case study KUALA LUMPUR, Dec 14 Malaysia has successfully secured Covid-19 vaccines for nearly a third of its population, potentially slowing down the epidemic next year that has dramatically surged in the past three weeks. However, the gruelling distribution process of the vaccine by US pharmaceutical company Pfizer Inc and its German partner, BioNTech which requires an historically low storage temperature requirement of minus 70 degrees Celsius, as cold as Antarctica in winter will pose major logistical challenges for an unprecedented vaccination campaign of this scale and complexity in Malaysia. Even high-income and cold countries like the United States and the United Kingdom foresee massive logistical hurdles in rolling out the Pfizer-BioNTech vaccine, as the UK's NHS described the Covid-19 immunisation programme as "one of the greatest challenges the NHS has ever faced". To put into perspective, Malaysia's Ministry of Health (MOH) vaccinated about fewer than 500,000 infants or children in 2017 under the National Immunisation Programme (NIP). The first round of Malaysia's Covid-19 vaccination programme, on the other hand, targets 6.4 million people throughout 2021 with Pfizer's two-dose regimen (12.8 million doses purchased so far). Another 10 per cent of the Malaysian population that will be covered next year with vaccines from the global COVAX Facility, co-led by the World Health Organization (WHO), is estimated to number about 3.2 million people. This totals 9.6 million people, 19 times more than those vaccinated under the NIP yearly. An anonymous personnel from a company that provides cold-chain management visibility solutions spoke to CodeBlue on the possible challenges that Malaysia might face to transport ultra-cold Covid-19 vaccines right upon reaching airplane cargo in the Kuala Lumpur International Airport (KLIA) from flights from vaccine manufacturing plants in Belgium, the US, or Germany. It is unclear if Pfizer will deliver its first million doses to Malaysia, by the first quarter of next year, in a single tranche, or if these will be staggered over the next few months. "Do we have enough facilities which can store vaccines under minus 70 degrees?" the person told CodeBlue on condition of anonymity due to the sensitivity of the issue. "It needs an ultra-low freezer to store vaccines under minus 70 degrees. We should invest in that technology if we have decided to buy that vaccine. "The technology is available to transport the vaccines from distribution centres to local clinics or hospitals using temperature-control packaging. The current temperaturecontrolled packaging solutions are able to provide thermal protection at two to eight degrees Celsius, minus 20 degrees Celsius, and minus 70 degrees Celsius for temperature-sensitive payloads." MABkargo, a cargo airline, did not respond to CodeBlue's questions at the time of writing on whether it had capacity, such as special unit load devices (ULD), to carry Covid-19 vaccines with ultra-cold temperature requirements. ULDs are containers for baggage and cargo. From KLIA, the first point of arrival in Malaysia, Covid-19 vaccines will likely then be delivered to distribution hubs, either through domestic flights or land transport, where they can be stored for six months in ultra-cold freezers at minus 70 degrees Celsius. The government has not yet said where vaccine distribution hubs will be located. The vaccines can then be delivered from distribution hubs to vaccination sites likely public clinics and hospitals in Pfizer's temperature-controlled thermal shippers packed with dry ice to maintain storage temperature conditions of minus 70 degrees Celsius, higher or below 10 degrees, for up to 10 days unopened. The reusable box is able to store up to 5,000 doses. These special thermal shippers can also act as temporary storage units by refilling with dry ice every five days for up to 30 days of storage. Upon delivery to the respective vaccination centres or sites, the Pfizer-BioNTech vaccine, once thawed, must be used quickly as it can only be kept for five days at normal fridge temperature of two to eight degrees Celsius. The government has not yet stated which states or districts vaccination sites will be set up in. It is likely that for the first round of immunisation with Pfizer's vaccine, due to its tricky storage requirements, densely populated cities or towns may be prioritised first. The major problem in Covid-19 vaccine transportation is the last-mile. An unbroken cold chain has to be maintained throughout various modes of transportation until carrying the vaccines to respective vaccination centres. Galen Centre for Health and Social Policy chief executive Azrul Mohd Khalib said the challenge of storing and distributing Covid-19 vaccines in Malaysia is similar to the difficulties faced by countries worldwide. question:---- c. Discuss the role of technology in the process of logistics activities for the storage and distribution of vaccines, as described in the article above