Planet Money - Before The Shot In The Arm

Episode Date: December 3, 2020

Inventing a vaccine for COVID-19 was hard, but getting billions of doses to billions of people is going to be even harder. | Subscribe to our weekly newsletter here.Learn more about sponsor message choices: podcastchoices.com/adchoicesNPR Privacy Policy

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So there's the COVID-19 vaccine. There's actually three promising vaccines, and they were made in record time. This is the fastest that we have ever made a brand new vaccine. Before this, the fastest vaccine developed was the one for the mumps, which took four years. So this is all great news for the world. COVID has already killed almost 1.5 million people globally. But now that we have this magic potion that can protect us from COVID, now we have to produce a ton of it. And just to give you an idea of what this will take, the International Federation of Pharmaceutical Manufacturers and Associations says that globally, the world produces three to five billion vaccine doses a year. This is for everything except the seasonal flu. So this is for

hepatitis C, for yellow fever, for the measles, for human papillomavirus. This is everything except the flu. Three to five billion doses are made globally. And in order to effectively inoculate the entire world against COVID, we will need about 6 billion COVID-19 vaccine doses. This is on top of all the vaccine doses we already make. So this is double our current capacity. And actually, all three COVID vaccines so far will likely require two doses, two doses a few weeks apart. So we'll really need about 12 billion additional doses, which is triple our current capacity. And yet, coming up with a miracle vaccine in record time and making it in quantities never seen before, that may just be the easy part. Hello and welcome to Planet Money. I'm Sarah Gonzalez.

And I'm Alexi Horowitz-Ghazi. Today on the show, the journey of a vaccine from the factory into the arms of billions of people. Getting the syringe in your arm with the magic potion, though, that is the end of a vaccine's journey. All kinds of things have to happen before that. We are going to need sand. We're going to need ice that doesn't melt and minerals you can really only get in one country. Also, a lot of airplanes. More planes than we actually even have. So we have the magic potion. We have three vaccines that will probably be on the market soon. And now, now we have to put them in something.

We are talking about special, very sought after, tiny little glass vials. You can't just use any kind of glass for this. The glass we use was invented in 1911. This is Stefan Mark Schmidt. He's in charge of global sales at a German company called Schott. They are the biggest makers of fancy medical glass. This glass is super stable and can withstand a higher shock resistance. And this glass is called borosilicate glass. Borosilicate glass doesn't shatter in ultra low temperatures. Invisible glass particles don't make their way into the vaccine

when you use borosilicate glass. This is the good stuff. There are like seven main ingredients. The biggest portion of ingredients is silicon, is sand actually. And then we have elements like boron, sodium, potassium, calcium, magnesium. The sand and all those minerals come from all over the world. Brazil, India, China, Europe, Australia, South America, Africa. India, China, Europe, Australia, South America, Africa. Some are more specific to one region.

For instance, boron is a material. I think 70% of the boron is coming from Turkey. It's a little mineral. It looks like little rocks. Yes, boron. Everything gets shipped to one of five melting plants where all the dry ingredients get mixed together. We have huge mixers. And then you heat these tanks up to over a thousand degrees and melt the sand and melt the ingredients until you have a homogeneous liquid glass melt. Not like water, but more like honey.

This sand melting is happening around the clock constantly. It's 24-7. We produce 365 days that glass because you cannot hold the tank to stop. Once you have heated up the tank, you go. If you turn off the heat, you have a tank full of hard glass. So you don't turn it off. And from that honey-like melted sand,

you then form long glass tubes that then get shipped to one of 16 cutting plants in places like Argentina, Mexico, the U.S., Switzerland, Germany, Indonesia, China. It's a lot of places. And here, the glass tubes get cut into vials, syringes, and cartridges. So it's a huge, long supply chain, and you have to manage all these different touch points so that nothing goes wrong. Yep. Stefan says Schott produces around 11 billion of the roughly 50 billion borosilicate glass containers made every year, including billions of vials. And basically, as soon as COVID exploded, so did the orders for more vials. Everybody is developing a vaccine,

and everybody thinks they're going to be successful. So what they all did, and which is certainly okay and normal, they all have booked capacity to buy vials. Yeah, everyone who wanted to get in the race for a COVID-19 vaccine, they put in their orders for vials months ago. But they all know they will only need the vials if their vaccine is successful. But they all know they will only need the vials if their vaccine is successful.

But they also know you're not even in the race if you don't have a container to put your vaccine in. Stefan says this has created kind of an overbooking problem. There are only so many vials Schott can make in a year. But they say not everyone is going to need vials at the exact same time. So they're hoping they'll be able to trade orders that Shah can be like, listen, company D, you don't have a vaccine yet. This other company does. Can we maybe give them your vial order just until your vaccine is ready? Here's another way pharmaceutical companies

have tried to avoid vial bottlenecks. They're putting the COVID vaccine in multiple-dose vials instead of single-dose vials. They're putting five doses in one vial, 20 doses in one vial. Now you need fewer vials. And Schott expects to make around 500 to 600 million additional vials in 2021, enough to support about 2 billion vaccine doses, each vial carrying multiple doses. No, it's not a big number. And it feels small. It feels small. But still, it's a stretch because you have to be able, you have to have that additional capacity and you have to have it in time. Stefan says this will already be pushing manufacturing to the limit. And it's not like Schott can switch over all of their other vial making capabilities and focus only on COVID vaccine vials. They make glass containers for a lot of really important things.

All the cancer drugs made worldwide, all these patients need their need their drug. And we have to make sure that that these these vials for those drugs are supplied as well. There are other vial makers, not just Schott. And Stefan says he doesn't think mass vaccinations will be held up because there aren't enough vials. But making sure that doesn't happen is the new focus at Schott. And that's what we're working at constantly. Schott is already shipping vials to vaccine makers, by the way. The vials arrive in pallets.

Nothing moves in this world without pallets. The Department of Homeland Security actually in March declared pallets and crates and other shipping containers essential critical infrastructure during COVID. Finally, the government giving pallets their due. Right. So the vials arrive at pharmaceutical companies in pallets. The vials get washed, sterilized, and filled with the vaccine. Next, you got to keep them cold. If vaccines get too warm, they don't work. It all goes to waste.

One of the vaccines, the Pfizer-BioNTech vaccine, is the most fragile one. This one needs to be kept in ultra low temperatures, negative 94 degrees Fahrenheit, super, super cold. Pfizer actually made their own boxes with thermal sensors and GPS trackers for their frozen vaccines to travel in. But even the Moderna vaccine needs to be frozen, just a little less frozen. A regular freezer will work for that one. The Oxford AstraZeneca vaccine just needs to be refrigerated. And to keep all these vaccines cold, we will need medical grade freezers and ultra low temperature freezers and airports with freezers and cold warehouses all over the world. But even if you have all the freezers in place,

the most perilous part of a vaccine's journey is getting between those freezers. And for that, you will need one of the most effective cooling technologies on Earth. Ice. The dry kind. Some of the vaccines will travel in dry ice. And for this, I FaceTimed Gio Escobar with

SubZero Dry Ice Services in Miami. He's a dry ice distributor. Are you at your distribution center right now? Like, is there dry ice near you that you can just show me very quickly? Let me walk. Gio walks out to the warehouse to show me all his dry ice. He lifts the lid off a big teal blue bin that's on the floor and a cloud of cold white smoke puffs out. Then Gio sticks his bare hand into thousands of little pellets of dry ice. It doesn't burn your hand? Yeah, it does. You see I'm switching hands. You stay alive. Gio drops a cube of dry ice in a glass of water, of course, and it bubbles up. Classic party trick.

But Gio says dry ice is way more sophisticated than just making smoke and bubbles. It doesn't melt because that's why its name is dry ice. It's dry. It never goes through liquid phase. It always goes through from solid to gas. What? Yes, that's why dry ice. That's the solid to gas. What? Yes, that's why dry ice, that's the concept of it. What? Yeah. So dry ice never melts. It goes from the block of ice to

just like invisible gas that you can't see? Yes. And the name for that reaction is sublimation. It sublimates. Dry ice doesn't melt, it sublimates. And if you keep dry ice in a very airtight cooler with good insulation, Gio says 10 to 15 percent of the ice will sublimate in a day. If it's a really bad cooler, you can lose the ice in an hour. Gio trucks in his dry ice from Augusta, Georgia. Then he distributes it to hospitals, lab researchers, blood centers, restaurants, freight forwarders, food e-commerce. I'd like to think some of it makes its way to Halloween parties. And when the first vaccines were announced, Gio says people who had never wanted dry ice before, people who didn't even know about sublimation, they started calling. We started having a call from big airline

freight forwarders named DHL, American Airlines, you know, big airlines, because they're going to move the vaccine. And then we also have a couple calls from big hospital systems. So they say like, hey, we just want to reach out now. We don't have the vaccine yet. Exactly. But when it comes, we want you to be ready. Like that. Exactly like that.

Will you be able to cover our needs and price? Yeah, as far as you let me know what you're going to need. Oh, no, we don't know. Okay, when you know, you call me, I will figure out. So they didn't tell you how much they need or when they want it? They don't know. They don't know. So you have no idea how much they're going to want from you?

No. And how do you know if you'll have enough ice for them? That's a good question. I don't know. I've been having my kind of panic attack lately because I don't know. Gio says he can't just buy a bunch of dry ice now and stock up on it and store it. Because remember, it sublimates. It is always sublimating. It's always disappearing.

It's not like you can just leave it in a normal freezer. A normal freezer isn't cold enough. We're going to need a cooler, cooler. Are you worried? Yeah, I am. Yeah, you look worried. If you have a limited quantity, who are you going to provide with? The vaccine? Are you going to provide your everyday customers being with you for many years? You know, it's complicated. If you had to choose, who would you prioritize? I don't know.

That's a hard question to answer. Because, you know, again, the people who buy dry ice from us doesn't buy dry ice for fun. You know, there is research centers, there is food for elderly. You know, there's medicine that goes to South America or goes to Europe that needs to be, you know, kept in dry ice. So it's not an easy decision to take, you know.

Gio says he'd probably turn away restaurants and bars first. But after that, it's going to get trickier to choose. The people who manufacture dry ice in Georgia, they told Gio that they're preparing and planning and doing everything they can to ramp up production. But this is just a lot more dry ice than normal. And machines break and things happen and people are already worried about dry ice shortages. And again, some vaccines will need dry ice in order to travel in the air. Which brings us to our final stop in the vaccine supply chain. After the break. Once we've made all the vaccine doses and we've made all the borosilicate glass

vials for the doses and the pallets for the vials to travel in and the dry ice to keep it all cold, now we have to move the vaccine all over the world. And for that, we will need, yes, trucks and cars and all sorts of stuff, but also airplanes. Okay, so we'll get started. Will you just say, and you're in like a quiet room, there's no fans or? I have no fans, no fans with me. All my fans are actually gone home for the evening. Great. Great. This is Glenn Hughes. He's the global head of cargo at the International Air Transport Association, which represents the interests of the commercial air industry. Glenn says moving all this new product will be an enormous undertaking. This is a sizable transactional volume that has been unheard of at any point in the past. The industry has never had to tackle

this magnitude of product that needs to be shipped to 200 plus countries around the world and territories with a certain degree of temperature control with it. And as governments and trucking companies and logistics companies and aviation authorities and everyone in the supply chain started to think about and plan and prepare for mass vaccinations, the Air Transport Association wanted to give the world a visual of what this would look like, just to help us picture what billions of vaccine doses would look like in a world where all the vaccines were available at the exact same time. What would the visual picture be if all these vials of vaccine were available now and stacked up? And we said, if you could just picture 8,000 planes side by side,

full, with each plane full of 100 tons worth of vaccine. 8,000 Boeing 747 planes, each filled with 100 tons of vaccines. Now, this is just a way to visualize how many vaccines will actually need to be moved. They could have chosen anything. They could have chosen how many vials will fit in a blue whale. But they are the airplane people. So they chose planes. Is 8,000 airplanes a lot of airplanes? I have no idea how many airplanes there are in the world. Well, just to give you an illustration, today there are about 2,000 dedicated freighter aircraft flying around the planet. So, you know, yes, that number of aircraft is indeed a

huge number of aircraft. The planet has about 2,000 cargo airplanes in total, making multiple trips a day. But we have about 27,000 cargo airplanes in total, making multiple trips a day. But we have about 27,000 passenger planes, too. All right. Now, Glenn's hypothetical fleet of 8,000 vaccine-filled cargo jets, it assumes that all the vaccines are ready at once, which they won't be. And it assumes that you can fill a plane with 100 tons of vaccines, which Glenn says you probably wouldn't do because countries wouldn't be able to handle such a large shipment. They wouldn't be able to move and properly store 100 tons of vaccines that all showed up in one plane. And you might be flying five tons to one location, two tons to another location. So it'll probably be a much larger number of flights with much smaller number of quantities on each. Glenn says it'll probably take two years to make all these trips.

And moving vaccines will be even more complicated now because people aren't flying as much. Yeah, air cargo doesn't just move in cargo aircraft. Glenn says half of the world's cargo actually flies in the bellies of passenger airplanes. But about 40% of passenger planes aren't flying right now because they don't have enough passengers. So this has removed a significant amount of cargo capacity from the supply chain. But airlines have gotten creative because technically passenger airplanes are approved to carry cargo in the cabin, like where the seats are, as long as there aren't any passengers.

So a passenger plane can be used to move cargo if you put the cargo in the belly of the plane, the overhead bins and the, like where your feet are? Yes, exactly, under the seats. Under there? Yes. About 2,500 passenger airplanes have switched to cargo only during the pandemic. And about 200 actually had the seats removed from the plane so that there's less weight and more room for cargo.

But the rest of them, they're just buckling boxes into seats. Wow. So is is the fact that people have have stopped flying as much? Is that better for bottlenecks? Like, does this does the fact that there are so many grounded airplanes, passenger airplanes, does this help us in trying to distribute all the vaccines or does it hurt? Well, in actual fact, the best way to distribute the vaccines would be to have a normal resumption of global networks. Glenn says that the best way to distribute vaccines would be for them to hitch a ride on all the thousands of passenger flights that go to the Caribbean and Alaska and Vanuatu every day. The web of flights that people use for work or to visit home or go on vacation is just much bigger and more frequent than every corner of the planet. And therefore, those passenger networks are the most optimal in terms of moving relatively small quantities of vaccine and other support around.

So the passenger airplanes are really what helps us get to all the little corners of the world. Absolutely. That's the easiest way. Absolutely. So then it's not good. It's not good that we're not flying right now. Exactly. But that's why the airlines have mobilized as much as they can in terms of those grounded passenger aircraft to try and address some of those those needs.

In a normally functioning economy with planes going everywhere every minute, it would be much easier to distribute the vaccine. So this is probably a little depressing. And we didn't even get to what happens once the plane full of vaccines arrives in a country. Local governments and truck companies and medical centers all have to figure out how to move the vaccines within the country. They have to make sure they stay cold and that no vaccine gets wasted. Then there's the issue of having enough syringes. The most likely scenario is that we will all have these mass vaccination centers so that we don't have to ship vaccines and freezers and syringes and masks and gloves and workers to so many places. There will be these vaccination centers where we all go to the vaccine to make it easier on the supply chain.

But everyone we spoke to said there is a level of coordination and communication like never before. Everyone is focusing on the distribution system. It will likely take years. But luckily, airplanes have been moving vaccines around the world for several decades. We know how to do it. We just have to do it faster and bigger than ever before. Once again, if you love Planet Money and are able to support the show,

the best way to do that is to donate to your local NPR member station. You can do that by going to donate.npr.org slash planetmoney. That's donate.npr.org slash planetmoney. Also, you can always get in touch with us. We love to hear from you. Planet money at NPR dot org. We're also on Twitter, Instagram, Facebook, TikTok, like we are

everywhere at Planet Money. Today's show was produced by Maria Paz Gutierrez and Alexi Horowitz-Gazi. Alex Goldmark is Planet Money's supervising producer and Bryant Erstadt edits the show. We also really want to thank Thomas Cuney and Abigail Jones at the International Federation of Pharmaceutical Manufacturers and Associations. They really helped us understand just what it will take to make all these additional vaccine doses. I'm Alexi Horowitz-Ghazi.

And I'm Sarah Gonzalez. This is NPR. Thanks for listening. And a special thanks to our funder, the Alfred P. Sloan Foundation, for helping to support this podcast.