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How officials will ensure the COVID-19 vaccine stays cold enough in transit
Pfizer's vaccine needs to be kept at -100°F until it's administered. Can caregivers deliver?
- Fair distribution of the Moderna and Pfizer vaccines is especially challenging because they need to be stored at extremely cold temperatures.
- Back in 2018, the WHO reported that over half of all vaccines are wasted worldwide due to lack of cold storage, and they were only talking about vaccines that need to be chilled or kept at standard freezer temperatures.
- Real-time logistics data, location tracking, and information about movements are crucial to track shipment progress, product temperature and other conditions.
The recent good news about the Moderna and Pfizer vaccines has opened up a new set of COVID-19 challenges: how to distribute and administer the vaccine to billions of people worldwide. Successfully inventing a vaccine, it seems, is just the beginning, even if health authorities were expecting its arrival.
The fair distribution challenge is especially tricky because the vaccines need to be stored at extremely cold temperatures. The fat molecules which are the vehicle for the vaccine degrade swiftly at ambient temperatures. The Moderna vaccine needs to be kept at -4°F (-20°C), which is not much colder than the average freezer, but the Pfizer vaccine needs to be kept at -100°F (-70°C), at least until shortly before it's due to be administered.
Pfizer has developed special insulated boxes packed with dry ice that keep the vaccine cold for up to 10 days, as long as they are unopened. The boxes can then be opened and the dry ice replenished up to three times, every five days.
Any COVID-19 vaccine will only be effective if it's distributed widely and applied worldwide, but that includes areas with high temperatures, regions with poor infrastructure for storing the vaccine, and countries that are a long and complicated journey away from the factories where the vaccines are produced and the warehouses where they're kept.
In light of these obstacles, Deutsche Post DHL predicts that two-thirds of the global population is unlikely to have easy access to cold chain COVID-19 vaccines.
Pharma companies, together with public health organizations worldwide, need to guarantee that the vaccine arrives safely and undamaged. That, in turn, will require accessing reliable data about whether vaccines have been compromised, so as to avoid administering useless vaccines and to increase confidence in a vaccine which already faces suspicion from the general public.
It has all the makings of a logistical nightmare.
Cold chain logistics could make or break the magic bullet
Ethical rules of fair distribution dictate that those who receive the first vaccines should be people who need it most, not the richest or most conveniently located. In the case of COVID-19, this includes healthcare workers, people who are elderly, immunocompromised or disabled, plus vulnerable populations on the poverty line, in prison, or in homeless shelters.
This is easier said than done. Regional health care facilities are often located several hours from the nearest transportation hub city. Many American nursing homes are high-risk locations but are geographically isolated in rural areas, and some of the poorest communities are scattered across rural counties.
"Rural midwestern states are current hot spots for COVID-19 infections, and those numbers will only worsen as temperatures continue to drop," said William A Haseltine, a former professor at the Harvard School of Public Health. "Getting vaccines to rural Americans in these states is imperative, but damaging some vaccines in transit seems more of a likelihood than a possibility."
Additionally, many of the world's most vulnerable populations cannot afford to pay for COVID-19 vaccines, which means public health bodies, which have already run-down budgets during the pandemic, will have to bear the brunt of the costs.
The same hurdles apply to poorer nations with low or non-existent health budgets, which still deserve an equal supply of the vaccine. Once Pfizer's "cold boxes" are opened, thousands of injections will need to be administered, even in sparsely populated areas, in order to ensure nothing goes to waste, and four weeks later, the process will need to be repeated for a second dose.
Chilling truths for many sectors
Public health organizations can't afford to waste vaccines, but they also can't afford expensive storage solutions. Deep freezers that can store the vaccine at -80°F or lower are too expensive for rural hospitals, plus the U.S. is facing a shortage of such freezers, even as manufacturers are scrambling to speed up production and shipment carriers scramble to outfit their containers.
"In this financial environment, you can imagine that there is simply no consideration of rural hospitals purchasing storage equipment for this ultra-cold distribution," noted National Rural Health Association CEO Alan Morgan.
Back in 2018, the WHO reported that over half of all vaccines are wasted worldwide due to lack of cold storage, and they were only talking about vaccines that need to be chilled or kept at standard freezer temperatures.
Few states in the U.S. are equipped to meet the cold chain challenge. Washington State's health department doesn't have a way to store Pfizer vaccine at a cold enough temperature. Many newer EU member states are in a similar position, along with much of South America, Africa, and Asia. States such as Arizona, North Dakota, and Oregon include large rural communities, tribal lands, and migrant communities, none of whom are easily reachable.
If public health bodies are unable to store the vaccine for longer periods of time, the onus rests on cold chain logistics to deliver it within a shorter period of time.
Improved logistics data can play a role
Shipping companies need the ability to transport vaccine batches swiftly, with transparent tracking, to their final destinations, if they're going to be trusted to supply rural and hard-to-reach areas.
"Cold chain logistics isn't just a matter of profit and loss. It can mean the difference between life and death for communities and individuals who are relying on vaccines and pharma products to arrive in their original condition," explained Janne Juhala, CEO of Logmore, via email. A supply chain condition analytics company, Logmore is launching a new product, Logmore Dry Ice, to help efforts to protect the COVID-19 vaccine in transit.
Real-time logistics data, location tracking, and information about movements are crucial to track shipment progress, product temperature and other conditions. For example, transport companies need to know if a shipment has been exposed to the sun, or get alerts to change the dry ice.
Pharma companies require this data so they can quickly rescue delayed vaccine shipments before they spoil, while accurate notifications that a shipment has been compromised enables public health authorities to rely on the integrity of the vaccine.
The logistics industry is preparing for its biggest challenge
At first glance, the outlook is bleak. The International Air Cargo Association (TIACA) and Pharma.Aero, a cross-industry consortium focused on reliable end-to-end air transportation for pharmaceutical shippers, surveyed airlines, freight forwarders, ground handlers, airport operators and solution providers about their preparedness for vaccine distribution, and found that only 28 percent are prepared.
The good news is that everyone involved is working flat-out to change that statistic. Air freight companies are converting passenger planes to cargo-only, increasing air transport capacity by 25 percent to 50 percent over the last six months.
Logistics companies are buying freezers as fast as possible and manufacturers are speeding up freezer production. UPS announced construction of a "freezer farm" in Louisville, Kentucky; FedEx already invested in freezers during the 2009 H1N1 pandemic; and Kuehne + Nagel International AG, a Switzerland-based warehousing and distribution company, has established coolers at 230+ distribution sites.
Another concern is the global shortage of dry ice needed to keep the vaccines cool. Dry ice is made from CO2, a by-product of ethanol production, which dropped in line with gasoline consumption due to stay-at-home orders. But delivery companies are preparing for that too; FedEx has installed dry ice machines, and UPS is considering adding them.
Private logistics companies can only take us so far, though.
Global cooperation is vital
Global planning and cooperation is vital to plan the timing of vaccine shipments, so that they are not ruined by air or land freight delays; ensure they aren't held up by needless paperwork in a transit country; and protect vaccines from being seized and redirected.
"The partners have to collaborate," said Detlef Trefzger, CEO of global shipping concern Kuehne + Nagel. "If you don't… you might run into a capacity shortage or equipment shortage."
TIACA and Pharma.aero called for air cargo stakeholders to collaborate to map storage capabilities and accelerate roll out of digital tracking and monitoring systems, and on governments, customs authorities, and border agencies to remove barriers to movement of COVID-19 vaccines. International organizations also need to work together to build cold chain capacity in developing countries.
Logmore's Juhala echoed this sentiment. "Logistics companies can only take matters so far. With the COVID vaccine specifically, the world is relying on effective communication with government bodies and public health organizations," he said, "so having verifiable data about the conditions of each shipment adds a much-needed layer of accountability."
When times get tough, the tough get going
The obstacles in the way of COVID-19 vaccine distribution are undeniable, but everyone involved is confident that they can be overcome.
Amy Maxmen, who covered the Ebola pandemic for Nature, pointed out that in 2018 the Democratic Republic of Congo distributed the Ebola vaccine even though it too required deep cold storage.
Although the coronavirus vaccines that have passed trial so far need specific and precise storage conditions, and many of those who need it most are difficult to reach, logistics companies and public health bodies are gearing up together to make it happen. With vigilant monitoring, investment in freight infrastructure and careful strategic planning, we just might see the end of COVID-19 in 2021.
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How would the ability to genetically customize children change society? Sci-fi author Eugene Clark explores the future on our horizon in Volume I of the "Genetic Pressure" series.
- A new sci-fi book series called "Genetic Pressure" explores the scientific and moral implications of a world with a burgeoning designer baby industry.
- It's currently illegal to implant genetically edited human embryos in most nations, but designer babies may someday become widespread.
- While gene-editing technology could help humans eliminate genetic diseases, some in the scientific community fear it may also usher in a new era of eugenics.
Tribalism and discrimination<p>One question the "Genetic Pressure" series explores: What would tribalism and discrimination look like in a world with designer babies? As designer babies grow up, they could be noticeably different from other people, potentially being smarter, more attractive and healthier. This could breed resentment between the groups—as it does in the series.</p><p>"[Designer babies] slowly find that 'everyone else,' and even their own parents, becomes less and less tolerable," author Eugene Clark told Big Think. "Meanwhile, everyone else slowly feels threatened by the designer babies."</p><p>For example, one character in the series who was born a designer baby faces discrimination and harassment from "normal people"—they call her "soulless" and say she was "made in a factory," a "consumer product." </p><p>Would such divisions emerge in the real world? The answer may depend on who's able to afford designer baby services. If it's only the ultra-wealthy, then it's easy to imagine how being a designer baby could be seen by society as a kind of hyper-privilege, which designer babies would have to reckon with. </p><p>Even if people from all socioeconomic backgrounds can someday afford designer babies, people born designer babies may struggle with tough existential questions: Can they ever take full credit for things they achieve, or were they born with an unfair advantage? To what extent should they spend their lives helping the less fortunate? </p>
Sexuality dilemmas<p>Sexuality presents another set of thorny questions. If a designer baby industry someday allows people to optimize humans for attractiveness, designer babies could grow up to find themselves surrounded by ultra-attractive people. That may not sound like a big problem.</p><p>But consider that, if designer babies someday become the standard way to have children, there'd necessarily be a years-long gap in which only some people are having designer babies. Meanwhile, the rest of society would be having children the old-fashioned way. So, in terms of attractiveness, society could see increasingly apparent disparities in physical appearances between the two groups. "Normal people" could begin to seem increasingly ugly.</p><p>But ultra-attractive people who were born designer babies could face problems, too. One could be the loss of body image. </p><p>When designer babies grow up in the "Genetic Pressure" series, men look like all the other men, and women look like all the other women. This homogeneity of physical appearance occurs because parents of designer babies start following trends, all choosing similar traits for their children: tall, athletic build, olive skin, etc. </p><p>Sure, facial traits remain relatively unique, but everyone's more or less equally attractive. And this causes strange changes to sexual preferences.</p><p>"In a society of sexual equals, they start looking for other differentiators," he said, noting that violet-colored eyes become a rare trait that genetically engineered humans find especially attractive in the series.</p><p>But what about sexual relationships between genetically engineered humans and "normal" people? In the "Genetic Pressure" series, many "normal" people want to have kids with (or at least have sex with) genetically engineered humans. But a minority of engineered humans oppose breeding with "normal" people, and this leads to an ideology that considers engineered humans to be racially supreme. </p>
Regulating designer babies<p>On a policy level, there are many open questions about how governments might legislate a world with designer babies. But it's not totally new territory, considering the West's dark history of eugenics experiments.</p><p>In the 20th century, the U.S. conducted multiple eugenics programs, including immigration restrictions based on genetic inferiority and forced sterilizations. In 1927, for example, the Supreme Court ruled that forcibly sterilizing the mentally handicapped didn't violate the Constitution. Supreme Court Justice Oliver Wendall Holmes wrote, "… three generations of imbeciles are enough." </p><p>After the Holocaust, eugenics programs became increasingly taboo and regulated in the U.S. (though some states continued forced sterilizations <a href="https://www.uvm.edu/~lkaelber/eugenics/" target="_blank">into the 1970s</a>). In recent years, some policymakers and scientists have expressed concerns about how gene-editing technologies could reanimate the eugenics nightmares of the 20th century. </p><p>Currently, the U.S. doesn't explicitly ban human germline genetic editing on the federal level, but a combination of laws effectively render it <a href="https://academic.oup.com/jlb/advance-article/doi/10.1093/jlb/lsaa006/5841599#204481018" target="_blank" rel="noopener noreferrer">illegal to implant a genetically modified embryo</a>. Part of the reason is that scientists still aren't sure of the unintended consequences of new gene-editing technologies. </p><p>But there are also concerns that these technologies could usher in a new era of eugenics. After all, the function of a designer baby industry, like the one in the "Genetic Pressure" series, wouldn't necessarily be limited to eliminating genetic diseases; it could also work to increase the occurrence of "desirable" traits. </p><p>If the industry did that, it'd effectively signal that the <em>opposites of those traits are undesirable. </em>As the International Bioethics Committee <a href="https://academic.oup.com/jlb/advance-article/doi/10.1093/jlb/lsaa006/5841599#204481018" target="_blank" rel="noopener noreferrer">wrote</a>, this would "jeopardize the inherent and therefore equal dignity of all human beings and renew eugenics, disguised as the fulfillment of the wish for a better, improved life."</p><p><em>"Genetic Pressure Volume I: Baby Steps"</em><em> by Eugene Clark is <a href="http://bigth.ink/38VhJn3" target="_blank">available now.</a></em></p>
It's hard to stop looking back and forth between these faces and the busts they came from.
- A quarantine project gone wild produces the possibly realistic faces of ancient Roman rulers.
- A designer worked with a machine learning app to produce the images.
- It's impossible to know if they're accurate, but they sure look plausible.
How the Roman emperors got faced<a href="https://payload.cargocollective.com/1/6/201108/14127595/2K-ENGLISH-24x36-Educational_v8_WATERMARKED_2000.jpg" ><img type="lazy-image" data-runner-src="https://assets.rebelmouse.io/eyJhbGciOiJIUzI1NiIsInR5cCI6IkpXVCJ9.eyJpbWFnZSI6Imh0dHBzOi8vYXNzZXRzLnJibC5tcy8yNDQ2NDk2MS9vcmlnaW4uanBnIiwiZXhwaXJlc19hdCI6MTYyOTUzMzIxMX0.OwHMrgKu4pzu0eCsmOUjybdkTcSlJpL_uWDCF2djRfc/img.jpg?width=980" id="775ca" class="rm-shortcode" data-rm-shortcode-id="436000b6976931b8320313478c624c82" data-rm-shortcode-name="rebelmouse-image" alt="lineup of emperor faces" data-width="1440" data-height="963" /></a>
Credit: Daniel Voshart<p>Voshart's imaginings began with an AI/neural-net program called <a href="https://www.artbreeder.com" target="_blank">Artbreeder</a>. The freemium online app intelligently generates new images from existing ones and can combine multiple images into…well, who knows. It's addictive — people have so far used it to generate nearly 72.7 million images, says the site — and it's easy to see how Voshart fell down the rabbit hole.</p><p>The Roman emperor project began with Voshart feeding Artbreeder images of 800 busts. Obviously, not all busts have weathered the centuries equally. Voshart told <a href="https://www.livescience.com/ai-roman-emperor-portraits.html" target="_blank" rel="noopener noreferrer">Live Science</a>, "There is a rule of thumb in computer programming called 'garbage in garbage out,' and it applies to Artbreeder. A well-lit, well-sculpted bust with little damage and standard face features is going to be quite easy to get a result." Fortunately, there were multiple busts for some of the emperors, and different angles of busts captured in different photographs.</p><p>For the renderings Artbreeder produced, each face required some 15-16 hours of additional input from Voshart, who was left to deduce/guess such details as hair and skin coloring, though in many cases, an individual's features suggested likely pigmentations. Voshart was also aided by written descriptions of some of the rulers.</p><p>There's no way to know for sure how frequently Voshart's guesses hit their marks. It is obviously the case, though, that his interpretations look incredibly plausible when you compare one of his emperors to the sculpture(s) from which it was derived.</p><p>For an in-depth description of Voshart's process, check out his posts on <a href="https://medium.com/@voshart/photoreal-roman-emperor-project-236be7f06c8f" target="_blank">Medium</a> or on his <a href="https://voshart.com/ROMAN-EMPEROR-PROJECT" target="_blank" rel="noopener noreferrer">website</a>.</p><p>It's fascinating to feel like you're face-to-face with these ancient and sometimes notorious figures. Here are two examples, along with some of what we think we know about the men behind the faces.</p>
Caligula<img type="lazy-image" data-runner-src="https://assets.rebelmouse.io/eyJhbGciOiJIUzI1NiIsInR5cCI6IkpXVCJ9.eyJpbWFnZSI6Imh0dHBzOi8vYXNzZXRzLnJibC5tcy8yNDQ2NDk4Mi9vcmlnaW4uanBnIiwiZXhwaXJlc19hdCI6MTY3MzQ1NTE5NX0.LiTmhPQlygl9Fa9lxay8PFPCSqShv4ELxbBRFkOW_qM/img.jpg?width=980" id="7bae0" class="rm-shortcode" data-rm-shortcode-id="ce795c554490fe0a36a8714b86f55b16" data-rm-shortcode-name="rebelmouse-image" data-width="992" data-height="558" />
One of numerous sculptures of Caligula, left
Nero<img type="lazy-image" data-runner-src="https://assets.rebelmouse.io/eyJhbGciOiJIUzI1NiIsInR5cCI6IkpXVCJ9.eyJpbWFnZSI6Imh0dHBzOi8vYXNzZXRzLnJibC5tcy8yNDQ2NTAwMC9vcmlnaW4uanBnIiwiZXhwaXJlc19hdCI6MTY1NTQ2ODU0NX0.AgYuQZzRQCanqehSI5UeakpxU8fwLagMc_POH7xB3-M/img.jpg?width=980" id="a8825" class="rm-shortcode" data-rm-shortcode-id="9e0593d79c591c97af4bd70f3423885e" data-rm-shortcode-name="rebelmouse-image" data-width="992" data-height="558" />
One of numerous sculptures of Nero, left
Scientists use new methods to discover what's inside drug containers used by ancient Mayan people.
- Archaeologists used new methods to identify contents of Mayan drug containers.
- They were able to discover a non-tobacco plant that was mixed in by the smoking Mayans.
- The approach promises to open up new frontiers in the knowledge of substances ancient people consumed.
PARME staff archaeologists excavating a burial site at the Tamanache site, Mérida, Yucatan.
To understand ourselves and our place in the universe, "we should have humility but also self-respect," Frank Wilczek writes in a new book.