Corona Daily 145: More on Bottlenecks

Vaccine developers are secretive about sharing the exact formula. Vaccines are patented products. Manufacturers have not shared the inventory of ingredients. But the supply chain has other critical products. The world is racing to have enough syringes to administer the vaccines.  USA and EU have been asking for more. Brazil has restricted exports of syringes and needles.              

In pre-covid years, the world used about 16 billion syringes a year. But only 5%-10% of them were meant for vaccination. In 2021, 10 billion syringes will be needed for covid vaccines alone.

Not any syringes will do the job. They must be smart, the auto-disable type (after using them once, they automatically become disabled.)

To maximise the output from a vial of the Pfizer vaccine, a syringe must carry an exact dose of 0.3 millimeters. The syringes also must have the so called low dead space – that minuscule distance between the plunger and the needle after the dose is fully injected- in order to minimize waste. Japan learnt this the hard way. It had paid for and secured 144 shots of the Pfizer vaccine for 72 million Japanese, assuming each vial contains six doses. But since Japan had standard syringes and not the “dead space” ones, they could extract only five doses per vial and vaccinate 60 million instead of 72 million.

USA and China are the biggest producers of syringes. But now, companies from other countries are entering the business. Mr Nath from Hindustan Syringes calls it a “bloodsucker” business, where upfront costs are astronomical and profits marginal.

*****

Lipid nanoparticles, the fat droplets used to deliver RNA into cells are a crucial piece of the Pfizer and Moderna vaccines that use the mRNA technology. In the past, this substance was used for research and a single approved treatment for a rare disease. Now it is suddenly in urgent demand for production of billions of vaccines.

Scaling up production of lipid nanoparticles has been identified as one of the most complex challenges. The Biden administration marked their shortage among “urgent gaps” in the vaccine supply chain. In December, the USA agreed to use the Defence Production Act to help Pfizer gain access to more lipids. Moderna has invented its own ionizable lipid and is also in a rush to build production capacity.

In the production process of the mRNA vaccines, a machine shoots two streams of solution – one containing mRNA and one containing lipids – into a high-speed collision. Such machines didn’t exist before the pandemic. The Biden administration has promised the use of the DPA to help Pfizer procure more specialized industrial machines. Pfizer and Moderna are committed to produce 300 million doses each for the USA till the end of July, and hundreds of millions more for Europe.

It is difficult to know the extent of possible shortfalls, because these companies don’t reveal such details. Though the USA has pumped millions of dollars into them, the vaccine makers have kept the raw materials supply chain secret, citing proprietary licensing deals and confidential contracts. Lipids were made in grams or kilograms pre-covid, now in tons.

*****

I will offer some basic figures to understand the vaccine production challenge.

Pre-covid, the world’s annual vaccine production capacity was 5 billion doses. One hopes that this capacity will not be diverted to covid, allowing resurgence of diseases like meningitis or HPV.

In 2020, the vaccine makers promised to produce 837 million covid vaccine doses. In reality, 31 million were produced (-96%)

In 2021, to vaccinate 75% of the world population with two doses, 11.5 billion doses will be needed.

With the existing capacity, expansion, no wastages, best-case scenarios, and a miracle, the production target is 9.5 billion (-18% of what is needed).

The first quarter (Jan-March) has produced 500 million doses. On a straight-line basis, if you multiply it by four, you get 2 billion for the year, much short of the 9.5 billion promise. That shows the level of the challenge.

In short, vaccination alone is unlikely to take us out of the pandemic in 2021. Share prices of AstraZeneca or Pfizer can shoot up suddenly, not their production capacities.

Ravi