Dock-to-Arm: A Tricky Challenge for the Coronavirus Vaccine

Dock-to-Arm: A Tricky Challenge for the Coronavirus Vaccine


We have three promising vaccines. Now the challenge is to distribute them to the masses.

Public health officials and health systems around the world are gearing up for the distribution of the vaccines to their populations. There are opportunities for error at every step of the distribution process, from transportation of the Pfizer vaccine at extremely cold temperatures to final distribution in remote or rural areas. This massive undertaking is going to require synchronized efforts among many different parties. Success will depend on seamless coordination and trust.


Video Spotlight: The Race to Move a Cold Chain Vaccine to the Masses

This post is based on The Washington Post article, Now Comes the Hardest Part: Getting a Coronavirus Vaccine from Loading Dock to Upper Arm, by L.H. Sun and F. Stead Sellers, November 23, 2020, and the YouTube video, Inside the Cold, Complex World of Getting a Covid-19 Vaccine into Arms, by The Washington Post, November 24, 2020. Image source: LightField Studios / Getty Images.

Discussion Questions:

1. What are the challenges posed by this colossal distribution effort?

Guidance: There are many challenges associated with this effort. The Pfizer vaccine needs to be kept in specialized freezers at ultracold temperatures. The Moderna vaccine also has to be kept at freezing temperatures. Any failure to maintain the subzero temperatures would affect the viability of the vaccines. The handoffs must be minimized and quick. Despite the need for flawless planning and execution, there is an urgency to act fast. Many parties are involved, thereby complicating communication and coordination. There needs to be a consensus on which populations will get priority to receive the vaccine, and reaching the most vulnerable and those living in remote areas will not be easy. Some healthcare facilities do not have the resources to store the vaccines, and the minimum order quantities are too large for some localities. Qualified staff and locations have to be secured for large-scale vaccination events. Misinformation and doubts about safety and effectiveness, administration of two doses of the vaccine, and unpleasant side-effects may deter people from getting immunized.

2. Why do the manufacturers have different minimum order quantities? What does that imply for storage and distribution to the population?

Guidance: The minimum order quantities for the Pfizer and Moderna vaccines are 975 and 100 doses, respectively. The Pfizer vaccine is more difficult and expensive to distribute because of the extremely low temperatures and specialized containers it requires, which justifies shipping and selling it in larger quantities. Pfizer plans to send smaller batches of 125 doses later, but these purchases must be coordinated with the ancillary kits for 100 doses. The discrepancies in order sizes add complexity, risk, and opportunity for waste. For the time being, the Pfizer vaccine seems better suited for distribution to large, urban areas. With order sizes of 100 doses, the Moderna vaccine can be more widely distributed throughout the country. Although there is currently no information on the minimum order quantity for the AstraZeneca vaccine, it appears that its lower transportation and holding costs (simple refrigeration) will make it possible for flexible quantities to be distributed anywhere.

3. Why is trust such an important factor in the success of this project?

Guidance: Not only are there many moving parts in the distribution of the vaccine, but there are also many parties that depend on each other. All players in the supply chain must trust each other to deliver the products in the right quantity, at the right time. Any uncertainties in lead time will weaken the whole chain. The people involved in Operation Warp Speed must trust that the incoming Biden Administration will not make major changes to their plans. State governments must trust that the federal government will provide the necessary resources for the local distribution and administration of the vaccine. Both clinicians and the general population must trust the manufacturers’ claims of efficacy and safety.


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