Recovery, Renewal, Resilience

Vaccines are highly perishable and must be kept at very cold, specific temperatures. The majority of COVID-19 vaccines under development will spoil, and need to be discarded, if they are not kept at the right temperature. National and local governments, alongside health systems and the private sector, need to imminently consider their cold chains to avoid unnecessary spoiling of vaccines. The cold chain is a supply chain that can keep vaccines in tightly controlled temperatures from the moment they are made to the moment that they are administered to a person. Preparing the cold chain may take months, so investments into planning and resources now can help expand and support the current vaccine cold chain so it is ready and able to meet the scale of the mass vaccination programmes required. To prepare/scale up the cold chain consider:

• Where vaccines will be produced and transported, and the requirements for transportation including planes and trucks within countries and for distribution abroad
• There are a number of vaccines under development, many of which require different temperatures and handling procedures. Which will be approved first is unknown, therefore to prepare staff when one is approved staff in the cold chain should be trained to handle all possible vaccines to save time and avoid spoilage
• The frequency of deliveries that may be needed to facilities where dispensing will take place. This depends on the refrigeration capacity of health care organizations and hospitals, staffing resources, the locations the vaccines, and the shelf life of the vaccine
• How to expand shipping and storage capacity, including the specialised equipment needed to store vaccines at certain temperatures. Encourage airports and logistics companies to evaluate how well they could meet cold chain requirements

Testing is considered critical to managing COVID-19, and mitigating the risk of diagnostic-supply shortages can help contain the virus and support efforts to scale testing. Diagnostic testing can confirm or determine the presence of disease in an individual suspected of having a disease. Continuing to identify those who are infected with COVID-19 remains important to treat and isolate them, and to enhance knowledge of the disease. Consider how to:

• Map available laboratory-testing capacity which can be underutilized e.g. laboratories around the USA have reported unused capacity which could be used to conduct more tests
• Maximize existing laboratory capacity by assessing: workflows; number of trained and personnel; compile a full inventory of equipment
• Partner with Universities and major diagnostic manufacturers e.g. to share equipment, research facilities, and trained personnel
• Using less resources through pooled testing of people for COVID-19 (The Manchester Briefing Week 17)

The transfer of diseases such as COVID-19, avian influenza and swine flu can occur in agriculture and food production sectors. This can be facilitated by the rapid industrialization of meat production and poor biosecurity. Consider:

• increased monitoring of agricultural production as 'big farms create big flu'
• careful monitoring of wild animal sales; simply banning such practices may only drive markets underground and reduce visibility
• disease mitigation measures on farming practices of vulnerable populations. In the avian influenza outbreak, poultry from 'backyard chicken' producers were slaughtered compulsorily in huge numbers which caused devastating impacts on livelihoods across southeast Asia
• affordable measures for smaller farmers to meet food and agricultural standards, and consideration that if you remove their livelihoods, they will likely become more susceptible to current disease or new zoonotic diseases as a result of wild animal sale or consumption

Spontaneous supply chains (SSC) emerge during a crisis to meet unmet demand. They may fill a gap locally or nationally i.e. transformation in manufacturing and production. In the USA, Amish communities have shifted their production from woodwork and carpentry organised by men, to the production of facemasks by women. Women were sewing up to 50,000 face masks per day that met hospital sanctioned quality control. Consider:

• How SSC can be integrated into formal supply chains to ensure quality and efficiency
• How SSC can be integrated into local government efforts. Many SSCs are locally driven and so integration into existing local supply chains would increase their efficiency and effectiveness
• How to build firm-frim relations to support SSC integration e.g. building trust, developing contracts, designing management systems
• Opportunities for staying connected to local communities that have capacity to support