Good things, small packages

The raw numbers, we can all agree, are astonishing. Since Covid-19 vaccines first appeared in December 2020, 11 billion doses have been administered worldwide, spread across 184 countries. According to the latest figures by Bloomberg, that means around 28.1 million shots are entering arms every single day, altogether representing 132 shots for every 100 people. The same goes for individual countries. In the US, by no means the world’s outstanding vaccination hub, 547 million doses have so far been doled out from sea to shining sea, and even that pales compared to success stories like Portugal or Cuba.

Yet if the vaccine rollout is one of the great scientific feats of modern times – we should never forget it is also a feat of logistics.

Those billions of vials, after all, didn’t simply appear by the rolled-up sleeves of eager punters. Rather, they have to be painstakingly packaged and transported, protected from bumpy roads and shielded from extreme weather. And though temperature-controlled packaging has been a vital part of the pharma supply chain for years, it’s equally clear the pandemic and its consequences have sped development up.

That’s particularly true when it comes to so-called hybrid container solutions. Rather than exclusively focusing on keeping drugs cool – often via expensive and unsustainable batteries – these hybrid systems instead seamlessly react to external temperatures. Apart from keeping medications secure whatever the climate throws at them, these platforms are also far greener than traditional containers. At their best, they could drastically cut human error from the supply chain equation, boosting efficiency, and cutting costs. Not that the path forward is necessarily straightforward. From staffing to costs, there are plenty of challenges for insiders to ponder. All the same, it’s clear that hybrid machines could soon transform how drugs get from manufacturers to patients – with happy consequences for the planet as a whole.

Chained down

If anyone can reflect on the monumental shifts in pharmaceutical supply chains, it’s Patricia Turney. Starting back in the mid-1990s, she spent most of her working life at Amgen, stationed everywhere from manufacturing operations to raw material supply. In 2016, she finally became the California giant’s vice president of external supply, no small feat at a company with annual revenue topping $25bn. And as Turney, since 2020 senior vice president of operations at Arcutis Biotherapeutics, emphasises, her long career has seen the supply chain only grow in importance. “Even in the past few years – and with the pandemic – much more visibility has been given to the supply chain.”

This can be appreciated in a number of ways. Covid certainly has a role to play here – but that’s also shadowed by the growing sophistication of other medical products. Complex gene therapies, for instance, now enjoy a CAGR of 27.85% and will soon be worth $1.2bn globally.

Beyond medications, Turney also highlights autoinjectors and other sensitive products that dovetail biological and mechanical components. It goes without saying, she adds, that all this requires robust and efficient transport containers. “It’s really complex,” she says, “if you have to keep something frozen, and you want to get it to remote parts of the world.” And though Arcutis is currently focused on products that can travel at ambient temperatures, it’s still important they’re not exposed to extremes – if nothing else because they risk hurting patients.

Yet despite their rising importance, medication containers have traditionally suffered from a number of drawbacks. That’s true of both so-called ‘passive’ and ‘active’ containers. The passive model, for its part, simply involves insulated containers with no active temperature controls, problematic if they’re being carried to different parts of the world. It’s all well and good, for instance, if a drug container is lightly protected when it leaves a factory in blazing Hyderabad.

But what about when it lands in frozen Moscow 12 hours later? ‘Active’ containers, meanwhile, risk suffering from mechanical problems. If, for instance, a battery isn’t replaced, or a container is abandoned by the dockside, the drugs inside will likely fail. Nor is this merely a hypothetical danger. Last year, for example, nearly 2,000 Moderna vaccines were dumped after a Massachusetts hospital cleaner accidentally unplugged their freezer.

More broadly, Turney suggests that these difficulties are even more pressing at a time of climate emergency. “Front and centre are not only the products themselves, but also the containers,” she explains, noting that working with shippers to be more sustainable is now common across the pharma supply chain. In practice, that includes everything from recycling old batteries to encouraging more localised shipping. To be fair, there are signs this is happening already. For instance, IBM's Supply Chain Sustainability Management Solution (SCSM) uses network modelling to offer shippers the greenest routes available. More broadly, supply chain insiders are experimenting with wool and other reusable packaging materials. Yet in a sector where relative emissions are 55% higher than in the automotive industry, there’s clearly much to be done.

Supplying answers

They look, at first glance, like regular drug containers – unremarkable cubes, with stencilled maps of the world on their side, and red ‘handle with care’ signs near the top. But look inside and it’s clear that the SkyCell is different. A so-called ‘hybrid’ container, this platform balances technology and robustness to offer, according to its website, “steady protection under extreme conditions and on long journeys”. And though the technology is still relatively new, Turney nonetheless seems excited about the SkyCell’s potential. She describes the “disruptive opportunity” it offers, adding that companies seem “very keen” to invest in it.

But beyond the headline excitement, what can the SkyCell, developed by a Swiss company of the same name, actually do? Fundamental is its ability to recharge independently – without the need for mechanical components like wires or removable batteries. Clearly, that lessens the risk of Massachusetts-style fiascos. More than that, it means sensitive drugs can stay out in extreme conditions for longer than they can in traditional containers.

In 2020, for instance, a shipment of 56 hybrid containers was left out on an Indian runway after its transfer flight was suddenly cancelled. Despite outside temperatures of 40°C, the medications inside were kept cool – because they’d automatically charged hours earlier. Given up to 50% of drugs are lost due to similar faults in the supply chain, that can only be a good thing. Even better, SkyCell has expanded on the old passive model to create a ‘double-door’ insulation system that protects pharmaceuticals from hot and cold weathers – ensuring drugs can hop between climates undamaged.

Aside from Turney’s enthusiasm, there’s evidence the SkyCell is quickly gaining an appreciative audience. In October 2021, for example, it raised $35m in new funding – on top of the $62m it secured in 2020. And though the company is coy about its precise client list, it recently announced partnerships with “the majority of the top 20” pharmaceutical companies worldwide. That’s reflected by similar technology elsewhere. Pelican BioThermal’s new model, for instance, is totally reusable. On retirement, for its part, Sonoco ThermoSafe’s new Pegasus unit is 90% recyclable too. As Turney emphasises, that’s a huge boon for companies desperate to cut their overheads – especially now that 80% of firms are passing on rising supply chain costs to consumers.

International deals

As all this activity implies, there’s an important environmental aspect to consider here. If hybrid machines like the SkyCell primarily support cost-saving and efficiency, they can also do their bit for the planet. Able to function independently for over 200 hours under extreme conditions, the Swiss devices are bound to cut electricity usage. No wonder SkyCell’s star looks set to soar even higher over the coming years, the Swiss firm deals with Singapore Airlines, Qatar Airways Cargo and other major pharmaceutical shippers.

Challenges remain for any supply chain giant eager to go hybrid. Though active container costs initially look higher, for example, they also take up less cargo space. On a more fundamental level, meanwhile, Turney warns that as drug development costs climb ever higher, the supply chain will soon be under even greater pressure.

“We’ve invested more and more money into final drug products – so obviously want to get those medicines to hospitals and patients.”

Personnel is another difficulty. Though SkyCell devices need less attention than their active cousins, supply chain operators are still likely to struggle with hiring. According to one recent poll, to take but one example, around 68% of pharma giants flagged securing quality workers as their biggest recruitment challenge. Even so, it’s hard to shake the feeling that firms like SkyCell are on the up, with revolutionary consequences for the industry they serve.

What’s at stake on the cold chain?

It’s not just Covid-19 vaccines that rely on companies that provide cold chain storage for safe transport. Treatments for diabetes, rheumatoid arthritis, cancer and Crohn’s disease are other examples of biologics that are especially sensitive to temperature changes and other common disruptions during air transport, such as vibration. In a recent article featured on online start-up focused magazine Maddyness, SkyCell CEO Richard Ettl writes “The pharmaceutical industry has historically suffered failure rates of between two and 12% per shipment depending on the region and technology used. Putting that into perspective, if a shipment of 10,000 diabetes vials was shipped with an accepted failure rate of 12%, then 1,200 vials would be lost.”

Ettle argues that if we consider this statistic at scale, the wastage in the industry prevents millions, if not billions of medicines from reaching those who need them. In monetary terms, he cites an IATA report that found the pharmaceutical industry lost $34.1bn through failures in temperature control logistics. This figure aligns with other reports in the industry that for some time now have placed the annual cost of failures at $35bn.