Health systems will be tasked with doling out millions of doses of COVID-19 vaccines when an antidote is ready.
While providers are well-versed in distributing annual flu vaccines, a COVID-19 vaccine will likely be more nuanced, supply chain experts said. Here are five things providers can do to prepare their supply chains as drug manufacturers test different iterations of potential vaccines.
1. Ready administrative/IT infrastructure for tracking two doses per patient
Several potential vaccines, like ones developed by Moderna and Pfizer, require two doses to be most effective, which could present logistical hurdles, said Michael Hogue, president of the American Pharmacists Association and dean and professor at the Loma Linda University School of Pharmacy.
Unlike the flu vaccine that only requires one dose for immunization, providers will have stock more, maintain inventory for a longer period of time, create a system to track who got doses when and align suppliers to ensure continuity, he said.
"You have to have a process to ensure the same person can get the same vaccine. I'm not sure how many health systems have this on their radar screen," Hogue said.
Providers should coordinate data analysis and tracking efforts with their pharmacy departments as well as the state-based immunization information systems, he said.
2. Secure multiple suppliers for ancillary products
Glass vials, syringes, rubber stoppers and saline are common bottlenecks in the healthcare supply chain. While vaccine manufacturers, in coordination with the federal government, typically supply all the necessary materials for immunization, adding some redundancy wouldn't hurt, experts said.
Coordinating supplies with manufacturers now could stem potential shortages, said Clint Hermes, counsel at Bass, Berry & Sims, noting that a Merck official recently said that glass vials are one of the biggest hurdles to having a COVID-19 vaccine ready for distribution.
"All vaccines use certain things in common, that's why vials and rubber stoppers are real problems," Hermes said.
3. Outfit outpatient facilities with proper storage and supply chain infrastructure
Vaccines typically aren't administered at hospitals. They are often funneled through doctors' offices, pharmacies and other outpatient facilities.
Those facilities will have to have the proper freezers, adequate storage space, tracking system to coordinate multiple doses per patient as well as the requisite staff training, among other logistical issues, Hogue said.
"Outpatient clinics are really the ones who have to deal with this," said Hogue, adding that it isn't in their typical purview.
Ultra-low temperature freezers, which may be required depending on the vaccine, can store frozen liquids at around -70 degrees Celsius for up to six months, Pfizer said at last month's Advisory Committee on Immunization Practices meeting.
After thawing, ultra-low temperature vaccines can be stored in 2 to 8 degrees Celsius refrigerators for up to 24 hours.
Insulated packaging can keep ultra-low temperature vaccines viable for up to 10 days if they are stored at 15 to 25 degrees Celsius without opening, Pfizer noted. When opened, the container should be replenished with dry ice within 24 hours.
But cold-chain requirements tend to loosen up after the initial clinical trials, some experts said.
4. Prepare for above-average flu season
Hospitals should plan to increase their supply of the flu vaccine for potential case spikes, Hogue said, noting that Australia's flu season started off higher than average but tapered off.
Some of the most populous parts of the world will be tapping flu vaccine supplies at the same time, which makes preparation even more critical, he said.
"We don't have enough data on if patients can be co-infected with both COVID and the flu at the same time, but it is certainly a possibility," Hogue said. "We need to protect patients from the flu so we could remove any potential complications involving COVID."
5. Ready internal/external messaging strategy
First responders and frontline healthcare employees, among other essential workers, will likely have priority access to a vaccine when it is available. Providers should be developing criteria to evaluate the vaccine and figure out their data-driven message to employees as well as the general public, experts said.
"I would very much be talking with my leadership team about how we are going to address staff concerns about safety, particularly if the FDA issues an (emergency use authorization) this fall," Hermes said.
