• Vaccines pose particular challenges for distribution, requiring constant refrigeration and sterile environments
  • The UN is already working to address these problems with lessons learned distributing protective equipment, but every step requires tradeoffs and risks
  • Even a relatively resilient vaccine would likely be beyond the storage capacities of the world poorest hospitals

As vaccines against COVID-19 move forward in clinical trials, a new limiting factor could prevent three billion people from accessing a shot: logistics.

Many vaccines require complex storage and transportation, including constant refrigeration, the Associated Press reports. That’s a tall order for the impoverished nations hit hardest by the disease, and depending on requirements could be a challenge even for advantaged countries.

The worldwide pandemic has prompted unprecedented strides in the development of vaccines, with the WHO reporting 42 candidates in clinical trials and a further 151 in pre-clinical evaluation. The investments that made this possible, however, haven’t extended to the supply chain needed to actually distribute a new drug.

Hopes for a rapid vaccine faced a setback by the suspension of trials for two candidates
Hopes for a rapid vaccine faced a setback by the suspension of trials for two candidates AFP / Ludovic MARIN

Vaccines can be extremely fragile, requiring sterile environments and refrigeration. This is made still more challenging by the dire state of the world’s shipping and production economies. Container ships are the most common and efficient way of transporting goods between continents, but the requirements of vaccines are simply impossible to maintain in that environment.

The fallback is expensive air transport.

Disruptions abound at every step. Unless schedules are carefully planned and executed, vaccines could spoil on the tarmac waiting for their ride. There are concerns that such a high-demand product could be stolen, a situation made worse if the thieves then distribute expired drugs. Dry ice can give organizers more flexibility, but it’s expensive and dry ice production lacks the capacity to fuel a worldwide vaccine distribution program.

Steps have been taken to address these problems. The United Nations’ UNICEF has been preparing for distribution with lessons learned from shortages of protective equipment at the start of the pandemic. It is only investing in vaccines that require normal refrigeration rather than the super-cold environments needed by some ebola vaccines.

Multi-dose vials of vaccines make transport easier but can result in waste during actual distribution if there aren’t enough people on hand to immediately receive every dose in a container.

Even with less stringent storage requirements, rural hospitals in impoverished countries often don’t have access to consistent refrigeration and can require patients to walk for hours or days to receive care.

For these people, already hit hardest by the virus, the announcement of a successful COVID-19 vaccine is far from the end of their troubles.