The Covid-19 Vaccine Cold Chain

On September 18, 2020 my article, "Keeping coronavirus vaccines at subzero temperatures during distribution will be hard, but likely key to ending pandemic," was published in The Conversation. I believed that it was imperative (and my Editors at The Conversation agreed) to start speaking to a broad audience on the necessity and importance of the cold chain to the effective distribution of the Covid-19 vaccines that are presently under development by major pharmaceutical firms.  There was much discussion and coverage in the press about the manufacturing aspects of the different vaccines as well as the R&D involved. However, there was very little being discussed about the distribution issues.  It was imperative to me  that emphasis (and associated challenges) on getting the approved vaccines ultimately from point A (manufacturing) to point B (point of administering of the vaccine), with the quality preserved in the transportation and distribution process, be brought to everyone's attention.

I have conducted research on perishable product supply chains from food to pharmaceuticals and even co-authored a book on the topic.

There are now 4 major Covid-19 vaccines that are far along in the trial phases and this is quite promising, with the Moderna and Pfizer vaccines requiring storage below freezing (Pfizer's to the extreme temp of -94 F) with those of Astrazeneca's and John & Johnson's needing to be in the range of 2-8 degrees C, which is standard for many vaccines. 

I have published multiple articles in The Conversation, but this one generated the greatest number of comments and even emails to me from around the globe, which continue. Clearly, the article that I wrote had touched on a very important issue, and I am also grateful that the article got reprinted in multiple media outlets.

Since the publication of my article, much has happened, and the momentum keeps on growing.

I had the pleasure of being interviewed by David Williams and John Driscoll for their Care Talk podcast, the link to which is below. 

 

Lori Hinnant, who is an Associated Press journalist, based in Paris, subsequently interviewed me for a fabulous article, "Vaccine storage issues could leave 3B without access."  My colleague at the Carey School of Business at Johns Hopkins, Tinglong Dai, was also interviewed for this article, which has been reprinted internationally in numerous outlets and also published in The Washington Post and ABCNews.

I have had additional interviews with journalists at The Wall Street Journal and am quoted in the article, "Covid-19 vaccines to be stored secretly under tight security," by Jared S. Hopkins on the security of the distribution of the vaccine. There is a slightly modified title in the hard copy version - a colleague kindly delivered his copy to my door!

I've done research with collaborators on freight security of highly value cargo and clearly the Covid-19 vaccines fall into this category!

And, on November 6, I will be featured on the NPR show The Pulse, based on an interview on the vaccine cold chain conducted by Alan Yu.

One of the goals of my Conversation article was to make the cold chain distribution issues more visible in order that appropriate preparedness measures would be taken, both nationally and globally, so that, once vaccines are approved, time is not wasted and the vaccines do not go to waste as well.

Many thanks to all those who have responded, including the amazing journalists, who continue to keep this important topic in the news!

And, just before publishing this blogpost, I received another inquiry from a journalist requesting an interview because of my article in The Conversation!

Meningitis on Campus - An Extremely Timely Lecture by a Public Health Nurse Extraordinaire

Yesterday was the final guest lecture in my Humanitarian Logistics and Healthcare class this semester at the Isenberg School and it was extremely timely and interesting.

The students and I had the privilege of hearing from Ms. Ann Becker, who is the University Health Services (UHS) Public Health Nurse and the Unit Coordinator for the Medical Reserve Corps at  UMass Amherst.

The title of her guest lecture was: Meningitis on Campus - Reaching Students During a Meningitis-B Outbreak.

As some of you may have heard, this past Fall there were two cases of Meningits-B, one in late October, and the other three weeks after. Since no linkages between the two cases could be identified, the Centers for Disease Control (CDC) termed these cases an outbreak. Students get vaccinated for other strains regularly but not for the B strain. And, in early March, the CDC confirmed that another case was diagnosed in a Smith College student, so this is now a 5 College outbreak. 

This disease is very rare but it can progress rapidly with extremely dire effects.  I remember last semester when I was teaching my Transportation and Logistics class at the Isenberg School that one of the students in this class knew the first student to contract meningitis-B because they were both in the same fraternity, and he was involved in helping to raise funds for the student's care and recovery.

10-40% of 16-24 year olds are carriers of this bacteria, and the illness is transmitted through direct contact with secretions. Risk factors include large parties and sharing of drinks, cigarettes, etc., and being stressed and not sleeping enough only increases the probability of contagion. It takes at least a week to identify the meningitis strain from a culture and these were sent both to the Massachusetts DPH and the CDC.

The UMass Amherst campus responded extremely professionally. There had actually been simulation exercises in place for a mass vaccination and I had even blogged about this. This was inspired by the cases in the US a few years back on college campuses, including Princeton University. And, at that time, there was not even a vaccine available in the US (but was in Europe). 

The UMass Amherst campus responded with an emergency call center, since, once the news went out, the staff was inundated with calls. Staffing was identified for the initial vaccination clinics and vaccine supply and cold storage had to be managed. It was interesting to hear that the annual flu clinics also served as a prep for the mass vaccination clinics. UMass Amherst, as a university, is in the business of education, and it was essential to have no disruptions to courses. The healthcare staff, with assistance from nursing students and the Medical Reserve Corp, in 3 hours gave 700 vaccinations. "Being prepared and knowing people" helped in the efficiency of the processes as well as their effectiveness. The cost for 10,000 doses was $1.5 million from Glaxo Smith.

In order to reach students, there were numerous communication media that were utilized - from social media and emails to the notification of parents and having a dedicated strip banner with info on the UMass homepage. Also, the MA DPH sent out messages to every healthcare provider in the state. Two shots are required for the vaccine and there was a one week Thanksgiving break in late November with some students also getting their first vaccines from their home healthcare providers.

UMass Amherst had 4 walkin clinics over consecutive days from noon until 6PM and Ms. Becker showed the class an excellent diagram with the flow of the process, which is something all the Operations students enjoyed and appreciated. It began with the registration and asking for the insurance (if students or insurers could not pay, then (bravo) UMass Amherst covered the expense). Impressively, the number vaccinated reached 1,500 per day with the longest wait time of 20 minutes, which is not bad, given the volume of students as well as the severity of the disease.

It was interesting to hear that the processes were aided by the youth of those vaccinated and that they were all ambulatory.

There are still unknowns, however, since we don't have an accurate count of how many students have received the two shots that are needed, as Ms. Becker pointed out in her lecture.  Interestingly, she also mentioned that, after a year of no more outbreaks, can we be considered "in the clear." They do know that more than 3,000 + students have already had 2 shots.

Our University Health Services are continuing with walk-in clinics, which is great and also reassuring, and they have also done an amazing job in educating students as to proper behavior so that this bacteria does not spread.

We presented our fabulous guest lecturer with a certificate and a gift from the Isenberg School and took the group photo below as a memento.

And, in her last slide of her presentation, featured above, we can see our Chancellor, Dr. Kumble Subbaswamy, "saying": Get Vaccinated.

It was very special to have Ms. Becker speak to my class and her expertise and kindness are truly inspiring. We are very lucky to have her at UHS at UMass Amherst!

Global Healthcare Supply Chains and Good Job News

I have been writing in this blog about our latest research on supply chain network design for critical needs products from vaccines to medicines and on hospital supply chains.

I was delighted to read in the Boston Globe that Sanofi-Aventis, one of the world's largest drug makers, is expanding its operations in Massachusetts and that this will mean more jobs -- jobs of importance and meaning.

According to the article: Sanofi-Aventis SA, is planning a $65 million expansion in Cambridge that will create about 300 jobs, making it the latest foreign pharmaceutical giant to invest in Massachusetts. The Paris-based drug maker is in the process of leasing space in Cambridgeport, where it will establish a joint headquarters for a new cancer division.

As you may recall (what a feeling of deja vu) last summer, at this time, the world was battling the H1N1 virus from Argentina (coincidentally, my most recent international trip in the summer of 2010) to China to the United States.

Sanofi-Aventis was one of only a handful of H1N1 vaccine producers and, given the low number of vaccine manufacturers, and the various challenges with the production of this vaccine, my research group began a study on multiproduct supply chain network design with applications to healthcare. Clearly, with fixed capacities, some of the vaccine producers had to switch from production of the annual flu vaccine to the challenging H1N1 vaccine.

We are pleased that the study has resulted in a paper/report, "Multiproduct Supply Chain Network Design with Applications to Healthcare," which, given the timeliness of the topic, we are making available to our readers through the Virtual Center for Supernetworks. The research allows pharmaceutical firms to redesign their supply chains in an optimal way to enable the cost-minimizing production of multiple vaccines and medicines with demand satisfaction.

Research at Business Schools is increasingly focusing not only on how wealth can be created but also how it can be done in a socially responsible way.

Rockefeller Foundation's Bellagio Center's 50th Anniversary and Humanitarian Supply Chains

This year, the Bellagio Center, on Lake Como, Italy is marking its 50th anniversary so congratulations are certainly in order! The Bellagio Center runs programs through the Rockefeller Foundation and it has released a special book commemorating the 50th anniversary. I have been privileged to have hosted two events at the Bellagio Center. The first event took place in March 2004, and consisted of a research team residency for two weeks on dynamic networks. The second event took place in May 2008 and was the "Humanitarian Logistics: Networks for Africa" conference, which convened academics, researchers, and practitioners from several continents. Both of these programs that I organized, and for which the Isenberg School of Management is also credited, are documented in this Rockefeller Foundation publication.

It is truly worthwhile to explore the special publications with luminous photographs on the Bellagio Center website that mark its 50th anniversary. You may marvel at some of the scholars featured (some of whom have certainly been in the news a lot lately). I remember telling my undergrads at the Isenberg School when my first proposal to the Bellagio Center got funded. One of my students, Cristina Calvaneso (who not only received a Leaders for the 21st Century Award from UMass Amherst, served as a student associate of the Virtual Center for Supernetworks, and who also has had wonderful professional career since graduating in 2004) told her grandmother about this. Grandma was very pleased (but mistaken) and thought that I was going to the Bellagio in Las Vegas!

Recently, there has been increasing interest from both researchers and practitioners surrounding humanitarian logistics and supply chains and I have been receiving more and more queries about our research and activities in this dimension. I have updated the website that was created explicitly for the Humanitarian Logistics: Networks for Africa conference to include information on my new book, Fragile Networks: Identifying Vulnerabilities and Synergies in an Uncertain World, with Q. Qiang, and on the book, Humanitarian Logistics, by Tomasini (who took part in my most recent Bellagio conference) and Van Wassenhove.

In addition, several associates of the Virtual Center for Supernetworks that I direct have just completed a major study on the design of supply chain networks in the case of humanitarian operations in which there is not only demand uncertainty but partnerships between/among organizations may present themselves. The study documents a new analytical framework, which is network-based, along with computer tools for scenario evaluations and simulations. This research was conducted with tremendous passion and determination since we are reading about the possible escalation of the flu come this fall and the measures that are being taken not only by vaccine and medicine manufacturers but by government, healthcare, and even educational officials. It is critical that top-level research on supply chains for humanitarian needs gets disseminated. Nevertheless, publishing and refereeing take time. At least, we know that we have done our part. Our Fragile Networks book, which includes material on humanitarian operations and supply chains, acknowledges support from the National Science Foundation, the Rockefeller Foundation, and the Radcliffe Institute for Advanced Study, which will soon be celebrating its special 10th anniversary!