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Medicine

Pfizer's COVID-19 Vaccine Distribution May Be a Logistical Nightmare (cbsnews.com) 143

Posted by BeauHD from the what-to-expect dept.
hey! writes: Pfizer's BNT162b2 vaccine must be stored at a constant -100F/-70C temperature, presenting a logistical nightmare for hospitals, which don't normally have freezers that go that low. This is because it is an mRNA vaccine, and mRNA is unstable unless stored at extremely low temperatures. Pfizer will distribute doses in dry-ice packed "suitcase" shipping containers containing 1,000-5000 doses, but these cases only work for ten days, during which they may be opened only twice a day, each time for less than three minutes. This will pose a special challenge for rural hospitals, who can't afford specialized freezers; they'll be forced to distribute hundreds of doses a day from the dry ice packed shipping crates to avoid their stocks going bad. Rural vaccination is further complicated by the fact that the vaccine must be given in two doses spaced three weeks apart.

The Moderna MRNA-1273 vaccine candidate is also an mRNA vaccine, but can be stored at -4F/-20C. This is because Moderna has experience in stabilizing mRNA. MRNA-1273 can be stored in a regular hospital freezer, making it a better candidate for smaller hospitals and clinics, although nationwide distribution in the volumes of doses needed is still going to take an unprecedented effort. If both vaccines are approved at the same time, we'll likely see both rolled out in parallel, with smaller hospitals and clinics getting the Moderna vaccine and higher volume facilities getting the Pfizer vaccine.
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Pfizer's COVID-19 Vaccine Distribution May Be a Logistical Nightmare More

Pfizer's COVID-19 Vaccine Distribution May Be a Logistical Nightmare

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  • I think someone smart in logistics can figure this (Score:5, Insightful)

    by GregMmm ( 5115215 ) on Tuesday November 17, 2020 @06:56PM (#60735858)

    Really, man just made a new mRNA vaccine and the major problem will be how to deliver it and store it? Yes I must admit that is some low temperatures.

    I think we have some smart people who know how to move/store/deliver the vaccine. Just another problem to fix, that's all.

    • Re: (Score:2)

      by Motard ( 1553251 )

      Agree. Fortunately, we appear to have more than one viable vaccine. Hopefully, we can draw some circles around facilities with the necessary extra cold storage and leave the rest to the vaccine that just requires the cold storage.

    • Yeah, the difficulty is being blown out of proportion, it's not going to be any sort of real showstopper, heck if you can't move the vaccine, move the people to the nearest city - problem solved. And even that is moot point, there is half the world population to be vaccinated in cities, before you even get to rural areas.

      • Yeah, the difficulty is being blown out of proportion, it's not going to be any sort of real showstopper, heck if you can't move the vaccine, move the people to the nearest city - problem solved. And even that is moot point, there is half the world population to be vaccinated in cities, before you even get to rural areas.

        It's not a showstopper, but it increases costs and complicates logistics. It's sort of like McDonald's coming up with a new sandwich that requires a new cooking appliance. It's possible to roll out, but someone has to pay for the new appliance, ship and install it, and train people on its use, and the franchisee will lose money until the initial capital cost is recovered. Some franchisees will balk at the new sandwich and refuse to offer it. In contrast, a new sandwich using no new equipment is a much e

        • If there is choice to be had, well market will sort it out. But that's sometime far down the line, for months the only choice will be vaccine or no vaccine and for much of the world the latter will be preselected. Picking and choosing which type.... just step out of the line, there is a next guy waiting his turn.

        • Re: (Score:2)

          by torkus ( 1133985 )

          It increases costs...compared to what though? Trillions in stimulus money? The fact that this is an issue because its "not easy" is ridiculous. I refuse to call distribution "hard" within developed countries. It might be expensive (but comparatively cheap) but it's VERY much well within the logistics capabilities of the US.

          FFS I got ice cream delivered today for a work "zoom social" and it came packed in dry ice. I'm sure the vaccine needs better care than the fedex guy dumping it on my doorstep but ..

          • It increases costs...compared to what though?

            Yes, this is the important question. The Moderna vaccine can be stored in the same freezers for current vaccines such as chicken pox. So, any clinic that already handles the chicken pox vaccine can reuse the same freezers with no extra cost and no additional space. In contrast, the Pfizer vaccine requires a new freezer.

      • Re: (Score:2)

        by jabuzz ( 182671 )

        I want to know which hospital's don't have access to -80 freezers? These things are ten a penny in any University biosciences research laboratory. I mean you will have rooms full of them for sample storage. I worked in IT support in such departments at multiple universities for nearly a decade.

        They are not exactly expensive either. A quick google shows that a 370lt -80 freezer is 4700GBP. So in the scheme of rolling out the vaccine this is a small cost compared to the vaccines themselves. You can also get s

        • It's no space tech of course, but the world is large and what counts for a hospital varies widely. In large cities its not an issue, but rural areas of developing world it very much is. Much of the world is still unreachable by cold chains on normal household fridge temps, you buy ice-cream you get a half melted and refrozen blob.

        • I want to know which hospital's don't have access to -80 freezers? These things are ten a penny in any University biosciences research laboratory. I mean you will have rooms full of them for sample storage.

          I work in a hospital, albeit not in the lab. We are a mid-sized safety-net hospital and we have quite a few -40C freezers, but not many -80s that I see. But those freezers are usually used for specimens that I would not want mixed with storage for a vaccine - small risk of cross contamination but enough that they need to be segregated.

          They are not exactly expensive either. A quick google shows that a 370lt -80 freezer is 4700GBP. So in the scheme of rolling out the vaccine this is a small cost compared to the vaccines themselves. You can also get smaller ones for a lot less.

          Please note all units in this post are metric.

          Agreed, these things run $10,000, but there's going to be the issue of procuring and setting up...not to mention I wouldn't doubt that we end up with a shortage of ULT (ult

        • Please note all units in this post are metric.

          GBP is a metric unit? When did that happen?

      • move the people to the nearest city - problem solved

        Significant numbers of the relevant people will resist that at gun point - being rural Americans (strictly, US-ians ; I'm not tarring Canadians or Mexicans with that brush), and therefore most likely right-wing lunatics with guns. On top of the high claimed rates of US anti-vaccination idiots, this is just going to keep the disease in circulation for years longer in America, until they impose movement restrictions on people trying to enter or leave the cit

    • Re: (Score:3)

      by hey! ( 33014 )

      It's easy to design solutions to tough logistical problems, what's hard is implementing them in the real world, especially the *first time*. That's when you find out all the things you wished you'd known. It's not just about being smart; it's having know-how of the task at hand.

      There's also a tradeoff here between speed and difficulty. If you take a simple problem and reduce the time you have to solve it enough, it becomes hard. Logistics wouldn't be a challenge if you were planning to deliver just few

      • Re: (Score:2)

        by torkus ( 1133985 )

        Well it depends...

        If we let government contracts handle this it'll be a debacle, cost 100x what it should, but (probably) not fail or waste the majority of doses.

        If we let some multi-billionaire philanthropist just 'get it down' it'd cost less (or nothing, hi philanthropy) and likely work far better.

        If -80 freezers are hard to come by, well it's pretty straight forward tech. let's start building them. We don't need millions, but we do need many thousands...so let's go. Ramp up dry ice production NOW. Th

    • Really, man just made a new mRNA vaccine and the major problem will be how to deliver it and store it?

      Given that the people who are currently responsible for managing this problem are instead going to be just stewing in a bunker and posting rage tweets for the next nine weeks, this is most likely going to end up being a major clusterf*ck.

    • Just another problem to fix, that's all.

      Well if you put it like that then man also knows precisely how to solve world energy through fusion power and superconductors. The only thing we are missing are how to keep temperatures low so that's just another problem to fix that's all.

  • OKAY (Score:4, Funny)

    by rotorbudd ( 1242864 ) on Tuesday November 17, 2020 @07:03PM (#60735898)

    I'm cool with that.

  • Put a compartment in the suitcase you can just refill with dry ice from the supermarket without disturbing the air in the main compartment, shouldn't be that hard.

    • Buying dry ice from a supermarket is US only phenomena I think, anywhere else in the world you need an specialty industrial gas supplier for that.

    • Re: (Score:2)

      by hey! ( 33014 )

      The suitcases can be refilled with dry ice, but it only extends the total design storage time from 10 to 15 days. That's probably because every time you open the case it degrades the vaccine inside, which is why you're limited to under three minutes, twice a day.

      • Just have one giant syringe in the suitcase and have the hypodermic needle extend in and out of the suitcase, or swap out the needle from a one-way nozzle that sticks just outside the suitcase. That way you never have to open the suitcase. Problem solved!

      • That's just a design problem.

        Say you put a slide in it with two compartments for dry ice, the slide can close one of the two compartments (or open them both up to the main storage area, this would be how you ship it). Then once you start refilling just close off the compartment you refill, never opening up the storage area air to the refrigerant compartment air till it's sufficiently cold.

        • Re: (Score:2)

          by hey! ( 33014 )

          You still have to open up the storage area to get the vaccine out, unless you're unloading the whole thing. That's why this vaccine is not going to be a big problem for large research hospitals who can just unload the case into a big freezer.

          I'm sure that in time a more convenient solution for smaller facilities could be devised. What we're looking here is the imperative to push out vast numbers of doses as soon as possible.

          This is only a short term issue though. The mRNA vaccines are first out of the gat

  • VIP only (Score:4, Interesting)

    by RyoShin ( 610051 ) <tukaro.gmail@com> on Tuesday November 17, 2020 @07:06PM (#60735926) Homepage Journal

    If both vaccines are approved at the same time, we'll likely see both rolled out in parallel, with smaller hospitals and clinics getting the Moderna vaccine and higher volume facilities getting the Pfizer vaccine.

    Even if they don't, I assume that the Pfizer one is initially limited to "priority" candidates: Medical personnel, "essential" personnel who will routinely come into contact with those likely to be infected (e.g. non-medical, but essential, nursing home staff such as janitors), and rich fucks with connections. Not a whole lot of rich fucks in more remote areas, so the hospitals/clinics will probably get stock for just their staff. With that assumption, while storage is still a concern the short time frame and requirements of the "suitcases" might be manageable. (Hospitals/clinics will probably administer it rather quickly, in many cases it wouldn't sit at the destination for more than a day or three.)

    Aside from that, I found this interesting:

    Pfizer has received $1.95 billion from the Operation Warp Speed to manufacture and distribute the first 100 million doses. The government will remain responsible for distributing syringes and other medical supplies needed for the vaccination effort.

    Considering how much the federal government has fucked up the response thus far, any hospital that assumes they'll get the distribution supplies at the same time as, or before, the doses is insane. (Particularly if they're in a "blue" state or have a Democratic government and distribution begins before Jan 20.) Hopefully most are handling their logistics assuming they'll have to personally order the supplies and/or use what they have in hand, and any government assistance will help them stock back up after the fact.

    • And the interview with Dr. Fauci this morning on NPR, where he stated that Moderna would have 25 million doses of their vaccine ready by the end of the year and Pfizer 15 million doses, so there would be 40 million doses available... and never once mentioned whether that was the number of doses the US would be getting, or if that was the total production that would be available for worldwide allocation, subtly creating the impression that the US would be getting 40 million doses, while I expect that's going

    • Oxford/Astrazenaca (Score:5, Interesting)

      by monkeyxpress ( 4016725 ) on Tuesday November 17, 2020 @08:20PM (#60736274)

      I think the reality is that most of us will get a ChadOx based vaccine because they are substantially cheaper and can be stored in a fridge. It doesn't sound like a very pleasant vaccine to take but it should do the job.

      We don't have the efficacy data for these yet, but remember that these types of vaccines have been in development the longest, and I believe, has been in trial for the most time. The very good mRNA vaccine results demonstrate it has a high chance of working but we will soon see.

      If one of the ChadOx ones (or even the J&J weakened virus version) come through then I suspect most of the world will be getting that. I also suspect part of the reason the mRNA candidates released preliminary results is because (a) the results were very good and (b) they realise they are going to be pushed aside in the news once the $5 a shot ChadOx results come in.

  • How much confidence should we have that the Pfizer vaccine we're being injected with has been stored at the requisite temperature through the entire supply chain? I'll have a lot more confidence in Moderna's vaccine.
    • As a Joe Sixpack when you will finally be able to get your shot (realistically Q3 next year) more vaccine options will be available anyway.

    • "Cold chains" is already a thing in the pharmaceutical supply chain for specialty/oncology therapeutics and things like....botox There are RFID temp trackers, climate controlled totes, special logistics around how long the product can be on a truck as it follows its route, and so on. Keep in mind some of these specialty drugs are literally life and death as well as $1000's per dose, and so they don't cut corners. Pfizer's vaccine is on the colder end of things, but not liquid helium cold, just normal d

    • It ships in a container that should keep the vaccine cold until the expiration date. After you take it out you thaw it and it's good for six hours. So it really boils down to whether you trust the clinic to handle medicine properly.

      In some cases it might be uncrated in a central location and shipped to a satellite location for administration later that day. This might happen with a major hospital with satellite sites, or with states setting up rural immunization sites. It depends on how much you trust that

  • It's not that bad (Score:3)

    by Thelasko ( 1196535 ) on Tuesday November 17, 2020 @07:10PM (#60735940) Journal
    The "suitcases" stay cold for 10 days. The vaccine can be stored in a refrigerator for up to five days. That's fifteen days to administer all of the vaccine.

    • That's a very city boy approach to the problem Mr Internetperson. In the meantime it's actual people involved with the logistics that are raising these concerns, so forgive me for dismissing your "it's not that bad" comment.

  • Only a 'nightmare' if you make it one. (Score:3)

    by tragedy ( 27079 ) on Tuesday November 17, 2020 @07:10PM (#60735942)

    It really just sounds like they need better designed cases. It's not like dry ice is really hard to come by. I could literally leave my house, and take three turns, driving about a mile, and I could buy 200 lbs of it right now if I needed to (unless the hours have changed, I haven't bought any since before COVID, so I might have to wait until the morning). The equipment to make it is not particularly sophisticated either. So, it sounds like they just need a case designed so you can get a single vial out without exposing all of the other vials to the open air. There are dozens of designs that can accomplish that. This seems a bit like complaining that it's a "logistical nightmare" to sweep out a stable because a handbrush is so small and you have to kneel on the floor to use it.

    • Re: (Score:3)

      by pz ( 113803 )

      One of the limiting factors is that air carriers have limitations on the amount of dry-ice cargo they can carry because of the potential CO2 flooding of the cargo area (which might have animals) and cabin (which might have passengers). So that impacts the logistics a bit by imposing a rate-limiting step on long-haul transportation.

      But, yeah, dry ice temperatures are really no big deal. I'm not sure why such a hullabaloo is being made about it. Shipping things in dry ice isn't new technology. And the lif

  • Take a deep breath everybody (Score:5, Insightful)

    by TomGreenhaw ( 929233 ) on Tuesday November 17, 2020 @07:11PM (#60735946)
    The first doses will go to health care workers. The initial supply will be limited in volume. Because the Pfizer and Moderna vaccines will be ready about the same time, hospitals that can store at a lower temperatures can get the Pfizer vaccine and smaller hospitals and nursing homes can get the Moderna vaccine. Most of the vaccine for health care and nursing homes will be used immediately, so longer term storage is moot anyway.

    Moreover, these companies have not had time to determine if it really needs to be stored at such a Low temperature. They are being conservative.

    The military guy in charge of logistics for Warp Speed knows what he is doing and the rest of us arm chair quarterbacks should get back to what we know how to do.

    That stuff isn't going to sit on a shelf for very long.

    • Re: (Score:2)

      by taustin ( 171655 )

      Just saw my doctor today for a routine followup. He ask, naturally, if I was interested in the vaccine once it's available. Medical professional first, and other front line people. Patients with risk factors next (I'm included), and he expects that to be about March or so, and he expects to have the Moderna vaccine available in his office at that time. (He's rarely wrong on such things.)

  • Carbon dioxide freezes at -78.5C, so an insulated cooler box plus a load of dry ice will keep the vaccine cold for several weeks.

    Australia has ordered 10 million doses of the Pfizer vaccine and the company has said that they will supply an insulated box capable of keeping the vaccine cold for 14 days, and the cooler is rated for two extra reloads of CO2. I've also heard today that the vaccine will keep in a domestic fridge (freezer section?) for up to five days.

    I'll agree that things might be more diffic

    • Re: (Score:2)

      by hey! ( 33014 )

      I'm assuming Pfizer isn't just being a dick when they say these cases have a ten day storage capacity -- fifteen if topped off.

      Vaccine makers don't really know the refrigerated shelf life of their vaccines; they've been going balls-to-the-wall just to get a safe and effective vaccine. If you used a vaccine that had been stored for twenty or thirty days it would almost certainly work, but nobody would be able to say how well. Is it still 90% effective? Is it 50% effective? Nobody can say.

      Fifteen days is pro

  • I can understand the iterative process when prototyping software, but when dealing with people's lives, maybe some safety check, trials, and perhaps a bit of testing, over a period of time, to check for exactly these kinds of issues, wouldn't be too much to ask for...?

    • That's a great idea!

      I propose we should have FOUR stages of testing.
      Let's call them "pre-clinical", "phase 1, "phase 2", and "phase 3".

      We can set up a web site https://www.raps.org/news-and-... [raps.org]
        where interested people can see how the various vaccine candidates are moving through these stages of testing.

  • 1. Make damned sure Modernas' vaccine is actually safe and effective
    2. Pfizer shelves their vaccine and teams up with Moderna to produce their vaccine
    3. Production capacity doubles, logistical problems cease to be a problem
    ...
    This is too important to our entire species to let bullshit like 'corporate profits' get in the way, clearly, objectively, and obviously.
    If Pfizer wants to whine and cry about 'lost profits' then they'll just have to console themselves with the fact that they'll still be one of t

    • Re:Solution is relatively simple: (Score:4, Interesting)

      by Pinky's Brain ( 1158667 ) on Tuesday November 17, 2020 @08:21PM (#60736276)

      As long as the epidemic is being used to do a massive experiment on mRNA vaccines, we might as well diversify.

      Maybe the Pfizer approach will be better suited to cancer vaccines, maybe they'll have less side effects ... the opportunity for this scale of experiment will likely not occur again in our lifetime.

    • The simpler solution is, as was already stated, to ship the Pfizer one to facilities which are equipped to handle it, and the Moderna one to the less well equipped ones. Even if the two companies combined can deliver 20 million doses per month, both are a 2 stage vaccine so at a rate of 10 million people per month it would still take just shy of two years to get the entire US Population vaccinated.

      If one of the two has a shorter effective period, and/or starts showing bad side effects, then you only have t

    • Right, or make Moderna sell Pfizer their presumably generic trick to make any mRNA more stable.

      • ..actually, I like your idea, too. They'd license it to Pfizer, I'm sure, but yes, that would solve the problems.
        I just really think that the traditional roadblocks should be set aside in this case because it's so universally important.

  • Wendover Productions did a video about this a month ago:
    https://www.youtube.com/watch?... [youtube.com]

    Why is this news?

  • News flash! (Score:5, Insightful)

    by dmay34 ( 6770232 ) on Tuesday November 17, 2020 @07:19PM (#60735994)

    Rolling out a billion units of LITERALLY ANYTHING in a year is a logistical nightmare.

    • Rolling out a billion units of LITERALLY ANYTHING in a year is a logistical nightmare.

      Well... figuratively anyway. Bacteria is pretty easy. My yogurt has several hundred billion of them in one container, and I got it a Walmart, right next to a bunch of other containers of yogurt.

      • Re: (Score:2)

        by dmay34 ( 6770232 )

        Okay, you try to figure out how to ship a billion bacteria to every country around the world. It wouldn't be easy.

  • These is used in just about every single medical labs that hospitals have. As such, not only western hospitals, but even larger city hospitals in undeveloped nations will have these.
    But, this break down for smaller hospitals, even in rural 'hospitals' (which are typically, just a couple of beds, nurse station, and a few 'sterile' rooms. Basically, they will not have medical labs and therefore no reason for it.

    • Re: (Score:2)

      by ceoyoyo ( 59147 )

      This excitement about -70 freezers is a bit weird. Any hospital that's associated with a university, so almost all the major ones in cities, will have these things cluttering up the hallways. I imagine someone can figure out how to distribute Pfizer vaccine to a couple billion people that way.

      You could also put -70 freezers on trucks and send them out to smaller towns, but an alternative vaccine would certainly help for that. Oh look, we've got one!

  • I don't believe it (Score:5, Insightful)

    by backslashdot ( 95548 ) on Tuesday November 17, 2020 @07:21PM (#60736016)

    I find moderna's claim that they are any better than biontech's vaccine a slightly fishy. I think biontech is just more cautious. Regular RNA is notoriously unstable, but even it can stay at -20 for weeks. Moderna is a bit secretive but what I understood from what I've seen about how they are stabilizing the RNA, it is more aimed at preventing it from being degraded by endonucleases (which are everywhere) or in the cell from stuff like ribosome collision etc. Biontech too incorporates many of these tricks. I would like to see independent comparisons of storing the biontech vaccine vs. the moderna vaccine.

    TL;DR .. the biontech vaccine too can probably last for at least a few months at -20C which may be good enough for a pandemic.

    Most decent quality fridges can become a -20C .. you just bypass the thermostat and it will likely get that low.

    If you need it though, liquid nitrogen dewars (at -196C) are cheap can last for months without refilling, so if a long term stockpile is needed that can be an option. Liquid nitrogen is dirt cheap btw.

    • Normal fridges have defrost cycles, so you have to bypass that as well.

      • Re: (Score:2)

        by jabuzz ( 182671 )

        Only frost free freezers have such a cycle and they are far from universal. Well here in UK anyway. Oh and you can bypass the thermostat on most UK freezers by putting it on "fast freeze" which basically runs the compressor 24/7.

  • It probably doesn't need to be kept that cold (paywalled):

    https://www.newscientist.com/a... [newscientist.com]

  • we have billions of lives/dollars at stake and we have problem with -70c?

  • Wouldn't Liquid Nitrogen be a better cooling option?

    I remember reading something in one of the Popular magazines decades ago that it was 'as cheap as beer" and I have eaten liquid nitrogen ice cream...

    • I can think of a few reasons.
      • Liquid nitrogen is more than 100 C colder than is needed. Perhaps getting too cold could also affect the vaccine?
      • It seems like dry ice requires ~2.5 times more energy to vaporize than LN2, by mass. The same mass of dry ice will keep the package cold for longer. (disclaimer: it's been a while since I took chemistry. dry ice [wikipedia.org], LN2 [engineeringtoolbox.com])
      • Logistical challenges with having a large volume of liquid in the package. It can't spill too if it gets jostled in transit, but you also can't seal

  • as part of "operation warp speed" which began back in May, and included funding multiple companies developing multiple vaccines in parallel, mass-producing all of them even before testing so that there would be millions of doses available immediately for any that work, and mobilizing the US Army [statnews.com] logistics people to handle rapid distribution, [defense.gov] including any special handling required (they've been in constant contact with the vendors and already know the handling requirements of each vaccine).

    It's one advantag

  • What happens when you inject something -70 into your bloodstream? I mean, that cannot possibly be good, right?
  • Give it to the icecream companies to distribute.
  • So in reality it's a useless vaccin, which it probably is anyway, and I wonder what the long term problems are with the new vaccin.

  • Use special drones;

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