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> -80C storage and transport needed. Challenging, but doable in developed countries, but still may slow down mass rollout. Not feasible in many developing countries.

True but it's also a bit more complicated than that. The YouTube channel Wendover Productions has a great video on the subject: https://www.youtube.com/watch?v=byW1GExQB84 (skip to 5:01 for the talk about the cold chain).

TL;DW, there are other factors:

- Whether the hospital is able to maintain the vaccine at the required temperature (many, especially the smaller ones, don't have the equipment)

- This is medical technology and unproven options (like buying a random box off Alibaba like someone suggested) are unlikely to be used

- Pfizer (vaccine in TFA) has developed a shipment container that uses dry ice and lasts 10 days but it can only be opened twice a day, for less than a minute at a time, so facilities administering vaccines need to be able to accurately predict how many they'll administer in a given day

- Pfizer's box is only built for multiples of a thousand doses and only lasts 10 days so isn't well-suited to smaller areas that can't administer 1000 vaccines in 10 days

⬐ Kliment

This is all true but is missing some important detail - the box (shipment container suggests shipping container sized things, it's more of a flight case size thing) is meant for long distance transport, rather than local distribution. It holds the vaccines at -80C for ten days, and can be refilled with dry ice (which is widely available anywhere that has a carbonated drinks industry) to extend that period. The ten days is how long it's expected to be in continuous transit, worst-case. The vaccine must be thawed before use, and can be stored in a regular freezer for a few days, just not indefinitely.

Since the transport cases are reusable, and don't need to be completely populated, what will likely happen in rural areas is that they'll have a case for shipment, refill it with dry ice on site, and use a second case to transport a small number of doses to the point of use. Repeat until used up, refilling with dry ice every few days at a central location (less than a week's travel from administration sites). I don't think it's going to be a major problem in practice.

About the logistical part. Wendover did on Youtube a really great video explaining the cold chain in international shipping and what companies are already doing to be ready for it. https://www.youtube.com/watch?v=byW1GExQB84

It will be an incredible challenge, but there is at least some economy of scale on our side.

Wendover did a nice video[0] on this topic month ago, explaining how UPS/FedEx/DHL/… are already massively upscaling their cold chain infrastructure. Retrofitting planes, building giant freezers in transport hubs.

[0] The Greatest Logistics Challenge Ever - https://www.youtube.com/watch?v=byW1GExQB84

⬐ localhost

Thanks for sharing this. I learned a lot from watching this video and I have another channel to subscribe to now :)

One thing that I found interesting was how they identified today's announcement of the BNT162b2 vaccine candidate (back in September) as one that would require the massive investment in cold chain infrastructure. They also highlight Pfizer's engineering of a separate series of cold boxes that would keep the vaccine at temperature for up to 10 days, thereby enabling it to be shipped through standard logistics networks. Great stuff.

> Almost all developer countries, urban centres, where majority of people live anyway.

At -80C?

Edit: There are hardly storage places right now for these temperatures.

https://www.youtube.com/watch?v=byW1GExQB84

⬐ m4rtink

If you are on the Concordia Station you can just leave it at the windowsill and it will be just fine. One of the perks of living in Antarctica. :)

⬐ inglor_cz

What if a freak heat wave comes and suddenly it is -55 overnight? :-)

⬐ m4rtink

Yeah, imagine that! You could like have just three layers of jackets or something! :)

Well, as long as the temperature is under zero, all is fine - otherwise the 4 kilometers of ice under your station might pose a problem.

⬐ bluGill

You can buy dry ice at your local grocery store. You can probably buy a cooler to put it in. And you get a week to use it after thawing, so if there is a break in the supply chain you only need to detect it and announce a vaccination clinic to that area. There might be some small town that gets 100% vaccination early on just because the truck broke down nearby and so local doctors were suddenly called upon to vaccinate their whole town just to use doses that couldn't be shipped any farther.

⬐ nemothekid

The linked video claims Pfizer has a similar solution and the currently tested parameters limit the cooler can only be opened 2x per day, and not more than 1 minute at a time, and the box only lasts 10 days, and carries doses in multiple of 1000s.

A breakdown scenario in a rural area could mean 1000s of wasted doses

⬐ bluGill

I can't think of a rural area that is more than 2 hours drive from a city large enough to take thousands of doses.

They should be able to put out a general announcement and get thousands to get the vaccine if they need to. A lot of people who can get off work on short notice if there is an emergency. Obviously not everyone, but thousands can be redirected to someone else on short notice. Of course this requires emergency shipments to those who should have got the original, but the breakdown would require that anyway.

I don't know what the thawing protocol is though - this is a real concern that needs to be handled. I assume those who deal with the logistics have plans and backup plans that account for all of the above.

⬐ throwaway2245

> A breakdown scenario in a rural area could mean 1000s of wasted doses

Don't you think Western countries are ordering many thousands more doses than they actually need?

Breakdowns happen - places don't need to have perfect infrastructure in order to warrant treatment.

⬐ bluGill

No. There isn't the ability to deliver more supplies than needed - at least not through the end of 2021. Until then every dose is urgently needed by several people only one of who can get it.

⬐ throwaway2245

I'll happily wager the UK and US will over-order and then tacitly use the argument you have made to say that African countries are wasteful and don't deserve their supply.

⬐ bluGill

US and UK may over order, but they will not get deliveries. Medical companies tend to have policies in place that will distribute to Africa ahead of richer countries if the richer countries are not seeing outbreaks. Obviously there is more money in the richer countries, so the early delivery will skew that way. However once enough are vaccinated (from all potentially passed vaccines) that a country can safely open they will start redirecting vaccines to poor countries.

Once the world is open the US and UK will be happy to say that they were able to cancel some unused vaccine supply if it turns out not needed. (which will be easy - between focusing on poor countries and moving production to something else (or winding down) as they recognize the need is gone they will be willing to end those contracts not completely filled. Politically it is a money saving move.

Of course the above assumes best (or at least) case. There are many ways things can go wrong. If all approved vaccines need a booster every 6 months things will be very different. (this is an unlikely but still possible very worst case)

⬐ nwallin

> > Almost all developer countries, urban centres, where majority of people live anyway.

> At -80C?

Absolutely. This is a solved problem.

You can buy dry ice at your local supermarket. I buy meat from a ethical farming operation that ships their product in insulated packages packed with dry ice. There's almost always dry ice left over. I made a bottle bomb out of the remainder once.

Every major medicine manufacturing company will already have had supply chains in place to deal with this for other medicines.

Storage is a red herring. It won't last more than a day in any given medical facility.

Great video about this exact topic https://www.youtube.com/watch?v=byW1GExQB84

⬐ 0_____0

interesting... vid suggests that we have to use cryogenic techniques to store vaccine partly because there hasn't been enough time to test how they store at higher temperatures.

so perhaps the infrastructure requirements will relax as time goes on

⬐ Invictus0

Skip to 3:20 if you don't want to hear a few minutes about why COVID is a big problem.