 degrees celsius. For reference, most flu vaccines are stored between 0 and -15 degrees celsius. Shipping hundreds of millions of vaccines at -70 degrees celsius would be an unprecedented distributive feat requiring thousands, if not millions of super cold transportation containers.
Air cargo transporters concerned about transporting these vaccines note a lacking supply of these containers. Of the 181 companies surveyed by the International Air Cargo Association, less than half were capable of sub-zero temperature shipments at every company location. Even after shipping vaccines from the production facility to a jurisdiction, that shipment must be safely offloaded, ground-transported to a distribution center, and again stored in a freezer capable of such low temperatures.
There seems to be an assumption that every healthcare center and pharmacy distributing these vaccines will have a sub-zero freezer on hand. Dry ice can keep the vaccines from thawing for a few days, but distributing thousands of vaccines in under a week to keep the vaccines potent seems to leave little room for error. The storage capabilities for keeping vaccines safe enough for long term storage and use are simply unavailable. Without federal support providing storage capabilities, it seems impossible to think rural or impoverished areas will have the vaccination success an urban area may have.
Most vaccine candidates require two doses, which only amplifies distribution concerns. The Centers for Disease Control and Prevention released a vaccine distribution playbook that outlines how state and local jurisdictions should prepare their vaccine operations. The playbook notes that in addition to cold storage, vaccines come in two doses administered a certain number of days apart.
Requiring two doses not only increases the load air cargo companies must transport, but it forces people to go get vaccinated twice. Going to a pharmacy twice in a month seems a small ask for those who own a car or live close to potential distribution centers, but two shots double the burden on the poor and rural communities. 8.7% of families were without a car in 2018. Low-income families may not have immediate access to a potential vaccine distribution site because of this. Parents in these families work long hours for low wages and may not have time to take the whole family via public transportation to a vaccine distribution site, not to mention twice.
Rural Americans face similar concerns. As noted in the playbook, shipments of the vaccine will be sent to jurisdictions in packages of one thousand. This is manageable for urban areas with one thousand people living within a few blocks, but in rural areas, one thousand vaccines may disperse over hundreds of miles. Large vaccine shipments would need wide dispersal across a rural jurisdiction.
Moving these vaccines may prove difficult in the coming months. Roads and weather will get treacherously icy in states like the Dakotas, Wyoming, Montana, etc. Rural midwestern states are current hot spots for Covid-19 infections, and those numbers will only worsen as temperatures continue to drop. Getting vaccines to rural Americans in these states is imperative, but damaging some vaccines in transit seems more of a likelihood than a possibility.
Transportation is just one of the many issues with Covid-19 vaccine distribution, as a fast-tracked vaccine can provoke health risks in the short and long term. AstraZeneca, for instance, had to pause trials after a volunteer developed a rare spinal disease. It remains to be seen whether the vaccine caused the illness or not. Trials typically extend over years to monitor these instances, but Covid-19 vaccine trials seem to be nearing the finish line already. Then the shot will be taken by hundreds of millions of Americans. It is impossible to know the long-term health risks of the fast-tracked vaccine.
Hesitations by air cargo companies, vaccine storage concerns, and poor and rural inaccessibility express how unprepared for a pandemic we were. While the vaccine development process has been unquestionably quick, it seems that haste was not paralleled in the distribution preparation process. A vaccine may be ready soon, but whether that vaccine will make it to every American remains to be seen.