While there have been issues with distribution of the COVID-19 vaccine at the political level, the complex supply chain that gets the shots from manufacturer to healthcare workers has been well-coordinated. It’s not surprising that the company in charge is an early adopter of Six Sigma.

McKesson, the company contracted by the Centers for Disease Control and Prevention (CDC) to distribute the COVID-19 vaccine, has a deep commitment to the process improvement methodology. The company proclaims on its website that it ranks among the first healthcare information technology and transactional businesses to embrace Six Sigma.

The company reports it has used Six Sigma to achieve:

  • Business transformation from function-oriented to process-oriented
  • More than $100 million in internal savings
  • Methods to identify and eliminate profit leaks
  • Improved customer experience
  • Improved service capabilities
  • A competitive edge and cost advantage

While McKesson has become highly successful using Six Sigma, they face many complex challenges with the COVID-19 vaccine supply chain.

One of the Most Complex Supply Chains Ever Built

The two current vaccines, one from Pfizer and the other from Moderna, both must be frozen for transportation. In the case of the Pfizer vaccine, ultracold storage is necessary at minus 94 degrees. Both require two shots.

To prepare for distribution of the Moderna vaccine, McKesson, which is the largest pharmaceutical distribution company in the United States, added extra distribution centers to the large number it already has across the country.

Tinglong Dai, who studies healthcare analytics at Johns Hopkins University, told USA Today that the system to distribute the vaccine developed by McKesson is “ just incredible. I think the vaccine supply chain is one of the most mind-bogglingly complex supply chains ever built.”

Different Supply Chain Routes For Two Vaccines

As of January 2021, the vaccines from Pfizer and Moderna are the only two getting distributed. McKesson is only handling the Moderna vaccine because of the ultracold requirements of the Pfizer vaccine. The process for getting an order works like this.

  • A healthcare provider submits a request to the state where it is located for “x” amount of vaccines shots (this request typically goes to a state health department)
  • State officials determine whether to fulfill the request, and how many shots they should have (this can be less than requested, because supplies remain limited in the early months of distribution)
  • The state then submits the order to the federal CDC, which also must approve the request and may change the number of doses sent, based on supply
  • An order is then sent to McKesson
  • McKesson ships the vaccine directly to the healthcare provider that made the original request

Maintaining the Cold Chain

In a news release about delivering the first order, McKesson offered an overview of how they are ensuring the integrity of the cold chain during transportation.

The company first verifies that the freezers that contain the vaccines sent to them from the manufacturer have maintained the proper temperature. They then place the vaccines in large, pharmaceutical-grade freezers at the McKesson warehouses. These freezers contain “sophisticated controls, monitoring systems and alarms intended to ensure the vaccines remain within the appropriate temperature ranges,” McKesson reported.

Once the CDC delivers an order, McKesson packs the vaccine in insulated coolers that contain specialized cold packs and temperature monitors to ensure the doses stay within the required temperature range while getting transported to the healthcare facility.

Along with the vaccine doses, McKesson also is responsible for shipping the ancillary supply kit that contains alcohol prep pads, face shields, surgical masks, needles and syringes, a vaccine administration sheet, and a vaccine record and reminder card.

McKesson is not alone in putting Six Sigma and Lean to work in its operations. DC Health has released its plan for distribution in the district, reporting that it is using Plan, Do, Study, Act on its distribution plan, as well as Fishbone diagrams and root-cause analysis in “leveraging the Lean Six Sigma infrastructure embedded within the city’s public health agency.”

The Issues with Distribution

While the supply chain seems to be in good shape, less than half of the planned vaccinations happened in December 2020. Quartz summed up the reason why: “The problem appears to be government dysfunction—specifically, an unfulfilled need for support from the federal government to the state agencies and local healthcare providers tasked with distributing the vaccine.”

National Public Radio reported much of the same issues and spoke with experts who offered ways to speed up distribution. They include better training for healthcare workers administering the shots, providing states with money to open more vaccination sites, raising public awareness of where and how to get the vaccine, and a steadier supply of vaccines from the manufacturer.