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class="mdc-u-grid mdc-u-grid-col-1 mdc-u-grid-col-md-12"><div class="mdc-u-grid-col-md-start-2 mdc-u-grid-col-md-end-12 mdc-u-grid-col-lg-start-3 mdc-u-grid-col-lg-end-11"><div class="mdc-o-content-body mck-u-dropcap"><div data-component="mdc-c-module-wrapper" data-module-theme="default" data-module-background="transparent" data-module-category="" class="DownloadsSidebar_mck-c-downloads-sidebar__iFmyt mck-o-xs-right-span"><div data-layer-region="downloads-right-rail"><h3 data-component="mdc-c-heading" class="mdc-c-heading___0fM1W_2734c4f mdc-c-heading--title___5qyOB_2734c4f mdc-c-heading--border___K8dj3_2734c4f"></h3><div><div data-component="mdc-c-link-container" class="mdc-c-link-container___xefGu_2734c4f"><a data-component="mdc-c-link" href="#/download/%2F~%2Fmedia%2Fmckinsey%2Fbusiness%20functions%2Frisk%2Four%20insights%2Fthe%20risks%20and%20challenges%20of%20the%20global%20covid%2019%20vaccine%20rollout%2Fthe-risks-and-challenges-of-the-global-covid-19-vaccine-rollout-vf.pdf%3FshouldIndex%3Dfalse" class="DownloadsSidebar_mck-c-downloads-sidebar__download-link__fPqFQ mdc-c-link___lBbY1_2734c4f" target="_self" data-layer-event-prefix="Download Link" data-layer-action="click" data-layer-report-type="" data-layer-file-name="the-risks-and-challenges-of-the-global-covid-19-vaccine-rollout-vf" data-layer-report-name="the-risks-and-challenges-of-the-global-covid-19-vaccine-rollout-vf>"><span data-component="mdc-c-icon" class="mdc-c-icon___oi7ef_2734c4f mdc-c-icon--size-md___yi5fA_2734c4f mck-download-icon"></span><span class="mdc-c-link__label___Pfqtd_2734c4f"> (10 pages)</span></a></div></div></div></div> <p><strong>The COVID-19 vaccines</strong> of the BioNTech and Pfizer partnership (Pfizer–BioNTech) and Moderna have received Emergency Use Authorization in Canada, the European Union, the United Kingdom, the United States, and other countries. Many frontline workers and priority population segments have received their first doses. Vaccines from AstraZeneca, Johnson & Johnson, and several other global manufacturers are also arriving (or are expected to arrive soon) and are being distributed for administration around the world. This monumental global effort has shattered the record for vaccine development: the fastest previous vaccine project, Merck’s mumps vaccine, was four and a half years in development (1963–67).</p> <div data-component="mdc-c-module-wrapper" data-module-theme="light" data-module-background="lightest-grey" data-module-category="" data-module-gradient-position="bottom-right" class="mck-c-inline-module-container SideBar_mck-c-sidebar__bgimg-wrapper__Qj4Dt mck-o-sm-left-span SideBar_mck-c-sidebar__sidebar-wrapper__Dpjw2 SideBar_mck-c-sidebar__sidebar-wrapper--istablet__IQ6ii mck-u-screen-only mck-c-module-wrapper" data-layer-region="sidebar"><div class="SideBar_mck-c-sidebar__epoAm mck-o-md-center"><div class="SideBar_mck-c-sidebar__share-icons-wrapper__9gB_c"><div data-component="mdc-c-link-container" class="mdc-c-link-container___xefGu_2734c4f mdc-c-link-container--display-column___X0HDD_2734c4f SideBar_mck-c-sidebar__share-icons___eQy6"><div data-component="mdc-c-dropdown-menu" class="mdc-c-drop-down"><button data-component="mdc-c-button" aria-label="" type="button" id="button_id" class="mdc-c-button___U4iY2_2734c4f mdc-c-button--ghost mdc-c-button--size-medium mdc-c-drop-down__rootmenu___yJzvz_2734c4f" aria-expanded="false" aria-haspopup="menu"><span data-component="mdc-c-icon" class="mdc-c-icon___oi7ef_2734c4f mdc-c-icon--default___f-hQM_2734c4f mdc-c-icon--size-md___yi5fA_2734c4f mck-share2-icon"></span></button><div data-component="mdc-c-module-wrapper" data-module-theme="light" data-module-background="white" data-module-category="" class=""></div></div><button data-component="mdc-c-button" aria-label="Expandable Sidebar" type="button" id="button_id" class="mdc-c-button___U4iY2_2734c4f mdc-c-button--ghost mdc-c-button--size-medium SideBar_mck-c-sidebar__toggle-btn__EL8iE" aria-expanded="false" data-layer-event-prefix="UI Item" data-layer-action="click" data-layer-category="sidebar" data-layer-subcategory="open" data-layer-text="open sidebar"><span data-component="mdc-c-icon" class="mdc-c-icon___oi7ef_2734c4f mdc-c-icon--radial___y3csX_2734c4f mdc-c-icon--size-xxl___cL3ZT_2734c4f mck-plus-no-circle-icon"></span></button></div></div><div class="SideBar_mck-c-sidebar__content-outer__UdWCq"><div class="SideBar_mck-c-sidebar__eyebrow__5GSEq"></div><div class="SideBar_mck-c-sidebar__content__raEwe"><h2 data-component="mdc-c-heading" class="mdc-c-heading___0fM1W_2734c4f mdc-u-ts-3 SideBar_mck-c-sidebar__content-heading__NJekY"><div>About the authors</div></h2><div class="SideBar_mck-c-sidebar__content-description__4p9iI mdc-u-ts-7"><div class="mdc-o-content-body"><p>This article was a collaborative effort by the global Risk Practice and authors from across the firm, including <a href="/our-people/gaurav-agrawal">Gaurav Agrawal</a>, Tara Azimi, Jennifer Heller, <a href="/our-people/pooja-kumar">Pooja Kumar</a>, <a href="/our-people/mihir-mysore">Mihir Mysore</a>, <a href="/our-people/parag-patel">Parag Patel</a>, <a href="/our-people/adam-sabow">Adam Sabow</a>, <a href="/our-people/shubham-singhal">Shubham Singhal</a>, and Joseph Truesdale.</p></div></div></div></div></div></div> <p>In certain places, the COVID-19-vaccine effort has hit a few speed bumps; stockpiles have accumulated, and deployment to vulnerable countries and at-risk groups has been slower than expected. Nonetheless, experts have expressed confidence that safe and highly efficacious vaccines are reaching the market, and we are beginning to see “the light at the end of the tunnel” of this devastating pandemic. The epidemiological end to the COVID-19 pandemic seemed like an optimistic dream a few short months ago, but, with the development, approval, and rollout of several vaccines, it is now <a href="/industries/healthcare/our-insights/when-will-the-covid-19-pandemic-end">practically realizable</a> in much of the world.</p>  <p>To arrive at the postpandemic era, in which populations experience herd immunity, vast numbers of dedicated individuals will need to continue working intensely in the months and years ahead. In this article, we consider elements of this enormous undertaking, the risks that are inherent, and potential means of further accelerating vaccination.</p> <p>A common operating model of COVID-19-vaccine delivery, shown in the interactive, demonstrates the complexity of the task at hand. Essentially, the interactive is a qualitative risk map, showing the many stages of vaccine deployment and highlighting areas of potential failure as one party interacts with another. A breakdown at any point in the deployment process can set off a cascade, shutting down the entire system.</p>  <p>In the United States alone, hundreds of organizations play a role in vaccine deployment, adapting their operations to meet demands for volume, speed, and better technology. Suppliers, manufacturers, and regulators are collaborating to ramp up production of vaccines. Massive volumes handled, distributed, and stored through cold chains must adhere to safety regulations. Tens of thousands of transporters, vaccine handlers, medical and pharmacy staff, and frontline workers have required training on the specific characteristics of each manufacturer’s distinct vaccines.</p> <div data-module-category="" class="PullQuote_mck-c-pullquote__DbaQ5 mck-o-lg-center"><blockquote data-component="mdc-c-blockquote" class="PullQuote_mck-c-blockquote__6n21p PullQuote_mck-c-blockquote--hide-quotes__CpGpg mdc-c-blockquote mdc-c-blockquote--is-quotes___TozKo_2734c4f"><p>To arrive at the postpandemic era, vast numbers of dedicated individuals will need to continue working intensely in the months and years ahead.</p></blockquote></div> <p>At the receiving end, vulnerable populations—especially in developing countries—could face added hurdles, including difficulty in reaching administrative sites, getting time off from work to receive doses, and arranging childcare for the same. Historical wariness of interacting with authorities can also be a barrier. A further issue is vaccine skepticism, affecting a certain segment of all populations, <a href="/industries/healthcare/our-insights/covid-19-vaccine-are-consumers-ready">including the United States</a>.</p> <p>In the United States and other countries with sufficient vaccine quantities and adoption, herd immunity by October 2021 is conceivable, but for that to happen, more than twice as many doses of COVID-19 vaccines will have to be administered each month as were administered during the 2009 H1N1 flu vaccine drive. Cumulatively, between 2.4 and 3.4 times as many doses (mainly because of the double-dose requirement) will be needed as are used for the annual flu vaccinations (exhibit).</p> <div data-component="mdc-c-module-wrapper" data-module-theme="default" data-module-background="transparent" data-module-category="" class="mck-c-inline-module-container mck-o-md-center"><div class="mdc-u-grid mdc-u-grid-gutter-lg mdc-u-grid-col-sm-1 mdc-u-grid--align-start mdc-u-mb-3 GenericItem_mck-c-generic-item__sGwKL"><div data-component="mdc-c-content-block" class="mdc-c-content-block___7p6Lu_2734c4f mdc-u-grid-gutter-xs GenericItem_mck-c-generic-item__content__gq1m0"><div class="mck-c-eyebrow mdc-u-ts-10"><span> </span></div></div></div><div class="mck-u-inline-module-border-top mck-u-inline-module-border-bottom"><picture data-component="mdc-c-picture" class="Exhibit_mck-c-exhibit__image__pyIDm"><source media="(min-width: 768px)" srcSet="/~/media/mckinsey/business%20functions/risk/our%20insights/the%20risks%20and%20challenges%20of%20the%20global%20covid%2019%20vaccine%20rollout/svgz-vaccinedelivery-ex2-vf.svgz?cq=50&cpy=Center"/><img alt="To reach COVID-19 herd immunity, the United States will have to administer 2.4 to 3.4 times as many vaccine doses as it does during annual flu vaccinations." src="/~/media/mckinsey/business%20functions/risk/our%20insights/the%20risks%20and%20challenges%20of%20the%20global%20covid%2019%20vaccine%20rollout/svgz-vaccinedelivery-ex2-vf.svgz?cq=50&cpy=Center" loading="lazy"/></picture></div><div class="mck-u-sr-only"></div></div> <p>Scientists, doctors, other healthcare workers, clinical-trial participants, and regulators have been working intensely to develop, distribute, and administer the vaccines that will help end this pandemic. Their often-heroic efforts give cause for hope. An array of complex challenges are still before us, as production is ramped up and rollouts are planned and executed. A realistic risk assessment of vaccine deployment is needed, because future success cannot be taken for granted. Much needs to be done for the promise of COVID-19 vaccines to become a reality.</p> <h2>Critical emerging risks</h2>  <p>The common operating model provides the details of end-to-end vaccine deployment. From this model, we have highlighted six possible areas of risk to the rapid delivery of COVID-19 vaccines in the United States and elsewhere. In a later section, we outline possible approaches to mitigating each of these risks, with practical steps for organizations that have a role in vaccine deployment.</p> <h3>Raw-materials constraints in production scaling</h3> <p>Scaling access to material inputs and boosting production levels can cause logistical, contractual, and even diplomatic challenges, requiring new forms of collaboration. Early indications suggest that there is sufficient global manufacturing capacity for syringes and fill-finish materials. The top two US manufacturers, for example, can produce 280 million vials per year, capable of holding up to 2.8 billion doses.<span class="FootNote_footnote-holder__tjRqy"><a aria-label="footnote" href="javascript:void(0);" class="FootNote_footnote-wrapper__AIRwL undefined FootNote_inactive__VZfCp" aria-describedby="1fdb391b-8746-4fd1-badd-d9d964a24bf5"><sup class="FootNote_footnotesup__e73z_">1</sup><span class="FootNote_notch-wrapper__b_5NS"><span class="FootNote_notch__omKtY"></span></span><span class="FootNote_tooltip__QtrbA mdc-u-mt-2"><span class="FootNote_footnote-content__r2OVl"><span id="1fdb391b-8746-4fd1-badd-d9d964a24bf5" aria-hidden="true" data-module-theme="light" class="FootNote_footnote-text__VjKgO mck-u-links-inline">Corning and SiO2 Materials Science have capacity for 164 million and 120 million vials, respectively; each vial can hold five to ten doses, depending on the vaccine, per the US Department of Health & Human Services.</span></span></span></a></span> However, the suppliers of many niche chemical and biological vaccine components are scattered, and countries may compete for limited resources. At the same time, because vaccine manufacturers must load mRNA into lipid nanoparticles and purify the resulting therapeutic on a massive scale while following strict regulations, many vaccine manufacturers have sought highly specialized contract-manufacturing partners. Moderna, for example, has collaborated with Catalent and Lonza to produce its COVID-19 vaccine. Such partnerships will likely become increasingly necessary to meet global vaccine demand and will be a major determinant of the campaign’s overall success.</p> <h3>Quality-assurance challenges in manufacturing</h3> <p>Generating yields while ensuring the safety and efficacy of each dose poses quality-assurance challenges. To produce a new class of vaccines—such as those based on mRNA or viral vectors—at an unprecedented scale (1.8 billion to 2.3 billion doses by mid-2021), manufacturers have required massive volumes of inputs, a larger technical workforce, and a much-expanded ecosystem of production facilities. At the same time, even while mass-scale production is ongoing, national regulators such as the US Food and Drug Administration continue to develop standards for these new therapeutics. Quality assurance in this context will remain vital.</p> <h3>Cold-chain logistics and storage-management challenges</h3> <p>In North America, manufacturers and distributors are planning to maintain cold-chain requirements for distribution and long-term storage of mRNA-based vaccines. Large amounts of dry ice may be needed at various locations before administration. Although the combined US–Canadian dry-ice manufacturing capacity of 30,000 to 35,000 tons annually will likely meet expected demand, supply chains may have to be strengthened in places to ensure that all areas are well served.<span class="FootNote_footnote-holder__tjRqy"><a aria-label="footnote" href="javascript:void(0);" class="FootNote_footnote-wrapper__AIRwL undefined FootNote_inactive__VZfCp" aria-describedby="4a30dac7-e798-46b8-b7aa-7d32cc41ab23"><sup class="FootNote_footnotesup__e73z_">2</sup><span class="FootNote_notch-wrapper__b_5NS"><span class="FootNote_notch__omKtY"></span></span><span class="FootNote_tooltip__QtrbA mdc-u-mt-2"><span class="FootNote_footnote-content__r2OVl"><span id="4a30dac7-e798-46b8-b7aa-7d32cc41ab23" aria-hidden="true" data-module-theme="light" class="FootNote_footnote-text__VjKgO mck-u-links-inline">“Compressed gas industry expects sufficient dry ice supply for COVID-19 vaccines in U.S. & Canada,” Compressed Gas Association, November 9, 2020, cganet.com.</span></span></span></a></span> This is a particularly acute concern in developing countries with less access to cold storage and dry ice. At points of care, the current high demand for vaccine doses may mitigate initial storage concerns, but projected high-volume distribution later in 2021 could temporarily overtake vaccine consumption, putting greater emphasis on storage management.</p> <h3>Increased labor requirements</h3> <p>Complex protocols for handling and preparing COVID-19 vaccines, as well as the added precautionary observation period after patients are injected, have the potential to strain labor capacities or divert workers from other critical roles. Our estimates suggest that at a relatively streamlined vaccination site, one administrator could vaccinate seven to ten patients per hour with the help of two support staff. This rate is significantly slower and 3.5 times more labor intensive than that of the annual flu vaccination. According to the US Centers for Disease Control and Prevention (CDC), if retail pharmacies alone were tasked with public administration of the COVID-19 vaccine, 15 to 20 percent of their qualified workforce would need to be allocated to this full-time task.</p> <h3>Wastage at points of care</h3> <p>Errors in storing, preparing, or scheduling administration of doses at points of care will have significant consequences. For example, failure to ensure that recipients attend their appointments will not only prevent individual immunity, it could also lead to product wastage, since all vaccine doses in multidose vials must be administered within a short window of time after the vial has been opened. Proper on-site storage conditions are also of critical importance. In 2014, the CDC’s Vaccines for Children program estimated that hundreds of thousands of vaccine doses are thrown out each year as a result of improper refrigeration, at a cost of about $20 million. The current mRNA vaccines will pose a larger challenge for on-site storage because of the temperature requirements.<span class="FootNote_footnote-holder__tjRqy"><a aria-label="footnote" href="javascript:void(0);" class="FootNote_footnote-wrapper__AIRwL undefined FootNote_inactive__VZfCp" aria-describedby="c6e01ea4-0524-4507-92fb-302e09b68a22"><sup class="FootNote_footnotesup__e73z_">3</sup><span class="FootNote_notch-wrapper__b_5NS"><span class="FootNote_notch__omKtY"></span></span><span class="FootNote_tooltip__QtrbA mdc-u-mt-2"><span class="FootNote_footnote-content__r2OVl"><span id="c6e01ea4-0524-4507-92fb-302e09b68a22" aria-hidden="true" data-module-theme="light" class="FootNote_footnote-text__VjKgO mck-u-links-inline">According to a survey of 18,000 adults from 15 countries conducted by Ipsos in October 2020, 64 percent of Americans and 73 percent in the overall sample want vaccination.</span></span></span></a></span></p> <h3>IT challenges</h3> <p>IT systems, including vaccine-tracking systems (such as CDC’s VTrckS) and immunization information systems (IIS), will be essential for allocating, distributing, recording, and monitoring the deployment of vaccines. In the United States, more than 50 uniquely designed IIS (for each state and territory) must interact with VTrckS. Ensuring that these can operate at unprecedented scale and are configured for a two-dose vaccine schedule has become a major software-development, data-hosting, and operational challenge. Additionally, it will remain vital that these systems protect patient privacy and are secure against cyberthreats, given the potential for hackers and criminals to cause damage. Cyberattacks have already occurred against COVID-19-vaccine developers and regulators.<span class="FootNote_footnote-holder__tjRqy"><a aria-label="footnote" href="javascript:void(0);" class="FootNote_footnote-wrapper__AIRwL undefined FootNote_inactive__VZfCp" aria-describedby="3942dda7-2d03-4642-80f4-c8521c0460d2"><sup class="FootNote_footnotesup__e73z_">4</sup><span class="FootNote_notch-wrapper__b_5NS"><span class="FootNote_notch__omKtY"></span></span><span class="FootNote_tooltip__QtrbA mdc-u-mt-2"><span class="FootNote_footnote-content__r2OVl"><span id="3942dda7-2d03-4642-80f4-c8521c0460d2" aria-hidden="true" data-module-theme="light" class="FootNote_footnote-text__VjKgO mck-u-links-inline">Christopher Bing and Marisa Taylor, “China-backed hackers ‘targeted COVID-19 vaccine firm Moderna,’” Reuters, July 30, 2020, reuters.com; Jack Stubbs, “Hackers steal Pfizer/BioNTech COVID-19 vaccine data in Europe, companies say,” Reuters, December 9, 2020, reuters.com.</span></span></span></a></span></p>  <h2>Collaborative approaches to help mitigate emerging risks</h2> <p>There are several possible approaches to help mitigate each of the six risks discussed, each with practical steps for organization to take across the common operating model.</p> <h3>Building resilient raw-materials supplies</h3> <ul> <li><em>Resilience planning.</em> Producers can partner with global suppliers of raw materials and ancillary-product manufacturers to create redundancies, where appropriate, across the supply chain. While manufacturers have established several new partnerships over the past six months, a greater diversity of global suppliers is needed to meet the unique demands of each vaccine seeking regulatory approval. Contracts could be negotiated with incentives for suppliers to invest early in scaling production and stockpiling goods. In addition, producers could reevaluate their own inventory management to reduce the risk of stock-outs of key raw materials.</li> <li><em>Collaboration between industry and government.</em> Ongoing industry engagement with government is essential for ramping-up production and maintaining high levels of production. In many instances, manufacturers and suppliers have worked closely with governments to manage national resource allocation. They can continue to collaborate over the economic and public-health implications of halting or outsourcing production of legacy products, as well as optimizing production lines for COVID-19 vaccines. At the same time, industry (including contract manufacturers) can work together with government to create technology-transfer timelines and devise new, creative means of bringing additional volumes to market and improving inventory management and last-mile distribution.</li> </ul> <div data-module-category="" class="PullQuote_mck-c-pullquote__DbaQ5 mck-o-lg-center"><blockquote data-component="mdc-c-blockquote" class="PullQuote_mck-c-blockquote__6n21p PullQuote_mck-c-blockquote--hide-quotes__CpGpg mdc-c-blockquote mdc-c-blockquote--is-quotes___TozKo_2734c4f"><p>A greater diversity of global suppliers is needed to meet the unique demands of each vaccine seeking regulatory approval.</p></blockquote></div> <h3>Scaling manufacturing within quality guidelines</h3> <ul> <li><em>Scale manufacturing in new and existing facilities.</em> As producers accelerate operations in new or existing manufacturing facilities, they could seek opportunities to ramp up capacity as quickly as possible. Various digital and analytics tools can help expand capacity and scale more quickly. Companies can also accelerate technology-transfer timelines, similar to what has been done in the last year. As an example, by conducting engineering runs, validation runs, and stability studies simultaneously, companies could both expand and speed up production.</li> <li><em>Assure quality and yield in current facilities.</em> By continuing to coordinate with regulators, manufacturers and authorities can ensure that procedures and dosage quality meet both long-established and newly issued guidelines. Through close coordination and understanding, higher throughput can be attained, given the higher likelihood of meeting these quality standards. Likewise, stakeholders can collaborate to establish new standards for the production of vaccines that employ novel technology platforms (such as mRNA). Establishing best practices at the facilities furthest along in production can help to create a clear road map for new manufacturing facilities. This can enhance the speed of future production capacity and throughput while meeting necessary quality standards.</li> <li><em>Establish predictable supplier plans.</em> Each manufacturing stakeholder can follow a clearly defined plan, with open communication to a manufacturing “control tower,” where expert teams direct and prioritize efforts across functions. They can also conduct regular cross-functional risk reviews to ensure that quality is not compromised and involve regulators at systematic intervals to assess progress.</li> </ul> <h3>Optimizing the cold chain</h3> <ul> <li><em>Build redundancy into distribution.</em> Manufacturers, distributers, and local allocation teams can mitigate distribution risks by quickly identifying points of failure and creating redundancies at each stage. For example, in warehouses fitted with ultracold freezers, dry ice could be made available in case of power loss or machine malfunctions. Across distribution routes, sources of dry ice could be identified to restock coolers as necessary.</li> <li><em>Leverage feedback loops.</em> Reporting systems could be set up to capture supply-chain disruption events as soon as they happen, with data used to refine best practices and procedures and avoid further losses.</li> <li><em>Use point-of-care stock management.</em> If vaccine demand drops to levels where point-of-care stocks are not immediately consumed, vaccine inventories can be redistributed to locations with greater demand. Strategies to avoid overstockpiling must ensure maintenance of the cold chain to prevent risks to the receiving administration site. Where this is not possible, long-term storage by replenishing dry ice or prioritizing freezer capacity will be necessary.</li> </ul> <h3>Addressing labor shortages</h3> <ul> <li><em>Use several types of point-of-care facilities.</em> Many locations have begun to rely on hospitals and primary-care locations for vaccine administration, in addition to retail pharmacies. This will become increasingly necessary when the vaccines are deployed to the general public, to prevent shortages of vaccine administrators. If hospitals and primary-care locations are used to supplement vaccine administration at retail pharmacies, only 2 to 3 percent of the healthcare workforce may need to be diverted from their primary functions.<span class="FootNote_footnote-holder__tjRqy"><a aria-label="footnote" href="javascript:void(0);" class="FootNote_footnote-wrapper__AIRwL undefined FootNote_inactive__VZfCp" aria-describedby="2a5ae77f-bcde-45c7-bf50-c0fe37e7d4a7"><sup class="FootNote_footnotesup__e73z_">5</sup><span class="FootNote_notch-wrapper__b_5NS"><span class="FootNote_notch__omKtY"></span></span><span class="FootNote_tooltip__QtrbA mdc-u-mt-2"><span class="FootNote_footnote-content__r2OVl"><span id="2a5ae77f-bcde-45c7-bf50-c0fe37e7d4a7" aria-hidden="true" data-module-theme="light" class="FootNote_footnote-text__VjKgO mck-u-links-inline">Centers for Disease Control and Prevention; McKinsey analysis.</span></span></span></a></span></li> <li><em>Streamline administration across sites.</em> Deploying vaccines at larger, streamlined vaccination sites can be more efficient and improve patient safety, labor utilization, and speed of vaccination.</li> </ul> <h3>Reducing spoilage at points of care</h3> <ul> <li><em>Track and monitor spoilage at points of care.</em> Manufacturers and distributors can collaborate to establish the means to identify and trace instances of spoilage. They can learn from experience and refine guidance, training, certification, and allocation to optimize utilization of doses.</li> <li><em>Pace first-dose allocation.</em> Especially with initial inventories, many authorities are directing allocations of first doses to populations and locations where the need is greatest and the confidence in the availability of second doses is high (such as healthcare professionals and vulnerable populations in nursing homes). As vaccines are made available to broader populations in greater numbers, pacing of first-dose allocation according to distribution schedules and available volumes will remain paramount.</li> <li><em>Prioritize second doses.</em> Authorities can help ensure that the recommended two-dose course schedule for such vaccines as the Pfizer-BioNTech, Moderna, and AstraZeneca vaccines are duly completed. Many medical experts are warning that distribution should not be artificially expanded by diverting second-dose allotments to patients awaiting their first dose.</li> <li><em>Establish recipient commitment.</em> Vaccine recipients could be asked to commit to second-dose appointments at their point of care before first-dose administration, improving the likelihood that second doses will not spoil.</li> <li><em>Manage certification.</em> National and local government institutions can collaborate to ensure that vaccination certifications are withheld until recipients receive their second dose, further increasing the number of citizens who are fully vaccinated.</li> </ul> <h3>Meeting IT challenges</h3> <ul> <li><em>Balance IT upgrades and resilience.</em> Stakeholders should identify IT systems that can be relied upon in the deployment of COVID-19 vaccines and assess their ability to perform at scale. They can consider using a risk-based approach to balance the need to upgrade systems with associated risks. Transforming infrastructure and systems during a time of critical need can be highly disruptive even if beneficial in the long run (for example, moving systems to the cloud can cause some downtime in the short term but better reliability in the long term).</li> <li><em>Share cyberthreat intelligence.</em> COVID-19-vaccine stakeholders should agree upon common requirements and processes for generating and sharing threat intelligence. Awareness of attacks on COVID-19-vaccine deployment will increase resilience to attacks and reduce the likelihood of attacks spreading in number and magnitude.</li> <li><em>Establish means of demonstrating immunity.</em> Manufacturers and distributers can commission systems to track and verify that vaccine recipients have demonstrated immunity. This would build popular confidence in immunity by fostering a single national view of the current level of population immunity.<span class="FootNote_footnote-holder__tjRqy"><a aria-label="footnote" href="javascript:void(0);" class="FootNote_footnote-wrapper__AIRwL undefined FootNote_inactive__VZfCp" aria-describedby="5c2de8d8-8635-4ea2-b24b-d6c4849b0798"><sup class="FootNote_footnotesup__e73z_">6</sup><span class="FootNote_notch-wrapper__b_5NS"><span class="FootNote_notch__omKtY"></span></span><span class="FootNote_tooltip__QtrbA mdc-u-mt-2"><span class="FootNote_footnote-content__r2OVl"><span id="5c2de8d8-8635-4ea2-b24b-d6c4849b0798" aria-hidden="true" data-module-theme="light" class="FootNote_footnote-text__VjKgO mck-u-links-inline">For example, a national view of current immunity could include the number of positive antibody tests within a recent time period, positive antigen tests within a recent time period, or vaccines administered but immunity not confirmed.</span></span></span></a></span> People will likely be very interested in having a recognizable and accepted means of proving that they have been vaccinated, especially if it will release them from travel limits and other pandemic-related restrictions.</li> </ul> <h2>Managing risks at the interface among organizations</h2> <p>Although none of the many organizations involved is solely responsible for managing vaccine deployment across the common operating model, the risks can be more fully addressed with increased stakeholder cooperation. To build this collaboration, working groups could meet to identify the various risks, assess their likelihood and potential impact, and determine whether certain risks are evolving and how urgently they should be addressed.</p> <p>The groups could align on lead organizations to manage issues while building scenarios to test responses to emerging crises. The benefits in managing each of these risks could be demonstrated with compelling metrics and communications. At this point, clear roles, activities, and capabilities for risk management could be established, building accountability within and across relevant organizations. Most importantly, these steps can be undertaken by manufacturers, distributers, and governments, as COVID-19-vaccine rollouts commence, to facilitate widespread adoption and minimize the challenges associated with the vaccines’ massive global deployment. By doing so, they will help ensure a more effective and efficient rollout of COVID-19 vaccines, paving the way for the epidemiological end to the devastating effects of the COVID-19 pandemic.</p></div><div class="container-placeholder"></div></div></div><div class="mdc-u-grid mdc-u-grid-gutter-xl"><section role="contentinfo" data-layer-region="article-about-authors" class="mdc-u-grid mdc-u-grid-col-md-12 AboutAuthor_mck-c-about-author__nRJzu"><div class="mdc-u-grid-col-md-start-2 mdc-u-grid-col-md-end-12 mdc-u-grid-col-lg-start-3 mdc-u-grid-col-lg-end-11"><h5 data-component="mdc-c-heading" class="mdc-c-heading___0fM1W_2734c4f mdc-c-heading--title___5qyOB_2734c4f mdc-c-heading--border___K8dj3_2734c4f mdc-u-align-center"></h5><div data-component="mdc-c-description" class="mdc-c-description___SrnQP_2734c4f mdc-u-ts-8 mck-u-links-inline mck-u-links-inline--secondary mdc-u-mt-5"><div><p><strong><a href="/our-people/gaurav-agrawal">Gaurav Agrawal</a></strong> is a partner in McKinsey’s New York office; <strong>Tara Azimi</strong> is a partner in the Washington, DC, office; <strong>Jennifer Heller</strong> and <strong><a href="/our-people/parag-patel">Parag Patel</a></strong> are partners in the Chicago office, where <strong><a href="/our-people/adam-sabow">Adam Sabow</a></strong> is a senior partner; <strong><a href="/our-people/pooja-kumar">Pooja Kumar</a></strong> is a partner in the Philadelphia office; <strong><a href="/our-people/mihir-mysore">Mihir Mysore</a></strong> is a partner in the Houston office; <strong><a href="/our-people/shubham-singhal">Shubham Singhal</a></strong> is a senior partner in the Detroit office; and <strong>Joseph Truesdale</strong> is an associate partner in the Boston office.</p> <p>The authors wish to thank Marie-Renée B-Lajoie, Rich Cracknell, and Daniel Croft for their contributions to this article.</p> <hr /> <p>This article was edited by Richard Bucci, a senior editor in the New York office.</p></div></div></div></section><section 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mdc-c-link___lBbY1_2734c4f"><div>COVID-19 vaccine: Are US consumers ready?</div></a></h6></div></div></div></div></div></div></div></main></div><script id="__NEXT_DATA__" type="application/json">{"props":{"pageProps":{"locale":"en","dictionary":{},"sitecoreContext":{"route":{"name":"The risks and challenges of the global COVID 19 vaccine rollout","displayName":"The risks and challenges of the global COVID 19 vaccine rollout","fields":null,"databaseName":"web","deviceId":"fe5d7fdf-89c0-4d99-9aa3-b5fbd009c9f3","itemId":"6afa9720-a44b-418b-8879-608de963ae2d","itemLanguage":"en","itemVersion":2,"layoutId":"ae753eb4-a035-40b4-83bf-4b4438df6742","templateId":"683910db-02ba-40ba-92e7-726c880160a9","templateName":"ArticleJSS","placeholders":{"jss-main":[{"uid":"232bb7e9-289f-492d-a916-2b6185e44a84","componentName":"ArticleTemplate","dataSource":"","fields":{"data":{"articleTemplate":{"title":{"jsonValue":{"value":"The risks and challenges of the global COVID-19-vaccine rollout"}},"sEOTitle":{"value":"COVID-19 vaccine-deployment risks"},"description":{"jsonValue":{"value":"A realistic assessment of the heroic effort to administer billions of doses of COVID-19 vaccines to an agonized global population is necessary—the stakes could not be higher."}},"sEODescription":{"value":"A realistic assessment of the heroic effort to administer billions of COVID-19 vaccines to a global population is necessary—the stakes could not be higher."},"displayDate":{"jsonValue":{"value":"2021-01-26T00:00:00Z"}},"body":{"value":"[[DownloadsSidebar]]\n\u003cp\u003e\u003cstrong\u003eThe COVID-19 vaccines\u003c/strong\u003e of the BioNTech and Pfizer partnership (Pfizer\u0026ndash;BioNTech) and Moderna have received Emergency Use Authorization in Canada, the European Union, the United Kingdom, the United States, and other countries. Many frontline workers and priority population segments have received their first doses. Vaccines from AstraZeneca, Johnson \u0026amp; Johnson, and several other global manufacturers are also arriving (or are expected to arrive soon) and are being distributed for administration around the world. This monumental global effort has shattered the record for vaccine development: the fastest previous vaccine project, Merck\u0026rsquo;s mumps vaccine, was four and a half years in development (1963\u0026ndash;67).\u003c/p\u003e\n[[Sidebar authors]]\n\u003cp\u003eIn certain places, the COVID-19-vaccine effort has hit a few speed bumps; stockpiles have accumulated, and deployment to vulnerable countries and at-risk groups has been slower than expected. Nonetheless, experts have expressed confidence that safe and highly efficacious vaccines are reaching the market, and we are beginning to see \u0026ldquo;the light at the end of the tunnel\u0026rdquo; of this devastating pandemic. The epidemiological end to the COVID-19 pandemic seemed like an optimistic dream a few short months ago, but, with the development, approval, and rollout of several vaccines, it is now \u003ca href=\"/industries/healthcare/our-insights/when-will-the-covid-19-pandemic-end\"\u003epractically realizable\u003c/a\u003e\u0026nbsp;in much of the world.\u003c/p\u003e\n[[Audio 1]]\n\u003cp\u003eTo arrive at the postpandemic era, in which populations experience herd immunity, vast numbers of dedicated individuals will need to continue working intensely in the months and years ahead. In this article, we consider elements of this enormous undertaking, the risks that are inherent, and potential means of further accelerating vaccination.\u003c/p\u003e\n\u003cp\u003eA common operating model of COVID-19-vaccine delivery, shown in the interactive, demonstrates the complexity of the task at hand. Essentially, the interactive is a qualitative risk map, showing the many stages of vaccine deployment and highlighting areas of potential failure as one party interacts with another. A breakdown at any point in the deployment process can set off a cascade, shutting down the entire system.\u003c/p\u003e\n[[Ceros 1]]\n\u003cp\u003eIn the United States alone, hundreds of organizations play a role in vaccine deployment, adapting their operations to meet demands for volume, speed, and better technology. Suppliers, manufacturers, and regulators are collaborating to ramp up production of vaccines. Massive volumes handled, distributed, and stored through cold chains must adhere to safety regulations. Tens of thousands of transporters, vaccine handlers, medical and pharmacy staff, and frontline workers have required training on the specific characteristics of each manufacturer\u0026rsquo;s distinct vaccines.\u003c/p\u003e\n[[PullQuote 1]]\n\u003cp\u003eAt the receiving end, vulnerable populations\u0026mdash;especially in developing countries\u0026mdash;could face added hurdles, including difficulty in reaching administrative sites, getting time off from work to receive doses, and arranging childcare for the same. Historical wariness of interacting with authorities can also be a barrier. A further issue is vaccine skepticism, affecting a certain segment of all populations, \u003ca href=\"/industries/healthcare/our-insights/covid-19-vaccine-are-consumers-ready\"\u003eincluding the United States\u003c/a\u003e.\u003c/p\u003e\n\u003cp\u003eIn the United States and other countries with sufficient vaccine quantities and adoption, herd immunity by October 2021 is conceivable, but for that to happen, more than twice as many doses of COVID-19 vaccines will have to be administered each month as were administered during the 2009 H1N1 flu vaccine drive. Cumulatively, between 2.4 and 3.4 times as many doses (mainly because of the double-dose requirement) will be needed as are used for the annual flu vaccinations (exhibit).\u003c/p\u003e\n[[Exhibit 2]]\n\u003cp\u003eScientists, doctors, other healthcare workers, clinical-trial participants, and regulators have been working intensely to develop, distribute, and administer the vaccines that will help end this pandemic. Their often-heroic efforts give cause for hope. An array of complex challenges are still before us, as production is ramped up and rollouts are planned and executed. A realistic risk assessment of vaccine deployment is needed, because future success cannot be taken for granted. Much needs to be done for the promise of COVID-19 vaccines to become a reality.\u003c/p\u003e\n\u003ch2\u003eCritical emerging risks\u003c/h2\u003e\n[[MostPopularArticles 5]]\n\u003cp\u003eThe common operating model provides the details of end-to-end vaccine deployment. From this model, we have highlighted six possible areas of risk to the rapid delivery of COVID-19 vaccines in the United States and elsewhere. In a later section, we outline possible approaches to mitigating each of these risks, with practical steps for organizations that have a role in vaccine deployment.\u003c/p\u003e\n\u003ch3\u003eRaw-materials constraints in production scaling\u003c/h3\u003e\n\u003cp\u003eScaling access to material inputs and boosting production levels can cause logistical, contractual, and even diplomatic challenges, requiring new forms of collaboration. Early indications suggest that there is sufficient global manufacturing capacity for syringes and fill-finish materials. The top two US manufacturers, for example, can produce 280 million vials per year, capable of holding up to 2.8 billion doses.[[footnote 1]] However, the suppliers of many niche chemical and biological vaccine components are scattered, and countries may compete for limited resources. At the same time, because vaccine manufacturers must load mRNA into lipid nanoparticles and purify the resulting therapeutic on a massive scale while following strict regulations, many vaccine manufacturers have sought highly specialized contract-manufacturing partners. Moderna, for example, has collaborated with Catalent and Lonza to produce its COVID-19 vaccine. Such partnerships will likely become increasingly necessary to meet global vaccine demand and will be a major determinant of the campaign\u0026rsquo;s overall success.\u003c/p\u003e\n\u003ch3\u003eQuality-assurance challenges in manufacturing\u003c/h3\u003e\n\u003cp\u003eGenerating yields while ensuring the safety and efficacy of each dose poses quality-assurance challenges. To produce a new class of vaccines\u0026mdash;such as those based on mRNA or viral vectors\u0026mdash;at an unprecedented scale (1.8 billion to 2.3 billion doses by mid-2021), manufacturers have required massive volumes of inputs, a larger technical workforce, and a much-expanded ecosystem of production facilities. At the same time, even while mass-scale production is ongoing, national regulators such as the US Food and Drug Administration continue to develop standards for these new therapeutics. Quality assurance in this context will remain vital.\u003c/p\u003e\n\u003ch3\u003eCold-chain logistics and storage-management challenges\u003c/h3\u003e\n\u003cp\u003eIn North America, manufacturers and distributors are planning to maintain cold-chain requirements for distribution and long-term storage of mRNA-based vaccines. Large amounts of dry ice may be needed at various locations before administration. Although the combined US\u0026ndash;Canadian dry-ice manufacturing capacity of 30,000 to 35,000 tons annually will likely meet expected demand, supply chains may have to be strengthened in places to ensure that all areas are well served.[[footnote 2]] This is a particularly acute concern in developing countries with less access to cold storage and dry ice. At points of care, the current high demand for vaccine doses may mitigate initial storage concerns, but projected high-volume distribution later in 2021 could temporarily overtake vaccine consumption, putting greater emphasis on storage management.\u003c/p\u003e\n\u003ch3\u003eIncreased labor requirements\u003c/h3\u003e\n\u003cp\u003eComplex protocols for handling and preparing COVID-19 vaccines, as well as the added precautionary observation period after patients are injected, have the potential to strain labor capacities or divert workers from other critical roles. Our estimates suggest that at a relatively streamlined vaccination site, one administrator could vaccinate seven to ten patients per hour with the help of two support staff. This rate is significantly slower and 3.5 times more labor intensive than that of the annual flu vaccination. According to the US Centers for Disease Control and Prevention (CDC), if retail pharmacies alone were tasked with public administration of the COVID-19 vaccine, 15 to 20 percent of their qualified workforce would need to be allocated to this full-time task.\u003c/p\u003e\n\u003ch3\u003eWastage at points of care\u003c/h3\u003e\n\u003cp\u003eErrors in storing, preparing, or scheduling administration of doses at points of care will have significant consequences. For example, failure to ensure that recipients attend their appointments will not only prevent individual immunity, it could also lead to product wastage, since all vaccine doses in multidose vials must be administered within a short window of time after the vial has been opened. Proper on-site storage conditions are also of critical importance. In 2014, the CDC\u0026rsquo;s Vaccines for Children program estimated that hundreds of thousands of vaccine doses are thrown out each year as a result of improper refrigeration, at a cost of about $20 million. The current mRNA vaccines will pose a larger challenge for on-site storage because of the temperature requirements.[[footnote 3]]\u003c/p\u003e\n\u003ch3\u003eIT challenges\u003c/h3\u003e\n\u003cp\u003eIT systems, including vaccine-tracking systems (such as CDC\u0026rsquo;s VTrckS) and immunization information systems (IIS), will be essential for allocating, distributing, recording, and monitoring the deployment of vaccines. In the United States, more than 50 uniquely designed IIS (for each state and territory) must interact with VTrckS. Ensuring that these can operate at unprecedented scale and are configured for a two-dose vaccine schedule has become a major software-development, data-hosting, and operational challenge. Additionally, it will remain vital that these systems protect patient privacy and are secure against cyberthreats, given the potential for hackers and criminals to cause damage. Cyberattacks have already occurred against COVID-19-vaccine developers and regulators.[[footnote 4]]\u003c/p\u003e\n[[Ceros covid]]\n\u003ch2\u003eCollaborative approaches to help mitigate emerging risks\u003c/h2\u003e\n\u003cp\u003eThere are several possible approaches to help mitigate each of the six risks discussed, each with practical steps for organization to take across the common operating model.\u003c/p\u003e\n\u003ch3\u003eBuilding resilient raw-materials supplies\u003c/h3\u003e\n\u003cul\u003e\n \u003cli\u003e\u003cem\u003eResilience planning.\u003c/em\u003e Producers can partner with global suppliers of raw materials and ancillary-product manufacturers to create redundancies, where appropriate, across the supply chain. While manufacturers have established several new partnerships over the past six months, a greater diversity of global suppliers is needed to meet the unique demands of each vaccine seeking regulatory approval. Contracts could be negotiated with incentives for suppliers to invest early in scaling production and stockpiling goods. In addition, producers could reevaluate their own inventory management to reduce the risk of stock-outs of key raw materials.\u003c/li\u003e\n \u003cli\u003e\u003cem\u003eCollaboration between industry and government.\u003c/em\u003e Ongoing industry engagement with government is essential for ramping-up production and maintaining high levels of production. In many instances, manufacturers and suppliers have worked closely with governments to manage national resource allocation. They can continue to collaborate over the economic and public-health implications of halting or outsourcing production of legacy products, as well as optimizing production lines for COVID-19 vaccines. At the same time, industry (including contract manufacturers) can work together with government to create technology-transfer timelines and devise new, creative means of bringing additional volumes to market and improving inventory management and last-mile distribution.\u003c/li\u003e\n\u003c/ul\u003e\n[[PullQuote 2]]\n\u003ch3\u003eScaling manufacturing within quality guidelines\u003c/h3\u003e\n\u003cul\u003e\n \u003cli\u003e\u003cem\u003eScale manufacturing in new and existing facilities.\u003c/em\u003e As producers accelerate operations in new or existing manufacturing facilities, they could seek opportunities to ramp up capacity as quickly as possible. Various digital and analytics tools can help expand capacity and scale more quickly. Companies can also accelerate technology-transfer timelines, similar to what has been done in the last year. As an example, by conducting engineering runs, validation runs, and stability studies simultaneously, companies could both expand and speed up production.\u003c/li\u003e\n \u003cli\u003e\u003cem\u003eAssure quality and yield in current facilities.\u003c/em\u003e By continuing to coordinate with regulators, manufacturers and authorities can ensure that procedures and dosage quality meet both long-established and newly issued guidelines. Through close coordination and understanding, higher throughput can be attained, given the higher likelihood of meeting these quality standards. Likewise, stakeholders can collaborate to establish new standards for the production of vaccines that employ novel technology platforms (such as mRNA). Establishing best practices at the facilities furthest along in production can help to create a clear road map for new manufacturing facilities. This can enhance the speed of future production capacity and throughput while meeting necessary quality standards.\u003c/li\u003e\n \u003cli\u003e\u003cem\u003eEstablish predictable supplier plans.\u003c/em\u003e Each manufacturing stakeholder can follow a clearly defined plan, with open communication to a manufacturing \u0026ldquo;control tower,\u0026rdquo; where expert teams direct and prioritize efforts across functions. They can also conduct regular cross-functional risk reviews to ensure that quality is not compromised and involve regulators at systematic intervals to assess progress.\u003c/li\u003e\n\u003c/ul\u003e\n\u003ch3\u003eOptimizing the cold chain\u003c/h3\u003e\n\u003cul\u003e\n \u003cli\u003e\u003cem\u003eBuild redundancy into distribution.\u003c/em\u003e Manufacturers, distributers, and local allocation teams can mitigate distribution risks by quickly identifying points of failure and creating redundancies at each stage. For example, in warehouses fitted with ultracold freezers, dry ice could be made available in case of power loss or machine malfunctions. Across distribution routes, sources of dry ice could be identified to restock coolers as necessary.\u003c/li\u003e\n \u003cli\u003e\u003cem\u003eLeverage feedback loops.\u003c/em\u003e Reporting systems could be set up to capture supply-chain disruption events as soon as they happen, with data used to refine best practices and procedures and avoid further losses.\u003c/li\u003e\n \u003cli\u003e\u003cem\u003eUse point-of-care stock management.\u003c/em\u003e If vaccine demand drops to levels where point-of-care stocks are not immediately consumed, vaccine inventories can be redistributed to locations with greater demand. Strategies to avoid overstockpiling must ensure maintenance of the cold chain to prevent risks to the receiving administration site. Where this is not possible, long-term storage by replenishing dry ice or prioritizing freezer capacity will be necessary.\u003c/li\u003e\n\u003c/ul\u003e\n\u003ch3\u003eAddressing labor shortages\u003c/h3\u003e\n\u003cul\u003e\n \u003cli\u003e\u003cem\u003eUse several types of point-of-care facilities.\u003c/em\u003e Many locations have begun to rely on hospitals and primary-care locations for vaccine administration, in addition to retail pharmacies. This will become increasingly necessary when the vaccines are deployed to the general public, to prevent shortages of vaccine administrators. If hospitals and primary-care locations are used to supplement vaccine administration at retail pharmacies, only 2 to 3 percent of the healthcare workforce may need to be diverted from their primary functions.[[footnote 5]]\u003c/li\u003e\n \u003cli\u003e\u003cem\u003eStreamline administration across sites.\u003c/em\u003e Deploying vaccines at larger, streamlined vaccination sites can be more efficient and improve patient safety, labor utilization, and speed of vaccination.\u003c/li\u003e\n\u003c/ul\u003e\n\u003ch3\u003eReducing spoilage at points of care\u003c/h3\u003e\n\u003cul\u003e\n \u003cli\u003e\u003cem\u003eTrack and monitor spoilage at points of care.\u003c/em\u003e Manufacturers and distributors can collaborate to establish the means to identify and trace instances of spoilage. They can learn from experience and refine guidance, training, certification, and allocation to optimize utilization of doses.\u003c/li\u003e\n \u003cli\u003e\u003cem\u003ePace first-dose allocation.\u003c/em\u003e Especially with initial inventories, many authorities are directing allocations of first doses to populations and locations where the need is greatest and the confidence in the availability of second doses is high (such as healthcare professionals and vulnerable populations in nursing homes). As vaccines are made available to broader populations in greater numbers, pacing of first-dose allocation according to distribution schedules and available volumes will remain paramount.\u003c/li\u003e\n \u003cli\u003e\u003cem\u003ePrioritize second doses.\u003c/em\u003e Authorities can help ensure that the recommended two-dose course schedule for such vaccines as the Pfizer-BioNTech, Moderna, and AstraZeneca vaccines are duly completed. Many medical experts are warning that distribution should not be artificially expanded by diverting second-dose allotments to patients awaiting their first dose.\u003c/li\u003e\n \u003cli\u003e\u003cem\u003eEstablish recipient commitment.\u003c/em\u003e Vaccine recipients could be asked to commit to second-dose appointments at their point of care before first-dose administration, improving the likelihood that second doses will not spoil.\u003c/li\u003e\n \u003cli\u003e\u003cem\u003eManage certification.\u003c/em\u003e National and local government institutions can collaborate to ensure that vaccination certifications are withheld until recipients receive their second dose, further increasing the number of citizens who are fully vaccinated.\u003c/li\u003e\n\u003c/ul\u003e\n\u003ch3\u003eMeeting IT challenges\u003c/h3\u003e\n\u003cul\u003e\n \u003cli\u003e\u003cem\u003eBalance IT upgrades and resilience.\u003c/em\u003e Stakeholders should identify IT systems that can be relied upon in the deployment of COVID-19 vaccines and assess their ability to perform at scale. They can consider using a risk-based approach to balance the need to upgrade systems with associated risks. Transforming infrastructure and systems during a time of critical need can be highly disruptive even if beneficial in the long run (for example, moving systems to the cloud can cause some downtime in the short term but better reliability in the long term).\u003c/li\u003e\n \u003cli\u003e\u003cem\u003eShare cyberthreat intelligence.\u003c/em\u003e COVID-19-vaccine stakeholders should agree upon common requirements and processes for generating and sharing threat intelligence. Awareness of attacks on COVID-19-vaccine deployment will increase resilience to attacks and reduce the likelihood of attacks spreading\n in number and magnitude.\u003c/li\u003e\n \u003cli\u003e\u003cem\u003eEstablish means of demonstrating immunity.\u003c/em\u003e Manufacturers and distributers can commission systems to track and verify that vaccine recipients have demonstrated immunity. This would build popular confidence in immunity by fostering a single national view of the current level of population immunity.[[footnote 6]] People will likely be very interested in having a recognizable and accepted means of proving that they have been vaccinated, especially if it will release them from travel limits and other pandemic-related restrictions.\u003c/li\u003e\n\u003c/ul\u003e\n\u003ch2\u003eManaging risks at the interface among organizations\u003c/h2\u003e\n\u003cp\u003eAlthough none of the many organizations involved is solely responsible for managing vaccine deployment across the common operating model, the risks can be more fully addressed with increased stakeholder cooperation. To build this collaboration, working groups could meet to identify the various risks, assess their likelihood and potential impact, and determine whether certain risks are evolving and how urgently they should be addressed.\u003c/p\u003e\n\u003cp\u003eThe groups could align on lead organizations to manage issues while building scenarios to test responses to emerging crises. The benefits in managing each of these risks could be demonstrated with compelling metrics and communications. At this point, clear roles, activities, and capabilities for risk management could be established, building accountability within and across relevant organizations. Most importantly, these steps can be undertaken by manufacturers, distributers, and governments, as COVID-19-vaccine rollouts commence, to facilitate widespread adoption and minimize the challenges associated with the vaccines\u0026rsquo; massive global deployment. By doing so, they will help ensure a more effective and efficient rollout of COVID-19 vaccines, paving the way for the epidemiological end to the devastating effects of the COVID-19 pandemic.\u003c/p\u003e"},"isFullScreenInteractive":{"boolValue":false},"hideStickySocialShareBar":{"boolValue":false},"desktopID":{"value":""},"mobileID":{"value":""},"desktopURL":{"value":""},"mobileURL":{"value":""},"desktopPaddingPercentage":{"value":""},"mobilePaddingPercentage":{"value":""},"desktopOverrideHeight":{"value":""},"mobileOverrideHeight":{"value":""},"cerosOembedURL":{"value":""},"cerosRenderMode":{"targetItem":null},"cerosBackgroundColor":{"targetItem":null},"hideByLine":{"boolValue":false},"tableOfContentsTitle":{"value":"TABLE OF CONTENTS"},"accessStatus":{"targetItem":{"key":{"value":"RegisteredUsers"},"value":{"value":"Registered Users"}}},"articleType":{"targetItem":{"displayName":"Article"}},"hasSpecialReport":{"boolValue":false},"contentType":{"targetItem":{"displayName":"Article"}},"sourcePublication":{"targetItem":null},"externalPublication":{"value":""},"mobileReady":{"boolValue":true},"forClientsOnly":{"boolValue":false},"excludeFromClientLink":{"boolValue":false},"originalPublishDate":{"jsonValue":{"value":"2021-01-26T00:00:00Z"}},"footnotes":{"value":"\u003col\u003e\n \u003cli\u003eCorning and SiO2 Materials Science have capacity for 164 million and 120 million vials, respectively; each vial can hold five to ten doses, depending on the vaccine, per the US Department of Health \u0026amp; Human Services.\u003c/li\u003e\n \u003cli\u003e\u0026ldquo;Compressed gas industry expects sufficient dry ice supply for COVID-19 vaccines in U.S. \u0026amp; Canada,\u0026rdquo; Compressed Gas Association, November 9, 2020, cganet.com.\u003c/li\u003e\n \u003cli\u003eAccording to a survey of 18,000 adults from 15 countries conducted by Ipsos in October 2020, 64 percent of Americans and 73 percent in the overall sample want vaccination.\u003c/li\u003e\n \u003cli\u003eChristopher Bing and Marisa Taylor, \u0026ldquo;China-backed hackers \u0026lsquo;targeted COVID-19 vaccine firm Moderna,\u0026rsquo;\u0026rdquo; Reuters, July 30, 2020, reuters.com; Jack Stubbs, \u0026ldquo;Hackers steal Pfizer/BioNTech COVID-19 vaccine data in Europe, companies say,\u0026rdquo; Reuters, December 9, 2020, reuters.com.\u003c/li\u003e\n \u003cli\u003eCenters for Disease Control and Prevention; McKinsey analysis.\u003c/li\u003e\n \u003cli\u003eFor example, a national view of current immunity could include the number of positive antibody tests within a recent time period, positive antigen tests within a recent time period, or vaccines administered but immunity not confirmed.\u003c/li\u003e\n\u003c/ol\u003e"},"contributoryPractice":{"targetItems":[{"displayName":"Risk \u0026#38; Resilience"},{"displayName":"Life Sciences"}]},"aboutTheAuthors":{"value":"\u003cp\u003e\u003cstrong\u003e\u003ca href=\"/our-people/gaurav-agrawal\"\u003eGaurav Agrawal\u003c/a\u003e\u003c/strong\u003e is a partner in McKinsey\u0026rsquo;s New York office; \u003cstrong\u003eTara Azimi\u003c/strong\u003e is a partner in the Washington, DC, office; \u003cstrong\u003eJennifer Heller\u003c/strong\u003e and \u003cstrong\u003e\u003ca href=\"/our-people/parag-patel\"\u003eParag Patel\u003c/a\u003e\u003c/strong\u003e are partners in the Chicago office, where \u003cstrong\u003e\u003ca href=\"/our-people/adam-sabow\"\u003eAdam Sabow\u003c/a\u003e\u003c/strong\u003e is a senior partner; \u003cstrong\u003e\u003ca href=\"/our-people/pooja-kumar\"\u003ePooja Kumar\u003c/a\u003e\u003c/strong\u003e is a partner in the Philadelphia office; \u003cstrong\u003e\u003ca href=\"/our-people/mihir-mysore\"\u003eMihir Mysore\u003c/a\u003e\u003c/strong\u003e is a partner in the Houston office; \u003cstrong\u003e\u003ca href=\"/our-people/shubham-singhal\"\u003eShubham Singhal\u003c/a\u003e\u003c/strong\u003e is a senior partner in the Detroit office; and \u003cstrong\u003eJoseph Truesdale\u003c/strong\u003e is an associate partner in the Boston office.\u003c/p\u003e\n\u003cp\u003eThe authors wish to thank Marie-Ren\u0026eacute;e B-Lajoie, Rich Cracknell, and Daniel Croft for their contributions to this article.\u003c/p\u003e\n\u003chr /\u003e\n\u003cp\u003eThis article was edited by Richard Bucci, a senior editor in the New York office.\u003c/p\u003e"},"authors":{"targetItems":[]},"nonPartnerAuthors":{"targetItems":[]},"interactiveToUse":{"targetItem":null},"enableArticleComponents":{"boolValue":false},"relatedArticles":{"targetItems":[{"sourcePublication":{"targetItem":null},"publicationSource":null,"externalPublication":{"value":""},"title":{"value":"When will the COVID-19 pandemic end?"},"url":{"path":"/industries/healthcare/our-insights/when-will-the-covid-19-pandemic-end"},"eyebrow":{"targetItem":{"name":"Article"}},"articleType":{"targetItem":{"name":"Article"}},"contentType":{"targetItem":{"name":"Article"}},"description":{"value":"Europe and the United States have entered the endemic stage of the COVID-19 outbreak: the virus is widespread, is significantly less fatal than it was in 2020, and is spurring only limited changes in public behavior. These endemic conditions are likely to continue through the summer and autumn, unless and until immunity-evading new variants emerge. As immunity wanes, however, the next stage remains highly uncertain. In this update, we discuss the outlook, the current and potential future use of boosters and therapeutics, and the shifts in response strategies to the COVID-19 crisis around the world. We also introduce the McKinsey COVID-19 Immunity Index\u0026mdash;a tool for understanding a community\u0026rsquo;s current level of risk from the disease."},"standardImage":{"src":"/~/media/mckinsey/industries/healthcare systems and services/our insights/when will the covid 19 pandemic end/when-will-the-covid-19-pandemic-end-1536x1536.jpg","alt":"When will the COVID-19 pandemic end?"},"heroImage":null,"thumbnailImage":null},{"sourcePublication":{"targetItem":null},"publicationSource":null,"externalPublication":{"value":""},"title":{"value":"COVID-19 vaccine: Are US consumers ready?"},"url":{"path":"/industries/healthcare/our-insights/covid-19-vaccine-are-consumers-ready"},"eyebrow":{"targetItem":{"name":"Article"}},"articleType":{"targetItem":{"name":"Article"}},"contentType":{"targetItem":{"name":"Article"}},"description":{"value":"While details of COVID-19 vaccine administration are still pending, healthcare stakeholders may want to consider their long-term plans for consumer engagement in immunization. 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