Covid-19 Vaccine Delivery: Can Air Cargo Meet The Challenge

In the race to defeat Covid-19, medical research is getting ready to pass the baton to aviation. Vaccines have been designed, tested, and approved; now they need to be delivered across the globe. Normally, the air cargo industry would easily have the capacity, network, and infrastructure to meet this challenge. But ironically, the distribution of Covid-19 vaccines depends on cargo capacity and robust air networks that the pandemic severely disrupted. Industry partners from regulators to manufacturers have been working together to look ahead and identify the obstacles that will need to be overcome for vaccines to be delivered safely and efficiently.
Capacity is the first challenge that must be addressed. Only about 40% of air freight is carried by dedicated cargo aircraft, while the rest is transported in the belly of passenger carrying aircraft. The epic drop in passenger demand has forced airlines to cut capacity, resulting in a 57% decrease in belly capacity compared to last year. Further, as flight schedules were slashed in response to plummeting demand, the networks connecting city pairs were also reduced, leaving cities with fewer air connections. Capacity and networks are slowly rebounding, primarily in the all-cargo sector, but there are still unanswered questions about exactly how much volume will be needed. The number of doses per vial of vaccine is not yet known for all types of vaccines, and that number will heavily influence how much vaccine each flight can carry safely.
Vaccines and other medicines also have stringent requirements that affect the infrastructure needed to transport them. Pfizer's PFE -0.3% vaccine, the first to receive FDA approval, requires cold storage at -70 degrees. Maintaining this cold chain involves using special storage boxes equipped with dry ice. However, because dry ice sublimates into carbon dioxide, the amount of dry ice that can be transported on each flight is strictly regulated. In an Aviation Week webinar, Niklas Adamsson, COO of the container manufacturer Envirotainer, explained that since the need for cold storage became apparent, sublimation rates have been re-evaluated, taking into account advanced storage techniques and materials. Both the FAA and the European Union Aviation Safety Agency have used the new data to issue updated guidance for operators, making it possible for airlines to carry more dry ice and therefore 
According to Adamsson, the Pfizer vaccine with its ultra-cold requirements will only make up about 10% of the global vaccine supply, and most of that supply has already been bought up by wealthy countries with the infrastructure to support the cold chain. Moderna's vaccine, already approved by the US and other nations, only requires temperatures of -20 degrees. Since that temperature can be sustained without the use of dry ice, air transport of the Moderna vaccine will only be limited by cargo capacity
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Having capacity, network, and infrastructure are critical, but even more critical may be coordination between vaccine manufacturers, storage equipment providers, freight forwarders, and operators. The greatest challenge, according to Adamsson, is timing. "Once a vaccine is approved by any country, of course, they would like to get it shipped as soon as possible, preferably yesterday," he explained, "No one can really predict when the approvals will come, so we all need to be very on our toes and be well prepared in order to serve the global community." Prior to the announcements of test results for vaccine trials in early December, the industry had prepared as well as it could. But as results came out and approvals were issued, there was a scramble as demand for vaccine transport increased almost overnight.
The sudden spike in demand also meant that the transportation process had to become very efficient. With a limited number of containers to carry vaccines requiring cold storage, logistics planning had to include delivering the empty containers back to the country where the vaccine is manufactured, so the cycle could be repeated.

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The high value, and in some circles, controversial nature of Covid-19 vaccines means that security must also be considered. With the vast geographic distribution network that will be required, the International Air Transport Association cautioned that planning is essential to ensure integrity of vaccines throughout the entire transportation process, from loading and departure to off-loading and storage.
Although the scale of the Covid-19 vaccine airlift is vast, experts point out that airlines have been transporting high value, cold chain pharmaceuticals for years. According to Daniel Williams, fleet and flight analyst for Aviation Week, "it's business as usual, but at a new level of volume".
The air cargo industry is increasingly optimistic about its ability to meet the challenges ahead. A survey conducted in mid-December by the International Air Cargo Association found that 46% of air cargo industry stakeholders felt well prepared for the transportation of Covid-19 vaccines, compared to 28% in October. For Adamsson, the vaccine airlift is a chance for the public to see how important air cargo is to our society. "When I wake up every morning," he said, "I know that I am on a mission, I have a vital role to play."
After conferring with Centers for Disease Control and Prevention Director Robert Redfield, Vice President Mike Pence and President-elect Joe Biden's team, and reviewing revised CDC guidance, the governor announced the immediate activation of Phase 1B of the state's COVID-19 Vaccination Plan.
Starting Monday, eligible groups will be expanded statewide to include all Marylanders 75 and older, as well as anyone of any age living in assisted living or independent living facilities and developmental disabilities and behavioral health group homes.
"Vaccines will now be available to all of Maryland's vulnerable population," Maryland Aging Secretary Rona Kramer said. "These vaccines are safe and effective."
Also starting Monday, the state is directing all Maryland hospitals and county health departments to begin using remaining doses by opening Phase 1B clinics focused on the elderly.
EDUCATORS: Those now eligible in Phase 1B also include K-12 teachers, education staff and child care providers. For teachers and education staff, the state superintendent has submitted plans for how each county school system will vaccinate its teachers and critical staff. The plans will be implemented in the coming weeks, Hogan said.
PHASE 1C: In addition to moving into Phase 1B, the governor announced the state wo;; move into Phase 1C starting Jan. 25, which will be open to all Maryland residents ages 65 to 74.
ONLINE PORTAL: The state is launching covidvax.maryland.gov, an online portal where Marylanders can find a list of vaccination sites in their area along with contact information. Due to limited supply, vaccinations will be done by appointment only at this time.
MASS VACCINATION SITES: In anticipation of increased vaccine production, the Maryland Department of Health and the Maryland National Guard are working with private partners to open mass vaccination sites at central locations.