The Pandemic Issue

Logistical Conundrums

demand, predict behavior, and understand the flow of the product itself.” Systems for collecting and analyz- ing such data can be hard to find in poorer regions, she notes. What’s more, many people in those areas lack any type of ID card, making it difficult to know who has or hasn’t received a vaccine. Weintraub and two coauthors published an article in April in the Harvard Business Review, suggesting solu- tions to these and other developing-world problems: solar direct-drive refrigerators, app-based data-capture systems, biometric digital IDs. But such measures— not to mention purchasing adequate supplies of vaccine—would require massive funding. And that’s where the logistical begins to overlap with the political. Global Access Versus “Vaccine Nationalism” A patchwork of institutions have already begun laying the groundwork for achieving worldwide, equitable access to COVID-19 vaccines. In February, the World Bank and the Norway-based Coalition for Epidemic Preparedness Innovations (CEPI) cohosted a global consultation on funding vaccine development and manufacturing. In late April, the World Health Organization (WHO), in collaboration with dozens of governments, nonprofits, and industry leaders, launched a program called the Access to COVID-19 Tools Accelerator to expedite such efforts. Soon afterward, the European Union, along with six countries and the Bill and Melinda Gates Founda- tion, held a Coronavirus Global Response telethon that raised $8 billion to support Gavi, the Vaccine Alliance—a public-private partnership that subsidizes immunization in low-income countries. The United States and Russia, however, chose not to participate.

Manufacturing and distributing billions of vaccine doses would be a daunting task even in the most harmonious of times. Take the packaging problem. The vaccines under development range from old- school (based on inactivated or weakened viruses) to cutting-edge (using snippets of RNA or DNA to train the immune system to attack the invader). Some may work better than others for different patient groups—the young versus the elderly, for example. All, however, must be stored in vials and administered with syringes. Among the handful of U.S. companies that manufac- ture such products, many must import the special glass tubing for vials, as well as the polypropylene for syringe barrels and the rubber or silicone for stoppers and plungers. These materials are commonly sourced from China and India, where lockdowns and export bans restrict supply. Rick Bright, the ousted director of the federal Biomedical Advanced Research and Development Authority (BARDA), claims he was ignored when he warned the Trump Administration that a medical-glass shortage was looming before the coronavirus crisis hit; securing enough to vaccinate 300 million Americans, he told Congress in May, could take up to two years. Getting the vaccine to poorer countries presents fur- ther hurdles. To begin with, there’s refrigeration. In- activated or live vaccines must be kept between 2 and 8 degrees Centigrade (or 35 to 46 degrees Fahrenheit); RNA or DNA vaccines require much colder tempera- tures—as low as -80 degrees. This makes storage and transport challenging in parts of the world that lack reliable electricity. Tracking vaccine distribution is another conundrum for low- to-middle-income countries. “Supply chain management is really about information,” explains Re- becca Weintraub, assistant professor of global health and social medicine at Harvard Medical School and director of the Better Evidence project at Harvard’s Ariadne Labs. “It’s about leveraging data to determine

This snub by the world’s remaining superpower and one of its principal challengers worried many


The Biggest Challenge for a COVID-19 Vaccine


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