As the delivery truck snaked its way over Northern California’s interstates and two-lane highways, a team of analysts watched over nearly every aspect of its journey in real-time. They could see the stops the driver took, they knew the weather outside and, most importantly, they knew the condition of the precious cargo onboard: thousands of doses of COVID-19 vaccine.
In the back of the truck, boxes packed with vials of Pfizer/BioNTech’s newly authorized vaccine were loaded onto customized trays, resembling small pizza boxes, each carrying a minimum of 975 doses. The containers were packed with sensors, tracking devices and dry ice, which enabled the team to watch as the temperatures of two of the trays—one destined for Napa, Calif.; another to Sonora, Calif.—plunged below the accepted threshold of -112°F.
A call was made to the truck driver to stop, and keep the trays in the vehicle. “They never left the truck,” Army General Gustave Perna, the commander overseeing logistics for the U.S. federal vaccine program, told reporters on Wednesday. “We returned them immediately back to Pfizer and we sent immediate shipments to replace those two trays.”
Shipping COVID-19 vaccine is a daunting challenge, not only because of the logistics involved in distributing millions of small glass vials to each corner of the country, but also because the doses must be kept frozen at far below normal freezer temperatures for the entire trip. To ensure safe delivery, the U.S. government, drug makers and delivery companies have had to work together to develop a network of monitoring devices and detection systems.
Every box is equipped with a GPS beacon, a temperature monitor and a barcode that’s scanned upon receipt. If the doses deviate from their target destination in each of the 41,689 U.S. zip codes, or if the vials get too hot or cold, officials at the companies and the government are immediately alerted to the problem. The information streams into the Vaccine Operations Center, known internally as the VOC. The windowless, conference hall-sized, command hub in downtown Washington is where uniformed military members, Department of Health and Human Services officials and U.S. Marshals keep a watchful eye over logistics for the federal vaccine program, dubbed Operation Warp Speed (OWS).
On the operations floor, dozens of analysts work behind rows of computer monitors. On the far wall in front of them, four large flat screens glow with real-time information about the day’s deliveries. The team there watched the temperature problem unfold in Northern California—and later saw the same thing happen with two other trays in Mobile, Ala. “Same anomaly,” Perna says. “We were able to stop and quarantine the vaccine.”
It remains unclear why it happened, but all three shipments fell to -133.6°F. “We’re working with the CDC, FDA and Pfizer to determine if that anomaly is safe or not, but we’re taking no chances,” Perna says.
This was one of the first delivery problems faced by Perna and his OWS team, but it certainly won’t be the last. And while the trouble with the deliveries were inconvenient, officials involved with the vaccine effort were uplifted by the fact the technology put in place to detect glitches worked. By Wednesday, replacement trays arrived in Alabama and California.
The @WVNationalGuard is on mission for the #COVID19Vaccine today! We were there upon initial receipt of the #vaccine in #WV and will be preparing for transport to our healthcare workers & long-term care facilities through breaking down, packing and sending out doses. pic.twitter.com/UGEH9NnSSD
— WV National Guard (@WVNationalGuard) December 14, 2020
Pfizer, the first company to ship vaccines in the U.S., is facing some special challenges with deliveries. The GPS tracking system and temperature-monitoring devices in the lid of the containers for the Pfizer shots—developed with the German biotech firm BioNTech—are necessary because they rely on a new mRNA technology that requires the shots to remain frozen until they are thawed for use.
The ultracold storage requirements prevent the vaccine components from degrading. Another vaccine, made by Moderna, which is expected to get FDA authorization this week, requires storage and shipping at -4°F—far less cold than the Pfizer shot requires, and at temperatures that can be achieved by most pharmacy freezers. Because of this, the primary vaccine distributors, UPS and FedEx, have expanded refrigeration capability, known as “freezer farms,” to ensure vaccines can be routinely shipped on long-distance journeys from one end of the country to the other.
After Pfizer boxes are opened, they need to be placed in an ultracold freezer or be re-packed with fresh dry ice every five days for up to four weeks. Seeing an opportunity, UPS increased capacity to produce dry ice, up to 1,200 pounds per hour, enabling it to resupply hospitals, clinics and other points of care. It also launched a joint venture with Stirling Ultracold to build and sell portable ultracold freezers with temperatures that go as low as -112°F.
FedEx is using a new monitoring program in collaboration with Microsoft, called Surround, which uses historical data around FedEx’s routes, weather and mapping data and analytics capabilities to expedite delivery. “To illustrate how this works practically, imagine if a pallet of vaccines were destined for transport from Michigan to California and the external data showed a high likelihood of delay because of weather,” writes Judson Althoff, a company executive. “In that scenario, an alert would be triggered to customer service agents and operations planners, who could then put the shipment on another flight. It’s the difference between the vaccine getting to California on time and ready to go or not.”
Dr. Moncef Slaoui, a co-leader on OWS with Perna, says he expects about 40 million doses of Pfizer and Moderna vaccine distributed by the end of December. As more vaccines become available and the distribution chain becomes more fine-tuned, the pace of vaccinations will also increase, hopefully to the point where 100 million Americans will be inoculated by the end of the first quarter of 2021.
To keep track of it all, the government developed a new software platform called Tiberius. It enables states and federal agencies to see their orders and track their vaccines. The program covers 50 states, eight territories, the Veterans Health Administration, the Bureau of Prisons, the Indian Health Service and the departments of Defense and State.
Tiberius allows every state health department to “see all of their enrolled providers there and they can dive in and really go into great detail on making decisions on where they’re going to send the vaccine within their jurisdiction,” says Deacon Maddox, a retired Army colonel and now OWS chief of plans, operations and analytics.
Each Thursday, vaccine producers inform OWS how much vaccine is available for the upcoming week. On Friday, Tiberius runs an algorithm that draws on a range of factors, including adult population and vaccine uptake, and allocates the maximum number of doses available to every state. On Saturday, every state finalizes their orders, which can go up to whatever cap Tiberius has set. Deliveries arrive on Monday.
To monitor side effects in people who have been vaccinated, the CDC is launching a new smartphone-based texting system, dubbed V-Safe, that will allow those who have received their shots to directly report any unusual health effects they experience. It’s the first system that will allow people to directly report side effects of a publicly available vaccine; existing systems rely on doctors and other health care providers to monitor and log adverse events.
Anyone who gets the vaccine and enrolls in the system will get daily texts the first week after both their first and second doses, asking about any side effects they might be experiencing and whether they interfered with their daily activities or prevented them from going to work. After the first week, the reminders come once a week for six weeks. The responses are logged and evaluated, and if they are deemed serious, or if experts at the CDC determine a pattern in the types of symptoms reported, they trigger an alert to the national Vaccine Adverse Event Reporting System (an established vaccine side effect tracking system that doctors and hospitals normally report to) and then followed up on to determine if the side effect was related to the vaccine.
The first recipients of the vaccine doses will be health care workers, including people who work in hospitals, long-term care facilities, home health care, pharmacies, emergency medical services as well as in public health, and older Americans living in skilled nursing or long-term care facilities. So—even with the gee-whiz technology advances—the vaccine is not expected to be widely available to most Americans until springtime.
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Contributor: W.J. Hennigan and Alice Park