How Chile’s cool logistics efficiency met the vaccination challenge.

On a first-dose basis, Chile has vaccinated a larger percentage of its population against COVID-19 than almost any other country on earth. Only the United Arab Emirates, Israel and the United Kingdom have inoculated more, according to figures compiled at the end of February. With an almost 18% inoculation rate, Chile leads the developing world and Latin America by a long shot.

The successful vaccination program is centered on remarkably efficient logistics and distribution, with months of coordinated planning and procedures before the first vial was shipped.

“We designed a plan exclusive for these vaccines,” said the Ministry of Transportation’s Zaida Muñoz Aravena, who was quick to add that there’s constant upgrading as well. “There are little details that we have to improve upon every time.”

Muñoz is among those at the forefront of her country’s effort. At the ripe young age of 29, the personable transportation engineer heads the ministry’s air-related logistics, now centered on vaccine distribution. Muñoz has been instrumental in drawing up plans to implement that critical part of the process, both the arrival of the vaccine from abroad as well as domestic airborne distribution.

The country hopes to inoculate 80% of its population by July.

Muñoz spoke to American Journal of Transportation (AJOT) from Santiago via Zoom as well as supplied written answers through email. “We need to be adaptable and dynamic to respond efficiently,” she said. “The biggest challenge is time.”

Chile’s efforts demonstrate how a developed cold chain must be armed with not only the proper technology, infrastructure and experience, but also with clear-cut chains of command and well-defined tasks. These can overcome immensely difficult undertakings, even across vast distances. In the case of Chile, that expanse encompasses mountains, deserts and a 4,000 mile coastline., not to mention islands that can be more than 2,000 miles from the mainland. The country, with a population of 19 million, stretches more than 2,600 miles north to south and often relies on air transport to reach far-flung locales.

Experience with Cold Storage

The vaccination program is a singular achievement, especially given Chile’s disturbingly high rate of the virus itself. Because of the spread, some regions continue to be locked down and an overnight curfew remains.

Chile is a major global exporter of fresh produce and fish and a lot of those fresh fruits and vegetables we eat this time of year come from Chilean farms. So, it has had long experience in cold storage. That has certainly helped, Muñoz said, as everyone from cargo handlers to truck drivers understand the importance of maintaining the cold chain.

“Fresh cargo has been a good school, not just for the government, but for every logistics worker related with these vaccines,” she said. “Most of the people who work in the airport or in the logistics and cold supply chain team know about fresh food and how to manage it, so [handling the vaccine] is a little easier for them. Cold chain is not so rare,” she said.

But that expertise only goes so far. The exacting standards required of vaccine temperature control, the precise handling and monitoring required, far exceeds that necessary in fresh food transport and delivery. The country’s yearly flu shot distribution program provided some direction as well, although standards of temperature control aren’t nearly as exacting.

Chile now distributes both Pfizer and China’s Sinovac Covid vaccines. Sinovac needs only standard refrigeration. The Pfizer vaccine requires ultra-cold storage of minus 70C. The country soon will begin to distribute Johnson & Johnson’s vaccine as well, possibly as early as April. That, too, needs only refrigeration from 2 to 8C. Chile relies on refrigerated trucks for the delivery of both the Pfizer and Sinovac vaccines over shorter distances, as the vaccines are carried in specialized boxes that can keep the vials safe for 48 hours.

Because the Pfizer vaccine demands such cold temperatures, air transport is a must for longer distances. “It was the biggest challenge in terms of the cold chain,” said Muñoz.

The country’s three major private airlines — LATAM, SKY and JetSmart — transport the vaccine free of charge. Not only is the vaccine highest priority, but they fit in well with usual airfreight cargo patterns, Muñoz said. Vaccine transport doesn’t disrupt other air cargo. Almost all of the refrigerated cargo comes from the regions to Santiago for export so there’s ample capacity traveling from Santiago outbound, and most of that comes via refrigerated trucks, not planes. “We don’t have local distribution [from Santiago] of fresh cargo in these airplanes,” she said.

In addition, a federation of private pilots and small airplane and helicopter operators is delivering vaccines for free to remote towns and villages.

Planning for Distribution

Government agencies started to plan for distribution in May, which Muñoz said, was problematic as the country wasn’t sure what vaccines would be approved or become available. By November, the vaccine choices were clear. What followed, she said, were three weeks of marathon discussions. That kind of coordination was critical for understanding what was necessary and who was responsible.

“We had many meetings with every actor involved to understand each process and improve the performance,” she said. The goal was “to have the shortest length of stay for the cargo at the airport and distribute faster.”

While the Sinovac vaccine comes from Beijing, the Pfizer vaccine is transported by air from Belgium, with a technical stop in Miami. It is stored at the Health Ministry’s ultra-cold storage facility in Santiago about 30 minutes from the airport. When it is ready to be transported to various regions, the vaccine is partially defrosted, which takes about eight hours, then trucked, with a police escort, from the cold store back to the airport. It is loaded onto a plane just 45 minutes before takeoff. All documentation is processed before the vaccines are transported at normal cold storage temperatures.

The Health Ministry is in sole charge of distribution and inoculation once the plane reaches its destination. The vaccines are administered for free by the ministry at public hospitals and private clinics. The vaccines need to be administered within five days of defrosting or they spoil. Each box of vaccine carries sophisticated track and trace sensors that identify location as well as monitor temperatures and advise of any adverse spike.

Part of her task, said Muñoz, was to have a fallback in her pocket, a “plan B,” she said, for every single flight, in case something goes wrong. On one occasion, Muñoz explained, a flight bound for the distant Juan Fernández Islands had to turn back just a few minutes after takeoff because of an electronic system failure. Muñoz was able to shift the vaccine to another plane that left just an hour later. All the vials survived.

On the day after we spoke, 12 planes carried vaccines to 15 different regions. The day before, one plane set a record, Muñoz said, by carrying 36,000 doses of the Pfizer vaccine.

Muñoz credits a small, centralized air transport team that coordinates logistics nationally and works closely with the Ministry of Health, the sole supplier and domestic distributor of the vaccine. So far, she said, not a single dose has been lost to temperature spikes or spoilage.