Sierra Leone and Pakistan might have a solution for Pfizer

Soon after news was released on November 9 that a vaccine has shown better-than-expected results against Covid-19, investors rushed to the stock markets. 

But their interest was not so much in Pfizer and BioNTech, the pharmaceutical companies behind the mRNA-based vaccine. 

They were after the shares of companies such as South Korea’s deep freezer maker, Daihan Scientific and Snowman Logistics, the operator of a large cold supply chain in India. 

That’s because the vaccine, BNT162b2, which has shown 90 percent effectiveness, has to be stored at the ultra-low temperature of minus 70 degrees celsius. Normal refrigerators at hospitals and pharmacies are not designed to handle that. 

Experts are concerned that a lack of cold supply chains can hamper the delivery of the vaccine and lead to spoilage, especially in low-income countries that have poor road networks and recurrent power breakdowns. 

Pfizer and BioNtech’s plan 

Pfizer says it can make 50 million doses this year and another 1.3 billion by the end of 2021. Rich nations, including the United States, United Kingdom and members of the European Union, have already booked 400 million doses. 

The injectable vaccine shot is based on a two-dose course - an initial dose followed by another three weeks later. 

Pfizer and BioNTech have already geared up production in the US and Belgium in order to roll out the vaccine as soon as they receive emergency use authorisation from authorities. 

For months, US-based Pfizer and BioNTech, its German partner, have been preparing for the handling of the logistics in anticipation of the expected challenge ahead. 

The vaccine doses will be delivered in specially designed suitcase-sized containers filled with dry ice, the solid form of carbon dioxide, already in wide industrial use. 

The vaccine vials can be stored in the containers, which hold around 1,000 doses, for up to 15 days by a replenishing of dry ice. The containers will then be transported from factories to airports and flown to different cities. 

Logistic firms such as DHL, FedEx and UPS say they are adding ultra-cold freezers capable of maintaining -80C temperatures to their facilities. 

Pfizer says the vaccine can be kept at a normal fridge temperature of 2C to 8C for five days after it has been thawed and diluted. 

What about the poor?

With almost all of the initial Pfizer-BioNTech vaccine doses destined for rich countries, it is almost certain that the poorest people won’t be vaccinated anytime soon. 

Organisations such as Gavi, the vaccine alliance, which aims for equitable distribution of the Covid-19 drugs, fears a race to vaccine nationalism of rich countries mop up all the supply. 

At the height of the avian influenza (H5N1) in 2007, Indonesia recorded the highest number of cases. But it wasn’t able to get hold of the vaccines because wealthy countries had bought most of the doses available on the market. In retaliation, Jakarta refused to share virus samples with the World Health Organisation (WHO). 

Currently, there are 9 other vaccine candidates in the advanced trial stage. Most of them won’t require an ultra low temperature cold-chain. But Pfizer’s mRNA vaccine, which triggers the immune system to fight Covid-19 virus, remains the best hope to control the pandemic in the foreseeable future. And that poses a challenge. 

Sunil Nair, the CEO of India’s Snowman Logistics, told a journalist that putting in place a delivery network that can handle something that requires a -70C temperature, will be difficult for many countries. 

“... not just for India, any country on this earth will have this difficulty of logistic storing as well as transporting at that temperature. Hence someone will have to come up with different technology,” he said. 

Fortunately, some of the poorest countries have experience in handling ultra-cold logistics for vaccines. 

The Ebola vaccine also needs to be kept at -60C temperature throughout its journey from factory to clinic. During the 2014-15 outbreak in Sierra Leone, where only 12 percent of the major roads are paved, health workers were able to vaccinate thousands of people in isolated villages. 

That was no easy task. Expensive ultra-cold freezers, which can cost more than $16,000 a unit, had to be imported and installed at central depots. The freezers needed multiple back-up power supplies as the national grid was unreliable and frequent outages spoiled the vaccines. Even the rooms where the deep freezers were placed needed air conditioning because their compressors were liable to stop working in a country with sub-Saharan Africa’s hot climate. 

Since Sierra Leone didn’t have a dry ice manufacturing capacity, it had to use the Arktek DF container, a high-tech cooler funded by the Gates Foundation, which can cost $1,200 to $2,400 a piece. Arktek DF were used to transport frozen vaccine vials more than 100 miles to rural depots. 

Medical practitioners had to be trained on how to thaw and dilute the vaccine before it was sent out on the last leg of its journey for administration. 

Some existing businesses, which use ultra-low temperature cold supply chains, can offer a solution. 

Ikram Elahi, the CEO of a Pakistan Fruit Juice Company, which has for years made a famous ice cream brand, says his vendors who sell ice cream from tricycles use dry ice to keep it from melting. 

He also owns a dairy farm on the outskirts of the city of Lahore. 

“We import bull semen for breeding purposes. It’s pretty common,” he says. 

“The specimens have to be kept at ultra-low temperatures. They come in liquid nitrogen containers like the ones most of us have seen in the Jurassic Park movie. They are widely available and don’t need a lot of investment.”