15 Jan 2021
In the healthcare and medical sectors, the quality of logistics can spell the difference between life and death. The COVID-19 vaccine is a case in point.
This article is an extract from our latest u‑blox magazine on eHealth. Download your own copy of the magazine today!
The right product, delivered to the right person at the right time, unblemished. Tick all four boxes and you have a successful logistics operation. Get one wrong, and you’re likely to hear complaints. But it’s one thing when an online delivery gets sent to the wrong doorstep. If a blood transfusion, a beating heart, or vial of vital vaccine gets switched up, lost, damaged, or delayed, the consequences can be dire. Valuable, life-saving resources are wasted and patients left waiting. When the stakes are so high, simply trusting the logistics chain is sometimes not enough. Harnessing wireless sensing, reliable and secure data communication, and satellite-based positioning, the IoT can help ensure that logistics saves lives.
Blood transfusions are a poignant example. According to a World Health Organization (WHO) factsheet on blood safety and availability, 118.5 million blood donations are collected globally each year. Once carefully labeled with the patient’s ABO blood group and Rhesus factor, this blood is typically either stored and then transfused to a patient unaltered, or it is broken down into its constituent components, including red blood cells, platelets, and plasma, before being delivered to patients in need.
Whole blood needs to be stored between two and six degrees Celsius. Any colder, and it can cause fatal bleeding or renal failure once delivered. Warmer and it can become a viable home for harmful bacteria. To avoid losing their blood clotting availability, platelets, on the other hand, must be stored at a warm 20 to 24 °C, while plasma, the fluid that carries the blood cells, must be stored frozen at -25 °C or less until it is thawed. These temperatures need to be guaranteed not only at the blood bank, but also during transport from the blood drive to the analytics lab, or from the blood bank to the patient, during which the blood bag can rack up hundreds if not thousands of kilometers.
In such a complex supply chain, many things can go wrong. Every step of the process is prone to temperature exceptions caused, for instance, by power outages or errors in handling. With every minute that the blood products spend outside their ideal storage temperatures, their quality deteriorates and the risk they present to patients goes up. And while receiving the wrong blood type is rare, with around four cases per million units of blood transfused, it can have potentially life-threatening consequences.
Solutions that leverage the Internet of Things aim to track blood and create a continuous data trail of its journey from the donor to the patient. EY Canada and the Canadian Blood Services have, for instance, put out a proposal to combine the strengths of the IoT with the Blockchain to this effect. The approach banks on the proven strengths of IoT sensors in asset tracking and condition monitoring to gather relevant timestamped data, and uses the Blockchain as a decentralized and virtually immutable platform to manage the visibility and security of the collected records. Other initiatives, such as one developed by Swedish-based Tridentify, include smart blood bags that automatically log data in real-time.
If transfusing blood sounds tricky, try transplanting a live kidney, spleen, or even a beating heart! In what has been described as one of the most complex procedures in medicine, all the challenges of getting blood from a donor to a patient are compounded. In addition to matching the blood type between donor and patient, the donor and the recipient need to be about the same size. Because organs can only survive for about four to 48 hours outside the body, depending on the organ, donors (often deceased) and recipients need to be in the same geographical area, in particular for hearts and lungs. And because such a match is so rare, doctors are unlikely to get a second chance at a transplant. The replacement organ has to be in perfect condition prior to the surgery.
As with blood, IoT-based solutions are being relied on to ensure that organ transplants are delivered on time and intact. According to an investigation by Kaiser Health News and Reveal from the Center for Investigative Reporting, between 2014 and 2019 there were around 170 transplant-ready organs that had to be discarded. More than twice as many were classified as near misses due to delays in transport. According to the report, kidneys and livers, which are less time-sensitive than hearts and lungs, often travel as standard cargo in the belly of commercial airliners, with no way to follow them in real-time.
As in the case of transporting blood, wireless connectivity and satellite-based positioning have the potential to bring transparency in these situations. Solutions such as TransMedics’s Organ Care System offer a means to track the location of critical organs and monitor their condition while en route. This is in addition to other tasks, such as controlling the biomimetic properties of smart transport boxes that are used to keep hearts, lungs, livers, and other organs alive via a user-friendly interface hosted on wireless smart devices.
Whenever blood, organs, or biological tissues are being shuttled from a donor to a recipient, they are racing against time. In places with poor transport infrastructure, such as rural Rwanda, drones can already look back at a four-year history of delivering blood to hospitals, unhindered by potholes, traffic, and, for that matter, curves. The drones, which are guided to their destination using a GPS-assisted autopilot, fly to the delivery point, drop off the cargo by parachute, and return to their home base, saving precious minutes, and lives.
More recently, there has been increasing interest in using autonomous flying vehicles – drones – for organ transport, with the potential of making these critical operations safer, faster, and more reliable. An article published on the website of the United Network for Organ Sharing (UNOS) shows not just what this would look like, but how it is already playing out in practice. The first drone-delivered live organ landed at the University of Maryland Medical Center in 2019. Now the approach has been proven to work, and drones are finding use in a growing number of medical use cases. It’s safe to say that we should expect big things to come!
Of the many challenges that will face us in the coming months, developing and then distributing a COVID-19 vaccine will be among the most formidable – and the most pressing. Over 170 teams of researchers working towards a safe and effective vaccine, eleven of which, at the time of writing, are in phase 3 clinical trials. Supply chains are being strengthened to be able to swiftly ramp up the production of those that prove their value. And, to save time, production facilities are being erected ahead of time to produce a so far unknown product.
The objective: 7 billion vials of vaccine. 14 billion if it requires two doses. Add another 20 to 30 percent to make up for losses during transit and storage, and you end up with a mind-blowing 19 billion vials, as estimated by the World Economic Forum (WEF). Swiftly addressing COVID-19 would take five times the number of vaccines produced in 2018, and that in addition to the 3.5 billion vaccines needed to prevent non-COVID-19-related diseases.
The logistics required to deliver them will be unprecedented. The sheer numbers are one thing. According to the International Air Transport Association (IATA), shipping 7.8 billion doses of the vaccine by air would require 8’000 747 cargo planes. Keeping the vaccine intact until it reaches the recipients is another challenge. The type of vaccine that makes the cut will ultimately determine the specifics of the distribution process, but it’s highly likely that it will require a rigorously controlled cold chain.
And, according to an article by PWC, ensuring the integrity of the products at every step of their journey will be vital. Every year, €150 billion to €200 billion worth of counterfeit pharmaceuticals, including vaccines, are sold globally. With the world in dire need of a COVID-19 vaccine, there will likely be a fierce market of fraudulent, and potentially unsafe, inefficacious vaccines to contend with.
Ensuring the equitable delivery of a vaccine to people around the world will require a global logistics system that can provide real-time tracking with high integrity and shared data access. According to WEF, this set of challenges makes it a perfect fit for distributed ledger technology, for instance, the Blockchain. As they report, Blockchain-based solutions that could store the location, state, and entire transport history of each and every vial of the vaccine are already under development, with a vast infrastructure of IoT devices and reliable and secure data communication as vital enablers.
Whether it is to deliver blood, a beating heart, or billions of vaccines, ensuring the reliability, integrity, and transparency of logistical operations can save lives. With the convergence of unprecedented technological opportunity and unprecedented global need, the logistical conundrum that is the COVID-19 vaccine delivery could well turn out to be our generation’s space race, only this time, right here on earth. Once proven, the technologies, platforms, facilities, and networks that helped us end the current pandemic might diffuse into every other aspect of our lives in the same way that space travel brought us some unlikely, yet widespread offshoots, such as wireless headsets, adjustable smoke detectors, and artificial limbs.