Australia The COVID-19 vaccine rollout presents a number of logistical challenges not all countries will overcome

22:50  24 october  2020
22:50  24 october  2020 Source:   abc.net.au

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Step one was discovering a vaccine. Step two is to find out how to ship it across the globe. (Pixabay: Jason Taix) © Provided by ABC Health Step one was discovering a vaccine. Step two is to find out how to ship it across the globe. (Pixabay: Jason Taix)

Finding a vaccine that protects us against coronavirus is the first challenge.

The second challenge will be getting that jab — or jabs — widely available, across all corners of the world, to enable any return to pre-COVID normal.

Vaccine technologies are intellectual property, meaning researchers need to undergo legal licensing procedures to pair up with a manufacturer.

University of Queensland biotechnology professor Linda Lua said the COVID-19 vaccine was not exempt from that process.

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"The different vaccine technologies belong to the researchers," Professor Lua said.

"[And] every vaccine will have a different arrangement depending on which country it started in."

Given the global implications of COVID-19, some researchers are licensing their vaccine technologies to multiple manufacturers around the world so that the vaccine can be produced domestically to reduce transport time, cost and risk.

All vaccines have to be transported through what is known as a "cold chain", where the vaccines remain refrigerated as they move through the different stages of shipping — from manufacturer to port, then to another country and to clinics.

But many vaccines have special requirements for transport — some are extremely fragile and others have to stay in freezing temperatures — and in some of these cases, these require expensive equipment.

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Take the frontrunning vaccines being developed in the US by Moderna and Pfizer/ BioNTech — neither of which are part of the Australian Government's current vaccine plan as local manufacturer CSL does not have the technology to mass-produce either vaccine in Australia.

Essentially, scientists from both teams are trying to genetically engineer a harmless version of COVID-19 that triggers the body's immune response — think of it like 3D-printing a synthetic model of the virus.

The man-made RNA (which viruses have instead of DNA) is coated in a bubble of fat and then injected into the body.

Early clinical trials delivered "promising results", however it has been revealed that the fatty bubble that protects the RNA has to remain frozen throughout transport, or else it disintegrates.

For the Moderna vaccine, the temperature must stay around -20C. For Pfizer's, it's more like -70C.

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Once thawed, Moderna's vaccine can then last for 14 days at normal fridge temperatures. For Pfizer's, it is five days.

But getting a vaccine to its location before this point is a logistical feat in itself, in particular for the Pfizer/BioNTech vaccine.

"If you work in the vaccine side of things, we all know that keeping cold chain is always a challenge," Professor Lua said.

"That one is a challenge of its own."

Pfizer says it has developed its own thermal shipping boxes that can hold up to 5,000 doses for up to 10 days, company senior director Brian Gleeson told a meeting at the Centers for Disease Control and Prevention (CDC).

But it says the containers should not be opened more than twice a day or for more than one minute at a time — which, experts say, is not enough time to sort through 5,000 doses.

The boxes need dry ice to keep cold — approximately 23 kilograms to be replenished within 24 hours after the box is first opened, and then five days after.

This presents major challenges for rural and developing areas.

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Australia has contributed $123 million to a global vaccine initiative, COVAX. The countries in the deal are guaranteed access to a supply of nine specific COVID-19 vaccines, if they pass clinical trials.

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If the successful vaccine requires two or more doses to be effective, the COVAX agreement may not deliver all the doses Australia needs.

So, countries including Australia are negotiating their own vaccine deals with individual manufacturers to cover such a scenario.

Australia has done that with the Oxford/AstraZeneca vaccine candidate — currently in phase 3 human trials — which uses a known method called "viral vector".

The viral vector method places a harmless virus — in this case, a common cold virus — inside the suit of a harmful one, like the one that causes COVID.

The idea is that the body will mount a defence against what it thinks is COVID, without the risk of getting sick.

Melbourne-based vaccine manufacturer CSL has received Government funding to help it restructure its technology to manufacture the vaccine locally if it passes the Therapeutic Goods Association benchmarks for distribution.

It is understood CSL plans to use its existing cold chain transportation methods used for its annual influenza vaccine — just on a larger scale — to transport the COVID vaccine all across Australia from its Melbourne manufacturing plant.

But for countries without domestic production deals with AstraZeneca, the transport logistics aren't nearly as fraught as the frozen RNA vaccines.

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Viral vector vaccines can be transported chilled, usually around -2C, a temperature far easier to maintain.

Challenges ahead

The other homegrown vaccine is the University of Queensland's (UQ) molecular clamp vaccine, which replicates the part of the virus that invades cells in our bodies.

The idea is that by injecting those invading parts without any of the coronavirus, it triggers the body's immune response without exposing the patient to the virus.

This vaccine is in early phase 1 human trials.

A number of research facilities in China, such as Sinovac and Sinopharm, are also making headway with research using dead virus cells for a vaccine, which is the most common type of vaccine.

The dead virus can no longer replicate and produce the disease, but the presence of the virus itself provokes the immune response.

The UQ and China-based vaccines can be transported using existing cold chain systems.

It's not entirely smooth sailing through these existing systems, however. The sheer number of doses required presents its own challenges.

"Of course the masses, in terms of doses of vaccine, it depends how the pharmaceutical company is going to package them," Professor Lua said.

"At the moment, I don't think we have any perspective into how the final product would look, so it depends on how they would be packaged and therefore distributed."

A spokesperson for the Department of Health said it was working with medical facilities around the country to prepare for the rollout of a COVID vaccine.

"The Department of Health is continuing to engage with vaccine manufacturers regarding transport and storage conditions for any COVID-19 vaccine."

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