Logistics lessons from past crises for Covid-19 vaccine shipment

Covid-19 is not the world’s first pandemic, and it may not be the last either. Africa, in particular, has faced many humanitarian crises in the past and there are learnings from those crises that can be drawn to ease the vaccine distribution for Covid-19. Logistics players in the African continent have a colossal task up their sleeve to ensure the vaccines reach the remotest corners regardless of limited cold-chain logistics infrastructure.

Not too long ago, before the Covid-19 pandemic spread across the globe, Africa was responding to another crisis – the Ebola outbreak. Although the footprint of the Ebola outbreak was confined to a smaller region in proportion to the Covid-19 pandemic which has affected all the 54 countries, the scale of the logistics in the transportation of the Ebola vaccines was extensive.

The Ebola outbreak in the northeast of the Democratic Republic of Congo (DRC) was declared over on June 25, 2020, almost two years since the first case was confirmed. The DRC Ministry of Health made the announcement after no new cases were reported 42 days since the last patient tested negative for the virus. The outbreak which began in August 2018 reported 3470 cases, 2287 lives lost and 1171 survivors, making it the second-deadliest after the one in West Africa that lasted from 2014 to 2016.

“The Ebola outbreak in DR Congo will provide valuable lessons for logisticians on how to deal with the Covid-19 crisis in Africa. WHO delivered 900 tonnes of supplies to DR Congo, Rwanda and Uganda over a period of 20 months which involved nearly 300,000 doses of vaccines besides PPEs,” informed Sanjeev Gadhia, CEO, Astral Aviation. Astral has played an important role in various immunization programs in Africa and across the world including supporting efforts to tackle Ebola in the Democratic Republic of Congo and the cholera pandemic in Yemen.

"The processes for exports have been tested thoroughly, when LGG handled more than 100 cargo charters to fight Ebola in Africa. This time, there will be imports and transshipments as well, as there were and are for the PPE material. We are preparing for different scenarios, different requirements."
Steven Verhasselt, Liege Airport

Is Africa prepared for Covid-19 vaccine distribution?

This time around, as Africa embarks on a similar delivery plan for the movement of Covid-19 vaccines, a recent analysis by World Health Organization (WHO) analysis has revealed that “Africa is far from ready” to take on the task. According to the report, Africa is just 33 percent ready for what WHO describes as the “continent’s largest ever immunization drive,” a figure far below the desired benchmark of 80 percent. This immunization readiness survey based on data from 40 countries on the continent shows only 44 percent of African countries have coordination structures in place for the adequate distribution of Covid-19 vaccines.

The first batch of Covid-19 vaccines is estimated to reach Africa only after the first quarter of 2021. During the Ebola crisis, most challenges faced were related to insecurity, lack of cold-storage facility and inaccessibility, which are going to be faced in the transportation of the Covid-19 vaccine to and within Africa, believes Gadhia.

The Covid-19 vaccine produced by Moderna has a shelf life of six months and needs to be transported and stored at a temperature of -20 degree C. When it finally reaches a clinic or pharmacy, where it will be kept in a regular refrigerator, it can remain there for in good quality for a maximum of 30 days. The vaccine produced by Pfizer/BioNTech must also be stored at -70 degree C with a shelf life of only five days at standard refrigeration temperatures. Obviously, this means that all countries need to step up their cold chain capabilities. In Sub-Saharan Africa, the World Bank estimates only about 48 percent of residents have access to electricity, which will make storing the vaccines at freezing temperatures extremely difficult.

“Only six of the airports in Africa have airside cold-storage facility hence the transshipment of vaccines will have to be coordinated via the hubs of Nairobi, Johannesburg and Addis Ababa, in addition to point-to-point shipments to certain countries which will have a larger population,” Gadhia highlighted.

Gavi, the Vaccine Alliance, which has been playing a central role in the global collaboration to make Covid-19 vaccines available to all countries, had earlier supported the establishment of the Ebola vaccine stockpile of 500,000 doses to strengthen the world’s defenses against the threat of infectious disease outbreaks. The stockpile includes licensed doses of the Ebola vaccine manufactured by MSD, known as Merck inside the United States of America and Canada, which has received approval from the European Medicines Agency (EMA) and the US Food and Drug Administration (FDA), in addition to prequalification from WHO.

"West and Central Africa is one of the most complex environments you will find."
Jean-Cedric Meeus, UNICEF

“The stockpile of thousands of Ebola vaccines is a ground-breaking development,” said UNICEF executive director Henrietta Fore in a media statement. “It is testimony to the unrelenting and unprecedented efforts of this global partnership to fight Ebola outbreaks -- and it provides an opportunity to learn from this success as we prepare for the global rollout of Covid-19 vaccines.”

As the largest single vaccine buyer in the world, UNICEF has been tasked with the delivery of vaccines for routine immunisations and disease outbreaks such as the Ebola virus. Now, UNICEF, in collaboration with the Pan American Health Organization (PAHO), is spearheading the campaign to procure and supply approved Covid-19 vaccines for 92 low- and lower middle-income countries around the world, of which one-quarter are in West and Central Africa. “West and Central Africa is one of the most complex environments you will find,” says Jean-Cedric Meeus, UNICEF’s Chief of Supply for the region in a blog post by the organisation. “We are dealing with the challenge of delivering Covid-19 vaccines to major cities, but also to extremely remote villages. We are preparing for all scenarios.”

Getting these vaccines from manufacturers to countries is a mammoth task. It not only requires that airlines have enough space to transport them, but also that the vaccines are kept at a stable, cold temperature from the moment they leave the manufacturer until they are administered. UNICEF plays a critical part in lending support to governments before the Covid-19 vaccines arrive ensuring that the facilities needed for this are in place.

"For Ebola, we have run a number of projects to Central and West Africa. Our customers are cognizant of our rich network footprint across the continent. For Covid-19, these movements will be in a grand scale we have not seen before."
Peter Musola, Kenya Airways

Since 2018, UNICEF, working with governments and with support from Gavi, the Vaccine Alliance, began buying and installing solar-powered fridges to store vaccines throughout the region. The idea would be a gamechanger for regional and district health workers who often struggle to carry out routine immunisations for children in places with unreliable electricity and cold storage facilities.

Airlines and airports prep up

Meanwhile, airlines are prepping up for this mammoth task despite the capacity crunch. Ethiopian Cargo & Logistics Services announced its readiness with all required capabilities for the distribution of potential Covid-19 vaccine across Africa and the rest of the world. Commenting on Ethiopian’s preparation for the vaccine distribution, “Ethiopian Pharma Wing will repeat its remarkable and globally recognized success in leading the fast delivery of PPE few months ago with similar delivery speed, professional handling and maintaining the cool chain during the forthcoming global distribution of the Covid-19 vaccine,” said Tewolde GebreMariam, group chief executive, Ethiopian Airlines in a media statement. GebreMariam further laid stress, “We are the major cargo partners of WHO, WFP donor governments and philanthropists in facilitating the flow of essential medical supplies owing to our massive cargo facility including our Pharma Wing, our large dedicated freighter fleet and well trained manpower. As the world prepares to welcome Covid-19 vaccine, we will be at the forefront to further discharge our responsibility in the distribution of the vaccine across the globe.”

Kenya Airways has also successfully handled previous vaccines projects in Africa. “For Ebola, we have run a number of projects to Central and West Africa. Our customers are cognizant of our rich network footprint across the continent,” said Peter Musola, Kenya Airways.

“For Covid-19, these movements will be in a grand scale we have not seen before. Our recent investments in a state-of-the-art pharma warehouse with capability to handle over 300 tonnes anchors our preparedness to handle the huge movements. Moreover, we have upscaled our staff through specialized product management trainings. The combination of the hardware and ‘software’ essentials place us ready for kickoff,” Musola added.

Gadhia’s Astral Aviation has also been upping its game in its preparation for the Covid-19 vaccine distribution. “With the arrival of the B767-200 Freighter in Nairobi, we will be able to offer air-transport of vaccines to and within Africa as our payload will be 42 tonnes with 350 cbm volume which will be ideal for the Covid-19 vaccine distribution in addition to our fleets of B727 (22 tonnes) and DC9F (14 tonnes) which will be able to perform the last mile delivery to the secondary airports in Africa,” he said.

"The Ebola outbreak in DR Congo will provide valuable lessons for logisticians on how to deal with the Covid-19 crisis in Africa. WHO delivered 900 tonnes of supplies to DR Congo, Rwanda and Uganda over a period of 20 months which involved nearly 300,000 doses of vaccines besides PPEs."
Sanjeev Gadhia, Astral Aviation

The vaccine distribution in Africa will cover 60 percent of Africa’s population of 1.3 billion people and will require 1.5 billion double doses of vaccines, which is an exercise which will take two years, according to Africa Centres for Disease Control and Prevention (CDC). This huge task will essentially require strong partnerships between stakeholders and informed planning that will help establish a comprehensive public health crisis management system supported by sophisticated supply chains. Such collaborations will also ensure that Africa is well prepared to deal with any extensive health emergency in the future.

“Hence it is likely that Africa’s Covid-19 vaccine drive will take time and will require extensive collaboration between the vaccine manufacturers, GAVI, Ministry of Health of the various African countries, airlines, airports, ground handlers and freight forwarders,” reasons Gadhia.

European hub for the World Food Programme Liege Airport (LGG) is also prepared with its vaccine distribution plan with a single point of contact for all information and questions related to the distribution. Liege Airport has already tested all its processes for exports when it moved charters to Africa to fight the Ebola crisis. “The processes for exports have been tested thoroughly, when LGG handled more than 100 cargo charters to fight Ebola in Africa. This time, there will be imports and transshipments as well, as there were and are for the PPE material. We are preparing for different scenarios, different requirements,” said Steven Verhasselt, vice president – commercial, Liege Airport.

In Africa, where past viral outbreaks have stretched already-strained healthcare systems in a number of countries, making sure cold storage facilities are in place from the manufacturer to where they will be administered is an uphill task which needs to be scaled to ensure vaccine stability. Another important aspect is ensuring that airlines dedicate enough space to transport them and build networks across Africa. While all stakeholders are stepping up their efforts, they need to rely on the lessons learned from a large-scale vaccine supply effort to curb the pandemic.