A logistical "roadmap" from Shanghai Fosun Pharmaceutical has been released showing the staggering logistical feats required to transport and store the Pfizer-BioNTech vaccine, which has just been christened by Bloomberg as "the vaccine of the rich".
Offering some more insight into details that have been the subject of much speculation on Wall Street, Bloomberg reported on this "complex and costly" private network that companies are building to help distribute vaccines like Pfizer's mRNA vaccine (a technology that's also being used by another leading candidate, Moderna), that is, once it has finally been approved.
Countries that don't already have these networks will need to build them from scratch if they wish to substantially reduce the supply bottleneck, which would be "a herculean task".
That means that countries will need to build from scratch the deep-freeze production, storage and transportation networks needed for the vaccine to survive. This massive investment and coordination required all but guarantees that only rich nations will manage to dial up access, with the wealthy first in line to receive their doses.
"Its production is costly, its component is unstable, it also requires cold-chain transportation and has a short shelf life," said Ding Sheng, director of the Beijing-based Global Health Drug Discovery Institute, which has received funding from the Bill & Melinda Gates Foundation.
The WHO and Bill Gates have invested plenty of time on a PR campaign warning that access to the vaccine must be made 'universal' - that is, extended to all of earth's 7.7 billion people - or humanity won't manage to eradicate COVID-19. Together, they've backed a project called 'Covax' which aims to raise $18 billion to pay for vaccines for poorer countries.
But even once they've been paid for, the task remains: how can we physically ship and store them in such vast quantities?
The massive expense of the infrastructure investment means many of these poorer countries are now faced with a difficult choice: invest in the supply network, even before the vaccines have been approved, and take a risk should unforeseen complications arise, or wait to see how everything pans out for the developed world, sacrificing valuable time. Many of these economies could simply wait longer until more conventional vaccines, using other technologies, such as Russia's adenovirus-vector vaccine, are available. Generally speaking, mRNA vaccines are a new class of vaccines, which is why some are apprehensive about the long-term side effects, which can't be reliably studied.
“If there is a protein-based vaccine that could achieve the same effect as an mRNA vaccine does and there’s the need to vaccinate billions of people every year, I’d go for the protein-based shots in the long run,” Ding said.
Countries like India are facing particular difficulties given that shipping regular consumer goods remains a difficult, even treacherous, process across much of the country's hinterland. Health-care experts in the country have already dismissed sub-zero storage as completely unworkable - "just forget it, one said."
Many working in the country’s public health and the pharmaceutical industry have already voiced concern that India lacks the necessary capacity and capability to deliver a vaccine across its vast rural hinterland and population of over 1.3 billion people at the breakneck speed now expected.
“Most of these vaccines need minus 70 degrees, which we just can’t do in India, just forget it,” said T. Sundararaman, a New Delhi-based global coordinator of the People’s Health Movement, an organization that brings together local activists, academics and civil society groups working on public health.
“Our current cold chains are not able to cope with some districts’ need for measles vaccines, and that’s only for children below the age of 3,” he said. “That’s a really trivial number of people compared to the numbers that will need a Covid-19 vaccine."
When asked at a Tuesday briefing if India’s government would look to buy any of the Pfizer vaccine, Rajesh Bhushan, the secretary at the health ministry, said New Delhi is in talks with all vaccine manufacturers. He added that India was in a position to “augment and strengthen” its existing cold-chain capacity, but declined to release any purchase details immediately.
So, judging by the way things are going...
...it looks like the world is headed for a tiered system: one vaccine for the wealthy, and one another for the poor.