When Larry Breen worked as a supply-chain manager for a supermarket, dealing with perishable goods came with an easy solution: you stick a yellow label on the item and sell it off for cheaper, in a win-win outcome for broke student customers.
Now, Breen is chief commercial officer for Irish software company NearForm, and as part of a new project, he is working on an app to improve the management of inventory and resource allocation for COVID-19 vaccines around the world. This time, to fix glitches in the supply chain, yellow stickers and a discount won't exactly cut it.
NearForm has recently found itself in the spotlight as the company behind Ireland's rather successful CovidTracker app, and the firm's technology has now expanded to contact-tracing apps in Northern Ireland, Scotland, Jersey, Gibraltar, and several states in the US. But in the past few weeks, NearForm's team started thinking about the months to come – and saw a big, knotty challenge looming. Once a vaccine was found to be successful against COVID-19, how would countries make sure that jabs ended up in patients' arms, at scale, and at speed?
As has been the case on many occasions during the past few months, technology seems to have solutions to offer. "We were very actively involved in the digital landscape of the response to COVID-19," Breen tells ZDNet. "Based on the learnings from the contact-tracing app, we started thinking about where we could provide added-value next."
Having worked in supply chains for the past 20 years, Breen knew of one fundamental challenge: to know where demand is going to be and when. But in healthcare, and particularly in vaccine distribution, there is only a "basic level" of understanding of demand, according to Breen – meaning, for any team of software developers, that there is room for improvement.
After a number of discussions with health authorities, who they were in talks with as part of their contact-tracing efforts, NearForm's team came up with a proof-of-concept for a vaccine app. The idea is seemingly simple: enable patients who want to get vaccinated to register for an appointment at the correct vaccination center, and to manage their booking digitally, from changing their slot to scheduling a time for their second injection.
A data repository of this kind, based on a self-serving process, and which can reflect demand for different vaccines simultaneously, in real time, and at various stages of the immunization process, does not exist yet. Yet behind the scenes, says Breen, having access to this across-the-board information could have a huge impact on the efficiency of vaccines' supply chains.
It's not just about understanding and predicting where the demand is, but also about allocating resources more efficiently as a result. "It's a complex supply-chain scenario," says Breen. "You need someone to handle the stock, but also someone who is qualified to make up the syringes, and someone who can administer the jab. We need to make sure we have the right people in the right place and at the right time, so we don't have folks sitting around in a vaccination center with nobody to vaccinate."
The impossible logistics of vaccine supply chains are by no means a novelty, and a vaccine app like NearForm's is just part of a complex set of systems that have to work together. Looking over a vaccine's journey from its point of manufacture and all the way to a patient's arm, there seems to be an endless number of parameters to account for. With most vaccines typically required to stay at very low temperatures, this is usually called a cold chain – and it involves managing resources such as refrigerating containers and alcohol swabs, but also qualified staff.
Bruce Y. Lee, executive director of PHICOR (Public Health Informatics, Computational and Operations Research) in New York, has worked on computer models that simulate vaccine supply chains for many years. Contrary to popular belief, he says, managing the delivery of vaccines to patients has nothing to do with ordering your latest Amazon Prime order.
"There is a tendency to think that delivering vaccines is like ordering socks or candy bars," Lee tells ZDNet. "Vaccine supply chains have been overlooked because there is some kind of assumption that that's the easy part. It really isn't."
Case in point: the Pfizer/BioNTech vaccine, which has been approved by health authorities in the UK, the EU and the US, comes with some taxing constraints; a well-known example is that the doses need to be stored at -70°C to avoid spoiling.
The point of manufacture is only the start of a long-winded chain. In the case of the UK, for example, the vaccine is produced in Belgium in vials of about five doses, before being placed in larger trays that are stocked in freezer containers for transportation. The containers are sent to a centralized depot, where they are dispatched to different vaccination hubs; and then distributed to local centers, where the vaccine is defrosted and injected to patients.
To make matters more complicated, the vaccine's lifespan shortens as soon as it leaves the freezer containers, and depending on the conditions the dose is kept it, can last from about a month to only a few hours.
The logistics tied to the jab's last mile are no less challenging: officials have to juggle forecasting and planning for demand across many different locations, managing cancellations and re-scheduling, while making sure that the vaccine, which comes in two separate jabs, is administered at the correct time intervals.
The scale of the challenge is immense. In the UK alone, the government plans to offer vaccination slots to 15 million people by mid-February. In the US, the incoming Biden administration has pledged to administer 100 million jabs in the next three months. Worldwide, scientists estimate that no less than 15.6 billion doses of COVID-19 vaccines will be required for a universal immunization program. The deadline? As soon as possible.
"No individual person can have an entire view of the supply chain unaided," says Lee. "To really understand the system requires technology, computational analytics – just like meteorology, manufacturing or air traffic."
"Fundamentally, you can't do this without the data. But the data is complex, it comes from different sources and it all has to be matched up."
When it comes to matching up the data, vaccine supply chains have historically performed very poorly: with information that is rarely readily accessible, reaching a uniform view of vaccines' journeys is an arduous task. This translates in tangible losses: the World Health Organization (WHO) estimates that over 50% of vaccines are wasted around the world – because of equipment failure, but also by lack of planning, which can lead to some doses in a vial being discarded to avoid contamination.
"One of the things that the COVID-19 pandemic has consistently done is expose a lot of the existing weaknesses in society," says Lee. "Vaccine supply chains is one of them. You create a stress to the system, and it's exposing the fact that existing vaccine supply chains have struggled to get vaccines to many different people. So, let's hope this will bring more solutions to it."
In this case, the problem is also the solution. The deluge of data generated by the COVID-19 vaccine supply chain, if it is managed with the right tools, could lead to better optimization of immunization programs. Armed with more insightful computer simulations and technologies like AI, experts could detect problems faster and even anticipate them, and re-allocate resources with more agility in response to unexpected changes.
Technology companies are putting forward their know-how to achieve that. IBM, for example, which has extensive experience in providing supply-chain management services, has made a blockchain-based open platform available to organizations working on delivering the COVID-19 vaccine – a technology that was piloted as part of a simulation for a drug-traceability project last year.
Jonathan Wright, global lead in supply-chain consulting at IBM, explains that as soon as the news broke of a vaccine being in the works, he started thinking about the next steps. "It was clear that we needed to solve some broken aspects of the supply chain with new technology," Wright tells ZDNet. "We figured that we would build an underlying data platform that would allow people who haven't worked together to have a common dataset."
An "open vaccine management platform" promptly followed, underpinned by blockchain technology, enabling different systems to update a common record at every step of the vials' trajectory. Location data, but also information pertaining to temperature, handling data or time stamps can be recorded in real time to provide a comprehensive view of the vaccines' trajectory.
If there is ever a problem with a batch of vials, for example, it is possible to instantaneously find out where the products are. Based on results from the simulated pilot, IBM estimates that the time taken to notify users of an affected product could reduce from three days to a few seconds.
Armed with a single source of data, operators could also run AI tools to identify early signs of disruption, and re-allocate inventory as a result. Although the technology is still in its early days, Wright said that IBM had seen interest from various organizations, such as vaccine manufacturers, government agencies and large retailers.
"The complexity now is to get all those parties to buy into it while they are under pressure," says Wright. "But in this completely unprecedented situation, we have an available platform that can facilitate collaboration and coordination across all these different parties."
IBM is not the only tech company endeavoring to fix the vaccine supply chain. Microsoft jumped in too, and announced a new "vaccine management solution" built in partnership with consulting business EY, to bring visibility to the supply chain thanks to advanced sensor monitoring and data analytics tools.
Like IBM, software giant SAP went down the blockchain road, in this case in an effort to identify counterfeit jabs. The company has partnered with vaccine manufacturer Moderna, and is leveraging a technology tried and tested in drug distribution. Moderna jabs will be given serialized IDs that will be added to a blockchain repository; users with access to the blockchain will be able to check the authenticity of any given product, at any stage of the supply chain, simply by scanning the product's barcode.
The technology space is crammed with ideas that could help optimise supply chains. Smart maps that combine tracking a shipment's location and the temperature in its containers could add further visibility in the movement of vaccine boxes. Digital twins could be developed to test different scenarios and design smart responses to different events. IoT sensors are also set to play a key role in monitoring the supplies of vials in real time.
San Francisco-based company Cloudleaf, for example, has partnered with smart-container business CSafe to provide what it calls a "digital visibility platform" for shipments that require a cold chain. The containers can be fitted with any type of IoT sensor that feed into a single database to provide real-time insights into the temperature, shock, vibration or humidity in the container.
Cloudleaf's CEO Mahesh Veerina argues that given the scale of the COVID-19 vaccination programs, such cutting-edge tools are imperative. "It is impossible to deal with the crisis we are facing with the tools we have," he tells ZDNet. "But with the onslaught of IoT sensors and AI, there is a big opportunity to digitally reform vaccine supply chains. The entire ecosystem is being pushed into deploying more digital means."
Biomedical organizations, packaging businesses and container companies have all shown interest in Cloudleaf's technology; over the past year, Veerina has seen a 500% growth in demand, and doesn't see the boom stopping anytime soon.
As the COVID-19 immunization programs gather pace in the next few months, it seems certain that more innovations will arise to facilitate critical links in the vaccine's supply chain – from manufacturing and transportation, to storage, distribution and the last mile. As often during the past year, the global health crisis has triggered a technological revolution, but this time in a field that is often overlooked: the critically important, but mind-bendingly complex channels that vaccine jabs go through before they are administered.
Back in Tramore, Ireland, NearForm's Breen reminisces about his early days managing supply chains in supermarkets. "Back then, you'd have the Coca-Cola representative coming in to each store with an order book, filling up how many pallets of Coca-Cola you wanted shipped in, and taking your order," says Breen. "Now, we have centralized systems that can see demand, predict demand and make sure stock can be distributed."
A similar transformation is currently happening, argues Breen – except instead of cans, technology is helping life-saving vaccines being administered on time to the people who need it, by mending the gaps and holes in the supply chain that have led to unnecessary waste. With many of the COVID-19 challenges still ahead of us, therefore, having an arsenal of innovative technologies to use might well be a key to kick-starting worldwide recovery.