Thread by @surajbrf

Recently various sources have pitched the Pfizer vaccine for India. This parlays the recent western ‘branding’ effort differentiating Pfizer, but it is known that this vaccine has some unique technical requirements.

This thread analyzes the Pfizer logistics in depth.

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Storage
The vaccine must be stored at -60 to -80C, i.e. ultra low temp (ULT), much colder than normal freezer (-20C) or fridge (2 to 8C). Such storage systems are costly but cost depends on capacity. These have alarm systems to notify of failure or temperature fluctuations.

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The Pfizer transport box shows ~5000 doses = 10L tray volume. It is packed with dry ice and can be transported for no more than 10 days unopened, 15 if dry ice recharged. Each pallet has IoT comm to notify Pfizer of problems:
truckinginfo.com/10134508/vacci…
bbc.com/news/technolog…

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The contents of each box must be moved into ULT storage in 2-5 minutes according to CDC guidelines. Not only must the vaccines not get too warm, but they must not get too cold either. This makes storage and transportation complicated:
thehill.com/policy/healthc…

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A major hospital could hold several boxes worth of doses, but the ULT freezers cost between 3-5lakh (pretax) for small ones, up to 25 lakh for ~800L Stirling Ultracold freezers suited to large storage nodes. ULT freezers have high operating cost and require stable power.

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Recently many high end hospitals were found lacking in on-premises O2 plant despite only 30-50L cost. This is generally useful and yet the cost could not be justified. How many hospitals will spend on specialized ULT storage ?
theprint.in/theprint-essen…

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In addition, an entire ULT infrastructure is needed. India has a vibrant cold chain infra but only for up to -25C needs, not ULT. The 28000-unit cold storage network used by Indian immunization programs support 2 to 8C storage.
thefederal.com/uncategorized/…
gavi.org/vaccineswork/l…

7/

Thawed vials can be kept in a fridge for 5 days. Once opened, each vial (5-6 doses) must be consumed within 6 hrs. Vials must be mixed with saline diluent beforehand. Moderna, J&J, Covaxin, Covishield, Sputnik etc don’t need a diluent.

cdc.gov/vaccines/covid…

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Transportation
While the cold transport box looks small, they are heavy (~38kg). Each refrigerated truck holds about 65 boxes, or about 3.2 lakh doses. Pallets cannot be left unattended & must be moved to ULT storage quickly. Boxes must be returned.
fiercepharma.com/manufacturing/…

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Transport by air is restricted in volume by FAA guidelines on dry ice transport. Current limit is 15000lb, which translates to at most 1 million doses per flight. This was after increasing from 3000lb. Not all jurisdictions did so:
npr.org/2020/12/11/945…

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Typical air transport is only 3-5 lakh doses per flight. This is how much Japan and Israel get per delivery, since not all countries allow much dry ice transport, which poses a cabin pressure risk from dry ice sublimation.

asia.nikkei.com/Spotlight/Coro…
healthcareitnews.com/news/emea/isra…

11/

In effect a plane carries about as much as a freezer trailer truck. This means any place served by air will be significantly costlier per dose, and will lack ability to scale, This is why Pfizer orders have been focused on N.America and EU/UK - local mfg + truck delivery.

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This won’t work with India. Pfizer's 2021 goal is 2.5 billion doses, but most are already reserved. Any availability will not only take time, but will be far too few, delivered too intermittently at too high cost to have an impact. Cost discussed further....

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Price
Pfizer discourages disclosure of prices. While US and EU order prices are known, most others are not. The Japanese PM declined to answer. Israel prices were found to be $47/dose (Rs.3500) after a parliamentary inquiry:
timesofisrael.com/israel-said-to…

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Pfizer has manufacturing plants in USA & Belgium. US/Canada/EU deliveries can be trucked cheaply given that a truck and plane carry the same 3-4L doses. Countries dependent on air freight pay much more - data shows this. US $19.50 price was only for the first 100m doses.

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Pfizer renegotiates prices per order and has stalled deliveries until new orders are paid. Anyone negotiating with Pfizer will need leverage. Small volume private orders will likely be more than $50 given govts are paying close to that much.
jpost.com/breaking-news/…

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At current production volume, Pfizer cannot supply more than 3% of weekly vaccination rate in India recently, even with weekly 5L shipments like Israel. This supply will cost 8-10x of Indian options, not counting additional ULT infrastructure capital and operating costs.

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Pfizer only makes sense to some private entities willing to invest in ULT infrastructure and have clientele who can afford above Rs.3500/dose. In terms of value for money, it makes no sense at all as an option for government procurement. Too costly, low volume.

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An army moves on its stomach. Pfizer moves on its ULT cold chain combined with very narrow logistics channels for countries where supplies cannot be trucked to destination in a week or less. This makes the Pfizer vaccine a niche product as far as India is concerned.

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It is best suited to N.America+EU which have current production bases and ULT truck supply chain. Or small wealthy nations that can do with half a million expensive doses delivered by air freight once a week or less.

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OTOH, Covaxin cost a fraction of Pfizer and can do normal fridge temp (2 to 8C). India has existing vaccine cold chain for this requirement. Covaxin production rate (20m/month) is almost 10x Pfizer delivery rate to Israel/Japan, and will increase further by summer.

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The only viable option where Pfizer makes sense to India is local production, combined with TRIPS waiver enabling duplication of raw material (e.g. lipid nanoparticles) locally. This would bridge price gap to only a few multiples, rather than over 10x as is the case now.

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Pfizer cannot deliver any significant volume to India and won’t be remotely cost competitive today. They would be best served by leveraging the PLI scheme to set up vaccine production in India as an FDI investment, enabling investment in ULT trucking and storage.

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Pfizer’s current ULT air freight infrastructure makes it too expensive. No bridging trial data on efficacy vs current dominant local strains is a critical problem in the middle of this wave. This makes even the value of such a premium a questionable proposition today.

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