A vaccine’s long journey from the factory to patients’ arms
Lesson summary
Hi there, get ready for another Plain English lesson; I’m Jeff, JR is the producer, and this is lesson 322. And you can see the full lesson at PlainEnglish.com/322.
Coming up today: The UK was the first country to approve the Pfizer-BioNTech vaccine against the novel coronavirus; Canada was second; the US came days later; and approval is expected soon in Europe, Australia, and other countries. And so starts the biggest vaccination effort in world history. Today we’ll talk about the complicated path a vaccine will take from the factory door and into (hopefully) your arm.
The cold chain in action
As 2020 comes to a close, all eyes are on two small towns: Puurs, Belgium, and Kalamazoo, Michigan, in the United States. Puurs is best known for producing the strong Belgian Duvel beer. Kalamazoo is home to Gibson guitars. But now those two towns share the spotlight at the center of a scientific breakthrough: they are where Pfizer is manufacturing the first doses of its coronavirus vaccine. The two facilities are expected to produce 50 million doses by the end of 2020, and the 171-year-old Pfizer says they’ll produce over a billion doses in 2021.
When the vaccine leaves the factory door, it goes on a long and complicated journey before it can be injected into a patient’s arm. It’s all based on a “just-in-time” manufacturing system, which aims to ship the vaccine where it’s needed, when it’s needed, and without spending any unnecessary time in a warehouse.
That’s critical because this vaccine must be kept between -70 and -84 degrees Celsius until just days before it’s administered to a patient. This critical requirement means that distribution of the vaccine must go through a cold chain—a supply chain equipped to keep the vaccine cold enough, for long enough. The vaccine loses its effectiveness quickly if it’s outside a narrow range of temperatures.
The vaccines leave Pfizer’s factories packed in re-usable super-cold refrigeration units. All units are equipped with temperature and location sensors, allowing the company to monitor their progress. If a shipment has been out too long, or if it leaves the temperature range, then Pfizer can proactively take that shipment out of the supply chain.
Pfizer intends to ship the majority of its vaccine doses by air to regional distribution hubs, and then by truck to individual hospitals and clinics. When the vaccine leaves the Michigan factory, it goes in unmarked trucks to airports, where one of three carriers will bring it to the world: UPS, FedEx, and DHL. The first doses from Belgium are being trucked straight to the UK through the Channel Tunnel, which connects England and France. Shipments will go to other countries as they begin to approve the vaccine.
Some regional hospitals have the ultra-cold refrigerators needed to maintain the temperature range of the vaccine. At those locations, the vaccine can be transferred from the Pfizer container to the freezer.
But the majority of smaller hospitals, clinics and pharmacies don’t have those capabilities. So Pfizer designed its own container to maintain its vaccines at the appropriate temperature. Vials containing the vaccine concentrate are packed into flax boxes that resemble pizza boxes, with 195 vials each. Five of those are packed together in one single container, topped with 50 pounds of dry ice. The whole thing weighs 80 pounds. The vaccine can survive in those containers for 30 days, as long as the dry ice is refilled every five days.
Local clinics remove the vials when they’re almost ready to administer them; they then return the box to Pfizer to be reused. Once the vaccines are removed from the box, they can survive for five days at a normal refrigerated temperature. That gives clinics a little flexibility in how many doses they administer per day—a little. They will need to carefully plan the number of people who come in for their vaccines each day to avoid any being spoiled.
As if that’s not complicated enough, there’s additional preparation needed in the hours before a vaccine can be administered to a patient. Each dose comes in concentrated form. It has to be diluted with a saline solution: each individual glass vial of the vaccine concentrate produces five doses of the vaccine. Once thawed and diluted, a vaccine must be administered within six hours.
Pfizer is also sending out kits of supplies ahead of the vaccine itself. Kits including syringes, alcohol wipes, and instructions are being shipped separately. Dry ice will also be shipped to locations that don’t have super-cold freezers. Airlines and shipping firms are gearing up to meet the distribution challenge; some passenger planes will be repurposed to carry the vaccine cargo.
Around the world, doctors, nurses, and health care workers are preparing for the challenge at their end of the supply chain. They’re practicing handling the vaccine, maintaining its temperature, and using their own personal protective equipment. In the first wave, two vaccines from Moderna and Pfizer will have two sets of handling instructions—two sets of instructions for health care workers to follow.
Hospitals and clinics are setting up staging areas, where they’ll manage the flow of patients—and information. This last part is critically important, because both the Pfizer and Moderna vaccines need to be administered in two doses: every patient needs to come back for a second dose exactly 21 days after the first one. That means distributors need to take careful records of which patients receive which vaccine and when, so they can get the correct booster shot at the correct time.
A towering achievement
I am in awe of this whole vaccine process. I really am. The development of a vaccine is a total mystery to me, so I can appreciate it only in a general sense. I know it’s a big deal, but I’m not in the sciences, so I don’t know the amount of work. I can’t picture or even really imagine how a company or university develops a vaccine.
But the logistics, I can imagine. It is a monumental challenge to get this done. The packaging, the trucks, the airplanes, the dry ice, the needles. Think about how many needles are necessary for this. There weren’t just a billion needles sitting around waiting to be used—that had to be procured, packaged. Same with dry ice. More refrigerators need to be made. I’m not in logistics, but I am in business and so I have such an appreciation for the complexity of all this, and the hard, hard work that people around the world have put into this challenge. It is a towering achievement, I think, for the world in an extremely stressful time.
Great stories make learning English fun
