The multiple announcements of potential vaccine candidates in the fight against COVID-19 has been greeted positively around the world, but rolling out immunization to every Canadian who needs and wants it will be a bigger challenge than many campaigns of the past.
And it all starts with having to keep things cold as ice — and then some — for far longer than with vaccines such as the flu shot.
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Temperature-controlled supply chains are referred to as a “cold chain.” These logistical challenges are not just medical. They show up every day in Canadian’s grocery stores and kitchens.
“The cold chain, you can’t miss a link in the system,” explained Lyle Edwards, owner of Frozen Solid. His Calgary-based company provides temperature-controlled food distribution to maintain the “cold” part of the cold chain for such items as groceries and pet food.
Think of the ice cream that is sitting in your freezer right now — it had to go through a cold chain to get there. If it warms up at any point along the way, it’s ruined.
“That’s the most important thing I learned from ice cream,” Edwards said. “The temperature requirements are so important … no link can be missed.”
Many vaccines are similar to those frozen foods in terms of transport requirements. At least two of the candidates announced must be kept at sub-zero temperatures from the point of manufacturing, through shipment to warehouses and storage at a distribution centre, such as a clinic, pharmacy or hospital.
That temperature needs to be extremely cold until an immunization is thawed and ready to get jabbed into your arm. In the case of Pfizer’s vaccine candidate, that temperature is around -70 C. For Moderna’s candidate, it must be kept at about -20 C.
To keep these vaccines safe and viable for use, manufacturers, distributors and governments need specialized equipment, additional insulation for warehouses and specially designed refrigerators and freezers.
While other medications and vaccines don’t always have these requirements, more common examples in the business world can be drawn on to understand the cold chain.
We all scream for ice cream, unless it’s melted
Just like vaccines, ice cream needs to stay in a cold chain until just before it’s ready to be used or consumed.
Think about what happens if your frozen dessert sits out, even for a short period of time, and is then refrozen. On top of potential food safety issues, it’s just not the same. It often tastes worse and has ice crystals in it.
This is an example of what happens when the cold chain is broken. But with vaccines, instead of losing taste and texture, you lose effectiveness.
It’s an operational challenge Edwards knows well.
Items that come to Frozen Solid for distribution, such as — yes — ice cream, have to be kept at the same temperature from Day 1.
It means companies such as Frozen Solid have to have a fleet of temperature-controlled trucks that essentially function as freezers on wheels, as well as distribution centres or warehouses that can keep everything cold.
An item like ice cream — just like the potential COVID-19 vaccines — cannot be allowed to melt before it gets to its end destination.
“They would manufacture it and then it would be flash frozen, and then from that the storage has got a kept temperature,” Edwards said while demonstrating a transport truck that was -20 C on the inside.
“That temperature has to be maintained right from the time that it was manufactured all the way through to the end user,” he said.
It’s so critical to maintain temperature constantly in a cold chain — even for something like dessert — that employees have to be dressed for the coldest Canadian winter just to work in Frozen Solid’s trucks and warehouses each day.
“The guys will put on their jackets and make sure they’ve got their gloves on and their hats on while they’re trying to pick all the orders,” Edwards said.
Many of the facilities, trucks and freezers that Frozen Solid staff work inside of are designed to keep things hovering around -20 C.
So the technology to keep things that cold, from the manufacturing point to the point of purchase, does exist in Canada. It’s as close as your local grocery store.
Can Canada keep vaccines cold enough?
The catch is, at least one of the vaccine candidates out there needs to be kept even colder than your typical ice cream van.
Experts say that the Canadian supply chain for vaccines is not set up to handle the volume material that needs to be kept as cold as the Pfizer vaccine candidate. At least, not yet.
“There’s going to be lots of things we need to do before we can actually distribute the vaccine,” said Mahesh Nagarajan, a professor of operations and logistics at the UBC Sauder School of Business in Vancouver.
In an interview with CBC Radio’s The Cost of Living, Nagarajan pointed out that Canadian governments and health authorities don’t yet know which of the vaccine candidates will be obtained first and in how many doses.
The logistics of keeping thousands of doses at -70 C for the Pfizer candidate, versus -20 C for the Moderna candidate, mean that multiple scenarios need to be considered to potentially accommodate both.
When it comes to the extremely low temperatures the Pfizer vaccine would require, purchasing gear becomes an issue. Nagarajan said Canada would need to procure more of the ultra-cold freezers required to keep that particular vaccine safe and effective.
“Very few products require refrigeration like that, on that scale,” he said, explaining why Canada wouldn’t have pre-existing infrastructure to keep millions of doses in a cold chain at -70 C.
“[The vaccines] would come to Canada, presumably by airplanes or by trucks, and then they would be trucked across in these cold or ultra-cold trucks, and then we would have to store them…. Then we have to send them out to regional distribution centres,” said Nagarajan, whose research has focused on supply chain management and health-care operations.
Canadian distributors and producers of ultra-cold freezers have already noted a spike in demand, both in Canada and worldwide.
According to an Ottawa retailer of lab equipment, it normally takes about three months to ship a container of 40 ultra-cold freezers from Asia to Canada.
But with global demand, that wait could increase.
On Thursday, the federal government said it’s already had an initial delivery of dozens of freezers for vaccine storage and will issue a request for proposals to obtain more soon. But officials didn’t provide details on where those freezers would be deployed.
Cold chain design means asking who gets it, and where?
Initially, there will be a limited supply of vaccines coming into Canada, and they may arrive gradually.
The design of a cold chain needs to take that into account, according to Hossein Abouee Mehrizi, an associate professor in the department of management sciences at the University of Waterloo.
“We need to have a really good demand estimation for each region,” said Mehrizi, whose research focuses on health-care logistics and supply chain management.
Just like ice cream being delivered to your local grocery store, these vaccines need to be transported in a frozen state and stored in a frozen state upon arrival until they are ready to be used.
WATCH: Public Services and Procurement Minister Anita Anand on vaccine arrival:
If demand isn’t estimated correctly for a specific region, resources may not be deployed to keep the material cold all along the way. And at -70 C, you can’t just use the freezer your ice cream is in.
While Pfizer has used transportation containers — dubbed pizza boxes in some media reports — that could each transport nearly 200 vials of concentrated vaccines at the right temperature, and safely, governments designing a supply chain will still have to develop protocols.
“We don’t know that if a box is opened, how long can we keep it?” Mehrizi asked.
Pharmaceutical distributors and cold transport companies often use dry ice to keep materials cold in transport, and an additional concern would be disposing of that dry ice safely.
Remote or rural locations may not have the ability to dispose of dangerous goods such as dry ice safely after the vaccine has been used and no longer needs to be stored.
Two batches of the frozen stuff needed
An additional challenge that must be taken into account is unique to these vaccines — and unfortunately the ice cream man can’t help on this front.
“Both Pfizer and Moderna vaccines, people need to get two doses of those vaccines. Therefore we need to have a very good tracking system to make sure that people get the same vaccine twice within a limited time window,” Mehrizi pointed out.
Vaccine won’t put an end to the pandemic. Only vaccination will do the job.– Tinglong Dai, associate professor, Johns Hopkins University
The federal government, along with the provinces and health authorities, must develop the infrastructure to track who gets what vaccine, where they get it and when to make sure that no doses go to waste.
The absence of a national registry tracking who is vaccinated in Canada could be a hurdle, although many provinces have this data
With that information, it could be easier to predict when and where cold storage needs to be deployed.
The social science to encourage you to get ‘ice cream’
The final piece to the puzzle of the cold chain is making sure that supply and demand match each other. That’s where social science to predict how and what people will do comes into play.
“Social science is really important because we are talking about vaccination, not just a vaccine,” said Tinglong Dai, associate professor of operations management and business analytics at Johns Hopkins University’s Carey Business School in Baltimore.
“Vaccine won’t put an end to the pandemic. Only vaccination will do the job,” Dai said in an interview with The Cost of Living.
The widespread news coverage of multiple vaccine candidates may help encourage more people to get vaccinated — albeit inadvertently.
Dai compared it to the influenza shot, which doesn’t normally get publicity around who makes it or what type is available. Typically, Canadians do not think about which brand of flu vaccine they might get.
But knowledge of various options could encourage more people to actually select something.
“If we present people with more choices, but not too many choices, then people are more likely to buy something. So the upside from my perspective is that when people are actually thinking about which vaccine to get, maybe that will help them overcome the hurdle of whether or not to get a vaccine,” Dai said.
Patience is key, but the job is doable
As things stand right now, multiple experts say Canada isn’t ready to distribute vaccines — yet.
We have a handle on getting ice cream from coast to coast to coast, but keeping multiple doses of a vaccine at -70 C isn’t within reach at this point.
It’s partly why the federal government is turning to organizations such as the military — which has experience in transporting dangerous goods across large distances — for assistance in rapidly scaling up cold chain distribution.
“We are not super prepared [right now], but I think we are getting there,” said UBC professor Nagarajan.
“This is going to be one of the biggest logistical exercises in my lifetime at least…. People need to understand that it’s a very complex operation, one that we haven’t quite done before. I think we need to be quite patient.”
Written by Anis Heydari, with files from Falice Chin and CBC News.
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