The Covid-19 pandemic will cast a long shadow over many industries and many aspects of regular life. The rapid development of the vaccines and the subsequent efforts to get people vaccinated is no different. Science delivered, but the efforts to get the vaccine to patients saw challenges with quantity and distribution. The life sciences sector will do well to incorporate learnings from the challenging vaccine roll-out.
The supply chain ends at the patient, not earlier
After developing and approving vaccines in record time, ‘the last mile’ became unexpectedly challenging. Delivering vaccines into the arms of the world’s entire population is no small feat, and the task is far from done, yet several areas were clearly underestimated.
- Funding: Billions went into the development of the vaccines (and trillions into steadying economies). Funding to get patients vaccinated, however, was an afterthought – which led to delays and other challenges.
- Planning: Vaccinating the world is a complex logistical operation. Only Israel seems to have gotten it right in one go, while other countries such as the UK and US stumbled before finding their footing. Others, like India, fell flat and are still trying to get up. The lesson here is that the planning process and the drug development process should happen in tandem and must align. The boxes Pfizer delivered contained a large number of doses, which helped significant quantities reach many areas – yet these large amounts complicated vaccination at pharmacies and primary care doctors.
- Communication: As with almost any complex operation, communication is key. In this case, between manufacturer and receiving party (national and local governments) and to the recipients – the patients. Given the speed, urgency and level of misinformation at all levels, clear communication and the ability for people to ask questions was critical but took a lot of time to get to appropriate levels.
Borders still matter
The pharmaceutical supply chain is integrated and global, and borders are highly relevant. It matters where a product is released, packaged and shipped from – including additional factors unsurfaced during the vaccine roll-out.
- Politics: National regulators determined which vaccines were approved (for emergency use or otherwise) for their country. This meant that the US, UK and EU had different vaccines available to them. Even within the EU, national regulators differed on which vaccines to approve. Meanwhile, Russian and Chinese vaccines were acquired and deployed in many developing countries.
- Contracts: The arguments and actions between the EU and AstraZeneca became a farce, albeit demonstrating how nationality and borders are relevant – with AstraZeneca having to prioritise the UK as part of its collaboration agreement with the University of Oxford, and the EU trying to enforce its contract by attempting to flex its muscle. Neither party looked good.
- India is a major player in global vaccine manufacturing. A dramatic surge of Covid infections impacted the global availability of vaccines – highlighting some of the vulnerabilities in the global supply chain.
- Various countries, including the US and China, did at some point limit the export of vaccines or core ingredients to ensure that their own populations were served first. This is not entirely unexpected, but it will force some countries to rethink their dependences. Companies involved anywhere in the pharmaceutical supply chain will do well to anticipate this.
Collaboration is needed and it increases complexity
The pandemic has generated many unexpected bedfellows, and at the same time highlighted that collaboration is possible in many ways if circumstances require it. For example, when Pfizer and BioNTech acted fast and strengthened their collaboration before contracts were negotiated, or Sanofi and Novartis offered manufacturing capacity to their competitors, or AstraZeneca established a collaboration with the University of Oxford in a space where they were newcomers. With ongoing debates on patent waivers, tech transfer and pricing, the collaboration in the vaccine arena will continue to evolve and will further opportunities throughout the industry.
Speed carries side effects
Vaccines were developed with extraordinary speed, paralleled with development to meet manufacturing needs, which followed quick roll-outs after emergency use approval by regulators. This was necessary and justified, and it also highlighted some implications that would not have surfaced if the pace had been more traditional:
- Initially, the Pfizer vaccine was to be stored at extremely low temperatures, which created some challenges. Later testing suggested that it could be stored in a regular fridge for a reasonable amount of time making it more accessible to other countries. Under a ‘normal’ timeline, this would have been identified before roll-out.
- Vaccines, like other medicines, are shipped with expiration dates. Although prudency is important, the delays in many locations required countries to destroy vaccines that were past expiration, even if the manufacturer assured that it would be fine after that date. With many doubters out there, administering expired vaccines would not be a good look.
- The rare side effects with the AstraZeneca and Janssen vaccines would likely (though not certainly) have been identified before the roll-out. The contradictory actions towards pausing and rolling out on bases of an extremely rare side effect did damage to public confidence regarding the vaccine, and this goes back to the need for good communication, especially with the high levels of misinformation out there.
- Inspections of manufacturing sites were well behind where they should have been, raising more questions around vaccine reliability. Regulators will catch up on this, and manufacturers need to be prepared.
Where does this leave us? The pandemic has been an extraordinary test of the pharmaceutical industry, and it has largely passed. However, there are many other players, and a key takeaway shows that the industry can play a bigger role as a facilitator and orchestrator. It knows its drugs, it knows the healthcare systems and it operates globally, which many other participants do not do, or do so in a limited way. Understanding all the players and their interests and acting to align those will bring the biggest benefit.