On 18 January Boris Johnson opened the Oxbox production plant in Oxford. The factory was originally intended to meet growing demand for the cell and gene therapy specialist Oxford Biomedica’s products. But last September, the firm signed an agreement with AstraZeneca to use the facility to produce Covid-19 vaccines instead.
With about 250 staff and covering 84,000 sq ft, Oxbox has been manufacturing vaccines for the UK since October. Every day at Oxbox, as well as at other facilities across the UK, Oxford Biomedica scientists work to produce enough AstraZeneca vaccine to meet the UK government’s order of 100 million doses. In order to meet such a challenge, AstraZeneca has established a network of partnerships to produce, bottle and distribute the vaccine doses.
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Once the substance has been produced in the Oxbox facility, it is sent to another facility for the so-called fill and finish process – the point at which the drug is put in vials. In August the UK government announced an 18-month agreement with Wockhardt to use their CP Pharmaceuticals facility in Wrexham, Wales, to both produce and bottle vaccines including AstraZeneca’s.
The government has reserved one fill and finish production line for its exclusive use for the next 18 months. The unassuming warehouse is based in Wrexham’s industrial estate and was producing 150,000 vials a day at the end of last year ahead of the vaccine roll-out in the UK. It is estimated to be able to produce up to 300 million doses of the vaccine per year.
Distribution and logistics
Making sure that bottled vaccine doses are safely distributed across the country and reach the population without losing effectiveness is one of the biggest challenges faced by the organisers of the roll-out.
It is also where the Oxford/AstraZeneca vaccine has the advantage. While the storage temperatures for vaccines from Pfizer/BioNTech and Moderna, once as low as -80˚C, have been revised, the Oxford/AstraZeneca vaccine’s requirements are more favourable.
Once vaccines have been dispatched from their manufacturing and fill and finish facilities, they are loaded on to vans and driven to quality control distribution centres, hospitals and other vaccination centres.
Logistics companies including DHL, FedEx and UPS have all signed agreements to help distribute Covid-19 vaccines across the UK. Edward Meinert, associate professor of eHealth at the University of Plymouth, explained why this is such a critical stage in the vaccine supply chain.
“As the currently approved Covid vaccines are biomolecules (mRNA and adenovirus), they are not stable outside of validated temperatures, causing them to lose potency. Improper storage at any point during the supply chain process can ruin valuable batches,” he said.
“This implies requirements for training logistics technicians to handle the products properly, specialised shippers and lorries, ultra-cold/cold storage facilities in airport hubs or ferry ports which are limited in capacity. Airports around the world have been actively preparing to handle the vaccines. For instance, the KLM Cargo warehouse at Schiphol, the Netherlands, has four cold storage areas for pharmaceuticals and was preparing a fifth at the beginning of this year,” Meinert added.
The logistics industry, however, sounds confident that it will meet the targets and that it will be able to produce even more vaccines without bottlenecks.
“FedEx is prepared to ship the Covid-19 vaccine for as long as is necessary. We have the experience, global network, aircraft fleet and technology solutions needed to transport vaccines safely across the region and around the world,” said a spokesperson for the American firm.
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The spokesperson also explained that in order to maintain the cold-chain distribution, FedEx has developed a near real-time tracking technology with the ability to monitor the status and location of shipments; added more than ten secure, cold-chain facilities across our global network; and is exploring a combination of solutions including stationary freezers, temperature-controlled ocean containers and refrigerated trailers.
From vans to vaccination centres
In the UK, the distribution of the AstraZeneca vaccine to the NHS is handled by Public Health England (PHE). Once all checks are complete, PHE makes the vaccine available to order by authorised sites in the NHS across the UK. NHS England decides how many doses are allocated to each NHS location or wholesaler.
The onward distribution to GP networks is managed by NHS England from these locations. The UK’s Department of Health and Social Care is confident that its vaccine roll-out plan is logistically sound and in a position to face significant increase in supplies.
“We have signed deals for substantial future supply of both vaccines to replenish our stocks and enable swift vaccination of first and second doses across the UK and we have sufficient doses to maintain our vaccination programme as it continues to accelerate,” a spokesperson said.
“Through the government’s Vaccines Taskforce, the UK has secured early access to 367 million doses of seven of the most promising vaccine candidates and invested millions in the Rapid Deployment Facility to ensure that the Oxford/AstraZeneca vaccine is available to the public as quickly as possible,” they added.
“The last 10 metres”
After PHE distributes the vaccines to NHS trusts, vaccination centres and other NHS-contracted wholesalers, doses enter the last stage of the journey. Ronald Piervincenzi, CEO of non-profit organisation United States Pharmacopeia, calls this “the last 10 metres” and describes it as perhaps the most challenging part of the supply chain.
“On a national scale, there are potentially hundreds of thousands of people that are involved in this process and who need to be trained to handle a vaccine they haven’t had experience with before,” he said.
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For the Oxford/AstraZeneca vaccine, this is the most delicate stage, as its need for a cold chain is not as pressing as for other vaccines. “The success of the Oxford/AstraZeneca’s vaccine distribution is less connected to the logistics part of the supply chain and more to the delivery and inoculation part,” Piervincenzi explained.
As it can be safely stored in a fridge, once the Oxford/AstraZeneca vaccines reach the place from which they get injected in people’s arms, it is in the hands of the doctors, nurses, pharmacists, and other practitioners who administer it.
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