[hef19898]

This is one of the best supply chain articles I ever read. Cudos!

As the article is mainly describing the supply chain, I'd like to add some of the challenges, especially downstream / last mile. The Biontech vaccine seems to be a royal pain to distribute. Cold chains are tricky to maintain, let alone at -70 C. Having doses packed in numbers larger than one makes it challenging to vaccinate people at the centers, the unfreezing takes some time, and the vaccine cannot be stored eternally once unfrozen. So you have to closely schedule appointments with the treatment of the vaccine itself for batches of people. Which cannot be allowed to wait in line because of COVID-19. It also means that existing infrastructure, doctors and care and nursing services, cannot be used to get the Biontech vaccine to the people. Yet another pain.

At yet, we are only discussing the purchased doses. Not even the delivery schedules, just the total quantity. As if that was the real bottle neck right now.

[Spooky23]

That’s the wicked nature of this disease at this point in time. It’s almost like it evolved to exploit the lunacy of modern society.

The politicians are busy blaming each other, and the news people are busy looking for bullshit scoops.

[jcims]

>It’s almost like it evolved to exploit the lunacy of modern society.

I think you're actually correct. If the lunacy of modern society helped it succeed vs genetically similar organisms I would call that a successful adaptation.

[jonemo]

Hi, author of the post here. I tried to include some info on temperature requirements and how cold chain distribution works, but it's hard to capture that comprehensively because it varies a lot geographically.

While I do appreciate how difficult it is to distribute the Pfizer-BioNTech vaccine at -70 C, I am still puzzled by how deep into the distribution this temperature gets maintained. As far as I know, the spec is that the vaccine can be stored (and transported) at regular fridge temperatures for up to 5 days. It seems like everyone (in the US anyway) is focused on maintaining -70C all the way to the point of use. What about the alternative of thawing it at some distribution center and focusing efforts on getting it into a person within five days after that?

[hef19898]

That's a good question. I didn't research the temp requirements that deep myself yet. Instead I worked from what I read online and in the press. Which is also the way it works in Germany. Now I am intrigued so, I will see what I can find.

EDIT: This really is frustrating. Either I am unable to google stuff or there really is no data sheet on the Biontech vaccine available online. All I found is nice pictures and text without numbers at Pfizer's website and second hand interviews of Biontech CFO saying the vaccine can be stored up to 5 days in a fridge. Real transparency doesn't seem to be a thing with everything Covid-19.

[jonemo]

This Pfizer site is intended for healthcare providers in the US so technically not meant for your eyes, but it has all the info: https://www.cvdvaccine-us.com/product-storage-and-dry-ice

The equivalent page for Germany where BioNTech distributes the same vaccine: https://www.comirnatyeducation.de/resources.html

[jjeaff]

I have read that once unfrozen, it lasts for 30 days while refrigerated at a reasonable temperature.

So why is the -70c an issue at all? It seems totally reasonable that we could just ship it at refrigerated temp and it would all be used up well before the 30 day expiration.

The only explanation I can think of is that the information I read was wrong and it won't keep that long after thawing.

[Animats]

What we have now is the minimum viable product. The convenience features come later. If it weren't urgent, the MVP wouldn't have been shipped.

There are vaccines that are more shelf-stable in development. Merck is working on a pill version. All those features add to development time. The whole clinical testing process has to be re-run for each modification to the delivery chemistry.

A year or two downstream, there will be plenty of supply, competing vendors, fewer side effects, and greater ease of use. But we need something now, so the working prototype had to be manufactured.

[hef19898]

I am happy that Biontech was as fast as they were. And their vaccine seems to work. It is just difficult to deploy on scale, that's all. And my impression is, politicians and officials in Germany, and the EU it seems, are underestimating that. Which slows down vaccinations. And then the public and the press jumped in, only to push for increased purchasing. Which doesn't help a bit until the last mile, in Germany handled locally by the states, is figured out.

A pill version, or just one general doctors practices can store and handle, will have a huge impact IMHO.

[lultimouomo]

Several regions in Italy had to stop giving first doses this week because Pfizer is delivering less vials than planned and they would risk not being able to administer the second dose in the proper time frame, so I think the distribution logistics, while complicated, are being worked out alright.

As of now, the supply is the bottleneck.

[hef19898]

Pfizer also closed down their facility in Belgium to increase capacity. One core function of Supply Chain management is matching demand and supply, at the point of use. In Germany, we had close to a million doses sitting in depots, at the same time vaccination centers didn't have enough doses.

I do have the impression, that Pfizer is partially increasing capacity to be able to meet the increased orders from European countries. That increase now will impact availability through the end of January and February. Nicely done, because just ordering more doesn't mean more is available right now.

As of December 2020, Germany ordered enough doses from Biontech / Pfizer and Moderna to vaccinate 68 million people. Herd immunity is achieved with 58.2 million. So the problem is not the overall number of purchased doses, it is a mismatch between supply and the vaccination schedule. Since people always ignore the time dimension when it comes t supply chains, the go to solution was to order more. Then everybody ordered more out of fear to not get enough. When politicians and media started to blame manufacturers for the perceived shortages, manufacturers wnet public saying governments didn't order more and they could deliver more.

This hooked back to the initial, and wrong, solution of just ordering more. Then orders flew in, the capacity at the Belgium plant was not sufficient anymore. Now they increasig capacity, not manufactring anythig for a while. Orderig more didn't help solve the perceived, current shortages, instead it aggrevated them.

Source (in German, sorry for that, but it was the best I could find) for the numbers: https://www.dw.com/de/deutschland-hat-genug-impfstoff-f%C3%B...).

This effect, when demand fluctuations (either normal fluctuations or artificial ones expressed in fluctuating order sizes) is screwing up availability and supply, is well know as the Bullwhip effect. We saw that in early 2020 with toilett paper. We saw it with masks. And now, at even larger scale with a more critical product, with vaccines. Looking at that from the sidelines is just frustrating.

EDIT: Somehow, there is no data (easy to find) out there regarding delivery schedules by month and supplier. Which sucks. But I did find this from the EU:

Total ordered doses: "Contracts have been concluded with AstraZeneca (400 million doses), Sanofi-GSK (300 million doses), Johnson and Johnson (400 million doses ), BioNTech-Pfizer 600 million doses, CureVac (405 million doses) and Moderna (160 million doses). The Commission has concluded exploratory talks with the pharmaceutical company Novavax with a view to purchasing up to 200 million doses." In total 2.2 billion doses ordered from various suppliers with options for an additional 200 million. There are 446 million inhabitants in the EU, they ordered almost 5 doses per citizen.

That part of the EU Q&A page is IMHo hinting at the true issue here:

"How will logistics work? How will vaccines be distributed?

Logistics and transportation is a key aspect on which all Member States have to work, as emphasised in the Communication on preparedness for COVID-19 vaccination strategies and vaccine deployment of 15 October.

Delivery to national distribution hub(s) will be ensured by the manufacturers.

Further distribution to vaccination centres will be ensured by Member States, who will also be responsible for the vaccination of their population."

Just having doses sitting in a central hub doesn't do anything. In Germany the 16 states are responsible for getting the doses to the people. With very different results so far. And to be honest, as long as manufacturers can keep production up with their agreed upon delivery schedules, the first mile from the manufacturer to the hubs is actually the easiest part of this whole operation.

Source:https://ec.europa.eu/commission/presscorner/detail/en/qanda_...

EDIT (again): I finally found some numbers, not even Google was helpfull here. Germany will get a total 91.3 million doses by end of Q2 2021 and another 127 million in Q3. Source: https://de.statista.com/statistik/daten/studie/1197100/umfra...

I stil didn't find any numbers for the EU, each EU-country or by month. That fact alone is troubling. These numbers do show so, assuming the delivery shedules will be similar for other EU countries, that ordering more is the wrong solution. instead, the focus should be, besides getting the local vaccination campaigns up and running, to get the already doses earlier. Swamping the manufacturers with additional orders already contributed, I assume, to the partial shut down of Pfizers EU plant. And that had the contrary effect of what everybody wants.

not sure, if me still being surprised by this kind of screw-ups by the German governmant and the EU is good thing or not. Especially the german government as a whole has quite a track record in failing at everything logistics and suplly chain related.

[Animats]

Somehow, there is no data (easy to find) out there regarding delivery schedules by month and supplier. Which sucks.

In the US, prying that information out of the previous administration was difficult. There's a database, called "Tiberius", with inventory info. The transition team only got access to it six days ago.[1]

Bloomberg has stats on how vaccinations are going in the US.[2]

Distribution should pick up soon, now that the nursing homes and medical providers have mostly been vaccinated. The next phase starts to move to big pharmacies doing most of the work.

[1] https://www.washingtonpost.com/health/2021/01/14/transition-...

[2] https://www.bloomberg.com/graphics/covid-vaccine-tracker-glo...

[iSnow]

I was amazed how super focused on the essential features Biontech seems. They are not originally from the vaccination business but cancer treatments, but were able to task SARS-COV-2 within days and get the first vaccine out.

Storage requirements? Not essential. Prepackaged syringes? Not essential. I'd bet they are now working on those aspects but went to grab a huge part of the market with their MVP.