Asia preps for mass COVID-19 vaccinations even as doubts on cold chain persist

Asian nations are gearing up to distribute COVID-19 vaccines to their populations, but many are likely to face cold-storage and transportation challenges, according to experts.

Several countries in the region have signed advance purchase agreements with vaccine makers but depending on the vaccine and available infrastructure, access to inoculations for people could be quite uneven.

Four Western biotechnology companies – Pfizer Inc., BioNTech SE, Moderna Inc. and AstraZeneca PLC, and two Chinese drugmakers, Sinovac Biotech Ltd. and China National Biotec Group Co. Ltd., a sister company of Hong Kong-listed Sinopharm Group Co. Ltd. — are leading the race to provide vaccine supplies to Asia.

Pfizer-BioNTech's COVID-19 vaccine BNT162b2, which is authorized for emergency use in the U.S. and the EU , and Moderna's mRNA-1273, which is also authorized in the U.S. and is under review in the EU, are based on new mRNA technology that require colder refrigeration than is typical for shipping and handling. The Pfizer-BioNTech vaccine, for example, needs to be stored and shipped at minus 70 degrees Celsius.

Uneven access

Many countries globally will face enormous challenges delivering the Pfizer-BioNTech vaccine as they do not have the infrastructure, William Moss, executive director of the International Vaccine Access Center, or IVAC, at the Johns Hopkins Bloomberg School of Public Health, told S&P Global Market Intelligence.

Cold chain logistics require refrigerated containers, trucks and warehouses geared for different temperature requirements including frozen, chilled and controlled room temperatures.

In Asia, only a few countries such as Singapore, Japan and China will be likely to meet the Pfizer-BioNTech vaccine's shipping and distribution requirements by rapidly scaling ultra-cold chain facilities in the short term.

In Singapore, a public-private collaboration known as Changi Ready Taskforce involving government agencies, cargo handlers, airlines and freight forwarders have been preparing for months how to handle vaccine shipments at the city-state's Changi airport cargo hub.

Nazri Othman, senior vice president of cargo services at SATS Ltd. said the airport, whose cargo handling operations offer a combined annual cool chain handling capacity of 375,000 tons, is investing in additional special equipment to enhance cold chain handling and storing capabilities for pharmaceutical products. These include electric cool dollies and dry ice production capacity of up to 4.5 tons per day.

Singapore received its first batch of Pfizer-BioNTech vaccines in December.

In Japan, two major international airports — Narita and Kansai — are major bases for inbound and outbound pharmaceutical shipments, with Narita Airport handling about half of all pharmaceutical trade in Japan, according to a Nov. 18 note by real estate services company Cushman & Wakefield.

Both have dedicated warehousing facilities for pharmaceutical products, the note said. Recent media reports said Japan plans to expand its capabilities by purchasing deep freezers for the novel coronavirus vaccines.

"The issue is not hardware but securing the required number of medics to handle injections," said Fumiyoshi Sakai, a Tokyo-based healthcare analyst at Credit Suisse. Earlier in December, Pfizer applied for marketing approval of its vaccine in the country.

"Japan already has a well-developed vaccine distribution network, so we think the logistics of distributing a COVID-19 vaccine should be manageable," said Jay Lee, Hong Kong-based healthcare analyst at investment research company Morningstar.

However, Japan has a large elderly population — 36 million — and has seen low daily COVID-19 testing conducted per capita, both of which suggest a potentially slower vaccine rollout, a Fitch Solutions report on Asia-Pacific's access to COVID-19 vaccines issued Dec. 18, 2020, noted.

In China, Shanghai Fosun Pharmaceutical (Group) Co. Ltd., has tied up with Sinopharm Group to manage distribution of the Pfizer-BioNTech vaccine.

"We have minus 70-degree Celsius freezers at some airports. After the vaccines arrive, they will be transported using Sinopharm Group's cold chain, which also has minus 70-degree Celsius transportation facilities. All the vaccination centers have ultra-cold freezers as well," Fosun said in a statement sent to Market Intelligence.

Fosun, which will distribute the vaccines, previously said BioNTech will supply 100 million doses to China.

Emerging Asia

In many other emerging Asian markets, vaccines will need to reach people in locations that lack a proper transport infrastructure and where basic refrigeration may be hard to find.

"Stockpiles of vaccine-related goods need to be built — things like syringes, glass vials, refrigerated containers to move and store the vaccine, and the list goes on. The difficulty in getting these items where they need to go, so people can be quickly vaccinated, is compounded by the ongoing global economic uncertainty," Steven Beck, head of trade finance at the Asian Development Bank, noted in a Dec. 14, 2020, blog post.

These countries may have to wait for vaccines that do not require ultra-cold chain logistics, said IVAC's Moss.

The essential requirement of vaccine storage is an environment between minus 80 degrees Celsius and 8 degrees Celsius, a note on the challenges to effective vaccine distribution in emerging Asia issued Oct. 7, 2020, by real estate consultancy Knight Frank said.

U.K.-based drugmaker AstraZeneca's COVID-19 vaccine — which has received authorization in India and Britain — is one that can be stored in normal refrigeration conditions.

Indonesia will be mainly relying on vaccines developed by Chinese companies, which can be transported using normal refrigeration, said Irfan Setiaputra, CEO of Indonesian airline Garuda Indonesia. "The infrastructure for delivering other vaccines such as for polio already exists," he said.

Malaysia, which has also seen success in its immunization program for polio, should be ready for delivering COVID-19 vaccines as well, according to Lo Ying-Ru, head of mission and WHO representative to Malaysia, Brunei Darussalam and Singapore.

India, meanwhile, is rolling out an Electronic Vaccine Intelligence Network, or eVIN, that will provide real time information on vaccine stocks and storage temperatures at all cold chain points in the country.

As of August 2020, more than 23,500 points across 585 districts in 22 Indian states and two union territories were covered by the network. The federal government said it will leverage eVIN to distribute any COVID-19 vaccine when it is approved.

"With a population of 1.3 billion (and 94 million over 65-year-olds), the domestic vaccination drive will be the largest in the world. The country has a good track record of such drives with masses of the population regularly gaining inoculation for various diseases such as polio and cholera," the Fitch Solutions report said.

The world's second most populous country reported more than 10.3 million COVID-19 cases in total as of Jan. 4.