COVAX delivered: The Humanitarian Airfreight Initiative takes flight

On the evening of June 21, an Air France 787-9 carrying 358,700 doses of AstraZeneca’s COVID-19 vaccine touched down at Kenya’s Jomo Kenyatta International Airport (NBO). Pallets bearing the logo of Denmark-based Scan Global Logistics, the freight forwarding partner for the shipment, were unloaded from the lower hold and greeted with fanfare, unusual for a relatively small cargo shipment.

The shipment, transported by Air France-KLM Cargo, came together through the backing of dozens of organizations dedicated to providing equitable vaccine access, several of which had representatives present at NBO to greet the Air France 787 on arrival. Along with Kenya’s Ministry of Health Principal Secretary Susan Mochache, donor country Denmark was represented by Ambassador Ole Thonke.

[caption id="attachment_96252" align="alignright" width="2560"] AstraZeneca vaccines donated by Denmark arrive in Nairobi on June 21, aboard an Air France 787 flight. (Photo: UNICEFKenya/2021/LameckOrina)[/caption] Two other organizations were also present: The World Health Organization (WHO) and UNICEF. The two organizations have worked closely with several other NGOs since virtually the beginning of the pandemic to prepare for precisely these moments, when parties supporting the COVID-19 Vaccine Global Access Facility, or COVAX, cooperate to provide equitable vaccine access around the world. Procurement is only one piece of the puzzle, however, and the world’s airlines are stepping up to transport doses as needed.

Preparation is key COVAX emerged early in the pandemic as one of four pillars of the Access to COVID-19 Tools (ACT) Accelerator, which was coordinated by Gavi, the Vaccine Alliance; the Coalition for Epidemic Preparedness Innovations (CEPI); WHO; and UNICEF. A forward-looking effort founded in April 2020 at the start of the pandemic, the ACT Accelerator aims to provide innovative and equitable access to COVID-19 diagnostics, treatments, health system strengthening and vaccines.

Vaccines are where COVAX comes in.

Of the 16.8 billion doses of COVID-19 vaccines currently secured globally, 4.19 billion of those have been secured and optioned through COVAX, according to UNICEF data. As an organization, UNICEF itself has procured doses, with more contributed by national and institutional buyers participating in the COVAX facility.

More than 100 million vaccine doses have already been donated and shipped through COVAX to 135 countries as of July 7, according to UNICEF. However, as the initial distribution of COVID-19 vaccines in late 2020 demonstrated, global vaccine distribution to populations that might otherwise not have access to vaccination is a complex undertaking. UNICEF is turning to airfreight for the solution.

“UNICEF has been working with some of the world’s biggest airlines to make sure COVID-19 vaccines are transported as quickly and safely as possible to countries,” a UNICEF spokesperson told Air Cargo World . “In fact, close collaboration with the industry and the International Air Transport Association (IATA) led to the establishment of the UNICEF Humanitarian Airfreight Initiative in January 2021.”

Sixteen major carriers around the world have signed on to the initiative: AirBridgeCargo, Air France-KLM, Astral Aviation, Brussels Airlines, Cargolux, Cathay Pacific, Emirates, Ethiopian Airlines, Etihad Airways, IAG Cargo, Korean Air, Lufthansa, Qatar Airways, Saudia, Singapore Airlines and United Airlines.

Humanitarian Airfreight Initiative (HAI) partner Air France was the transport partner supporting the June 21 flight to Kenya, with vaccines donated by COVAX participant Denmark. Other organizations and nations are also becoming involved in the shipments, including the United States, which made its first donation through COVAX with 1.5 million doses to Honduras that were transported on an Amerijet 767-200 freighter June 27.

The details of distribution Most major carriers are accustomed to transporting valuable pharmaceutical cargo and have spent years building up their cold chains as pharma transport has become more complex and higher-value products leave less room for error.

Still, given the global attention on the vaccine rollout, COVID-19 vaccines often receive preferential treatment when moving through networks. When distribution began late in 2020, carriers worried about uncertain temperature requirements for the various vaccines in development but, after months of preparation, HAI members are confident in their capabilities.

HAI partner United Airlines similarly prioritizes COVID-19 vaccine shipments in its network. Before the airline began shipments of COVID-19 vaccines in late 2020, United Cargo created its COVID Vaccine Task Force to prepare to utilize its hubs and avoid potential bottlenecks. One method the carrier uses to prioritize vaccine movements is the use of special cargo designations specifically for vaccines and related cargo, Jennifer Haigh, head of specialty products for the Americas with United Cargo, told Air Cargo World .

“We've created two different booking codes within our system, one being ‘CVD,' which we assign specifically to a finished COVID vaccine,” said Haigh. “And so that actually goes onto a list that is sent out companywide on a daily basis. That way, internally, the hubs or the stations that are receiving these vaccines acknowledge it and notify us all along the way.”

United Cargo’s close watch on the shipments through its network helps it quickly respond to its transportation and shipper partners as the shipment nears its destination or if there are any potential slowdowns during transport, said Haigh.

“We've implemented different measures that we are notifying the freight forwarding customer, and in some cases the shipper, as to when these are moving. If there's a departure, even if there's a delay, they need to know if there's a delay so they can make any arrangements at destination,” she added.

“We’ve also implemented [designation] ‘CV2’ that is for any supporting materials,” said Haigh. “So in some cases, the active pharma ingredients will go on that: syringes, face masks, anything across the board that would help to support the vaccine movement. Those as well go out to another distribution group within our organization, and it's something that from the United Cargo side and our specialty products team, that we have direct visibility pretty much on a daily basis.”

“It's the first thing that I check in the morning, in order to see what we have moving, whether it's CVD or CV2,” said Haigh.

Alongside the outsized focus on movements, COVAX shipments at times get the outsized cargo treatment, moving aboard large widebody aircraft due to the range requirements, despite the small shipment sizes. Like the Air France 787 and Amerijet 767 shipments, HAI partner Singapore Airlines has utilized its large widebody freighters and passenger aircraft for COVAX missions, Ong Geok Suan, general manager of key accounts and verticals for cargo at Singapore Airlines, told Air Cargo World .

“These deliveries are transported on our Boeing 747-400 freighter, Boeing 777-300ER and Airbus 350-900 aircraft,” said Ong. “The focus for the vaccine-related airfreight movements to date has, primarily, been on the vaccines themselves. While we are also prepared to transport supporting equipment and supplies for vaccination programs, e.g. syringes, by air, there haven’t been many requests for such movements through our network so far.”

Expectation vs. reality The COVID-19 vaccine rollout has not gone exactly as expected, according to carriers involved in the HAI. Vaccine manufacturers have failed to supply the vaccines they originally promised, due to export restrictions or issues on the production front, leading to shipment delays and stoppages, the carriers indicated.

From the outset, the COVAX facility has planned to vaccinate 20% of the populations of countries participating in COVAX, according to GAVI’s website. However, no participating country will be given enough vaccines to vaccinate more than 20% of their population until all other participating countries have been offered the same quantity.

“We were actually told that if we got all the vaccines and finished, then COVID-19 would come to an end. But the reality was that the vaccines were not available,” said Sanjeev Gadhia, CEO of Astral Aviation, a founding member of the HAI. “What we got were very small quantities.”

Africa was supposed to receive 20% of the vaccines from COVAX in 2021, Gadhia said. However, the India-based vaccine manufacturer, which Gadhia declined to name, wasn’t able to follow through after the government decided to reduce the number of vaccines the country would export, he said. As a result, Africa has only received 2% of the COVAX vaccines so far.

[caption id="attachment_96254" align="alignright" width="1024"] Transported by Astral Aviation, the first COVID-19 vaccines from the COVAX facility are offloaded in Aden International Airport, Aden, Yemen, on March 31. (Photo/UNICEF/2021/Mahmood Fadhel)[/caption] That sentiment was echoed by United’s Haigh, who pointed to a time earlier in the pandemic when vaccine distribution was estimated to require up to 8,000 747 freighters’ worth of capacity, “and we’re definitely not seeing that,” she said.

However, United intends to stay flexible for transportation needs as they do arise, with Haigh saying the carrier maintains regular contact with shippers and freight forwarders around the shipments.

“We’ve definitely seen some adjustments, ups and downs with quantities, but we’ve been able to be very nimble and work with the forwarder and the shipper in order to make sure we can move them on their schedule,” said Haigh.

Astral, meanwhile, has not carried any vaccines for COVAX in the past three months, according to Gadhia, though they have carried vaccines for the African Vaccine Acquisition Trust (AVAT). The vaccine shipments the airline did carry for COVAX were also much smaller than expected, said Gadhia. So far, for COVAX Astral has carried just 2 million doses of vaccine, which were divided between Yemen and South Sudan.

Export restrictions on vaccines originating in India have also been a factor for Air France-KLM, another original member of the HAI. “We were expecting a lot of vaccines from India, then the situation in the UK became out of control, and there were export restrictions. So then that didn't happen,” said Marcel Kuijn, global head of pharma logistics for Air France-KLM Martinair Cargo.

When the HAI began, carriers also expected vaccine-adjacent goods, such as masks, syringes, and gloves, to be delivered to vaccination sites ahead of the vaccines themselves, ideally by sea and well in advance. But that’s not always possible, said Kuijn, who noted that Air France-KLM has had to deliver vaccines as they become available, often at the last minute.

Looking ahead “By now, we should have actually vaccinated at least 10% of the population out of the 20%, which is what was promised,” said Gadhia. “And what that actually means is that the transport program will take a number of years compared to what was originally forecasted. Originally, they forecasted that the vaccines will be given to Africa within 2021 to 2022. But it seems though that it is going to go beyond 2023.”

According to UNICEF, another initiative, the African Union/African Vaccine Acquisition Task Team program, aims to increase the vaccination rate in Africa to 60%, building on and complementing COVAX initiatives. That would require about 800 million vaccines and take as long as five years, Astral's Gadhia said. An added complication is the large number of people who believe they don’t need vaccines. Vaccine hesitancy is a growing problem in Africa, as on other continents, according to a 2021 article released in The Pan African Medical Journal.

Dennis Lister, vice president of product and business development at Emirates, refused to hazard a guess as to the number of years the vaccine rollout could take. “In terms of duration, I’m not completely clear on how long this will last,” said Lister. “Every day is a new day in this pandemic; every day we see these new variants coming out. So I don’t think this is a three-month or a six-month conversation. I think this will continue for many years to come.”

Despite the fanfare greeting the COVAX shipments, as with the arrival of the Air France 787 at NBO last month, there is a long way to go before the facility can safely declare victory over COVID. The initiative must patch together a fragmented network of carriers and capacity the industry has dealt with since the pandemic’s beginning if it is to meet its ambitious goals.

COVAX delivered: The Humanitarian Airfreight Initiative takes flight

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