Professional Documents
Culture Documents
The COVID-19
vaccines are here:
What comes next?
Countries must prepare now for the largest simultaneous global
public-health initiative ever undertaken.
This article was a collaborative effort by Gaurav Agrawal, Nawaz Ahmad, Tania Holt, Brindan Suresh,
and Lieven Van der Veken.
December 2020
Coronavirus vaccines have started becoming available, administrable, accessible, acceptable,
available in some countries1 and are expected to be affordable, and accountable. Countries can take
critical tools in ending the pandemic. Several near-term actions to speed their efforts, such as
vaccines in development have reported promising setting up or strengthening vaccine task forces;
initial data, with some receiving authorization for use.2 developing a delivery road map and agreed-upon
governance; and starting no-regrets activities such
Now the focus is likely to shift to how quickly and as supply-chain logistics planning, administration-
successfully vaccines can be distributed, an effort site selection, and service-delivery model planning.
that will be the largest simultaneous global public- Done correctly, vaccine delivery efforts can save lives
health initiative ever undertaken. The scale of the and restore livelihoods, strengthen public trust in
challenge is immense: from the sheer volume of governments, and allow us to start the next normal.
doses needed to planning for uncertainties around
the vaccines’ safety, efficacy, and durability—and
from logistical and storage challenges to the The COVID-19 vaccine delivery challenge
service-delivery model. Governments will likely be The outstanding progress made by the scientific
expected to mount communication and education community has brought the vaccine closer to
campaigns to address the concerns that consumers our doorstep. The baton now passes from the
have about vaccine safety. In particular, without scientific community to a new collaborative effort,
proactive planning, underserved populations led by government and policy makers, healthcare
disproportionately affected by COVID-19—including professionals, the private sector, and other
ethnic, minority, and socioeconomically deprived community groups. The COVID-19 vaccine rollout
groups, as well as rural populations—may face will be unlike any other prior vaccine delivery effort.
disparities in vaccine adoption. Governments and their partners will be expected to
rapidly accelerate their efforts to ensure they are
Citizens will look to national and regional able to address community expectations.
governments for a delivery plan. As vaccine
availability nears, communities and consumers will Multiple factors will make the rollout of a COVID-19
want answers to many questions, including: vaccine more complex than any other previous
vaccine effort.
— Is the vaccine effective and safe?
Accelerated pace and giant scale of delivery
— Who will get vaccinated first? Countries face a four-by-four challenge: a vaccine
arriving at four times the pace and requiring
— Which vaccine will we receive, especially if delivery at four times the scale.
multiple vaccines are available?
Four times the pace. The coronavirus vaccine
— Where and when can we get vaccinated? has been developed four times faster than the
mumps vaccine, which was the previous record
— Will we have to pay? for a vaccine developed for use in a widespread
community setting. The consequence of this pace
— Above all, what do we need to worry about? of clinical development is that governments and
policy makers have had far less time than previously
Unfortunately, many countries are not yet ready to to prepare for a robust vaccination program.
respond to these questions and are underprepared
for the scale of the delivery challenge. In response, Four times the scale. The COVID-19 vaccine
they could pursue a structured program that we call rollout is expected to be four times larger than any
the 6A framework, an approach that accelerates previous effort because the aspiration is for broad
end-to-end planning to ensure vaccines are adoption at significantly higher rates than typically
1
“COVID-19 vaccine: First person receives Pfizer jab in UK,” BBC News, December 8, 2020.
2
“UK authorizes Pfizer/BioNTech COVID-19 vaccine,” Gov.UK, December 2, 2020.
3
Denis Campbell, “NHS assembles army of staff for mass coronavirus vaccinations,” Guardian, November 19, 2020, theguardian.com.
Phase 1
Phase 2
Phase 3
Highly targeted and prioritized Larger target population but not General population
population open to the general population
Limited but accumulating clinical Strengthening clinical data with Extensive clinical data and “real
data—vaccines available under full marketing authorization for world” data on multiple vaccines
emergency-use authorization some; others still in emergency
Significant and sufficient amount
use authorization
Low amount of vaccine available of vaccine available
Moderate quantity of vaccine available
● Global supply may be constrained ● As globe moves toward control of virus ● Full marketing authorization
depending on individual country or (assuming an efficacious and adopted is likely to result in vaccination of
regional contracts. vaccine), vaccine supply may begin to general populations.
increase—particularly those vaccines
● Likely public control of vaccine that receive full marketing authorization. ● Booster vaccinations (likely with all
supply limiting availability to highly major candidates) may need to
targeted population groups may ● Range of vaccine options may create be monitored to ensure appropriate
impact traditional delivery strategy challenges in population segmentation protection into the future.
considerations. and appropriate vaccine use.
Source: “COVID-19 Tracker,” Milken Institute, updated March 18, 2020, milkeninstitute.org; clinicaltrials.gov, BioCentury.
for successful adoption of vaccines. Countries Economic Forum/Ipsos poll in August 2020 and
may consider investing in public communication, October 2020 showed a decrease in respondents
messaging, and education to ensure that their who said they would take a COVID-19 vaccine,4
citizens choose to receive the vaccine. At the same illustrating the scale of the challenge. The recent
time, they must account for the personal choice of promising trials of vaccines in several countries may
citizens regarding vaccines with emergency-use influence public opinion in the opposite direction.
authorizations and limited long-term safety data.
It will not be a straightforward task due to diverse
and changing population sentiment, variable trust Now what? Countries need to move fast
in public health communications, fragmented news Most countries are underprepared for the scale of
and media ecosystems, “messaging fatigue,” and the delivery challenge. Many have not approved
persistent dis- and misinformation—alongside the sufficient funding specifically for delivery, and only
shortage of long-term safety data that is typically a minority have published a vaccine strategy or
available when launching a vaccination for the assembled a vaccine delivery task force.
general public. Most countries polled in a World
4
Gayle Markovitz and Amanda Russo, “Survey Shows Rising Vaccine Hesitancy Threatening COVID-19 Recovery,” World Economic Forum,
November 5, 2020, weforum.org.
Exhibit 2
An
Aneffective
effective COVID-19
COVID-19immunization
immunizationstrategy
strategyaddresses
addresseseach
eachcomponent
component of
of vaccine
vaccine adoption.
adoption.
Key activities of vaccine adoption
Upstream/down-
stream sourcing
and manufacturing
Public policy
planning
Exhibit 3
AAsuccessful
successful COVID-19
COVID-19vaccine
vaccinerollout
rolloutrequires
requiresleaders
leaderstotohave
haveat-a-glance
at-a-glance key
metrics
key andand
metrics accurate implementation
accurate implementationdata.
data.
Example visualization modules from McKinsey Vaccine Implementation Dashboard
PODS XX
Operational Readiness
Hospitals 200 400 beds Hospitals < 200 beds Urgent Care Sites
2 Provider 5 Consumer
County Z PODS X
readiness journey
78k
County C PODS C
What is our overall and regional What friction exists in the
72k
County G
County P
PODS A3
PODS I
56k
55k
3 Provider monitoring
Which providers have the
6 Compliance
Are we adhering to any
County Y PODS Z 50k lowest throughput? What is federal or centralized reporting
Total On Hand At Risk of Spoilage the current inventory per site? requirements?
Players in the cold-chain industry have largely standardized procedures and technologies for
chilled and frozen pharma distribution, but deep-frozen requirements are rare.
Storage at healthcare
Centralized distribution Storage facility1 Last-mile distribution facility or pharmacy
Industry • Third-party logistics provider • Distributor or wholesaler • Distributor or wholesaler • Healthcare facility
player
• Freight carrier • Third-party logistics provider • Pharmacy
Chilled • Air: Pallets/shippers in actively • Refrigerated warehouses • Insulated parcel shippers with • Medical refrigerators
cooled containers cooling material (e.g., ice packs)
• Refrigerated cross-docking
• Road: Ambient trucks with stations • Ambient/dry vans or reefer
passively cooled shippers and trucks/ delivery vans
cooling material or refrigerated
(2° to 8°C) (reefer) trucks
Frozen • Air: Passively cooled shippers in • Standalone medical freezer • Insulated parcel shippers with • Medical freezers
actively cooled containers with cooling material (e.g., dry ice,
cooling material • Smaller container sized frozen ice packs)
unites within a refrigerated
• Road: Reefer trucks with warehouse • Ambient/dry vans; reefer trucks
passively cooled shippers and not necessary
• Typically requires specialized
(–15° to –25°C) cooling material
training and SOP2
Deep-frozen • Air: Passively cooled packaging • Single medical deep freezers • Passive parcel shippers with • Ultra-low temperature freezers
using liquid nitrogen (not (deep-freezer farms), typically liquid nitrogen or dry ice3 (currently used in laboratories
restricted) or dry ice (restricted within refrigerated or frozen for biological samples)
due to hazard classification) warehouses • Ambient/dry vans or reefer
trucks (powered via electrical • Short-term storage within
• Road: Ambient or reefer trucks • Staff typically requires outlet or generator when not packaging may require recharge
with passively cooled shippers specialized training and SOP plugged in) of dry ice or liquid nitrogen
(–60° to –80°C) using liquid nitrogen or dry ice for freight handling.
• Medical staff require specialized
training, SOP, and PPE4 to
unload cryogenic containers
1
Industry trend is to ship directly from manufacturer to healthcare facility, bypassing storage in a distributor’s or wholesaler’s warehouse.
2
SOP = standard operating procedure.
3
Liquid nitrogen shippers can hold shipment up to 10 days vs 3-4 days for dry ice, making reefer trucks potentially unnecessary.
4
PPE = personal protective equipment.
Exhibit 4
Addressing
Addressing gaps
gaps in
invaccine
vaccine willingness
willingnesscan
canmaximize
maximizeaccess
access in
invulnerable
vulnerable
communities.
communities.
Focus area Example interventions
Understanding
● Work with leaders of communities most in need to ensure that vaccine distribution
is perceived to be fair, collaborative, and equitable.
● Simplify process (documentation, waiting times) and criteria to receive vaccine.
● Provide community-based administration setting.
● Provide small incentives for timely compliance.
Access
● Offer free or cost-reduced transportation.
One of the most consequential scientific quests This task could hardly be more daunting. But
of our lifetime—the development of a safe and countries that meticulously plan and execute
effective vaccine against SARS-CoV-2—is starting will see the long-lasting benefits on lives and
to yield highly positive initial outcomes. While much livelihoods. The preparedness framework and
work remains to establish long-term safety and immediate actions described above provide a
duration of immunity, the likely end to the pandemic starting point for this journey.
Gaurav Agrawal is a partner in McKinsey’s New York office; Nawaz Ahmad is a consultant in the London office, where
Tania Holt and Brindan Suresh are partners; and Lieven Van der Veken is a senior partner in the Geneva office.
The authors wish to thank Aliza Apple, Damien Bruce, Michael Conway, Kareen Forissier, Jennifer Heller, Jessica Kahn,
Parag Patel, Adam Sabow, Boyd Spencer, and Matt Wilson for their contributions to this article.