[Senate Hearing 116-630]
[From the U.S. Government Publishing Office]
S. Hrg. 116-630
THE LOGISTICS OF TRANSPORTING
A COVID-19 VACCINE
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HEARING
BEFORE THE
SUBCOMMITTEE ON TRANSPORTATION AND SAFETY
OF THE
COMMITTEE ON COMMERCE,
SCIENCE, AND TRANSPORTATION
UNITED STATES SENATE
ONE HUNDRED SIXTEENTH CONGRESS
SECOND SESSION
__________
DECEMBER 10, 2020
__________
Printed for the use of the Committee on Commerce, Science, and
Transportation
[GRAPHIC NOT AVAILABLE IN TIFF FORMAT]
Available online: http://www.govinfo.gov
__________
U.S. GOVERNMENT PUBLISHING OFFICE
52-857 PDF WASHINGTON : 2023
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SENATE COMMITTEE ON COMMERCE, SCIENCE, AND TRANSPORTATION
ONE HUNDRED SIXTEENTH CONGRESS
SECOND SESSION
ROGER WICKER, Mississippi, Chairman
JOHN THUNE, South Dakota MARIA CANTWELL, Washington,
ROY BLUNT, Missouri Ranking
TED CRUZ, Texas AMY KLOBUCHAR, Minnesota
DEB FISCHER, Nebraska RICHARD BLUMENTHAL, Connecticut
JERRY MORAN, Kansas BRIAN SCHATZ, Hawaii
DAN SULLIVAN, Alaska EDWARD MARKEY, Massachusetts
CORY GARDNER, Colorado TOM UDALL, New Mexico
MARSHA BLACKBURN, Tennessee GARY PETERS, Michigan
SHELLEY MOORE CAPITO, West Virginia TAMMY BALDWIN, Wisconsin
MIKE LEE, Utah TAMMY DUCKWORTH, Illinois
RON JOHNSON, Wisconsin JON TESTER, Montana
TODD YOUNG, Indiana KYRSTEN SINEMA, Arizona
RICK SCOTT, Florida JACKY ROSEN, Nevada
John Keast, Staff Director
Crystal Tully, Deputy Staff Director
Steven Wall, General Counsel
Kim Lipsky, Democratic Staff Director
Chris Day, Democratic Deputy Staff Director
Renae Black, Senior Counsel
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SUBCOMMITTEE ON TRANSPORTATION AND SAFETY
DEB FISCHER, Nebraska, Chairman TAMMY DUCKWORTH, Illinois, Ranking
JOHN THUNE, South Dakota AMY KLOBUCHAR, Minnesota
ROY BLUNT, Missouri RICHARD BLUMENTHAL, Connecticut
JERRY MORAN, Kansas EDWARD MARKEY, Massachusetts
CORY GARDNER, Colorado TOM UDALL, New Mexico
SHELLEY MOORE CAPITO, West Virginia GARY PETERS, Michigan
TODD YOUNG, Indiana TAMMY BALDWIN, Wisconsin
RICK SCOTT, Florida
C O N T E N T S
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Page
Hearing held on December 10, 2020................................ 1
Statement of Senator Fischer..................................... 1
Letter dated December 10, 2020 to Hon. Deb Fischer and Hon.
Tammy Duckworth from Pete Slone, Senior Vice President,
Public Affairs, McKesson Corporation....................... 39
Statement from Shawn Seamans, President, RxCrossroads,
Executive Sponsor Enterprise COVID Vaccine Program,
McKesson Corporation....................................... 40
Letter dated December 8, 2020 to Hon. Deb Fischer and Hon.
Tammy Duckworth from Anne Reinke, President and CEO,
Transportation Intermediaries Association.................. 42
Letter dated December 9, 2020 to Hon. Deb Fischer and Hon.
Tammy Duckworth from Advocates for Highway and Auto Safety,
Citizens for Reliable and Safe Highways, Consumer
Federation of America, Consumers for Auto Reliability and
Safety, KidsAndCars.org, National Consumers League, Parents
Against Tired Truckers, Public Citizen, Trauma Foundation,
and Truck Safety Coalition................................. 43
Article dated December 1, 2020 by Thomas Pallini from the
Business Insider entitled, ``How United Airlines overcame
one of the largest limitations to transporting Pfizer's
COVID-19 vaccine to the US''............................... 45
Letter dated December 9, 2020 to Hon. Roger Wicker, Hon.
Maria Cantwell, Hon. Deb Fischer and Hon. Tammy Duckworth
from Joseph G. DePete, President, Air Line Pilots
Association, International................................. 46
Statement of Senator Duckworth................................... 2
Statement of Senator Wicker...................................... 4
Statement of Senator Klobuchar................................... 19
Statement of Senator Thune....................................... 22
Statement of Senator Peters...................................... 24
Statement of Senator Capito...................................... 25
Statement of Senator Baldwin..................................... 28
Statement of Senator Tester...................................... 30
Statement of Senator Blumenthal.................................. 33
Statement of Senator Cantwell.................................... 37
Witnesses
Rachel L. Levine, MD, Secretary and State Health Official,
Pennsylvania Department of Health; and President, Association
of State and Territorial Health Officials...................... 5
Prepared statement........................................... 7
Richard W. Smith, Regional President, Americas and Executive Vice
President, Global Support, FedEx Express....................... 11
Prepared statement........................................... 13
Wesley Wheeler, President, Global Healthcare, United Parcel
Service........................................................ 14
Prepared statement........................................... 16
Appendix
Response to written questions submitted to Rachel L. Levine, MD
by:
Hon. Dan Sullivan............................................ 49
Hon. Maria Cantwell.......................................... 50
Hon. Tammy Duckworth......................................... 52
Hon. Gary Peters............................................. 52
Hon. Kyrsten Sinema.......................................... 53
Response to written questions submitted to Richard W. Smith by:
Hon. Dan Sullivan............................................ 53
Hon. Rick Scott.............................................. 54
Hon. Maria Cantwell.......................................... 54
Hon. Jon Tester.............................................. 55
Hon. Gary Peters............................................. 56
Hon. Kyrsten Sinema.......................................... 56
Response to written questions submitted to Wesley Wheeler by:
Hon. Maria Cantwell.......................................... 57
Hon. Jon Tester.............................................. 57
Hon. Gary Peters............................................. 58
Hon. Kyrsten Sinema.......................................... 58
THE LOGISTICS OF TRANSPORTING
A COVID-19 VACCINE
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THURSDAY, DECEMBER 10, 2020
U.S. Senate,
Subcommittee on Transportation and Safety,
Committee on Commerce, Science, and Transportation,
Washington, DC.
The Subcommittee met, pursuant to notice, at 9:31 a.m., in
room SR-253, Russell Senate Office Building, Hon. Deb Fischer,
Chairman of the Subcommittee, presiding.
Present: Senators Fischer [presiding], Wicker, Thune,
Capito, Duckworth, Cantwell, Klobuchar, Blumenthal, Peters,
Baldwin, and Tester.
OPENING STATEMENT OF HON. DEB FISCHER,
U.S. SENATOR FROM NEBRASKA
Senator Fischer. The hearing will come to order. Good
morning. I am pleased to convene today's hearing as Chairman of
the Senate Subcommittee on Transportation and Safety.
Since the beginning of the pandemic, over 280,000 of our
family members, friends, and fellow citizens have died from
COVID-19. Many more have had the disease and, in some cases,
with severe symptoms and potential long-term impacts. Even more
have felt the economic impacts, either through losing a job,
facing shorter work hours, or being forced to close businesses.
And all of us have adjusted to what we modestly call a new
normal, which has kept us apart from family, friends, and
colleagues. It has kept us from celebrating holidays together,
engaging in our favorite pastimes, and enjoying each other's
company in person.
So when we all heard news that vaccines may soon be
available, we were impressed with the science and the hard work
that went into developing them and relieved that we may be
nearing the beginning of the end to this pandemic. We must all
remember that until vaccines are widely available and people
are vaccinated, we need to continue to wear masks, social
distance, and wash our hands.
Once the vaccines are vetted and approved, we will again
rely on the transportation sector, as we have throughout this
year, to complete what has been one of the biggest logistics
challenges in recent history. Today, we have an opportunity to
hear about the ongoing preparation to ensure the quick, safe,
and efficient transportation of a vaccine to its destination--
from the manufacturer to State-designated providers.
First, I want to thank the administration, Operation Warp
Speed, participating agencies, scientists, and vaccine
manufacturers for all of their dedication and ingenuity to
getting us where we are today. We must also remember all of the
frontline workers who have given so much this past year.
The CDC says its goal is for everyone who wants to get a
vaccine to be able to get one as soon as possible. HHS and DOD,
as part of Operation Warp Speed, aim to procure and assemble
enough supply kits to support administering 660 million vaccine
doses. UPS and FedEx will play a critical role in ensuring
these vaccines are delivered to providers identified by the
states. States will then ensure the vaccine is either
administered or redistributed, as necessary.
Each of the witnesses here today will provide insight into
the planning that has already gone into transporting and
distributing a vaccine, the anticipated challenges, and what
Congress and the public should expect from this process.
One of the more notable challenges will be maintaining the
cold chain, meaning that the vaccine does not experience a
warmer temperature during transportation and storage than it
can handle without spoilage. The Pfizer vaccine must be kept at
-70 degrees Celsius, or -94 degrees Fahrenheit. The Moderna
vaccine must be maintained at -20 degrees Celsius, or -4
degrees Fahrenheit. We want to hear about the transportation
network's capacity to ship a vaccine.
More people were already using e-commerce as a result of
the pandemic, and even more will want to ship gifts for the
holidays. So how will the vaccine transportation fit into this
demand for shipping?
We also want to know if the witnesses have the necessary
Federal guidance and resources to transport the vaccine,
particularly following the Department of Transportation's
notice last week that the necessary guidance and waivers were
in place for the vaccine transport.
Finally, we want to hear about near-and long-term plans to
transport an increasing number of vaccine doses through the
spring and summer of 2021.
I look forward to your testimony, and I would now like to
invite my colleague and the Ranking Member, Senator Duckworth,
to offer her opening remarks. And I believe Senator Duckworth
is speaking to us remotely.
STATEMENT OF HON. TAMMY DUCKWORTH,
U.S. SENATOR FROM ILLINOIS
Senator Duckworth. Thank you, Madam Chair. Thank you for
holding this very important hearing. As this is likely our last
subcommittee hearing of the 116th Congress, I want to take a
moment to thank you for your leadership and for your
partnership in working with me to address pressing
transportation and safety issues that are facing our Nation.
In our very first meeting as Chair and Ranking Member in
early 2019, we discussed issues of mutual interest and agreed
to work collaboratively on critical legislative matters, such
as passing a bipartisan pipeline safety reauthorization, and
today, we are extremely close to finalizing that important
safety legislation. I hope we are able to complete that journey
with our House counterparts over the next few days.
Luck has been in short supply for so many this year, but
should we both be fortunate to find ourselves in these seats
again in the 117th Congress, I look forward to continuing our
productive, bipartisan collaboration.
And to our witnesses, thank you for your participation
today. Unfortunately, millions of our friends and neighbors are
grieving the loss of a family member or loved one this holiday
season. This tragedy has been repeatedly exacerbated by
President Trump's refusal to take this pandemic seriously.
To say that I am disappointed with the President's
coronavirus response is a depressing understatement of epic
proportions. From the onset of COVID-19, the President has
renounced his responsibilities and abandoned logic, civility,
and expert advice, while prioritizing self-promotion and blame
shifting. But for the hard work of many dedicated career public
servants, health officials, and frontline workers, COVID-19 may
very well have stolen twice as many American lives than the
more than 290,000 souls who have already perished.
If committee staff could please bring up the graphic. In
October, the President once again dismissed the pandemic as a
media hoax by suggesting that after Election Day, and if you
look at this graphic, I quote, ``We won't be hearing much about
it anymore.'' Well, Mr. President, since Election Day, an
additional 55,000 Americans have died, and COVID-19 infections
and hospitalizations have spiked to record highs across this
Nation.
In the past week and a half, the President has held
potential super spreader holiday parties at the White House,
despite the advice of his own health experts. He has held a
self-congratulatory vaccine summit and issued an executive
order so meaningless that he did not even bother to inform the
top scientists for Operation Warp Speed.
As is often the case with this administration, others must
plan, others must prepare, and others must implement, in the
absence of Presidential leadership. Fortunately, industry
appears confident, particularly FedEx and UPS, that they
already operate a massive logistics network capable of
distributing all types of vaccines nationwide.
Perhaps most importantly, the shippers testifying before us
today appear to be confident that their respective network of
freezers that already exists for transporting perishables,
medical goods, and supplies will be up to the task of safely
shipping vaccines. Of course, this subcommittee does not exist
to simply accept confident predictions at face value. After
all, in 2020, it is prudent to prepare for and expect things to
go terribly wrong.
Accordingly, I hope today we will learn more about what
evidence underlies the confidence of our witnesses. Have
shippers stress-tested their capacity to handle the massive
holiday shipping boom and the distribution of a lifesaving
vaccine, or multiple vaccines with different storage
requirements, for example? Have companies taken the steps to
proactively secure supplies, like dry ice, in anticipation of
shortages resulting from a spike in global demand?
While the President has undermined America's scientists,
public health experts, and logistics professionals at every
turn, our longstanding history of public-private partnerships
and developing medical countermeasures has enabled us to
develop vaccines in record time. Until the Oval Office returns
next month to patient and practiced hands, our Nation is
depending on the private sector and State and local governments
to execute what may be one of the most complex logistical
challenges our country has ever faced.
This won't be easy. Our country has lost significant
ground. However, I am cautiously optimistic about the outcome
because of actions taken thus far by many public and private
sector stakeholders to develop and implement a strategic road
map needed to ensure the safe, efficient, and equitable
distribution of vaccines to Americans as quickly as possible.
Again, thank you to our witnesses for participating. Thank
you, Madam Chair, for holding today's hearing.
I am going to be turning off my camera because, as you can
see, I am at home. I am doing my daughter's distance education,
and it is a little crazy here. Nobody needs to see this. But
thank you, everyone, and I look forward to today's hearing.
Senator Fischer. Thank you, Senator Duckworth. It has been
a pleasure to work with you on the issues that we agree with
each other on, and it is always a joy to be able to work out
differences, so that we can pass good legislation for the
people of this country. Thank you, Senator.
Next, I would like to recognize Senator Roger Wicker.
Chairman Wicker, you are recognized for an opening statement. I
believe you are also at a remote location.
STATEMENT OF HON. ROGER WICKER,
U.S. SENATOR FROM MISSISSIPPI
The Chairman. Right. I am at a remote location in the
Dirksen Building. Can you hear me, Madam Chair?
Senator Fischer. I can. I see you are in your office, sir.
Good to see you.
The Chairman. OK. And my office does not compare to Senator
Duckworth's kitchen--hers is much--her location is much neater
and tidier than my desk, but here we are. And thank you,
Senator Fischer, for your leadership and holding this hearing.
I just checked. We just hit over 290,000 deaths in the
United States because of the COVID-19 pandemic, and that is--it
is tragic in every way. But really, today is a day of good
news. I anticipate the FDA will give approval today to one of
the vaccines. I certainly hope so.
And also, it is just a time to celebrate the great success
of Operation Warp Speed. It is breathtaking how our scientists
have really exceeded expectations and performed miracles. And
here we are, where vaccines are now being given globally and
will soon be given in the United States. So there is good news
amidst the tragedy.
Today's hearing will inform the Committee about the
logistics of distributing the vaccines across the country.
These newly developed vaccines were produced at record pace
because of Operation Warp Speed, a public-private partnership
devised by the Trump administration. There is just no way
around that. Congress passed legislation to invest in this. It
has been bipartisan, and it makes me feel good, as an American
and as a member of the U.S. Senate and a member of this
committee.
Efforts to ship and deliver vaccines will begin
immediately, once the FDA issues emergency authorization. So we
will be looking for news today. Our Nation's transportation
network has been critical in helping sustain our economy during
this pandemic, and it will be just as critical in enabling us
to defeat the virus in the months ahead. I know there is much
left to do, but we are turning the corner. And as we turn the
page on a new year, I think things are really looking up, and
thank goodness for that.
I look forward to hearing today from our witnesses about
their roles in ensuring the vaccines are distributed safely and
efficiently. We will be asking about adequate communication
between Federal, State, and local officials
[inaudible] vaccines with the rest of what we are looking
for, and then we will be wanting to hear from witnesses about
any cyber threats that we might have.
So thank you very much. Glad to be part of this. Thank you
much to our witnesses, and I yield back to you, Madam Chair.
Senator Fischer. Thank you, Chairman Wicker.
Next, I would like to introduce our witnesses for their
opening statements. Let us begin with Dr. Rachel Levine,
Secretary of Health for the Commonwealth of Pennsylvania. Dr.
Levine is also here today as President of the Association of
State and Territorial Health Officials.
Welcome, Dr. Levine.
STATEMENT OF RACHEL L. LEVINE, MD, SECRETARY AND STATE HEALTH
OFFICIAL, PENNSYLVANIA DEPARTMENT OF HEALTH; AND PRESIDENT,
ASSOCIATION OF STATE AND TERRITORIAL HEALTH OFFICIALS
Dr. Levine. Well, good morning. Thank you very much.
And so, I would like to thank Chairman Senator Wicker,
Ranking Member Senator Cantwell, Subcommittee Chair Senator
Fischer, Subcommittee Ranking Member Senator Duckworth, and all
of the distinguished members of the Senate Commerce, Science,
and Transportation Committee for the opportunity to appear
before you to discuss the challenges facing states like
Pennsylvania due to the COVID-19 pandemic.
As you kindly stated, my name is Dr. Rachel Levine. I am
the Secretary of Health for the Commonwealth of Pennsylvania,
and I am currently the President of the Association of State
and Territorial Health Officials. I joined the Wolf
administration in January 2015, after approximately 20 years at
the Penn State Hershey Medical Center and Penn State College of
Medicine. As the Physician General of the Commonwealth, I was
named Acting Secretary in July 2017 and then confirmed in 2018.
During this time, public health preparedness has always
been one of my absolute priorities. And what I would always say
is the thing that would keep me up at night would be the risk
of a global pandemic, or what the CDC has called Disease X, and
unfortunately, that has come to pass.
From a public health perspective, there are three ways to
address a pandemic such as COVID-19. You can work on
containment, which includes testing and contact tracing, with
appropriate isolation and quarantine. You can work on
mitigation, such as wearing a mask, washing your hands, social
distancing, avoiding large and small gatherings, and other
necessary mitigation factors that have been implemented by
states. And then, there is a vaccination. We continue to apply
containment, mitigation measures to control the spread of
COVID-19, and we have seen success, and we have seen
challenges. But as has been mentioned, the only way to truly
end this pandemic is through widespread vaccination, and this
will be our biggest challenge yet.
As has been stated, there are two vaccines currently that
we anticipate will be available in the next several weeks, the
Pfizer vaccine and the Moderna vaccine. And I also applaud the
success of Operation Warp Speed in terms of the development of
these vaccines. These are two vaccines based on novel
technology using genetic material called messenger RNA to
induce an immune response. It has never been done before. It is
really a tremendous achievement.
Each vaccine needs different methods of containment,
transportation, and distribution. In Pennsylvania, we have
collaborated with public health officials from across the
country to solve these logistical challenges. However, the
challenges of this essential mission do go beyond getting the
vaccine from point A to point B.
We are facing challenges in coordination and in
communication in such a massive mission between Federal, State,
and local health agencies. We are facing challenges--and I must
say that states had little or no involvement in any key policy
decisions or discussions. We are facing challenge in terms of
the development of a coordinated communication strategy to
promote confidence in the public in the safety and efficacy of
the COVID-19 vaccines and to be able to counter vaccine
hesitancy. And finally, we are facing challenges in finding
sufficient funding to execute a timely, comprehensive, and
equitable vaccine campaign over the long haul.
But despite this, we are confident in our ability to carry
out this mission because running vaccination programs is really
fundamental to our work in public health. We do have experience
in vaccinations, and we have detailed plans to meet the
challenge of this historic moment.
But I emphasize this will not be a short-term operation,
and the $300 million allocated to states, territories, and big
cities is simply insufficient. If you break it down, there are
about 330 million people in the United States. So that is a
little over $1 per person in the United States to mount an
immunization enterprise that is unparalleled in scale and
complication, and it is insufficient.
The Association of State and Territorial Health Officials,
of which I am President, has partnered with the Association for
Immunization Managers, and we are requesting that Congress
provide $8.4 billion in emergency supplemental funding for this
ongoing mass vaccination campaign. That will include funding
for work force, for infrastructure, for outreach to priority
populations, communications, and educational efforts to
increase vaccine confidence and combat misinformation.
At the Pennsylvania Department of Health, our vision is a
healthy Pennsylvania for all, and we are laser focused in
moving toward that mission and ensuring all people have access
to the COVID-19 vaccines. I am so proud of the immense public
health work we have done in Pennsylvania, and across the
country, that has worked to slow the spread of this virus and
save lives. But one thing this pandemic has reinforced is the
need for continued investment in public health and place a
spotlight on the need for additional funding to support our
efforts to vaccinate the entire country to bring this pandemic
under control.
Thank you so much for the opportunity to offer this
testimony and for all of your partnership, and I am pleased to
answer any questions.
[The prepared statement of Dr. Levine follows:]
Prepared Statement of Rachel L. Levine, MD, Secretary and State Health
Official, Pennsylvania Department of Health; and President, Association
of State and Territorial Health Officials
Chairman Wicker, Ranking Member Cantwell, Subcommittee Chair
Fischer, and Subcommittee Ranking Member Duckworth and distinguished
committee members of the Senate Commerce, Science, and Transportation
Committee, thank you for the opportunity to appear before the committee
today to discuss the challenges presented by the biggest public health
crisis facing this country in the last century, the COVID-19 pandemic.
As the United States experiences an exponential increase in new
infections of COVID-19 nationwide, we must redouble our efforts to
combat the pandemic through a comprehensive and multi-faceted approach.
As public health officials and indeed as a nation we have and must
continue to apply strong containment and mitigation efforts to combat
the virus. These efforts include but are not limited to case
investigation, contact tracing, capacity and event limits, encouraging
mask usage, and more.
The introduction of safe and effective COVID-19 vaccines will be a
critical tool to combat the rampant viral spread in the United States.
However, distributing the COVID-19 vaccine along with administrating it
is a herculean effort, one that our Nation has never experienced.
Currently, there are two vaccines under consideration by the Food and
Drug Administration (FDA) for an Emergency Use Authorization (EUA); and
most likely to be the first product that states receive, is the Pfizer
vaccine which requires ultra-cold storage capacity and ships quantities
of 975 doses that cannot be broken down into smaller allotments. The
second product likely to receive an EUA is from Moderna. The Moderna
vaccine does not have the same logistical constraints that Pfizer's
product requires. The Moderna vaccine can be stored and handled much
like other vaccines that providers use daily.
While we along with public health officials throughout the country
spent countless hours preparing this mission is fraught with
significant challenges that go well beyond just transporting the
vaccine from point a to point b. The challenges to this effort include
sufficient funding to rapidly execute a timely, comprehensive, and
equitable vaccination campaign; coordination and communication between
federal, state, and local health agencies; minimal state or local
governmental public health pre-decisional involvement in key policy
decisions such as the use of private sector pharmacy providers,
including chain pharmacies, by the Federal government to administer
vaccines, all confounded by the lack of a coordinated communication
strategy to promote confidence in the safety and efficacy of COVID-19
vaccines.
At the Pennsylvania Department of Health, our vision is a healthy
Pennsylvania for all. Right now, we are laser focused in moving towards
that vision by ensuring all people have access to the lifesaving COVID-
19 vaccinations. It will take very careful orchestration to get the
right vaccine into the right arm at the right time. However,
Pennsylvania, and many other of my state health official colleagues are
committed to this task. Running vaccination programs is foundational to
our work in public health. We learned a lot through our collective
experience during H1N1 and we have detailed plans to meet the challenge
of this historic moment; however it will take a comprehensive national
approach to ensure its success, making coordinated adjustments along
the way, and bring an end to the pandemic.
Pennsylvania is a large and geographically diverse state with
population density varying from fewer than 15.0 people per square mile
in our most rural counties to 64,263.1 people per square mile in our
most urban counties, according to the 2010 U.S. Census.\1\
Additionally, there are about 250 hospitals across the Commonwealth
that vary in size from small critical access hospitals to health
systems offering quaternary care. These geographic, resource, and
jurisdictional issues present unique challenges and planning
considerations to our statewide COVID-19 vaccine distribution efforts.
These challenges are not only presented in Pennsylvania, but across the
Nation's states and territories.
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\1\ 2010 Census: Pennsylvania Profile https://www2.census.gov/geo/
maps/dc10_thematic/2010
_Profile/2010_Profile_Map_Pennsylvania.pdf.
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COVID-19 Vaccine Logistics
The logistics of the vaccine distribution are complicated and the
degree of coordination among federal, state, and local levels of
government (and commercial and nonprofit entities) required for this
enormous undertaking is unprecedented. The direction and pace of each
state's vaccine distribution plan is determined by the individual
jurisdictional characteristics, vaccine type, amount, and availability.
Transport of COVID-19 vaccines to the states will be the sole
responsibility of Operation Warp Speed (OWS), and the Centers for
Disease Control and Prevention (CDC) in partnership with federal,
state, local, tribal and territorial health departments. The Pfizer
vaccine, which requires ultracold storage, will be delivered directly
from Pfizer, as arranged by OWS, to pre-identified large health systems
with existing ultracold storage capabilities. Other vaccines, including
Moderna, will be distributed to states through McKesson Distribution.
Proper, swift, and reliable transportation, of not only the vaccine but
the ancillary supplies that are needed to provide the vaccination, will
be absolutely key in getting COVID 19 vaccines into the hands of
providers standing ready to administer the vaccine.
Given the differences in the logistical requirements of the Pfizer
and Moderna vaccines and the anticipated limited supply of vaccine in
the early months of the vaccination efforts, each state and local
department have had to develop plans taking into account their own
jurisdictional characteristics (geography, storage capabilities, among
others) and healthcare system capability to develop a strategy to most
effectively use the two vaccine products as they become available. Due
to the less than optimal logistical constraints of the Pfizer vaccine,
Pennsylvania intends to direct the Pfizer vaccine to go to large health
systems that have ultracold storage capacity and the ability to
vaccinate many adults in a short period of time meeting the storage and
administration requirements. Pennsylvania intends to use the Moderna
product in more rural settings (hospitals and providers) who may not
have the ability to store an ultracold vaccine and may have smaller
numbers of staff and patients to vaccine at once.
In addition to the complexities around transportation and storage
of both vaccines, each vaccine requires a second does in a specific
timeframe. At this time, both vaccines have been shown to have some
side-effects which may prompt some people to be more hesitant to
receive a second dose. Disadvantaged and marginalized communities will
face more hurdles to achieve their access to care.
States and territorial public health departments are responsible
for identifying the health systems, hospitals, and providers to receive
vaccines and coordinating with CVS and Walgreens regarding their access
to long term care facilities.
COVID-19 vaccine providers are required to sign a specific provider
agreement; which notes that the site is responsible for documentation,
storage, and administration of the COVID-19 vaccine. The sites are also
responsible for security of the vaccine while in their possession. Any
additional transferring or moving of vaccine is at the discretion of
the facility as long as the provider agreement is being adhered to.
Like most states, Pennsylvania's COVID-19 vaccine plan is broken
into three phases, with Phase 1 divided to protect the highest risk or
most critical workforce. In Phase 1a, when limited doses are expected
initially, Pennsylvania will align with the recommendation of the
Centers for Disease Control and Prevention's Advisory Committee on
Immunization Practices in identifying the priority populations of
health care personnel in hospitals and skilled nursing facilities and
residents of skilled nursing facilities as the first groups to be
vaccinated.
Ten large health systems distributed across the Commonwealth will
be responsible for immunizing their providers, as well as providers
from nearby hospitals. Pennsylvania has opted into the Pharmacy
Partnership with CVS and Walgreens. Under this partnership, those
organizations will send personnel into skilled nursing and assisted
living facilities and personal care homes to vaccinate residents and
staff.
Phase 1b will include health care personnel who were not vaccinated
in 1a and utilize partnerships with pharmacies and Federally Qualified
Health Centers to reach our rural settings. Additionally, the Emergency
Management agencies located in each of the 66 counties will be
essential in coordinating community-based vaccination in those
counties.
At the same time, Pennsylvania will shift focus to other congregate
settings, correctional facilities, businesses, critical workers,
colleges, and universities. This will be done through partnerships and
unprecedented collaboration with providers and pharmacies who know
their communities best.
In late spring or early summer, we will hold mass vaccination
clinics in communities across the Commonwealth to ensure accessibility
to all who desire to be immunized. Pennsylvania specifically focused
our COVID-19 vaccine plan with deliberate intent to reach individuals
of rural, ethnic, religious, homeless, differently abled, immigrant,
refugee and LBGTQ populations. These efforts will be executed in close
partnership with our Office of Heath Equity and already established
community partners through our COVID-19 testing initiatives.
Health Equity
As with other communicable and chronic diseases, COVID-19 has
disproportionately impacted communities of color, people living with
disabilities, and those living in rural and frontier areas. Immediate
policy changes that support investments in social and environmental
health factors and address these disparities head on are needed to
reduce COVID-19 illness and death in all populations, especially in
communities of color, settings where individuals with disabilities live
and rural and frontier communities. This focus on equitable access to
the COVID-19 vaccine and addressing health disparities is a key tenet
of Governor Wolf's administration. Pennsylvania's COVID-19 vaccine plan
was developed through a departmental health equity lens, heavily
influenced by the Secretary's Vaccine Crisis Committee, a group of
hospital specialists including vaccinology, gerontology, and medical
ethics, as well as representation from the pharmacist association,
federally qualified health centers, business, and aging, which
developed our ethical allocation strategy, and was informed by our
departmental Health Equity Workgroup.
When we talk about vaccinating ``healthcare workers,'' we're not
just talking about physicians and nurses. We intend to prioritize all
personnel who work in healthcare settings in that top tier of need for
early vaccination. This includes all paid and unpaid persons serving in
healthcare settings who have potential for direct or indirect exposure
to patients or infectious material. These healthcare workers could
include emergency medical service personnel, nurses, nursing
assistants, students and trainees, environmental services, laundry, and
volunteer personnel.
Communications
According to a recent poll conducted by the Kaiser Family
Foundation, the share of adults who trust CDC to provide reliable
information has decreased by 16 percent since April.1 Moreover, public
health experts and institutions have been attacked, threatened, and
intimated by the public. To date, there has been little clarity on a
CDC and HHS plan to raise public confidence in COVID-19 vaccine safety.
We believe this communications strategy is imperative and must be
tailored state-by-state to address our Nation's diversity, as well as
local concerns that may not apply nationwide. This pandemic has
reinforced the value of consistent and coordinated communication
between the Federal government, state and territorial government
entities, and stakeholders. In this case, it is key for state
government entities to have a clear understanding of their anticipated
vaccine allotments, and the absence of that information can and has
presented challenges in vaccine planning operations and logistics. It
is important to emphasize that distribution including transportation of
the COVID-19 vaccine is just one component of this mission.
The incoming administration should execute a robust communications
strategy across the entire Federal government, and ``flow down''
throughout all levels, including state, local, and tribal governments.
A robust scientific evidence base should be utilized devoid of
political interference. This communications strategy ensures a unified
approach to combatting COVID-19 without sending confusing mixed
messages. Communications about COVID-19 should leverage the expertise
of local leadership, celebrities, and businesses to target hard-to
reach-populations. The information should be shared in a culturally
competent way for multiple audiences
Among all Pennsylvanians and especially with our underserved
communities, appropriate and effective communication strategies will be
vital. We have been working hard to deliver key health messages related
to prevention of COVID-19 and increase access to testing to all
Pennsylvanians through multiple channels. We have been relying on
community partners on COVID-19 education and testing access and will be
leveraging those relationships when the time is available to do
community-based vaccinations.
There is a baseline level of governmental distrust among
Pennsylvanians, and a historic national distrust of the medical
enterprise among our black and indigenous people of color that could
significantly negatively impact vaccine uptake in the Commonwealth.
Combatting this vaccine hesitancy and building trust in these
communities a is a cornerstone of the Commonwealth's vaccine plan. In
addition, given the unprecedented speed these vaccines have gone from
concept to production has caused a level of distrust among the American
people that will need to be addressed with accessible, actionable, and
coordinated messaging. My communications team, along with other state's
communications teams, have a host of creative ideas and concepts they
would love to bring to fruition.
Challenges
Unfortunately, states and territories do not have the adequate
funding to support communication campaigns to promote the safe and
effective vaccines, recruit and train the necessary workforce to reach
communities of color and other vulnerable populations, stand up
federally supported supplemental vaccination sites and promote new
strategies for mass vaccination, enhance existing public health
infrastructure and strengthen vaccine confidence. The $340 million
allocated for states, territories and big cities to date is simply not
enough. If you break it down, that's about $1 per American to mount an
immunization enterprise that is unparalleled in scale and complication.
The Association of State and Territorial Health Officials along with
our partners at the Association for Immunization Managers are
requesting that Congress provide $8.4 billion in emergency supplemental
funding for a mass vaccination campaign which will include funding for
workforce, infrastructure, cold supply chain management and outreach to
priority populations, communications, and educational efforts to
increase vaccine confidence and combat misinformation.
This will not be a short-term operation. We expect this operation
will take months to vaccinate all the citizens across the states and
territories. This task will be undertaken by a public health and
healthcare system that is already strained and stressed by the current
and ongoing response to COVID-19. The resource challenges--monetary and
personnel--are enormous. Although vaccination will be accomplished
through many healthcare partnerships; states and territories understand
that some portion of this will fall on public health and public health
nurses, who are already overtasked with case investigation and general
public health response. The public health infrastructure and investment
in this country has been systematically stripped away over decades.
What we have seen is that this pandemic has revealed the devastating
impacts of that reality, along with the disconnect between public
health and medicine.
In recent mock shipments of vaccine to train and test the
transportation/logistics planning that has been done by OWS, there have
been varying levels of success. While the authorization of a vaccine,
is a great step towards the ending the pandemic, it is critical that
vaccine and ancillary supplies arrive in a timely manner to the
appropriate location. In approximately \1/4\ of states, at least one
significant issue arose during the mock shipment that requires
attention prior to shipping actual vaccine. States experienced vaccine
arrivals with a 2-day lag in the arrival of ancillary supplies. Vaccine
that arrives without the ancillary supplies required to administer it
will delay the vaccination of key prioritized populations.
Lastly, following a successful rollout of vaccination, states and
territories will need to continue to work with CDC, Health and Human
Services (HHS), and Centers for Medicare and Medicaid Services (CMS) as
to how the vaccination will impact those who have already had COVID,
and how this will impact CMS guidance on frequency of staff and
resident testing which are real operational and funding initiatives
that we would be better able to plan for if we understand where things
are going. Continuing these multi-level discussions will be key to a
coordinated nationwide plan.
Conclusion
Despite these challenges I outlined today, I am proud of the
immense amount of public health work that have led in the mitigation
and containment of the virus not only in Pennsylvania, but throughout
the Nation. This pandemic has reinforced the need for investment in
public health, collaboration among public and private partnerships, and
public health education.
There is a grave need for additional funding to support additional
personnel and the creation of an impactful communication campaign to
ensure that we can achieve the life-saving goal of vaccinating everyone
who wants it in order to bring the COVID-19 pandemic under control.
Thank you for the opportunity to offer this testimony and for all
your partnership. I am pleased to take any questions you may have.
Senator Fischer. Thank you, Dr. Levine.
Next, I would like to introduce Richard Smith. Mr. Smith is
the Regional President of the Americas and Executive Vice
President of Global Support for FedEx Express. In this role, he
oversees operations in the United States domestic market,
Canada, Latin America, and the Caribbean. Welcome.
STATEMENT OF RICHARD W. SMITH, REGIONAL PRESIDENT, AMERICAS AND
EXECUTIVE VICE PRESIDENT, GLOBAL
SUPPORT, FEDEX EXPRESS
Mr. Smith. Thank you. Chairman Fischer, Ranking Member
Duckworth, and members of the Committee, thank you for inviting
me, representing FedEx and UPS, here today to speak about our
efforts to support the upcoming distribution of vaccines to
combat the spread of COVID-19. We recognize that this is
complex and critical work and appreciate the Subcommittee's
focus on this mission.
Before I begin, I would like to express my sincere
appreciation for the courageous work of our more than 600,000
FedEx Global team members who have been on the front lines
since the start of this pandemic, providing essential
transportation services and keeping critical supply chains
moving. As a result of their dedication and commitment to the
communities we serve, we have delivered over 2 billion face and
surgical masks, 55 kilotons of personal protective equipment,
and over 9,600 discrete humanitarian aid shipments to support
the global response to COVID-19, to date.
Earlier this year, when the pandemic reached the United
States, we worked quickly to support over 40 community testing
sites, spanning across 10 states, delivering test kits and
samples for analysis. I am very proud of the significant,
positive impact the FedEx team's work has had on the response
to this pandemic and will continue to have as we enter this
next critical phase. I am grateful for and humbled by their
continued, unrelenting commitment to service, which we refer to
at FedEx as ``delivering the Purple Promise.''
Forty-seven years ago, FedEx was created for the exact
purpose and service required for today's mission--fast,
reliable delivery of time-sensitive, high-priority goods. As
the largest global express transportation provider, FedEx has
an unparalleled worldwide network serving over 220 countries
and territories, connecting more than 99 percent of the world's
gross domestic product. Within the United States, we can
deliver to every zip code. With the largest fleet of cargo
airplanes, over 670, and over 180,000 motorized ground
vehicles, we deliver more than 17 million packages on an
average day.
Every day at FedEx, we focus on what we can control and
prepare for the things we cannot. We invest in our team members
and innovative technologies, all in preparation to serve the
needs of our customers and communities. FedEx has a long
history of supporting critical relief efforts around the world,
and we are ready for the challenge ahead.
For the past several months, we have been working closely
with our healthcare customers, both the vaccine manufacturers
and distributors, as well as the Federal Government on vaccine
distribution plans. We have years of experience in this area,
shipping flu vaccines every flu season and moving vaccines
globally for decades, as well as transporting over 80 million
vaccine doses to combat H1N1 in 2009.
We also regularly carry vaccines for commercial and
government organizations, both domestic and international. Our
healthcare team has been able to leverage this experience, flex
our comprehensive network, and work with various stakeholders
to build customized solutions to achieve our collective goal--
moving COVID-19 vaccine shipments as safely, securely, and
quickly as possible. This is who we are and what we do.
Once the vaccines are approved and ready for distribution,
vaccine and related healthcare shipments will be the top
priority for FedEx Express' network. Our Priority Alert team
will actively monitor and track vaccine shipments for our
healthcare customers using a suite of advanced tracking and
monitoring tools, including SenseAware ID, which uses FedEx
patented technology, as well as our FedEx Surround platform,
providing predictive analytics. These technologies provide
increased visibility and real-time updates on sensitive
packages, enabling us to intervene and intercept a shipment, if
necessary. Long ago, we recognized that information about the
package was just as important as the package itself. We
invested in these innovative solutions for this exact purpose.
We have also made significant investments in our cold chain
infrastructure over the years, including our packaging,
aircraft, motorized vehicles, and facilities. At present, we
have more than 90 temp-controlled facilities across 5
continents, with plans to open additional facilities in the
coming years. We are also expanding our network of ultra-low
temperature freezers at some of our major hubs. As demonstrated
by these actions, we have planned for the various contingencies
required for missions like this and are prepared to respond as
needed.
Finally, maintaining the health and safety of our essential
frontline workers will remain our top priority throughout this
effort. To date, we have spent over $225 million in personal
protective equipment and cleaning services to keep our
employees safe. We will continue to invest in our employee
health, safety, and monitoring programs, providing safety
equipment, regularly cleaning our facilities, and ensuring that
our employees have access to COVID-19 testing. Their health and
fitness are vital to this effort.
From day one of our operation, FedEx has taken the
necessary steps and is well positioned to respond, both here
and abroad. This concludes my statement. I appreciate your time
today and look forward to answering any questions you may have.
[The prepared statement of Mr. Smith follows:]
Prepared Statement of Richard W. Smith, Regional President, Americas
and Executive Vice President, Global Support, FedEx Express
Chairman Fischer, Ranking Member Duckworth, and Members of the
Committee:
Thank you for inviting me here today to speak about our efforts to
support the upcoming distribution of vaccines to combat the spread of
COVID-19. We recognize that this is complex and critical work and
appreciate the Subcommittee's focus on this mission. Before I begin, I
would like to express my sincere appreciation for the courageous work
of our more than 600,000 FedEx global team members who have been on the
frontlines since the start of this pandemic providing essential
transportation services and keeping critical supply chains moving. As a
result of their dedication and commitment to the communities we serve,
we have delivered over two billion face and surgical masks, 55 kilotons
of personal protective equipment, and over 9,600 humanitarian aid
shipments to support the global response to COVID-19 to date. Earlier
this year when the pandemic reached the United States, we worked
quickly to support over forty community testing sites, spanning across
ten states, delivering test kits and samples for analysis. I am very
proud of the significant, positive impact the FedEx team's work has had
on the response to this pandemic and will continue to have as we enter
this next critical phase. I am grateful for and humbled by their
continued, unrelenting commitment to service, which we refer to at
FedEx as delivering the Purple Promise.
Forty-seven years ago, FedEx was created for the exact purpose and
service required for today's mission: fast, reliable delivery of time-
sensitive, high priority goods. As the largest global express
transportation provider, FedEx has an unparalleled world-wide network
serving over 220 countries and territories, connecting more than 99
percent of the world's gross domestic product. Within the U.S., we can
deliver to every ZIP code. With the largest fleet of cargo airplanes
(over 670), and over 180,000 motorized ground vehicles, we deliver more
than 17 million packages a day. Every day at FedEx, we focus on what we
can control and prepare for the things we cannot. We invest in our team
members and innovative technologies, all in preparation to serve the
needs of our customers and communities. FedEx has a long history of
supporting critical relief efforts around the world and we are ready
for the challenge ahead.
For the past several months, we have been working closely with our
healthcare customers, both the vaccine manufacturers and distributors,
as well as the Centers for Disease Control and Prevention, U.S.
Department of Health and Human Services, U.S. Department of Defense,
U.S. Department of Transportation, and U.S. Department of Homeland
Security on vaccine distribution plans. We have years of experience in
this area, shipping flu vaccines every flu season and moving vaccines
globally for decades, as well as transporting over 80 million vaccine
doses to combat H1N1 in 2009. We also regularly carry vaccines for
commercial and government organizations, both domestic and
international, including Defense Logistics Agency Troop Support and
Logistics Health, a U.S. Army contractor. Our dedicated, experienced
healthcare team has been able to leverage this experience, flex our
comprehensive network, and work with various stakeholders to build
customized solutions to achieve our collective goal: moving COVID-19
vaccine shipments as safely, securely, and quickly as possible. This is
who we are and what we do.
Once the vaccines are approved and ready for distribution, vaccine
and related healthcare shipments will be the top priority for the FedEx
Express network, with support provided by our FedEx Logistics and
Custom Critical teams. Our established FedEx Priority Alert team will
actively monitor and track vaccine shipments for our healthcare
customers using a suite of advanced tracking and monitoring tools to
ensure the integrity of the shipments as they move through the system,
including SenseAware ID (which uses FedEx patented technology), as well
as our FedEx Surround platform. These technologies provide increased
visibility and near realtime updates on sensitive packages. Our FedEx
Priority Alert teams and healthcare customers will have access to this
information, enabling us to intervene and intercept a shipment if
necessary. Long ago, we recognized that information about the package
was just as important as the package itself and invested in these
innovative tracking and monitoring solutions for this exact purpose.
In addition to our tracking and monitoring technologies, we have
made significant investments in our infrastructure over the years to
develop temperature-control solutions throughout the network, including
our packaging, aircraft, motorized vehicles, and facilities. At
present, we have more than 90 cold chain facilities across five
continents, with plans to open additional facilities in the coming
years. In 2016, we opened the Cold Chain Center at our world
headquarters in Memphis, Tennessee, creating over 20,000 square feet
dedicated to temperaturecontrolled storage. This facility incorporates
the latest temperature control solutions, allowing us to maintain
packages at frozen, refrigerated, and room temperatures in the event of
unforeseen delays. We are also expanding our network of ultra-low
temperature freezers, capable of maintaining temperatures as low as -
94+to -112+F. As demonstrated by these investments, we have planned for
the various contingencies required for missions like this and are
prepared to respond as needed.
Finally, maintaining the health and safety of our essential
frontline workers will remain our top priority throughout this effort.
To date, we have invested over $225 million in personal protective
equipment and cleaning services to keep our employees safe. We will
continue to invest in our employee health safety and monitoring
programs, providing the recommended health safety equipment, cleaning
our facilities regularly, and ensuring that our employees have access
to COVID-19 testing, if needed. We encourage our team members to take
any signs of illness seriously and seek medical attention as needed.
Their health and fitness remain vital to this effort and we will follow
and promote the health safety guidance issued by the leading health
organizations to ensure their safety.
As evidenced by the above, from day one of our operation, FedEx has
taken the necessary steps and is well-positioned to respond on a
domestic and global level to events like we currently face. We will
continue to support our healthcare customers throughout this effort,
and work with the various Federal and state agencies as necessary to
ensure a coordinated, safe, secure, and efficient vaccine distribution
effort.
This concludes my statement. I appreciate your time today and look
forward to answering any questions you may have.
Senator Fischer. Thank you, Mr. Smith.
Next, I would like to introduce Wesley Wheeler. Mr. Wheeler
is the President of Global Healthcare at UPS. In this role, he
oversees UPS' work related to pharmaceuticals and medical
device transportation, wholesalers, retail distributors, and
customers of regulated healthcare products. Welcome, sir.
STATEMENT OF WESLEY WHEELER, PRESIDENT, GLOBAL HEALTHCARE,
UNITED PARCEL SERVICE
Mr. Wheeler. Good morning, Chairwoman Fischer, Ranking
Member Duckworth, and members of the Subcommittee. My name is
Wes Wheeler. I am the President of UPS Healthcare, the
company's Healthcare and Life Sciences Division. Thank you for
the opportunity to appear before you this morning and discuss
our involvement in COVID-19.
I will focus my testimony today on our capabilities, our
involvement in Operation Warp Speed, and the solutions we are
implementing to ensure the safe and effective delivery of
vaccines upon approval. I trust that my testimony today will
clarify our involvement, and I look forward to your responses
and questions.
While UPS is known primarily for its brown trucks and
drivers, members of the Subcommittee may not be aware that UPS
is also a longstanding provider of supply chain services for
the many healthcare companies around the world. We handle
medicines in more than 10 million square feet of facilities in
more than 30 countries. Our regulated facilities are designed
to handle biologically derived drugs, such as vaccines, at any
temperature. We also offer end-to-end cold chain transportation
service by air, ground, or ocean, and we deliver, on average,
more than 25 million packages per day.
UPS has been on the front lines of COVID-19, as FedEx has,
since February of this year. We supported FEMA and Project
Airbridge by moving more than 24 million pounds of PPE and
opened up our facilities to the National Strategic Stockpile
Program. We also supported 32 states by distributing millions
of diagnostic test kits and biologic samples for COVID-19.
We are also involved in clinical trials. Our UPS Healthcare
group was proud to be the logistics partner for the Pfizer
COVID-19 vaccine clinical trial. In fact, we are providing
logistics support for 8 of the 10 leading vaccines in clinical
trials today. Our experience with these trials helps us to
prepare for vaccines when they come to market.
UPS is a proud partner of Operation Warp Speed, and we were
delighted to present at the Vaccine Summit this week for the
President, and we are in daily contact at all levels with the
team. And just last week, General Perna and Dr. Slaoui visited
one of our newest healthcare facilities in Louisville,
Kentucky, where we reviewed our supply chain planning and the
preparations we have in place. We discussed how we will handle
ultra-low temperature shipments and, in particular, how our dry
ice replenishment program will be managed. I believe they left
feeling confident with our degree of readiness.
Let me elaborate further on the transportation security and
temperature issues, which I believe the Subcommittee is
interested in. Please understand that UPS has spent many weeks
designing the supply routes and expected data flows for these
vaccines. Capacity has been reserved in our air network, our
operating hubs, and our ground operations. Our 3,000 U.S.-based
pilots will know that they are carrying vaccines. Our trailers
will have escorts.
We will monitor all vaccine shipments in a newly dedicated
24/7 command center, which collects data from all sources
including GPS and temperature monitors. Each package will also
carry a UPS exclusive active tag, which provides visibility in
our network. Command center staff have been trained to monitor
and, if required, intervene and recover a vaccine package. UPS
has also designed software which can detect network disruptions
before they occur.
On the issue of temperature control, UPS has extensive
experience handling shipments at any temperature. However, it
is important to note that in the case of these vaccines, the
temperature in transit will be maintained by its packaging,
which is designed to keep its internal temperature at
temperature for several days. Pfizer and McKesson have chosen
appropriate, validated, and environmentally friendly packaging
for these two vaccines, and we have extensively tested both.
UPS has also invested in dry ice manufacturing capacity for
replenishment at dosing sites, where required. UPS will produce
over 24,000 pounds of dry ice per day in Louisville, and we
will ship 40 pounds of dry ice to all Pfizer dosing locations 1
day after the vaccine arrives. UPS is also nearing completion
of two very large coolers and freezers in the same facility for
storage of future vaccines in the pipeline. And we offer a
program to supply ultra-low temperature freezers for dosing
sites where dry ice may not be available.
We are ready. I would like to take a moment to thank the
thousands of UPSers who are poised and ready to deliver the
greatest contribution to this country we could possibly
imagine. Together, without General Perna and our colleagues at
Operation Warp Speed, none of this would be possible.
Thank you very much, Chairwoman Fischer. I will take your
questions.
[The prepared statement of Mr. Wheeler follows:]
Prepared Statement of Wesley Wheeler, President, Global Healthcare,
United Parcel Service
Good Afternoon Chairwoman Fischer, Ranking Member Duckworth, and
members of the Subcommittee. My name is Wes Wheeler, and I am the
President of UPS Healthcare, the company's healthcare and life sciences
division. Thank you for the opportunity to appear before you to discuss
our involvement in COVID-19 vaccine distribution. I will focus my
testimony on our capabilities, our involvement in Operation Warp Speed
and the solutions we are implementing to ensure the safe and effective
delivery of vaccines upon approval. I trust that my testimony today
will clarify UPS's involvement in this effort and I look forward to
answering your questions.
While UPS is known primarily for its network of brown trucks and
drivers, members of the subcommittee may not be aware that UPS is also
a longstanding provider of supply chain services for many healthcare
companies. We handle regulated medicines in more than 10 million square
feet of facilities in 32 countries. Our temperature controlled
facilities are designed to handle biologically derived drugs such as
vaccines at any temperature. We also offer an end-to-end cold chain
transportation service by air, ground or ocean and we deliver 50,000
shipments per day of lifesaving medicines.
UPS has been at the forefront of the COVID-19 fight since February
of this year. We supported FEMA and Project Air Bridge by moving over
24 million pounds of PPE and we opened up our facilities to the
National Stockpile program. We also supported 32 states in distributing
millions of diagnostic test kits and biologic samples for COVID-19.
We are also involved on the clinical side. UPS Healthcare was proud
to be the logistics partner for Pfizer's COVID-19 vaccine clinical
trial. In fact, we are providing logistics support for eight of the ten
leading vaccines in clinical trials today. Our experience with these
trials is helping us prepare for the vaccines when they come to market.
UPS is proud to be a partner in Operation Warp Speed. We are in
daily contact with each member company and the OWS team itself. Just
last week, General Perna and Dr. Slaoui visited one of our newest
healthcare facilities in Louisville, KY. We reviewed our supply lane
plans and the preparations we have in place with their guidance. We
discussed how we will handle ultra-low temperature shipments and in
particular, how our dry ice replenishment program will be managed. I
believe they left feeling confident with our degree of readiness.
Let me elaborate on the subjects of transportation security and
temperature-controlled shipping, as I understand these are areas of
interest for the subcommittee.
Please understand that UPS has spent many weeks designing the
supply routes and expected data flows for these vaccines. Capacity has
been reserved in our air network, operating hubs and ground operations.
Our pilots and drivers will know they are carrying vaccines. We will
monitor all vaccine shipments in a newly dedicated 24/7 command center
which collects data from all sources including our client's temperature
recorders. Each package will also carry a UPS-exclusive active tag
which provides visibility in our network. Command center staff have
been trained to monitor and, if required, recover any vaccine package.
UPS has also designed software that can detect network disruptions
before they occur, and then recommend counter-measures in real time.
On the issue of temperature control, allow me to correct any
misperceptions about our ability to deliver vaccines at ultra-low
temperatures. UPS has extensive experience with storage and transport
of any material at any temperature. However it is important to note
that, in the case of these vaccines, the temperature-in-transit will be
maintained by its packaging, which is designed to keep its internal
temperature--at temperature--for several days. Pfizer and McKesson have
chosen appropriate, validated and environmentally-friendly packaging
for the first two vaccines, and we have prior experience handling them.
UPS has also invested in dry ice manufacturing capacity for
replenishment at dosing sites where needed. UPS will produce over
24,000 pounds of dry ice per day in our Louisville facility and we will
ship a box with 40 pounds of dry ice to all Pfizer dosing locations a
day after the vaccine arrives. UPS is also nearing completion of very
large coolers and freezers in the same facility for storage of future
vaccines in the pipeline. We have also invested in a `freezer farm' for
-80C storage and we offer a program to supply portable ultra-low
temperature freezers for dosing sites where dry ice may not be
available.
I'd like to take a moment to thank the thousands of UPSers who have
devoted their time and energy into making sure our network is prepared
for the challenges ahead. Without their dedication, none of this would
be possible.
Thank you for the opportunity to testify, and I look forward to
answering your questions.
Senator Fischer. Thank you, Mr. Wheeler, and thank you to
all of our panel.
I would like to begin the first round of questions. Mr.
Wheeler and Mr. Smith, as you know, we are in the midst of peak
shipping season, when transport capacity is expected to be
tight. At the same time, tens of millions of vaccine doses are
likely to be available today. Once vaccines are approved, will
UPS and FedEx ensure capacity is available in your network for
COVID-19 vaccines, and if so, how will you ensure that capacity
is available? Mr. Smith?
Mr. Smith. Well, we begin planning for peak in January of
that year. So we recognized early on this would be a record
peak season, and of course, throughout the months, as the COVID
picture changed and we saw all of the folks ordering things at
home and the volume spike, we adjust our plans accordingly. So
we have even taken to calling this peak ``the ship-a-thon''
months ago because we knew it was going to be a record peak.
But just as my esteemed competitor here said about their
network, we also knew the vaccines would be coming when we
started planning for this with Operation Warp Speed and our
healthcare customers, the manufacturers and distributors who
would play a role in this. So we started reserving capacity for
that.
We have been preparing for months, working with all of our
customers, as I said, to match network capacity with the demand
we expect to see, just as we do for any surge event. Whether it
is peak season, a new iPhone release, or any new product
introduction, we have been planning for this for some time. We
have also hired 70,000 more team members across the FedEx
enterprise to support all of our needs this season. And again,
as I said before, this is who we are and what we do. This is
what we were built for, and we plan for things like this
regularly. Maybe not on this scale, with all of the ins and
outs, but we are well versed in this type of planning.
Also, I will point out for FedEx, we run--we have different
operating companies that focus on different things. You may
note that you will see a FedEx Ground truck on the road, and
sometimes you will see a FedEx Express truck. The FedEx Ground
system, which we have been investing in tremendously, will
handle the bulk of the surging online retail orders, all of
your Christmas presents. And the Express network focuses more
on time-definite critical deliveries, like vaccines. That is
the company that will be focused on delivering your mission-
critical vaccines.
Thank you.
Senator Fischer. Mr. Wheeler?
Mr. Wheeler. Thank you. I am an engineer. About 2 or 3
months ago, we started building a forecasting model trying to
predict, as best we could, how many vaccine companies would be
approved this year and next year, where the manufacturing
locations were. So we had the origins. We started to think
about how many doses per shipment, and we built a very detailed
forecasting model, which would allow us to predict--sorry--
which would allow us to predict how much we would be having to
reserve in our capacity.
During peak, of course, we are now above our 25 million per
day. We are at 34 million, I think, a couple of days ago. We
have reserved plenty of capacity in all the lanes, from all the
manufacturing locations, even for the vaccines that are still
in development. So we have talked to all the companies,
including Novavax, AstraZeneca, J&J, to find out just how much
volume may come through the pipeline at the first of the year,
or beyond.
So we have reserved plenty of capacity in all the lanes. We
are ready now. We have the dry ice capacity to start with a
large number of Pfizer vaccine shipments, starting next week,
we hope, and we are very much looking forward to that.
Senator Fischer. So if I am understanding you both
correctly, you knew this was going to be a peak season anyway,
and now you put COVID on top of it and the challenges that we
face there, just in our daily lives, with people becoming ill
and having to take time off and having those people replaced.
So you hire more people. You use different delivery systems,
whether it is for regular shipping, compared to the shipping we
are going to see now with the vaccines.
When you--do you foresee a need that the vaccines are going
to have to become a priority because of the--if the development
of the vaccine increases at a higher capacity, at a faster
capacity, have you planned for that? And then, how do you plan
to get that out? Do you plan to follow a model of hiring more
people, getting the resources you need, whether it is finding
other shipping companies, air freight, and then the freezing
capacity and getting it delivered throughout the United States?
Mr. Smith. Well, we have said throughout this that there
will be no higher priority shipments in our network than these
vaccine shipments. So they will have the highest priority of
anything we carry in all of our FedEx networks, but certainly
in the FedEx Express system that will be carrying them.
We will be using new technologies, and I am sure someone
will get to a question on that. So I will not go into too much
detail about our respective monitoring and tracking
technologies that will allow us to have positive control of
these shipments at all times, know where they are, give them
that highest priority in our network, and make sure they are
delivered, intercede if there are any unforeseen delays,
weather related, on road traffic delays. We will have eyes on
them. We will be able to jump into action. But make----
Senator Fischer. Do you--I am going to interrupt you.
Mr. Smith. Yep.
Senator Fischer. Do you have a good working relationship
with airports, for example----
Mr. Smith. Absolutely.
Senator Fischer.--that you will move into priority lanes
there? Do you transport by rail, trucking?
Mr. Smith. These shipments will move in our integrated air-
ground system, the Express network, but we are working closely
with the FAA, and we have great relationships with the
airports. But we are working with the FAA to identify the
flights that will have these shipments. So they will get the
highest priority.
To your question on staffing, so as I said, we staff up,
just like UPS does, for peak. We hire a lot of new team members
during peak. We know that as these vaccines come on and ramp
up, we will continue operating at elevated levels post peak.
But we are confident we have the team members in place and will
maintain a lot of those team members that we have staffed up
for peak to continue with this vaccine distribution beyond.
Senator Fischer. Thank you. Mr. Wheeler, did you have any--
--
Mr. Wheeler. Very similar. So, every year, we plan on peak.
We have added 100,000 temporary workers to get us through. This
was going to be our biggest peak ever. I believe that is
probably the same for my colleague here. So planning for the
capacity is something we do every year, and we have done this
now for several months. It turns out that the volume is there.
We are seeing that.
In terms of the vaccines, similar to what Richard was
showing is we have a UPS Premier gold service. This is--there
is four radios in this label. This label will go on every
single vaccine package and every dry ice package. This allows
us to see the package as soon as it arrives in any of our
locations. So as soon as it arrives in any hub, any airport,
and even some of our ancillary supply areas, we will see the
package. It will get priority. It goes on the plane first. It
comes off the plane first. And so, that gives us the ability to
see the package.
We have triple redundancy. So when the packages leave
Kalamazoo, Michigan, or one of the locations of the vaccine
manufacturers, the trucks will have a sensory device. This is a
GPS tracker that also gives temperature, that gives light
exposure, and motion. So it gives us a lot of data. And Pfizer
is also providing data from their own packages. So we have
three ways of looking at the package through the system. And
all that data streams into our command center, and we transmit
that data to Operation Warp Speed.
So we are all watching the packages all day long. And we
have very, very high confidence that we will see all the
packages running through the network.
Senator Fischer. Thank you, sir. Senator Klobuchar.
STATEMENT OF HON. AMY KLOBUCHAR,
U.S. SENATOR FROM MINNESOTA
Senator Klobuchar. Thank you very much, and thank you to
all the witnesses here. I think we all know that this vaccine--
or the vaccines are going to be critical to getting our economy
moving again in such a big way. And while states, including my
own state of Minnesota, are making the decisions about exactly
their own plans for distribution, I think we all know they
can't do it alone. So that is why this time is so critical, as
we are in this hearing room. And I want to thank the Chair and
the Ranking Member for holding this important hearing at this
time.
We have got to make sure that our resources are there for
the states and locals. And so, I guess I would start with a
quick question there of Dr. Levine, and that is that could you
explain, Dr. Levine--and thank you for your good work--why it
is so important to get some Federal help in getting the vaccine
distribution going?
Dr. Levine. Well, thank you very much, Senator, for that
question. So, you know, the states and the territories as well
as the big cities chosen for this mission stand ready to
accomplish it and to immunize everyone in the United States
that will accept the vaccine. But that is a critical point. It
is absolutely essential that we have proper communication and
education messages from the CDC, but also from each state,
territory, and city, to be able to educate people about the
safety and effectiveness of the vaccine, and to educate people,
and to dispel misconceptions about the vaccine, as well as work
past vaccine hesitancy. We currently have no funding to
accomplish that part of our mission.
So, again, $340 million to all of the states.
Pennsylvania's share of that is approximately $14.6 million,
and that is going to give us a start as we work to distribute
and administer the vaccine, hopefully starting next week and
then through December and into January. But this is a long
mission----
Senator Klobuchar. Agreed.
Dr. Levine.--and it is going to take much more funding.
Senator Klobuchar. OK.
Dr. Levine. And we have no money for the communication.
Senator Klobuchar. OK, thank you.
Dr. Smith and--Mr. Smith--you feel like everyone is
becoming doctors now--and Mr. Wheeler, thank you for the work,
and also of your employees right now. I left my apartment
building in Washington and saw all the packages and people
working hard, including Postal Service employees, your
employees, and so many people every single day are on the front
lines. So I want to thank them, through you, for that. Make no
complaints about package deliveries. That is not--everything
has been going well.
But I was concerned about how these vaccines are going to
get to the rural areas, because they are not just going to be
parachuted in the middle of Laverne, Minnesota, or to one of
the communities in Nebraska, for Senator Fischer. So could you
talk about how you are paying attention to that?
Mr. Smith. Sure, of course. As I mentioned in my remarks,
we have the capability to serve every zip code in the United
States of America. We do it every day. We have over 1.7 billion
zip code service combinations. So, with this network capacity,
whether you live in Chicago, Illinois, or Murdo, South Dakota,
we are able to ensure time-definite deliveries of these
shipments, and we feel very confident in our capabilities in
this regard. This is what our network was built to do.
Senator Klobuchar. OK. And then could I add, Mr. Wheeler,
just because time is limited here, pharmaceutical companies
have reported that about 5 to 20 percent of vaccines spoil
during distribution. Not your fault, it is just a fact since
they are highly perishable products. We don't have an unlimited
supply. More than ever, it is really, really important that
they not do that. And I assume this tracking technology that
you both were talking about is part of that. So, in addition to
talking about rural, could you get at that?
Mr. Wheeler. If I understand the question, Senator
Klobuchar, it is about the protection of the product?
Senator Klobuchar. Mm-hmm.
Mr. Wheeler. OK. Well, this is the product. This is a 2-mL
vial.
Senator Klobuchar. Mm-hmm.
Mr. Wheeler. So this is the Pfizer vaccine. Five--not the
actual vaccine----
Senator Klobuchar. OK, that is good to know.
Mr. Wheeler.--salt water. Five doses from this, when they
dilute it. With the packaging that Pfizer has developed, and
exclusive to Pfizer, we presented that to the President's
vaccine summit this week. Very, very highly complex, it has dry
ice in the bottom. It has the payload in the middle. It has
what we call ``pizza trays'' where they can put up to 195 of
these small vials in the tray. And then they are packed with
more dry ice, and then there is a tracking device on top.
I can assure you that I have never seen packaging quite
that complicated before, and they have been very proud to
develop that, and we are the first to show that out this week.
I am pretty confident, aside from real big damage, that we are
going to have a lot less spoilage than you think.
Senator Klobuchar. Mm-hmm. And my last question is just the
dry ice that I think, Mr. Wheeler, you talked about how--I know
UPS Healthcare announced increased dry ice production capacity,
producing something like 1,200 pounds of dry ice per hour? Is
that right?
Mr. Wheeler. Twenty-four thousand per day.
Senator Klobuchar. Can any of that dry--OK. Can any of that
dry ice be made available for hospitals and clinics that need
extra cold storage? And how is supply for necessary
transportation and storage materials kept up with this
increased demand? I am trying to look at this as, you know, the
entire supply chain here as we get this vaccine out.
Mr. Wheeler. Well, I am sure we both agree on the same,
that there is plenty of third-party supply for dry ice, and we
are both prepared to do that. We have that now, and we are fine
with the first several months of dry ice. But to top that off,
we actually built a dry ice manufacturing plant in Kentucky. So
we now have the contingency dry ice, and we are able, if we
have extra dry ice--and I am sure we will--we can provide that
to independent hospitals and clinics around the world--around
the country.
Senator Klobuchar. Very good. You want to add anything, Mr.
Smith?
Mr. Smith. No, I think he covered it well. We have talked
to a number of vendors we use across the country--across the
world on dry ice, in terms of dry ice replenishment or top-off
for packages when they experience a delay, particularly an
international package with a prolonged delay, where you may be
asked by the customer to top it off. We are not being asked in
this instance to do that while it is in transit.
Post delivery, there may be some dry ice top-off that
certain specialty couriers and vendors--Marken, which UPS
acquired and is part of their healthcare business, which Mr.
Wheeler ran, will be providing some of those services where
they top off post delivery. But in talking to all these vendors
out there, they do not believe that this talk of a dry ice
shortage is real. They think there is plenty of dry ice out
there.
Senator Klobuchar. OK, good. Thank you, both of you, and
thank you, Dr. Levine, as well.
Senator Fischer. Thank you, Senator Klobuchar. I appreciate
your comments on how to get things out to rural America. I live
an hour and a half south of Murdo, South Dakota. And with that,
I would like to recognize Senator John Thune.
STATEMENT OF HON. JOHN THUNE,
U.S. SENATOR FROM SOUTH DAKOTA
Senator Thune. Thank you, Chairman Fischer, for holding
this important hearing in the midst of such a challenging year.
We are excited about the high level of innovation and ingenuity
that went into developing these vaccines, and it is going to
take a high level of ingenuity and innovation and coordination,
obviously, to get the vaccines distributed across the country.
And I also will echo what my Chair from Nebraska and my
colleague from Minnesota said about getting it to rural areas,
particularly places like Murdo, and so, I appreciate your focus
on that.
And I want to know--there is a--obviously, it is going to
take a sophisticated, multimodal supply chain at this scale.
And that is going to require logistical coordination not only
within the individual organizations, but between them. At least
two vaccines, each with its own set of considerations and
methods for distribution, are likely to be authorized in the
near future. Could you speak, Mr. Smith and Mr. Wheeler, to how
are you preparing to simultaneously distribute these vaccines
at scale in a safe and rapid manner? And does the potential
authorization of additional vaccines add further complexity to
that challenge?
Mr. Smith. Well, there are two models currently with the
vaccines that we are talking about here, the Pfizer and the
Moderna vaccine. Moderna has opted to use McKesson to put
together the full package, if you will, to do the kitting of
the vaccine with the syringes, needles, alcohol wipes, and if
vaccines require a diluent or an adjuvant, they will do all of
that at the distributor's site, ship it out at once.
Pfizer's model is a little different. The actual vaccine
will come from the Pfizer manufacturing site, and it will marry
up with the kitting, which will come from McKesson, at the
administrationsite.
Having said that, as I alluded to earlier, when I talked
about the discrete--just in the U.S., the discrete origin-
destination pairs we can connect with our network and a network
like UPS, that is not really a challenge. We can--as more
vaccines come on--this is what we do every single day.
They are asking us to transport them rapidly and reliably
from point A to point B, to get them from either the
manufacturer or the distributor site to tens of thousands of
administration sites. We do that every single day. And the
packaging, as Mr. Wheeler alluded to, the onus of protecting
the product is mostly on the packaging in transit, unless there
is some sort of unforeseen delay.
Mr. Wheeler. I think Richard said it well. I will just add
to this. There is a complex difference between the two. The
Pfizer vaccine does require a diluent and the diluent is going
with the McKesson shipment, with the kits and the PPE and the
syringes that are necessary.
The good thing about that process is that those kits are
going out from UPS a day before the vaccines arrive. It gives
us good visibility of where the vaccines will be delivered. So
if there are any errors at all in the addresses, we will know
that. So when the kits arrive at the dosing sites, then the
vaccine the next day, and then we top it up with dry ice. That
is the Pfizer.
Moderna is a little different, just as Richard said. All
the whole package is going together from McKesson. Makes it a
little bit easier, that we are picking up from the McKessonsite
in Shepherdsville, Kentucky, and then taking it to all
destinations that we are assigned.
Senator Thune. So, in addition to the work that you all are
doing, there are some passenger carriers, including United,
American, and Delta, that are preparing also to rapidly
distribute some of the vaccines. Can you describe how your
companies plan to coordinate with other carriers in that
distribution?
Mr. Smith. Well, I think in the domestic United States, we
don't have a need to collaborate with any passenger carriers.
As I mentioned, we run the largest all cargo airline in the
world. Our esteemed competitor here runs a pretty substantial
airline themselves, and we have plenty of capacity for this in
our own system, particularly in the domestic United States, but
we think worldwide.
Senator Thune. As you know, the U.S. Department of
Transportation is committed to providing the regulatory
flexibility that is necessary for rapid vaccine distribution.
Beyond the actions that have been taken by the Department so
far, do you have any suggestions for regulatory relief that
would improve the ability of supply chains to adequately meet
the task? Are you getting what you need from the Transportation
Department?
Mr. Smith. I mean, in our view, the Federal Government has
been highly supportive in helping essential service providers
to continue to operate during these difficult times. As one
example, the DOT has been proactive, issuing guidance and
providing relief on expiring driver's and pilot's licenses,
medical certifications, facilitating alternative methods of
training where appropriate, developing guidance on employee
health safety practices, and working with states and foreign
governments on policies that allow our team members to continue
to work. So we have been getting a lot of great support.
Senator Thune. OK. Mr. Wheeler?
Mr. Wheeler. I will just add one thing that was mentioned
earlier. We are working with the FAA. They have actually asked
us to send them a file every day of where the flights are
landing. So, in the event that they have difficulties or backup
landing aircraft in a certain airport, they will know that
vaccines are coming and will give priority to those shipments
coming in.
Senator Thune. Good. I am pleased to hear that.
Madam Chair, I think that the willingness of the DOT to
make this as easy as possible, given obviously all the
regulations that you all live by on a daily basis, it is really
important to expedite it, and get it out there as quickly as
possible in a safe way. So, thank you, we appreciate you being
here.
Senator Fischer. Thank you, Senator Thune. Next, we have
Senator Peters, please.
STATEMENT OF HON. GARY PETERS,
U.S. SENATOR FROM MICHIGAN
Senator Peters. Thank you, Madam Chair.
Good morning, gentlemen. Good to have both of you here, and
a third via the online here.
Dr. Levine, a question for you. I think it is a similar
question that was asked of Mr. Smith, but it think it is
important for me to get a sense from your state because
Pennsylvania is a lot like Michigan. Michigan is the home of a
significant number of rural communities. In fact, two-thirds of
our state is classified as rural, and about 30 percent of those
residents in those areas are over 60, who, as you know, are
high priority for receiving the vaccine.
But given the number--limited number of medical facilities
and infrastructure in these communities, give me a sense of how
you are preparing to make sure these vaccines remain stable and
at the temperature that they need. It is a significant
challenge, and we have got to get a sense of what you are doing
in Pennsylvania, and it may help us as we are thinking through
our issues.
Dr. Levine. Well, thank you very much for that question,
Senator.
So, yes, Pennsylvania is a very rural state. So, for the
first vaccine, the Pfizer vaccine, we have approximately 100
hospitals that will be served as the first stage of the vaccine
to be able to immunize healthcare workers for that first part
of the mission. Those are hospitals that have the ability to do
two things. One is to have the cold chain storage and the
refrigeration capacity at their hospital. And the second is to
do a widespread vaccination of at least 975 doses with the
first trays, as our colleagues talked about.
After that, we are anticipating that the Moderna vaccine
will come out, hopefully within several weeks. That is the
vaccine that will be distributed to the rural hospitals, much
of whom do not have the capacity to be able to store the Pfizer
vaccine. And we will be accomplishing the mission of immunizing
healthcare workers in those rural areas with a hub-and-spokes
method.
In terms of long-term care living facilities, both vaccines
will be going to distribution centers for our pharmacy
partners, CVS and Walgreens, and then they have hired
significant personnel to go out to nursing homes and other
facilities to accomplish those immunizations.
Senator Peters. Does your state or other states have
resources to implement perhaps a mobile vaccination clinic to
reach some of these areas rurally?
Dr. Levine. Yes, we will. That will come into play with
future phases of the vaccine, particularly Phase 2 and Phase 3,
where actually the Department of Health is coordinating much of
the vaccination through vaccine clinics, through FQHCs, and
through something like mobile vans. For Phase 1, it really is
going to be the hospitals that will be immunizing most of the
healthcare workers, and again, CVS and Walgreens, our pharmacy
partners, going directly to long-term care facilities to
accomplish those immunizations.
Senator Peters. All right. Well, thank you.
Question for Mr. Smith and Mr. Wheeler. You know, IBM
recently released a very disturbing report detailing cyber
attacks on COVID-19 vaccine distribution infrastructure. And
just last month, a cold chain storage company also reported
that they were the target of a cyber attack. So my question to
both of you is, what specific steps have you taken to ensure
hackers are not able to disrupt the distribution networks for
the vaccines through your companies?
Mr. Smith. Thank you, Senator, appreciate this question. I
know you understand the sensitivity of this type of information
that we are dealing with. We certainly do at FedEx, and we are
engaged with all of the relevant agencies and stakeholders on
this issue. We are taking all of the necessary precautions,
using the latest technology, as we pointed out, to safely and
securely support these vaccines.
We also have a tremendously strong information security
group, Infosec we call it, at FedEx. It is not my area. I run
operations and network planning and engineering for the
Americas, but we can certainly follow up with you with more
specifics on all the things we have done. They do a fantastic
job hardening our network and protecting us from attacks.
Senator Peters. All right, thank you. Mr. Wheeler?
Mr. Wheeler. Just to add to that, I think a good way to
answer the question is Pfizer and McKesson, the two primary
distributors coming up soon, are longstanding clients of ours,
and I am sure FedEx works with them as well. So the data
movement between these companies and UPS is well, well trodden.
It is a path that we have been walking for a very long time.
Those data feeds are well protected. We have firewalls. We
have all the necessary security measures. And we actually
presented this yesterday at the Operation Warp Speed
headquarters, here at HHS, to give them the assurance that we
have the right security measures in place.
Senator Peters. Right. Thank you.
Senator Fischer. Thank you, Senator Peters. Next, we have
Senator Capito.
STATEMENT OF HON. SHELLEY MOORE CAPITO,
U.S. SENATOR FROM WEST VIRGINIA
Senator Capito. Thank you, Madam Chair, and thank you all
for being here. Can you see me here?
Senator Fischer. Yes, we see you.
Senator Capito. OK, we got it.
Senator Fischer. We hear you, as well.
Senator Capito. Great. Great. Thank you for having this
hearing, and thank you, all three of you, for being here. As
you can imagine, this is very much top of mind of many, many
people, certainly in the State of West Virginia, but all across
the country, and the logistics of this, I think, are
exceedingly important.
So, Dr. Levine, I would like to ask you the first question.
In your neighboring state of Pennsylvania, you might have
noticed our state of West Virginia. We have really relied on
our National Guard to serve as the supply chain, to do PPE for
our schools. They have done a lot of testing and have really
filled in an enormous gap for us, as a state, and have really
been the frontline workers, and the Governor has relied quite a
bit on them. Is there any plan in Pennsylvania to use that
supply chain, or that knowledge that the Guard has accumulated
over the last 8 to 9 months, to be a part of this distribution
once you secure the vaccine?
Dr. Levine. So I know that other states do plan to utilize
the National Guard for that mission. Right now, in
Pennsylvania, we do not. Our National Guard members, who also
have been integral to our response, are actually working
primarily in nursing homes and long-term care living
facilities. And so, we have used medical personnel extensively
as strike teams, to go into challenged nursing homes to provide
direct care to patients and to--who have specific--in nursing
homes that have particular staffing issues because their staff
either have COVID-19, or they are in quarantine.
In addition, if we have to open alternative care sites for
hospitalized patients, then we would use National Guard for
that purpose. So we have not used the Guard in our planning.
Senator Capito. OK. Second question is on the dosages. Let
me ask a simple question. If you get the Pfizer first dose, is
the amount of the first dose the same as the amount of the
Pfizer second dose? In other words, are they alike? Yes?
Dr. Levine. Yes.
Senator Capito. OK. On tracking that, I think this going to
be a potential problem, particularly in rural America. How do
you track who has gotten the first one? How do you retrack if
you don't have connectivity for certain areas?
Who has the responsibility of that? Do you, as the Chief
Medical Officer? Does Pfizer have that responsibility? Where
does that responsibility lie, and where is the recheck going to
be on this? Because my understanding is that second dose is
very critical.
Dr. Levine. So you are correct. The second dose is critical
to produce the appropriate immune response so that the
individual will have a really good chance of being immune to
COVID-19. It is primarily our responsibility to track when the
first dose is given and the second dose is given. We will be,
of course, working with the healthcare providers themselves,
who have to input into our system that those doses are given.
And both the healthcare providers and the Department of Health
have recall mechanisms to contact patients who don't come for
their second dose.
Senator Capito. So do you have the systems already
available to you that would be perfect for inputting this data
so that you can follow up quickly and all that? That system, I
am going to assume, exists now? It is not something you have to
build?
Dr. Levine. No, the system exists now. We did have to
update our current immunization system and make it much more
robust, with redundancies for this mission, which is much
bigger than other immunization campaigns we have had. But we
have those systems present now.
Senator Capito. OK. Mr. Smith and Mr. Wheeler, let me ask
you this question in terms of last house. My understanding is
that, in some cases, the last house delivery from UPS or from
FedEx may be from the U.S. Postal Service. Is that a correct
assumption? Am I right there?
Mr. Smith. You want to take it? We both have services where
we utilize the United States Postal Service for final mile
delivery, primarily of lightweight, low-value, e-commerce
items.
Senator Capito. Would the--OK, would the vaccine fall into
this, or would that be something that you----
Mr. Smith. Absolutely not. The vaccine will be delivered by
FedEx Express, by a FedEx Express courier to these
administration sites.
Senator Capito. And is that the same with UPS?
Mr. Wheeler. Exactly the same with UPS. We are a 100
percent UPS network. And as you know----
Senator Capito. OK, good.
Mr. Wheeler.--all the employees are UPS employees.
Senator Capito. Good. Well, I would imagine, I mean,
utilization of that--however many--the fewer hands between----
Mr. Wheeler. We agree.
Senator Capito.--the vaccine and the person who actually
receives it obviously eliminates any kind of room for error
there. So I am pleased to hear that.
Mr. Wheeler. Agree 100 percent.
Senator Capito. Good. And then I was interested to hear,
too, that there have been some relaxations of certain
regulations, times of service. I heard expired licenses of
pilots--or extension of pilot licenses and other things. I
understand that is going to be very helpful to both of you to
make sure that you have got full capacity to be able to move
forward. Do you have anything to add on that aspect, where you
might need some other flexibilities?
Mr. Wheeler. We are actively testing all of our pilots on a
regular basis to make sure that we can rotate the pilots
efficiently. We have 3,000 pilots in the U.S., and we are
testing them all.
Mr. Smith. We are doing the same. Our pilots are being
tested before they fly on a mission, particularly
internationally. So, same.
Senator Capito. OK. But then, let us say--let us go to your
trucks, same thing? I mean, there are hours of service
restrictions on those, too. Do those come into play for you, or
not----
Mr. Smith. We think we can----
Senator Capito.--in this instance?
Mr. Smith. We can manage those, and we don't have any
additional asks in that regard here.
Senator Capito. OK.
Mr. Wheeler. I will just add, we said before that we are
giving priority to all the vaccine shipments. So as soon as
they arrive in the destination location, our sort facilities or
our hub facilities, the drivers will know exactly that they are
moving vaccines. So it is a priority for them. They will put
those packages on their trucks first, and the others will
follow.
Senator Capito. OK, final question for both of you.
Obviously, getting a vaccine--I saw you with the little vial of
the fake Pfizer vaccine. Obviously, you need swabs. You need
injection devices. Are you in contact with those manufacturers,
too, to make sure that--are you a part of that whole stream of
logistics that are going to be important to delivering this
vaccine? Mr. Wheeler?
Mr. Wheeler. Yes, UPS moves everything. So we are moving
ancillary supplies to our customers. We are moving glass
vials----
Senator Capito. But I mean, is that something that you are
making special considerations for, as you are for the vaccine
itself?
Mr. Wheeler. Of course.
Senator Capito. Yes.
Mr. Smith. We are planning for everything.
Senator Capito. OK. Mr. Smith?
Mr. Smith. Yes, same. We are planning for everything,
anything that we are asked to move from a distributor like
McKesson or directly from a manufacturer like Pfizer. In terms
of just shipping vaccine or whether we are shipping vaccine and
kitting, we are same as UPS. We are prepared for it and ready
and planning that with them.
Senator Capito. OK, thank you.
Senator Fischer. Thank you, Senator Capito. Senator
Baldwin, you are recognized.
STATEMENT OF HON. TAMMY BALDWIN,
U.S. SENATOR FROM WISCONSIN
Senator Baldwin. Thank you, Madam Chairwoman.
Like so many of my colleagues, we are very much looking
forward to hearing from the FDA later today, but we all know
that we have a lot of work to do. We still need to wear our
masks. We still need to limit our gatherings, until at least 70
percent of Americans are vaccinated. And to get there, our
states are going to need support.
I want to share that in hearing from Wisconsin officials,
they have been working overtime to provide care to patients
with COVID-19, reduce the spread, and prepare for the vaccine
distribution. But the state estimates that they will need an
additional $10 million for vaccine infrastructure readiness
over the months to come.
States are doing as much as they can to get ready, but they
can't do this work alone, as we all know. And I am concerned
about the potential for breakdown in coordination between the
Federal Government, states, and partners of the private sector.
We have got to get this right from the very start.
So, Mr. Wheeler and Mr. Smith, given your roles in the
distribution process, can you describe which points in the
distribution coordination will be the most critical and where
you see the potential for breakdowns? What do we need to do to
ensure better coordination at these various points?
Mr. Wheeler. I think what I would ask is that the State
jurisdictions that are working with Operation Warp Speed come
up with a very good forecasting model. As soon as we can see
the volume coming through the pipeline and through the system,
the better. We--I think that is probably the best way to answer
it. We are taking orders from McKesson and Pfizer for these two
vaccines that come straight in. We have embedded employees at
their locations, so we are scanning everything from the origin
to the final destination. And Operation Warp Speed is really
driving the train here. They are the ones giving us the orders
to move.
Mr. Smith. Yes, and I would just second that. I mean, we
feel very confident, as I know UPS does, about our role in
this, particularly the transport from point A to point B. You
know, we don't decide where the vaccines go, how much is
allocated to each state, how it is allocated within the state.
We are the transportation provider, and our mission is to get
it there rapidly and reliably, safely and securely.
But we are very confident about it in our system. There are
certainly things before it enters our system that are outside
of our control. There are things after we deliver it that are
outside of our control. But I am confident about it when it is
within our control, and I will just echo what Wes----
Mr. Wheeler. I might add that it is very useful to have CVS
and Walgreens signed up as really the primary destinations, at
least for these first few months. That is very helpful because
both companies know CVS and Walgreens very well. We have all
the addresses. We deliver every day for all sorts of things. So
having that focus is very, very important to the supply chain,
I believe.
Senator Baldwin. Thank you.
Dr. Levine, I would like to ask you about dry ice,
especially given its essential role in delivering the Pfizer
vaccine doses. Pfizer has developed plans to secure access to
dry ice for their initial shipments. But I am wondering about
the second phase of dry ice demand, when Pfizer's shipping
containers are replenished with dry ice, at the State and local
level. I understand that it is State and local health leaders,
or whoever receives the shipment within the state, who are
responsible for ensuring their supply at that point.
This is all happening at a time of heightened demand for
dry ice around the holidays, and in an industry that operates
in a just-in-time basis, given the short window to use dry ice
after it is manufactured. Do State and local leaders who
anticipate receiving a shipment of Pfizer vaccines have clear
and robust information about how and where to source dry ice
that is needed for the replenishment and adequate cooling of
the supplies they are likely to receive?
Dr. Levine. So, yes. The Pennsylvania Department of Health,
working with PEMA--the Pennsylvania Emergency Management
Agency--would be able to obtain dry ice, if necessary. For the
first stages, we actually don't anticipate it will be necessary
because, again, the Pfizer vaccine will be going to hospitals.
And particularly, that vaccine will be going to hospitals that
have, themselves, the refrigeration capacity to be able to keep
it at the ultra-cold storage temperature that is necessary. And
then, for the long-term care facilities, as was mentioned, it
is going to distribution centers at CVS and Walgreens, and
those centers also have the refrigeration capacity to be able
to keep it at an ultra-cold temperature.
Now, with future distributions, as it goes more out to
FQHCs, and et cetera, you know, we are going to be able to
really try to work that they can be administered, you know,
right when the box is opened, and we can administer that amount
of vaccine. I think the Moderna vaccine, which has less
requirements, will be much easier to distribute, as I
mentioned, to rural Pennsylvania and other parts of
Pennsylvania that will not really have access to those
refrigeration capacities.
Senator Baldwin. Is there any information that you would
like to be made available, by the Federal Government or through
cooperation of the industry, to ensure that local health
officials have a clear direction on dry ice sourcing protocols
or alternative sourcing plans, if needed, and pricing? Any sort
of dashboard that should be required?
Dr. Levine. Absolutely. I think what we have shown is that
it is really challenging when the states are almost competing
with each other for needed resources, and that occurred in the
spring, particularly for personal protective equipment. Since,
you know, we know that every state in the country is going to
need this material for the eventual distribution, as time goes
by, of the Pfizer product, it would be helpful if the Federal
Government coordinated that, and we didn't have to bid against
our sister States.
Senator Baldwin. Thank you.
Senator Fischer. Thank you, Senator Baldwin. Senator
Tester, you are recognized.
STATEMENT OF HON. JON TESTER,
U.S. SENATOR FROM MONTANA
Senator Tester. Well, thank you, Chairman Fischer. I want
to thank you and the Ranking Member for holding this hearing.
It is one of the reasons--I don't normally sit on this
Subcommittee, but it is a critically important area, and I want
to thank you guys for doing this. And I want to thank all the
folks who have testified.
Now, this is for Mr. Smith and Mr. Wheeler. We have got
about 10,000 doses coming into Montana in this first round.
They are all going to be allocated to hospitals that are in the
seven major cities in Montana. I hope there is going to be no
problem there, and I don't think there will be a problem. It
sounds like you guys have planned for that. They have access to
things that a lot of the rural and frontier towns that have
hospitals in them do not. I think if this vaccine is going to
be distributed throughout the country, and I think Chairman
Fischer knows this as well as anybody, the rural areas are
really going to, I think, pose some issues.
And so, the first question I had, for either or both of you
is, and I know it depends on location, but how long to the
furthest location out there, do you think it will take to get
from the distribution center, where you pick the vaccine up, to
its final location, assuming that it is more than just those
seven major cities in Montana--assuming it is a town like
Chester, Montana; or Harlowton, Montana, that have much smaller
populations, that are a ways away from these more populated
areas in the State of Montana?
Mr. Smith. I have to take this one because I can't resist.
In the United States, as our old tagline used to say,
absolutely, positively, overnight.
Senator Tester. OK, good. Mr. Wheeler?
Mr. Wheeler. We are planning on a next day, 10:30 a.m.
arrival anywhere in the--anywhere that we are assigned. So, of
course, FedEx and UPS have split the country into two. We know
exactly what states we have, and they know what states they
have. We are guaranteeing overnight, from the time that it
leaves the Pfizer location or the McKesson location until it
arrives the next morning at 10:30.
And of course, remember that the dry ice packaging with
Pfizer is a 10-day package. So it is good for 10 days, and then
they will have additional 40 pounds of dry ice to replenish,
which gives you more life.
Senator Tester. No, I think that is good. I think the key
is to get the vaccine into the bodies of the people who need
it.
Has Pfizer or Moderna or anybody--CDC or anybody--told you
guys what the protocol is going to be to let you know when you
are going to pick it up so that the hospital knows? I mean, you
guys are going to deliver it overnight or within--by 10:30 the
next day. That hospital has to be ready for it. They have to
let their patients know it is available and probably
individually call the patients who are most susceptible.
What is going to--have they told you what the protocol is
going to be to letting people know that, you know, this vaccine
is coming to X town in Montana?
Mr. Wheeler. Not really, but we have some--we have an idea
how they want to do this. Pfizer has very, very specific
protocol for how the package is handled, how many times a day
it can be opened, how many vials can be withdrawn.
I think the best answer to the question is the states and
the jurisdictions and all the dosing centers have to have their
patients lined up, lined up so they don't waste any vials. Once
you take the vials out of the box and they thaw, you can't
refreeze them.
Senator Tester. Got you.
Mr. Smith. Yes. I will just echo my colleague here that,
you know, they have those processes they are working on. When
it is tendered to us, we are told to transport it to the
administrationsite overnight, and as Wes pointed out, we also
deliver it by 10:30. We have the same commit time for our
priority overnight shipments to business locations by 10:30.
Like good competitors, we keep each other--one another on our
toes, and we have the same commitment.
Senator Tester. We like competition. So this isn't on you
guys, but I certainly hope somebody out there. We are going to
distribute these vaccines in the winter. I mean, truthfully,
some will be done in the spring, too, but primarily in the
winter. And you guys know, because you deal with this stuff, if
they are going to get a hold of the patients, get them there so
we don't waste the vaccine, it is going to take some planning.
And I hope somebody is listening to this hearing that has some
stroke in that because, quite frankly, you get a blizzard that
blows through, and it is going to screw stuff up. And so, it is
important.
Mr. Smith, I want to touch base with you, and this is a
question that Senator Thune asked, and it didn't go to Wheeler.
But very, very quickly, he talked about Delta and American and
the airlines--the commercial airlines, potentially carrying
this, and his question was how are you going to work with them?
And you said, ``We got the capacity. Don't worry about it.''
Well, let us say that whoever is the king maker out there
says, ``Well, you know what? I don't care if UPS or FedEx has
the capacity, we are using Delta,'' for whatever reason it
might be. Do you guys have that relationship to be able to work
with those commercial airlines, in case it isn't on your ship?
Mr. Smith. Sure. We work with them in the international
environment, both our companies do, with what the industry
calls freight forwarding, where we will use passenger
underbelly lift to move deferred air cargo point to point,
airport to airport, as we say. But in the United States, we
have plenty of capacity, as I pointed out, that decision to use
a commercial airline I don't think would make a lot of sense
because they don't have the infrastructure to connect all those
origin-destination pairs that I talked about, right, the 1.7
billion zip code combinations we connect. Because it is not
just about moving it from airport to airport. You have got to
move it from the ramp at the airport to the station and then
get it out into the field. So they don't have the
infrastructure ability to do that----
Senator Tester. I got it.
Mr. Smith.--and connect the country on such a widespread
basis. So I don't think that would happen in the U.S., but we
would certainly work with them if they were brought in.
Senator Tester. OK, that is fine. That is good. Thank you
very much.
And once again, Madam Chair and Ranking Member Duckworth, I
just want to thank you guys for doing this hearing. I
appreciate all the witnesses. Thank you.
Senator Fischer. Thank you, Senator Tester. While we are
waiting for a couple more Senators to come, I am going to ask a
couple more questions here, please.
Dr. Levine, you noted in your testimony that during mock
vaccine shipments, a quarter of the states experienced a lag in
receiving the ancillary supply kits. Could you elaborate on
what the challenge was, and have you noticed any corrective
action that is being taken to address it?
Dr. Levine. Well, as you have stated, through ASTHO, you
know, we keep in touch with all of the State health officials,
and there was a dry run. In Pennsylvania, we did receive the
mock shipment and the mock kitting that was discussed that will
be shipped separately for the Pfizer product. But in
significant number of states, they did not all come at the same
time. So, as was mentioned, you are going to have three
different components--the vaccine itself, the diluent, and the
kitting--and it all needs to arrive at the exact same place at
the right time so that the vaccine can be administered.
Now we don't transport that. I mean, that is being
transported, you know, through our partners here, the other
testifiers, as well as, you know, under the jurisdiction of
Operation Warp Speed. And so, when the ball comes to us, and
all of it is present, and then our supervision comes in and we
work with the hospitals and then with the pharmaceutical
partners to administer the vaccine.
So all of that was relayed to Operation Warp Speed about
the challenges that some of the states had. And so, hopefully,
those difficulties will be ironed out, and everything will
arrive at the correct time next week, when the Pfizer product,
hopefully, will ship.
Senator Fischer. Thank you. And Mr. Smith or Mr. Wheeler,
is FedEx or UPS planning to be involved in the shipping of the
ancillary supply kits? And how are you ensuring those shipments
are timed to arrive with the vaccines doses that are arriving?
Mr. Wheeler. I was going to mention that this week when we
presented to the vaccine task force, McKesson basically said
that they have built 150 million test kits already. So they
have stockpiled the ancillary supplies. Moderna and Pfizer are
both being built now. So they are ready to go. That has the
syringe, the diluent, the PPE, the instructions to the dosing
sites, the mixing vials as well.
All that is ready to go. UPS will be supplying 100 percent
of all the kits to the country. FedEx and UPS will then follow
with the vaccine shipments, and then we will follow all 100
percent of the sites with dry ice.
Senator Fischer. OK, thank you.
Mr. Smith. So, in some respects, just to point out how
profound this is, you have two fierce rivals here and
competitors in FedEx and UPS, who literally are teaming up to
get this delivered. And in some cases, that relationship is
interdependent, with them shipping the kitting and us shipping
the vaccine to certain states. So we are relying on one
another. It is almost like, and I hope Senator Wicker is still
watching, but it is almost like two rival college football
teams--say, Ole Miss, Hotty Toddy, and Mississippi State--
coming together on the same NFL team to play as teammates.
Senator Fischer. OK, thank you. Senator Blumenthal, you are
recognized.
STATEMENT OF HON. RICHARD BLUMENTHAL,
U.S. SENATOR FROM CONNECTICUT
Senator Blumenthal. Thanks, Mr. Chairman, and thank you
both for being here. Thanks for your cooperation. I don't know
whether football is a perfect analogy, but on this issue, I am
glad you are on the same team and that you are working together
because the American people really need that kind of
cooperation.
And we are on the cusp of historic approval of the Pfizer
vaccine, hopefully next week the Moderna vaccine, and as you
know, there are challenges in shipping it. I am proud to say
that a number of efforts by manufacturers are innovating in
this area on cold storage and transport.
In fact, I attended a virtual demonstration of the Bozrah-
based Gilman Brothers vaccine transport system, demonstrating
their capability for vaccine transportation. And I think that
kind of innovation and invention can help in the massive--and I
emphasize massive--challenge of distribution. People expect
that it will arrive at their local CVS tomorrow because that is
the way American enterprise works, but I recognize you have
great challenges ahead.
I want to emphasize one particular aspect of this
challenge, which actually arose yesterday in a hearing of the
Veterans' Affairs Committee. The head of the Veterans Affairs
health system indicated that they are facing obstacles and
challenges to deliver the vaccine to their health facilities.
That is veterans health facilities. Could you address what
specific steps you are taking to provide this vaccine to our
veterans, which is so important?
They are in the age group that is most vulnerable. Many of
them are veterans of wars of decades ago, and they need this
vaccine, and they need it right away. They are going to get it,
hopefully, through their veterans facilities, like the West
Haven facility in Connecticut, which, right now, is apparently
not on the list to receive it because of these logistical
obstacles. So maybe you can address that aspect of the issue.
Mr. Smith. I am not aware of any logistical obstacles that
prevent us from delivering to the veterans. We were founded by
a proud veteran of the Marine Corps, Vietnam veteran, who did
two tours of duty in Vietnam. So we live to serve our veterans.
We employ a lot of veterans.
We don't have any control over where the vaccine goes. We
are told where to deliver it. We are simply the transportation
provider here. So I am not aware of any logistics challenges
that would prevent us from delivering to the VA hospitals or to
getting it to our veterans. Certainly willing to look into
that, anything you have heard on the logistics side, because I
have not heard that.
Mr. Wheeler. Senator Blumenthal, I think Connecticut is
assigned to UPS, so we will be delivering to Connecticut. We
don't have the addresses yet. I was on the phone with General
Perna yesterday, and we are waiting for the addresses any day
now. We have sent the kits out. So the kits have gone. They are
arriving this morning. We will look at the addresses and make
sure we get them.
Senator Blumenthal. I am so glad to hear that because I
think our veterans will expect it, and I would like to work
with both of you, have my staff perhaps contact you and work
with the VA to make sure that there are no difficulties. I am
not attributing any of those obstacles to you, I should
emphasize, but I just want to make sure that we focus on
getting the job done.
As you know, onsite cold storage is as critical to vaccine
efficacy and effectiveness as storage during transportation.
What challenges do you anticipate providers may face after
receiving those vaccine shipments?
Mr. Wheeler. Yes, we have talked a lot about--I mean,
Moderna and Pfizer are a little bit different. So, Moderna is
at -20, typical freezer temperature. So, in terms of storage at
the sites, there is probably more of that available at most of
these sites.
Pfizer, recognizing that, has built this amazing package
that can keep that -70 for 10 days, and we are providing
additional dry ice to keep it longer. And beyond that, we have
offered to many sites--in fact, we already have 100 orders of
portable freezers that you plug into your outlet, at -70
degrees, and it maintains temperature forever. So we have
offered that as well.
Senator Blumenthal. Thank you.
Mr. Smith. We have talked to some of the big pharmacies
like Walgreens, who is our customer, and they are acquiring
some of these freezer units as well to stage the product and
keep it ultra-cold after delivery.
Senator Blumenthal. Thank you. Thank you both.
My time has expired, but this topic is top of mind, I
think, for all of us, and your being here today, along with Dr.
Levine of Pennsylvania is very welcome, and I am sure we will
be hearing from you again. Thanks so much.
Senator Fischer. Thank you, Senator Blumenthal.
As we wait for the Ranking Member, Senator Cantwell, to
come ask questions, I have a couple more questions that I would
like to ask.
Dr. Levine, the CDC, and Operation Warp Speed planning
documents, indicate that the jurisdictions will be responsible
for any redistribution of vaccines after the doses are shipped
to the identified provider. Do you anticipate jurisdictions
redistributing many vaccine doses after those have been
received by the providers, and if so, can you outline what
those redistribution procedures may look like?
Dr. Levine. Well, so as the Moderna product is going out--
particularly because it doesn't require the ultra-cold chain--
to hospitals, we will distribute some of those, for instance,
to federally Qualified Health Centers because we want to think
of healthcare providers extremely broadly. It is not just
hospital providers. It really has to be anybody that is on the
front lines, seeing patients with COVID-19, for instance,
including EMS providers. So we do anticipate some
redistribution, particularly of the Moderna, to accomplish
that.
Senator Fischer. Thank you. And for the entire panel, given
the magnitude of transporting so many vaccine doses, I
anticipate flexibility among all stakeholders is going to be
extremely important. How are each of you planning to
incorporate changes into your logistics or planning as the
vaccination effort progresses?
Dr. Levine, would you like to start, please?
Dr. Levine. Sure. So, you know, all of the vaccine plans
that we have, really, I consider drafts for our state and for
all of the states because there are many different factors that
are going to come up as this mission proceeds. For example, we
don't yet know what recommendations the FDA might state about
the Pfizer and then the Moderna product, which would change our
vaccine plans, as well as when it goes to the Advisory
Committee on Immunization Practice from the CDC, which might
have some specific recommendations about administration, which
would then change our plans. That would be true of the Moderna
product as well.
Of course, as the time is going and we are immunizing
according to the three phases of the CDC, things are going to
change in terms of the spread of the virus and which groups
might be most impacted. And so, I think that it will be very
important for the States, territories, and cities involved to
be very nimble and flexible with their plans going forward,
just to make sure that we are able to immunize the members of
the public, as is necessary.
Senator Fischer. Thank you. Mr. Smith?
Mr. Smith. Sure. There is an old saying I am very fond of.
Men make plans--or men and women make plans, and the gods
laugh. We deal with the unforeseen every day--weather, traffic,
you name it. For international shipments, regulatory holds,
customs delays, and that sort or thing. So our plans have to be
flexible every single day. And it is customer specific, often.
I mentioned a new product introduction, like a new iPhone
or a new medicine that is being brought to market. I mean,
those things require tremendous planning, and sometimes the
forecasting is wrong, so you have to adjust. So we do this
every day, adjust to changes on the battlefield, as we say. And
we are well versed in it, and we don't expect anything that we
won't be able to handle in that regard.
Mr. Wheeler. The beauty of our network is that all of these
vaccine shipments are going from--for the first couple of
months anyway until we get the next vaccine approved, will come
from three locations into our Louisville Worldport facility.
Every day, we have 400 flights landing and 400 flights taking
off to reach destinations around the country the next morning.
Every time a vaccine shipment is sourced, it comes with the
tag, the tag gives it priority, and as soon as we have a change
in addresses or change in priority or change in volume, we can
immediately pivot to make sure that those vaccines arrive the
next day at whatever location is required. We are taking
direction from General Perna and his team, and we are very
flexible, both companies.
Mr. Smith. Yes, I should add that both of these networks
have tremendous redundancy built into them. So we have our
Express super hub in Memphis, Tennessee. We have our other
major inland sort location in Indianapolis. We also have hubs
in Newark, Greensboro, Miami, Dallas-Fort Worth, Oakland, and
Anchorage, Alaska, just in the United States alone. So we have
redundancy in the event of weather events or other unforeseen
things.
Senator Fischer. OK. And I would like to go back to follow
up a little bit on Senator Peters' question about the IBM
report on the cyber attacks. IBM specifically identified
phishing e-mail attacks in its report. What also are you doing
to ensure employees have the appropriate cybersecurity training
to ward off these attacks?
Mr. Smith. Yes, we battle those every day. As I mentioned,
our Infosec, information security department, is extremely
good. We can certainly follow up with more information about
all of the things they are doing, in cooperation with Federal
agencies and internally, to battle this.
We have regular training and communications that go out to
employees. We mark any e-mail that doesn't come from within the
FedEx system behind the firewalls as external, so they know
that it is an external e-mail. We tell them not to open links,
not to open the e-mail. We constantly train them and refresh
that training. So we do a number of things to harden our
systems, but also to educate our employees about what to look
out for.
Senator Fischer. I imagine you both face hundreds of
thousands of attacks every single day. In this public setting,
can you give us any information on if you have been
specifically targeted by any type of cyber attack, and if it
was to your administration, or was it to an employee? Can you
tell us any of that in this setting?
Mr. Wheeler. We are not in a position to say that today,
but we have attacks every day, and we have information security
and cybersecurity. We work with CISA on best practices.
Whatever comes up in the industry that is new, that is better
than we have, we adopt those things. But we have incredibly
tight e-mail systems and systems around the country. And as I
said earlier, Pfizer and McKesson, the data flows between
Pfizer and McKesson and UPS and Operation Warp Speed are well
established and have been for quite some time.
Senator Fischer. OK. Thank you very much. Senator Cantwell.
STATEMENT OF HON. MARIA CANTWELL,
U.S. SENATOR FROM WASHINGTON
Senator Cantwell. Thank you, Madam Chair, and thank you and
Senator Duckworth for holding this important hearing. I have
had to be in and out because Small Business is also talking
about PPP, so we are really trying to pay attention to what we
need to help people dealing with this unbelievable COVID
pandemic that is increasing in impact right now at a very
critical moment.
So I wanted to ask a question about what we are doing to
help states and municipalities on the delivery system. I have
heard from my mayors in my state. I have heard from my state's
health officials. This is a very intense operation on the
ground, and they are going to need help and resources in the
delivery system.
And I want to make sure that we are thinking about how to
give equitable access. I heard some of the discussion about
nursing homes and I definitely agree about that distribution,
but I want to make sure that we are getting equitable
distribution to very challenged and hard to serve communities.
We, in the State of Washington, have 29 tribes and a big
geographic area and delivering to Native Americans, and I am
sure I could give other examples of hard to serve communities.
And then I just want, one more time, to ask the question
that Senator Capito was trying to get at. With major layoffs in
the aviation sector, are we sure that there is nothing we need
to do there, to make sure that both pilots and equipment are
ready on the rotation side? When you lay people off they
obviously have to then requalify. And when you have equipment
that has been out of service, it needs to be--I don't know what
the right word is--reevaluated and put back into service in a
new way.
So I just want--if you can answer those questions or
address those issues which are, what do we need to do to help
State and local governments on the distribution side? What do
we need to make sure to do to be equitable for minority
communities? And are you sure we have this figured out on the
workforce and equipment side?
Mr. Smith. Let me answer those in reverse order. We are
very confident, and I believe that Wes would say the same, that
we have the assets, we have the crews, we have the
infrastructure to support this mission. We have----
Senator Cantwell. And is that--just if I could, because
nobody in the rest of the larger aviation sector will be called
on or will there be some transport over our general carriers?
Because they are in the carrier business, too. So, is there
nothing that they are going to be impacted on?
Mr. Smith. We don't believe, at this point in time, in the
United States, to deliver this we are going to need to rely on
the passenger airline sector at all. Again, they could fly it
airport to airport. We have plenty of capacity for that, plenty
of well-trained, excellent pilots and crew members who fly our
missions every day. I know UPS is the same. We have plenty of
capacity in the United States.
But also, the ability with these networks we operate, there
are only two companies in the United States of America that
have the networks to connect all those O&D pairs that I talked
about on an overnight basis, and they are both represented at
this table. So the reason we are both here and we are both
doing this is because we are the only ones that can. So that is
the answer to the last question.
On the second, in terms of equitable distribution, we have
no say in how this is being distributed. We are simply the
transportation arm, and our job is to get it from point A to
point B, rapidly and reliably, safely and securely. That is
just not a decision that we make. We are told where to take the
vaccines on a daily basis, and that is what we do.
And then getting it out to rural areas, as I mentioned, we
service every zip code in the United States of America. So does
UPS. And we do that every day, on an overnight basis, by 10:30
the next day.
Mr. Wheeler. A lot of what he said, but just to add to
that. The beauty of our network is that it works only as a
network. So we are planning 100 percent with the UPS aircraft,
UPS package cars, and drivers and trucks. But we also have a
very extensive courier network. So if we get into trouble
anywhere and we have to get a vaccine overnight on a commercial
aircraft, we have relationships with all of them, and charter
aircraft. And we are actually working with a lot of the
manufacturers to move active ingredient and bulk product into
the United States from overseas on charter aircraft. So we have
that ability.
To go back to the question about helping states. We got
pretty good at this with test kits. So when we started testing
and moving laboratory samples from patients to lab companies,
we got very, very familiar with the State governments, the
State jurisdictions, and the health authorities there. And we
were helping a lot of the states to do that, and we still are,
and that allows us to give you help wherever you need it.
Senator Cantwell. Yes, Madam Chair, thank you again. It is
so great that you had this hearing, but we need to figure out
whether it is us or someone else that has to have the rest of
this conversation. It reminds me a lot of what happened with
the hurricanes in Puerto Rico, where there was a lot of
undistributed cargo on the docks.
And I know you have equipment that can get you into
communities, but we still have this big question of who are you
delivering the vaccine to, and what do they have set up? And we
see the complexity on TV, of what it takes to actually
administer the vaccine. So the question is, who is going to do
that?
And my sense is that states, cities, and public health
districts need resources, and we need to make sure they have
them. Otherwise, you are going to do a really great job, and we
are still going to have a roadblock.
So, thank you so much. This is helpful.
Mr. Smith. I will just add, I am very familiar with the
situation in Puerto Rico because we flew a ton of that cargo
into Puerto Rico. A lot of the issue there on the ground was
the infrastructure being wiped out, so----
Senator Cantwell. Well, we--you have to have the
infrastructure to deliver the vaccine. So, anyway, we will get
to this question, but again, thank you, Madam Chair, and thank
you for working around the clock to help us on this pandemic.
Senator Fischer. Thank you, Senator Cantwell.
At this time, I ask consent to enter several letters into
the record--a statement from McKesson, regarding their role in
the vaccine distribution process; a letter from the
Transportation Intermediaries Association regarding third-party
logistics providers' role in the distribution process; letters
from transportation industry and labor associations regarding
vaccine prioritization; and a letter from the transportation
safety associations regarding the safe transportation of
vaccines.
Without objection, so ordered.
[The information referred to follows:]
Testimony of Shawn Seamans, President, RxCrossroads; Executive Sponsor
Enterprise COVID Vaccine Program, McKesson Corporation
Chairman Fischer, Ranking Member Duckworth and Members of the
Subcommittee on Transportation and Safety. On behalf of the 80,000
employees of McKesson Corporation, I am pleased to share with the
Committee our effort to distribute COVID-19 vaccines and supply kits to
the American People. In a highly integrated plan with government and
private sector partners, we are proud to play an important role in
helping to address the needs of the healthcare community during this
global health crisis.
Our mission
For over 185 years, McKesson has led the industry in the delivery
of medicines and healthcare products. As one of the world's largest and
oldest healthcare companies, we are at the forefront of supply chain
innovation; delivering vital medicines and supplies that touch the
lives of over 100 million patients in healthcare settings.
McKesson is a mission driven company, focused on our vision to
improve healthcare in every setting--one product, one partner, one
patient at a time. We believe the patient comes first.
Vaccine Distribution
Our leadership and experience in managing complex logistics extends
to vaccine solutions and cold chain handling. McKesson is the largest
seasonal flu vaccine distributor, delivering millions of doses annually
to all settings of care including public health clinics, hospitals,
physician offices, nursing homes and other long-term care facilities.
We also deliver many millions of other refrigerated non-flu vaccines
every year.
For the last 13 years, McKesson has been the central distributor
for the Centers for Disease Control (the ``CDC'') Vaccines for Children
program. The Vaccines for Children program, including the CDC's Vaccine
Tracking System (``VTrckS''), is also the backbone to the distribution
of COVID-19 vaccines. Each year we work at the direction of the CDC to
distribute 75 million doses of over 60 different vaccines to 44,000
locations across the U.S. In addition, we delivered millions of vaccine
doses, meeting critical logistical needs, during the 2009 H1N1
outbreak. As the CDC's central distributor, we delivered 127 million
H1N1 vaccines to 90,000 locations. At the time, this was the Federal
government's largest public health initiative. As you can see, McKesson
has deep experience and a track record of successfully moving vaccines
and medical supplies at scale.
COVID-19 Response
McKesson has been steadfast in our support of Federal and state
response efforts to the COVID-19 public health crisis. We have played a
critical role supporting the U.S. Department of Health and Human
Services and the Federal Emergency Management Agency in their sourcing
and distribution efforts, contributing our advanced understanding of
the supply chain.
As a participant in Project Airbridge, we coordinated closely with
Federal and state agencies to move products to the front lines. Our
Health Mart pharmacies have leveraged their significant footprint in
rural and medically underserved communities to expand the reach of
community based COVID testing to patients nationwide. These pharmacy
locations are prepared to join the many other administration sites
being marshaled to deliver hundreds of millions of COVID vaccine doses
to patients.
Our commitment to the COVID-19 response extends to Operation Warp
Speed. McKesson is the CDC's central distributor of COVID-19 vaccines
(except Pfizer) and ancillary supply kits for all vaccines, including
Pfizer. Now that two COVID-19 vaccines are near Emergency Use
Authorization by the Food and Drug Administration, we are prepared to
meet this moment for our Nation. Our best-in-class practices make
McKesson well-positioned to assist the government in getting the right
vaccines and supplies needed for administration to the right place at
the right time.
I would like to discuss in greater detail the operational steps
McKesson is tasked with in furtherance of the largest mass vaccination
initiative in the history of the United States. Our program is designed
to ease the burden on the states by allowing them to focus on
administration itself.
McKesson is today operating dedicated distribution centers for both
the vaccines and ancillary supply kits in close proximity to hub
operations of FedEx and UPS in Memphis, Tennessee and Louisville,
Kentucky.
Safety, security, and accuracy are our highest priorities at every
step of the process.
McKesson will distribute the Moderna vaccine--and other future
vaccines that would require refrigeration or frozen storage, as well as
any that can be maintained at ambient temperatures. Pfizer has
maintained responsibility for distributing its vaccine, directly
through FedEx and UPS, which requires ultra-frozen storage and
distribution. We, however, will distribute supply kits that are needed
to administer all vaccines, including Pfizer's vaccine.
We have a superior cold chain process to maintain the right
temperature throughout the transportation process. McKesson will accept
Moderna's vaccine at its manufacturing site, bring vaccine doses to
McKesson distribution centers, verify via temperature sensors that
proper temperature was maintained while in transit, and finally, store
the vaccine doses in pharmaceutical grade freezers until a fulfillment
order is placed by the Federal Government.
The Federal government--in coordination with state governments--
will determine where, when, and how many doses McKesson will
distribute. Once an order is received, McKesson will package the
vaccines into a specially designed shipping container with cold packs
that are designed to maintain the product within the manufacturer's
required temperature range during transit from our distribution center
to the administration site. Each package will include a temperature
monitor so the administration site can confirm upon receipt of shipment
that vaccines remained within the appropriate temperature range. Our
carrier partners, FedEx and UPS, will retrieve the vaccine shipments
from our distribution centers and deliver them to administration sites,
typically within 24 hours. Those carriers will use their highest
priority shipping method and will embed Bluetooth technology to track
each package.
McKesson has already pre-assembled ancillary supply kits (including
syringes, needles, alcohol wipes and face shields) to support
administration of more than 150 million doses. Supply kits for Pfizer's
vaccine also include diluent to reconstitute the vaccine to its proper
dosage. The ancillary supply kits are also shipped by FedEx or UPS and
are intended to arrive prior to or at the same time as the vaccine
shipments.
Safety for our employees is equally important. McKesson takes very
seriously compliance with Federal and state public health COVID
guidelines and protocols. We are proud of the thousands of associates
across the United States who are working tirelessly to deliver
vaccines, supply kits and other critical personal protective equipment
such as masks, gloves, and gowns during this pandemic.
While McKesson will be instrumental in the distribution of COVID
vaccines and supply kits, all decisions regarding allocation and
prioritization will be made by the Federal government, in consultations
with the states. State governments will determine how vaccines will be
received, stored, and where administered. Agreements between government
agencies and pharmacy chains or independent pharmacy networks allow for
vaccines to be shipped directly to their site locations. CVS and
Walgreens, for example, have agreements to administer vaccinations at
long-term care facilities.
Centralized distribution for COVID vaccine delivery leverages the
strength of all stakeholders. This model is important for the current
pandemic and future pandemic preparedness. McKesson believes that
public-private partnerships can help ensure that our country deploys an
integrated set of solutions, informed by experience and careful
consideration of the ways in which future crises could differ from the
one at hand. A comprehensive pandemic response plan should include
material preparedness; supply chain resiliency; data sharing and highly
integrated communication and coordination. These elements are built
into the COVID vaccine and kit distribution plan.
We look forward to working with the Congress and the states, along
with our private sector partners on maintaining an integrated supply
chain to support efficient procurement, inventory management, and
deployment of essential vaccines, medical supplies, therapeutics, and
medicines.
Together we will alter the trajectory of this pandemic.
______
ADDENDUM
THE CENTRALIZED VACCINE DISTRIBUTION MODEL
The Federal government utilizes its buying power to procure
the vaccines and develops an overarching strategy for
administration.
The state governments leverage their local resources--public
health entities and private sector providers--to facilitate
administration.
The Federal Government purchases vaccines and ancillary
supplies. Over one and one-half million supply kits, supporting
more than 150 million vaccine doses, have been assembled and
ready for shipment. Supply kits include syringe, needle,
alcohol wipe, and face shield. Supply kits for the Pfizer
vaccine will also include diluent to reconstitute the vaccine
to its proper dosage.
Manufacturers ship to the central distributor, where product
is inventoried and stored.
Health and Human Services has ownership of the Pfizer
vaccine stock. The Centers for Disease Control has ownership of
the Moderna vaccine stock and supply kits. Each Federal entity
allocates product to the states (factoring in population size,
needs of prioritized groups, as well as other national health
imperatives and criteria).
McKesson, as central distributor, then distributes vaccines
and ancillary supplies at the CDC's direction. States can
designate a redistribution site or have products shipped
directly to end administration sites.
States are responsible for overseeing vaccines
administration and coordinating the local healthcare response.
______
Transportation Intermediaries Association
Alexandria, VA, December 8, 2020
Hon. Deb Fischer,
Chairwoman,
Subcommittee on Transportation and Safety,
Committee on Commerce, Science, and Transportation,
United States Senate,
Washington, DC.
Hon. Tammy Duckworth,
Ranking Member,
Subcommittee on Transportation and Safety,
Committee on Commerce, Science, and Transportation,
United States Senate,
Washington, DC.
Dear Senator Fischer and Duckworth:
I am writing on behalf of the almost 1,800 members of the
Transportation Intermediaries Association (TIA) to voice our
willingness to be a part of both the discussion and operations for
delivering a vaccine to all 50 states in a timely manner. Thank you for
having this important oversight hearing entitled ``The Logistics of
Transporting a COVID-19 Vaccine.'' As you know, our industry
facilitates the movement of freight from a shipper to the actual
carrier of record. The distribution of the COVID-19 vaccine could be
the largest logistics operations in the country's history and our
members are eager to be on forefront of this monumental task. Moving
pharmaceuticals, and vaccines, is among the highest maintenance, time
sensitive and sophisticated freight that exists. TIA members have
experience moving these types of goods.
Transportation intermediaries or third-party logistics
professionals act somewhat as the ``travel agents'' for freight;
however, given the wide varieties of freight, specific needs of each
shipper the diverse issues applicable to anyone load, third-party
logistics professionals must have expertise far beyond what a
traditional ``travel agent'' must possess. They serve tens of thousands
of shippers and carriers, bringing together the transportation needs of
the cargo interests with the corresponding capacity and special
equipment offered by rail, motor, air, and ocean carriers.
I urge Congress and the incoming and outgoing administrations to
utilize the 3PL industry as a resource both for information and for the
physical movement of the vaccine. I have heard directly from our
members who are eager to serve their country. Just like these companies
did earlier this year during the economic shutdowns, TIA members will
step up and do what it takes to ensure that this important vaccine is
distributed safely and efficiently. Thank you again for this important
oversight hearing.
Sincerely,
Anne Reinke,
President & CEO,
TIA.
______
[GRAPHICS NOT AVAILABLE IN TIFF FORMAT]
______
Business Insider
12/01/2020
How United Airlines overcame one of the largest limitations to
transporting Pfizer's COVID-19 vaccine to the US
Author: Thomas Pallini
To read this story on the web, please click:
https://www.businessinsider.com/how-united-airlines-overcame-major-
limitation-to-fly-pfizer-vaccine-2020-11
Pfizer has tasked United Airlines with transporting the first doses
of its vaccine to the U.S., the Wall Street Journal reported on Friday,
in preparation for an expected emergency authorization from the Food
and Drug Administration scheduled to come in the upcoming weeks.
A chartered Boeing 777-200 aircraft filled with the pandemic-ending
drugs first flew on Friday, the Journal reported, traveling from
Brussels, Belgium to Chicago, a United hub. Unlike the daily United
passenger flight between the two cities, Pfizer would have likely had
the entire plane to itself as a dedicated charter.
United set up a vaccine task force earlier this year for this very
possibility and had crafted standard operating procedures for each
vaccine as it wasn't initially clear which one would cross the finish
line first. In November, it became clear that the two leading
contenders would be Pfizer and Moderna.But transporting Pfizer's
vaccine came with a problem: its below-freezing storage temperature
requirement of -94 degrees Fahrenheit. Drugs with requirements that far
below-freezing are packed with dry ice to keep them at temperature,
presenting a problem for airlines tasked with flying them.
Dry ice is classified as a dangerous good in aviation as it
sublimates from a solid to gaseous carbon dioxide, which can
incapacitate the flight crew and passengers. Regulators limit how much
dry ice can be flown on cargo and passenger planes but given the unique
circumstances, carriers have request exemptions to these limits in
order to fly more vaccine doses in the upcoming airlift to transport
doses around the world.
The Federal Aviation Administration granted United an exemption to
the dry ice limitation, according to the Journal, allowing the airline
to fly more of the drug than it normally would have. As the flight was
a charter, no other passengers were onboard, and only essential crew
were looking after the aircraft during the flight.
``The FAA is working with manufacturers, air carriers, and airport
authorities to provide guidance on implementing current regulatory
requirements for safely transporting large quantities of dry ice in air
cargo,'' the regulator said in a statement e-mailed to Business
Insider.
United is now allowed to fly up to 15,000 pounds of dry ice on the
Boeing 777-200, according to the Journal, five times the previously
allowed limit for the wide-body aircraft. The shipping containers
carrying Pfizer's vaccine have around 23 kilograms, or around 50
pounds, of dry ice packed inside of them, according to Julian Sutch,
Emirates SkyCargo's global manager for pharma, in a previous interview
with Business Insider.
Although operating cargo-only flights with no passengers, the
Chicago-based airline still has to comply with regulations for
passenger airliners such as the Boeing 777-200, according to Chris
Busch, managing director for United Cargo in the Americas, in a
previous interview with Business Insider. And even without passengers,
all freight flown by United flies in the belly cargo hold and not the
passenger cabin.
Most, if not all major airlines with pharmaceutical-carrying
capabilities are gearing up to potentially participate in the life-
saving airlift as more vaccine candidates enter the authorization
process. But unlike the first mass transport of COVID-19 supplies that
saw anybody with a plane transport personal protective equipment from
China, aircraft operators will face hurdles including adequate storage
and limited onboard space thanks to the dry ice limitations of each
aircraft.
Pfizer taking the steps to move around the vaccine before its
authorization shows the confidence the drug-maker has in the product.
Chartering a Boeing 777 can quite easily cost tens of thousands of
dollars per hour and multi-day international trips can easily add up,
especially as cargo space is now yielding a premium during the
pandemic.
Now that it's in the U.S., Pfizer will rely on over-the-road trucks
for regional transportation to its storage facilities until the Food
and Drug Administration passes down an approval that will see immediate
distribution as the U.S. begins the long journey to herd
immunity.Trucks can better deal with transporting a frozen vaccine as
they have higher dry ice limitations than aircraft. From Chicago or one
of Pfizer's storage facilities, the vaccine can be on either coast in a
matter of days using team-truck driving.
The Food and Drug Administration is expected to grant Pfizer's
emergency authorization request as early as December 10, with Moderna
set to file for emergency authorization on Monday.
______
[GRAPHICS NOT AVAILABLE IN TIFF FORMAT]
Senator Fischer. The hearing record will remain open for
two weeks. During this time, Senators are asked to submit
questions for the record. Upon receipt, the witnesses are
requested to submit their written answers to the Committee as
soon as possible.
I would like to thank all of our panel today for a very
informative hearing that we had. I appreciate the work that you
and the people you represent do every single day to keep this
country moving and keep us being able to receive what we need,
when we need it, so that it is effective.
So, thank you very, very much. Thank you, Dr. Levine,
remotely. We appreciate your comments, as well.
With that, the hearing is adjourned.
[Whereupon, at 11:12 a.m., the hearing was adjourned.]
A P P E N D I X
Response to Written Questions Submitted by Hon. Dan Sullivan to
Rachel L. Levine, MD
Background: On average, rural populations are older, poorer, and
sicker than their urban counterparts. These populations are more
severely impacted by a coronavirus infection. To make matters worse,
nationally, 61 percent of rural hospitals do not have an Intensive Care
Unit (ICU)-and that is when a rural area has a hospital. It is
imperative that we immunize rural populations according the CDC
guidelines at the very same time as their urban counterparts. A delay
will allow COVID-19 to continue to severely overwhelm rural health
systems, like hospitals, clinics and the emergency medical systems that
support rural communities.
Question 1. As Congress continues to discuss what should be
included in the next COVID relief package, what should we prioritize to
ensure equitable access to the COVID-19 vaccine to all individuals in
each population group, regardless of their zip code, rural or urban?
Answer. Investment into communication campaigns is important.
Reaching our most vulnerable populations who may speak another
language, not understand how to access electronic media, or be part of
the digital divide can be difficult. Additionally, states have
different populations that speak different languages. Reaching these
populations through proper language translations and different mediums
is important to improve messenger services to help combat vaccine
hesitancy. Additional flexible support for equitable vaccine
distribution methods and evaluation is also important--mainly state
logistic resources and data and system collection improvements for
reaching and understanding vulnerable populations and those in rural
areas.
Background: COVID-19 deaths are on the rise in rural America. For
the fifth straight week, the number of rural deaths due to COVID-19 set
records. Last week, there were more than 3,000 rural deaths due to the
virus. Alaska has personal experience with this type of rural tragedy.
The 1918 pandemic decimated our rural regions, which are largely made
up of predominantly Alaska Native communities. The fear and historical
trauma of that pandemic is still felt today. HHS has allocated vaccines
specifically for tribes, which has been incredibly helpful.
Question 2. Do you think that states and IHS are equipped to
distribute vaccines across challenging geographies that ensure
equitable access to the Covid-19 vaccine for every population,
including Alaskan Natives and other Native American populations? Are
there ways to better support our states as they endeavor to take on
this responsibility and to ensure that high-risk populations do not
fall through the cracks?
Answer. HIS has a well laid plan to describe vaccine availability,
prioritization, distribution and ordering, administration, safety, and
communications. Although Pennsylvania is not one of the states with
tribal territories, it has a population of more than 51,000 American
Indians or Alaskan Americans. Pennsylvania's goals are to prioritize
persons, while the vaccine supply remains limited, who receive the
vaccine to maximize benefits and minimize harms caused by the virus,
promote justice, mitigate health inequities, and promote transparency.
Pennsylvania has worked throughout the pandemic to address disparities
within racial and ethnic minority groups.
Addressing COVID-19 through a health equity lens is just as
critical for the administration of vaccines. Providing vaccines to
American Indians or Alaskan Americans is essential to creating a
healthy Pennsylvania for all. Investment into communication campaigns
and additional vaccine dosages to increase coverage is important.
Support to improve trusted messenger services to help combat vaccine
hesitancy would be of great assistance.
______
Response to Written Questions Submitted by Hon. Maria Cantwell to
Rachel L. Levine, MD
State Funding. States and local communities have been on the
frontlines fighting the COVID-19 virus from the beginning of this
pandemic. Healthcare workers have been battling this virus around the
clock since it first came to our Nation despite being underfunded and
undersupplied. Now they are being tasked with the herculean effort of
distributing and administering a vaccine to millions of people on an
accelerated timetable. In September, CDC Director Robert Redfield
testified before Congress and said that states will need $6 billion for
vaccine distribution. The Association for State and Territorial Health
Officials puts that number closer to $8.4 billion. Yet so far, less
than $340 million has been allocated to states to help plan for and
distribute a vaccine. Facing a national emergency and a vaccine
campaign of unprecedented proportions, that amount is simply
unacceptable.
Question 1. What are the most critical elements for ensuring a
successful vaccination campaign at the state and local level?
Answer. Use of multiple partnerships for planning and
operationalizing. Ability to pivot planning and operational needs to
adjust to the vaccine availability, phase and timing and the engagement
of traditional and non-traditional vaccination partners.
Question 2. What are the public health consequences that will
result if states and localities do not receive more financial support?
Answer. It will take longer to get all Pennsylvanians vaccinated
who want to be. The greater the delay in vaccination of large numbers
of Pennsylvanians, the longer it will take to achieve herd immunity,
the longer people will suffer the consequences of the COVID-19
pandemic, including the disproportionate effects on vulnerable
communities.
Strain on the Healthcare System. The U.S. healthcare system is
under severe strain. Our healthcare workers have been working nonstop
to treat this virus and to keep people safe. However, there are not an
unlimited number of healthcare workers, and that number is further
strained as we deal with a surge in COVID-19 cases. Additionally, with
mass vaccine distribution underway, those healthcare systems need
infrastructure and inventory management systems that can ensure extreme
temperature requirements are maintained for the COVID-19 vaccine.
Question 3. Are you concerned about the healthcare system's ability
to handle a mass vaccination campaign while also managing the recent
surge in COVID-19 cases? If so, what are the most critical pressure
points in the healthcare system that must be bolstered?
Answer. Yes. We have been relying on our health system partners to
vaccinate not only their own staff but also non-affiliated healthcare
personnel--in addition to managing surging COVID-19 admissions.
Additional Federal funding would enable us to hire a contractor or
contractors to conduct mass vaccination clinics that would allow the
health systems to focus on their primary mission and increase the rate
of vaccination across the Commonwealth.
Question 4. How are states addressing the distribution needs of
rural or remote areas that may not have cold-chain storage to support
some of the vaccines?
Answer. We are utilizing the Moderna vaccine which does not have
the ultra-cold chain requirements of the Pfizer-BioNTech vaccine for
our hospitals and providers in rural and remote areas. Our Federally
Qualified Health Centers (FQHCs) and enrolled local pharmacies are key
partners in this effort. We also anticipate that the Retail Pharmacy
Partnership (PA has chosen Rite Aid and Topco) will also be important
and we will be choosing locations in parts of the state with limited
existing vaccine providers.
Vaccine Equity. COVID-19 has disproportionately impacted
communities of color, people living with disabilities, and those living
in rural and frontier areas. Minority communities have faced higher
cases rates, hospitalization rates, and death rates than white
Americans. There are also concerns about distributing the vaccine
equitably to communities that speak different languages or are
difficult to reach, especially when supply is limited.
Question 5. How are states ensuring that the vaccine is distributed
equitably, and are there any specific shortages of personal protective
equipment or infrastructure that may impact equitable distribution of
the vaccine across the country? Where are those shortages likely to
occur?
Answer. Public health crises have the potential to affect all
populations but typically have more severe impacts on underserved
populations, making those populations more vulnerable to severe illness
and death. A first step in developing an equitable vaccine distribution
plan is to understand and identify populations most at risk of
contracting COVID-19 and severe illness. We have worked across state
agencies and with external partners to identify vulnerable populations
for whom receiving the COVID-19 vaccine is especially critical.
Estimates of the number of these identified vulnerable populations are
derived from the 2019 U.S. Census, the Behavioral Risk Factor
Surveillance System (BRFSS), State Health Assessment, and health
systems patient databases (Medicaid, IBX), and Tiberius. We have also
developed a vulnerability index to look at social factors,
demographics, and health risks to identify potential areas that are
most in need of the vaccine.
Currently, the vaccine distribution is not affected by lack of PPE.
However, we are cognizant that the PPE supply chain is still strained,
and that any disruption in supply (or significant increase in demand)
is likely to impact the ability to procure PPE necessary for an
effective vaccination campaign.
Question 6. What do states and local governments need from the
Federal Government to ensure equitable vaccine distribution?
Answer. The Commonwealth's approach for Pennsylvania's COVID-19
Interim Vaccination Plan utilized a health equity lens to proactively
mitigate the disparities in the risks associated with COVID-19 with no
new resources for health equity assessment. We have been relying on our
limited health equity staff to collect data and assess social risks and
health statuses associated with severe outcomes from COVID-19.
Additional Federal funding would enable us to hire a contractor or
contractors to conduct assessments and lead interventions to addresses
health disparities associated with COVID-19.
Question 7. What social and environmental investments are needed to
address the disproportionate impact on certain communities in the
future?
Answer. Interventions to address the digital divide across
different geographies and socioeconomic statuses; trusted messenger
strategies and centralized approaches to sharing evidence, mitigation
standards, and vaccine planning; information technology platform
readiness, specific to demographic race and ethnicity reporting
capabilities and exercising mandates to create corporate support for
the collection of actionable public health data; funding and
implementation support for vaccine strategies and pharmacy partnership
programs specific to underserved communities.
Security. In late 2020 we saw reports that cyber criminals and
foreign adversaries had attacked companies involved with the storage
and transport of the vaccine in Europe. Additionally, it has come to
light that Russia was likely behind one of the largest cyber-attacks
against the United States. I am concerned that entities critical to the
distribution of the vaccine may not have the cyber expertise needed to
deal with these new threats.
There have also been reports of some individuals intentionally
sabotaging vaccines once they have been received by healthcare
facilities by removing them from the appropriate storage containers.
Question 8. What are the top threats to vaccine viability that
state and local healthcare facilities and providers must deal with, and
what is needed from the Federal government to bolster state and local
responses to those threats?
Answer. Anecdotally, we have heard that the largest challenge to
vaccine viability at the facility level is ``vaccine shopping'' by
eligible individuals, who may make appointments with or seek vaccine
from multiple providers; this leaves a vaccine provider with
reconstituted vaccine but without a patient to vaccinate. We have not
heard of any credible external threats, such as tampering or theft,
from any partners.
Question 9. Are you aware of any impacts the recent SolarWind
cyber-attack or other cyber security threats have had on the Nation's
healthcare infrastructure or the COVID vaccine supply chain?
Answer. We are not aware of any impacts.
COVID Vaccine Distribution Delays. It has been reported that states
are seeing a reduction in the number of vaccines allocated to them
through the end of the year. On December 17, 2020, Pfizer released a
statement stating that they have had no production issues and that
millions of vaccines are waiting in storage waiting on shipping
instructions from the Federal government.
Question 10. Has the Federal government provided states with an
explanation for the reduction in vaccine allocation?
Answer. We have been advised to use the numbers initially given for
planning purposes only. We have also been advised that it would take
several weeks to establish a cadence for the amount of vaccine
allocations.
Question 11. Are you aware of, or have you experienced delays in
vaccine delivery?
Answer. Delays have been due to incorrect addresses in the vaccine
tracking system which prevents delivery of vaccine until the address is
confirmed.
______
Response to Written Questions Submitted by Hon. Tammy Duckworth to
Rachel L. Levine, MD
Temperature Requirements. Preserving cold chain and temperature
requirements for bulk distribution.
Question 1. In review of the COVID-19 Distribution Plan established
by Operation Warp Speed, it is clear that steps have been taken to
preserve the cold chain and temperature requirements for the bulk
distribution of the vaccines to each State under the supervision of
state health departments. This addresses some key risks during these
early steps of the cold-chain process. However, it is still important
to promote public confidence that the vaccine is effective when
administered to the patient.
What percentage of COVID-19 vaccines do you estimate will be lost
in transit, due to temperature, or other issues? What precautions are
you taking to minimize this?
Answer. The vaccine is delivered either directly to the site from
the manufacturer or to the site through the distributor. The state is
not involved in this transport.
Question 2. What measures is your state taking to mitigate the
risks during the ``Last Mile'' administration of the vaccine?
Answer. The Commonwealth is not directly involved with the last
mile; we have provided storage and handling training to providers
receiving the vaccine.
Question 3. As containers, pallets and boxes of vaccine are broken
down to be distributed throughout each state, will temperature
technology on the individual vials of vaccine be utilized and requested
by the state health departments to ensure the vaccine vials remain at
the required temperature range and are safe and effective for the
patient receiving these doses?
Answer. The Commonwealth is not redistributing the vaccine. The
Pfizer-BioNTech vaccine does arrive with a tracker for temperature
monitoring due to the ultracold requirements. There are no additional
requirements by the state outside the routine temperature monitoring by
each site.
______
Response to Written Questions Submitted by Hon. Gary Peters to
Rachel L. Levine, MD
FEMA and Healthcare Distribution. As Ranking Member of the Senate
Homeland Security and Governmental Affairs Committee, I have been
conducting oversight of FEMA's role in the Federal COVID-19 response.
FEMA played a large part in the distribution of personal protective
equipment (PPE) throughout this pandemic and we unfortunately continue
to hear reports of shortages.
Question 1. From your perspective as Secretary of Health for
Pennsylvania as well as President of ASTHO, how has the PPE
distribution process with FEMA gone, and what can be learned from that
experience as the Federal government executes a similar distribution
effort of vaccines and ancillary supplies?
Answer. FEMA and other Federal partners (such as HHS) have provided
significant quantities of PPE to the commonwealth over the last 11
months. One of the largest challenges to the order and receipt of
Federal assets throughout has been the change in process and
eligibility requirements--to date, we have had at least 2 request
process changes (between HHS and FEMA) and one major revision to
eligibility. These changes, especially at the incipient phase of the
response created challenges to the timely procurement of PPE through
Federal partners. However, recently, we have not had any challenges in
procuring PPE.
Question 2. Is a lack of PPE in your state affecting vaccine
distribution plans?
Answer. Currently, the vaccine distribution is not affected by lack
of PPE. However, we are cognizant that the PPE supply chain is still
strained, and that any disruption in supply (or significant increase in
demand) is likely to impact the ability to procure PPE necessary for an
effective vaccination campaign.
All parties involved in the distribution of COVID-19 vaccines must
be closely coordinated to ensure successful and safe vaccine delivery.
I am concerned by recent reports of miscommunication regarding vaccine
allocations to states. States must receive accurate, timely information
about vaccine deliveries from the Federal government, so they can plan
accordingly.
Question 3. Has your state received clear communication from the
Administration on vaccine allocations, including visibility into the
number of COVID-19 vaccines you expect to receive and when you expect
to receive them?
Answer. The vaccine allocations are uploaded weekly. Vaccines are
tracked through the vaccine tracking system. There are daily reports
sent to states as to the delivery of vaccines.
Question 4. What can be improved in the communication between
states and the Federal government regarding COVID-19 vaccine allocation
and distribution?
Answer. Communication between states and the Federal government
would be improved by the provision of a longer time frame for expected
allocations rather than weekly.
Question 5. What are the most pressing unanswered questions that
states have regarding the vaccine distribution process?
Answer. When will the allocations increase to meet the demand of
vaccination needs?
Question 6. Vaccine distribution efforts will be a costly
undertaking for the states. Has your state received adequate guidance
from FEMA on what vaccine distribution costs will be reimbursable under
this national emergency?
Answer. Our state emergency management agency has taken the lead
for Federal reimbursement through the Stafford Act/FEMA process. This
partnership has ensured that we have the relevant information to seek
appropriate reimbursement for costs not covered under other HHS Federal
funding steams.
Question 7. What further information does your state need to
understand what costs can be covered by the Federal government, whether
FEMA or another Federal agency?
Answer. Both HHS and FEMA have provided adequate guidance and
continuing consultation on the eligibility of Federal reimbursement of
costs incurred under this response.
______
Response to Written Question Submitted by Hon. Kyrsten Sinema to
Rachel L. Levine, MD
Vaccine Security. Vaccine security is an important issue that must
be addressed as part of the logistics process for vaccine distribution.
Earlier this month, Interpol issued a global warning alerting its
members that organized crime networks could attempt to steal doses of
the vaccine.
Question. Are there any particular considerations related to
vaccine security that smaller regional hospitals must consider as they
receive the vaccine?
Answer. Since the shipments of vaccine are going directly to the
providers without the commonwealth as a logistics intermediary,
security and responsibility for the vaccine is within the purview of
the receiving site
______
Response to Written Questions Submitted by Hon. Dan Sullivan to
Richard W. Smith
Background: On average, rural populations are older, poorer, and
sicker than their urban counterparts. These populations are more
severely impacted by a coronavirus infection. To make matters worse,
nationally, 61 percent of rural hospitals do not have an Intensive Care
Unit (ICU)-and that is when a rural area has a hospital. It is
imperative that we immunize rural populations according the CDC
guidelines at the very same time as their urban counterparts. A delay
will allow COVID-19 to continue to severely overwhelm rural health
systems, like hospitals, clinics and the emergency medical systems that
support rural communities.
Question 1. As Congress continues to discuss what should be
included in the next COVID relief package, what should we prioritize to
ensure equitable access to the COVID-19 vaccine to all individuals in
each population group, regardless of their zip code, rural or urban?
Answer. Our role in this effort has been focused on providing rapid
and reliable transportation to the administration sites across the
Nation using our robust air and ground network. This is a complex task
and there are only a few companies in the world that can do we what we
do, connecting an incredible number of origin-destination pairs across
countries and continents via the vast networks we operate, including
rural communities across the U.S. FedEx has the ability to service
every ZIP code in the U.S. As the U.S. moves forward in this effort, it
is critical that we continue to work closely with our healthcare
customers, as well as federal, state and local officials, on plans for
transporting the vaccines as soon as they become available to ensure
they reach their destination as determined by the Federal and state
authorities.
Background: We all know the story of Balto, the lead sled dog who
helped deliver the diphtheria vaccine to Nome, Alaska in 1925. The
weather was so cold that planes would not start, but Nome needed that
vaccine. Over 20 mushers took part in a race to get the vaccine to
Nome-in a negative 23-degree blizzard. Balto and his team safety
delivered the vaccine, resulting in many lives saved. The point of this
story is that Alaska has many barriers that other states do not have.
We have ultra-rural, sometimes referred to as frontier regions,
communities off the road system, communities without water, blizzards
that shut down entire communities. Recently, a 37-year old tragically
died in a rural community off the road system in Alaska because he was
unable to get to the nearest hospital, and helicopters and planes were
unable to get to him because of severe weather. This is a rural
problem, most acute in Alaska.
Question 2. The CDC Advisory Committee on Immunization Practices
appropriately outlined vaccine priorities based on population groups.
While states are leading the distribution effort, many rural states,
including Alaska, will have geographic challenges. How will you work
with states to ensure equitable access for high-risk populations in
rural areas? For example, will a frontline health care worker in
Bethel, Alaska get the vaccine at the same time as a health care worker
in Anchorage?
Answer. The FedEx network was created for the exact purpose and
service required for today's mission. FedEx is the world's largest
express transportation provider, with an unparalleled global network of
more than 680 aircraft, including a wide range of aircraft types that
can serve both large metropolitan areas and smaller, rural communities
alike, and with more than 200,000 vehicles. We have made significant
investments in our people, infrastructure, and assets that allow us to
serve every ZIP code in the U.S., including facilities on Tribal lands
and those in rural communities. For example, we have a hub at Ted
Stevens International Airport and more than a thousand Alaskan team
members who understand the unique needs of the communities they serve.
We have been working closely with Federal and state government
officials since the start of this effort to ensure that as soon as
vaccines are available, they are delivered to the destinations as
determined by the government authorities.
______
Response to Written Question Submitted by Hon. Rick Scott to
Richard W. Smith
Background: Recently, the U.S. Department of Transportation
announced that it had taken all regulatory measures to provide
flexibility for companies to transport the vaccine. The CDC also
requested that states provide a plan for how they will operationalize
the vaccine response within their jurisdictions.
Question. Do you feel the Federal government and states have
provided clear plans and guidance for vaccine distribution?
Answer. FedEx has been working closely over the past several months
with our healthcare customers, as well as federal, state and local
officials, on plans for transporting the vaccines as soon as they are
approved and become available to ensure they reach their destination as
determined by the government authorities. This is a complex task that
requires close coordination. It is essential that as we move forward in
this effort, the collaboration with these stakeholders continues.
______
Response to Written Questions Submitted by Hon. Maria Cantwell to
Richard W. Smith
Cyber Security. In late 2020 we saw reports that cyber criminals
and foreign adversaries are attacking companies involved with the
storage and transport of the vaccine in Europe. Additionally, it has
come to light that Russia was likely behind one of the largest cyber-
attacks against the United States.
Question 1. What is FedEx doing to ensure the security of the
vaccines from both virtual and physical threats?
Answer. In addition to complying with regulatory obligations set
forth by the Transportation Security Administration, FedEx operates
under a high level of physical and virtual security awareness at all
times and has robust policies and procedures designed to protect our
employees, equipment, packages and customers. In preparation to support
this effort, we conducted targeted risk analyses and physical security
audits and enhanced threat monitoring capabilities. As an added
safeguard, we have developed protocols to enable our team to react
immediately to any potential vaccine shipment anomalies.
To combat potential threats from cyber adversaries, FedEx relies on
multiple layers of security defense mechanisms using the latest
technologies and network monitoring 24 hours a day, 365 days a year.
Regarding the physical security of the vaccines, FedEx and our
customers are using the latest technology to monitor the shipments in
real-time. This includes the use of FedEx-patented technology,
SenseAware ID device, that can precisely track a package's location.
FedEx Priority Alert teams have been engaged from the beginning,
monitoring, tracking and tracing these shipments from the moment they
enter our network until they are delivered to our customers, leveraging
our FedEx Surround platform, that uses predictive analytics to alert
our agents of potential exception events such as weather or traffic
before a failure occurs so they can proactively intercede.
Question 2. Are you aware of any impacts the recent SolarWind
cyber-attack have had on your infrastructure or the COVID vaccine
supply chain?
Answer. Neither the FedEx infrastructure nor our COVID-19 vaccine
distribution have had any impacts from the recent SolarWinds cyber-
attack.
COVID Vaccine Distribution Delays. It has been reported that states
are seeing a reduction in the number of vaccines allocated to them
through the end of the year. On December 17, 2020, Pfizer released a
statement stating that they have had no production issues and that
millions of vaccines are waiting in storage waiting on shipping
instructions from the Federal government.
Question 3. Are you aware of, or have you experienced, delays in
distribution of the vaccine? If so, what have been the causes of those
delays?
Answer. Vaccine shipments remain the top priority for the FedEx
Express network. At this time, we have not experienced any delays in
distribution based on factors within our control.
Question 4. Specifically, are you aware of or have you experienced
delays in the distribution of the vaccine as a result of lack of
instruction from the Federal government?
Answer. FedEx has not experienced any delays in distribution based
on factors within our control and continues to work closely with the
U.S. government task force to ensure timely distribution.
______
Response to Written Questions Submitted by Hon. Jon Tester to
Richard W. Smith
Question 1. COVID has disproportionately impacted minority
communities, and in Montana, this pandemic has significantly impacted
our Native communities. As we discuss the distribution of a vaccine, it
is absolutely critical that we consider the unique challenges of
reaching the remote communities where many Native folks live. What
steps are you taking to make sure that remote facilities like those on
Tribal lands receive vaccines in a safe and timely manner?
Answer. FedEx was created for the exact purpose and service
required for today's mission: fast, reliable delivery of time-
sensitive, high priority goods. Over the years, we have invested in our
people, infrastructure, and assets, to ensure we have solutions that
meet the needs of the communities we serve. As a result of these
investments, within the U.S., we can deliver to every ZIP code,
including facilities on Tribal lands, and are committed to ensuring
timely vaccine distribution to the communities we serve at the
direction of federal, state and local officials.
Question 2. At the beginning of the pandemic my office heard from a
number of businesses in rural Montana that they either were not
receiving shipments or they took much longer than usual. When there are
major disruptions in the supply chain, rural America often faces the
brunt of those changes. What precautions are you putting in place to
ensure a stable supply chain to our rural communities?
Answer. FedEx has been on the frontlines since the start of this
pandemic providing essential transportation services and keeping
critical supply chains moving across the U.S and the world. In the
U.S., we have continued to serve rural communities without disruption
and will continue to do so. The FedEx network was designed for today's
mission and we remain committed to serving communities across the U.S.
and the world.
______
Response to Written Questions Submitted by Hon. Gary Peters to
Richard W. Smith
Cybersecurity. Cyber-attacks are a real threat as our Nation ramps
up efforts to distribute millions of COVID-19 vaccines. In 2017, the
largest container ship company was hit by the NotPetya cyber-attack,
which compromised the company's operations for months. Just this month,
the U.S. government experienced troubling cyber-attacks from foreign
adversaries. At the hearing, I asked you about the security measures
your company has in place to ensure vaccine distribution networks are
protected from bad actors.
Question 1. Please detail the specific security measures that are
currently in place, including contingency plans, and whether these
plans include cooperation with Federal agencies and commercial
competition to ensure the safe delivery of vaccines.
Answer. FedEx and our customers are using the latest technology to
monitor vaccine shipments in real-time. FedEx operates under a high
level of physical and virtual security awareness at all times and has
robust policies and procedures designed to protect our employees,
equipment, packages and customers. To combat potential threats from
cyber adversaries, FedEx relies on multiple layers of security defense
mechanisms using the latest technologies, and we constantly monitor our
networks for illicit activity via a dedicated global cybersecurity
operations center operating 24 hours a day, 365 days a year.
FedEx Express is CTPAT certified and has a Transportation Security
Administration compliant security program. Beyond compliance with
Federal regulations intended to secure and deny unauthorized access to
air cargo shipments, FedEx has conducted targeted risk analyses and
physical security audits in preparation for vaccine transportation and
has enhanced our threat monitoring capabilities. As an added safeguard,
we have developed protocols to enable our team to react immediately to
any potential vaccine shipment anomalies.
FedEx is actively engaged with the U.S. government task force and
has robust security relationships with Federal agencies, as well as
with major distributors and manufacturers globally. Contingency and
crisis management capabilities are in place to address potential
business interruption scenarios.
Question 2. Have you received sufficient support and guidance from
the Department of Homeland Security's Cybersecurity and Infrastructure
Security Agency?
Answer. FedEx engages with CISA via multiple information sharing
platforms and has open channels of communication with the Agency at
both the headquarters and regional levels.
______
Response to Written Question Submitted by Hon. Kyrsten Sinema to
Richard W. Smith
Rural and Tribal Communities. As you know, Arizona is a vast
state--the sixth largest state by area. Arizona is home to Phoenix, one
of the largest cities in the country, and is also home to many smaller,
rural, and tribal communities across the state. Unfortunately, many of
these smaller, rural, and tribal communities have been particularly
impacted by the COVID-19 pandemic.
Question 1. What are the challenges associated with vaccine
distribution to rural and tribal communities, as compared to larger
urban areas and what has your company done to address those challenges?
Answer. The FedEx network was created for the exact purpose and
service required for today's mission. FedEx is the largest global
express transportation provider, with an unparalleled global network of
more than 680 aircraft, including aircraft capable of serving large
metropolitan areas and smaller, rural communities, and more than
200,000 vehicles. We have made significant investments in our people,
infrastructure, and assets that allow us to serve every ZIP code in the
U.S., including facilities on Tribal lands, and will continue to do so
to ensure continued connectivity to the communities we serve.
Vaccine Security. Vaccine security is an important issue that must
be addressed as part of the logistics process for vaccine distribution.
Earlier this month, Interpol issued a global warning alerting its
members that organized crime networks could attempt to steal doses of
the vaccine.
Question 2. What security and tracking measures are in place for
vaccine shipments to ensure that vaccine shipments reach their
destination?
Answer. FedEx has a robust suite of tools and technology we are
deploying to ensure the safety, security, and integrity of vaccine
shipments. This includes the FedEx SenseAware ID device, our sensor-
based technology that can precisely track a package's location, and
FedEx Surround platform, which uses data and predictive analytics to
alert our agents of potential exception events before a failure occurs
so they can proactively intercede if needed. These tools are monitored
by our Priority Alert teams who have been engaged from the beginning,
monitoring, tracking and tracing these shipments from the moment they
enter our system until they are delivered to our customers.
______
Response to Written Questions Submitted by Hon. Maria Cantwell to
Wesley Wheeler
Cyber Security. In late 2020 we saw reports that cyber criminals
and foreign adversaries are attacking companies involved with the
storage and transport of the vaccine in Europe. Additionally, it has
come to light that Russia was likely behind one of the largest cyber-
attacks against the United States.
Question 1. What is UPS doing to ensure the security of the
vaccines from both virtual and physical threats?
Answer. UPS leverages secure escorts (US Marshals and/or local law
enforcement on moves into Louisville. Internal UPS Security and UPS's
Command Center monitor each vaccine shipment with UPS Premier, which
includes real-time monitoring in the UPS network. UPS networks are
secure and protected by threat (we offer our best practices to CISA on
a regular basis). Vaccine tracking information is secured behind UPS
firewalls and only shared in protected transactions to vaccine
partners.
Question 2. Are you aware of any impacts the recent SolarWind
cyber-attack have had on your infrastructure or the COVID vaccine
supply chain?
Answer. UPS has not been impacted by SolarWind cyber threats and
vaccine delivery specifically has not been impacted.
COVID Vaccine Distribution Delays. It has been reported that states
are seeing a reduction in the number of vaccine's allocated to them
through the end of the year. On December 17, 2020, Pfizer released a
statement stating that they have had no production issues and that
millions of vaccines are waiting in storage waiting on shipping
instructions from the Federal Government.
Question 3. Are you aware of, or have you experienced, delays in
distribution of the vaccine? If so, what have been the causes of those
delays?
Answer. No. UPS delivered 100 percent vaccines by scheduled day in
December and near perfect in January. Since the start of vaccine
shipments UPS is running 99.98 percent on time by day and 99.9 percent
on time by 10:30 AM commit times.
Question 4. Specifically, are you aware of or have you experienced
delays in the distribution of the vaccine as a result of lack of
instruction from the Federal government?
Answer. UPS is not aware of any delays related to the lack of
instruction from the Federal Government.
______
Response to Written Questions Submitted by Hon. Jon Tester to
Wesley Wheeler
Question 1. COVID has disproportionately impacted minority
communities, and in Montana, this pandemic has significantly impacted
our Native communities. As we discuss the distribution of a vaccine, it
is absolutely critical that we consider the unique challenges of
reaching the remote communities where many Native folks live. What
steps are you taking to make sure that remote facilities like those on
Tribal lands receive vaccines in a safe and timely manner?
Answer. These remote territories are serviced by UPS with next day
service. Time commitments may be later within the day, but UPS will
deliver the next business day as with urban areas. UPS has experienced
severe weather in some of these areas since the vaccine distribution
began, but extraordinary efforts have been made by our people to ensure
vaccines were delivered on the proper day.
Question 2. At the beginning of the pandemic my office heard from a
number of businesses in rural Montana that they either were not
receiving shipments or they took much longer than usual. When there are
major disruptions in the supply chain, rural America often faces the
brunt of those changes. What precautions are you putting in place to
ensure a stable supply chain to our rural communities?
Answer. This has not been an issue for UPS. Our service rate has
been 99.98 percent on time by day for vaccines since the start of
vaccine shipments in mid-December. If weather or other events delayed
movements of vaccines into these territories, UPS has contingent
support in these locations to receive later aircraft and ensure same
day deliveries. If needed, UPS can leverage support from our Marken/
Express Critical groups for same day ground or air movements. UPS is
prepared to leverage charters as well if needed in case of significant
circumstances, which has not been required to date.
______
Response to Written Questions Submitted by Hon. Gary Peters to
Wesley Wheeler
Cybersecurity. Cyber-attacks are a real threat as our Nation ramps
up efforts to distribute millions of COVID-19 vaccines. In 2017, the
largest container ship company was hit by the NotPetya cyber-attack,
which compromised the company's operations for months. Just this month,
the U.S. government experienced troubling cyber-attacks from foreign
adversaries. At the hearing, I asked you about the security measures
your company has in place to ensure vaccine distribution networks are
protected from bad actors.
Question 1. Please detail the specific security measures that are
currently in place, including contingency plans, and whether these
plans include cooperation with Federal agencies and commercial
competition to ensure the safe delivery of vaccines.
Answer. UPS takes extensive actions to ensure our networks are
protected from cyber-attacks. This includes regular training for our
employees on threats. UPS regularly interfaces with CISA and other
security support groups to share best practices. In terms of physical
security, UPS leverages U.S. Marshals and local law enforcement escorts
for bulk ground moves as well as private security when vaccines are on
UPS property. Real-time tracking is used and monitored by UPS's Command
Center and internal UPS security. Contingency plans are a way of life
at UPS. We have late aircraft plans by specific location to ensure
timely delivery, hot spare aircraft, and same day capabilities with our
Express Critical and Marken business units. UPS does collaborate with
commercial airlines and other logistics providers to enable this
contingency support.
Question 2. Have you received sufficient support and guidance from
the Department of Homeland Security's Cybersecurity and Infrastructure
Security Agency?
Answer. Yes, UPS has regularly meets with these agencies and
receives ample support. The CISA team met with UPS in December of 2020
to specifically discuss security with vaccine rollout.
______
Response to Written Question Submitted by Hon. Kyrsten Sinema to
Wesley Wheeler
Rural and Tribal Communities. As you know, Arizona is a vast
state--the sixth largest state by area. Arizona is home to Phoenix, one
of the largest cities in the country, and is also home to many smaller,
rural, and tribal communities across the state. Unfortunately, many of
these smaller, rural, and tribal communities have been particularly
impacted by the COVID-19 pandemic.
Question 1. What are the challenges associated with vaccine
distribution to rural and tribal communities, as compared to larger
urban areas and what has your company done to address those challenges?
Answer. The greatest challenge posed for rural deliveries is
related to weather threats. Rural communities are delivered next
business day, as with urban deliveries. At times, weather can impact
the small feeder aircraft used to reach these areas, which is an
additional challenge. In addition, longer driver and road conditions
when storms hit can be a difficult factor. UPS is proud to say that we
have worked to overcome these factors in the handful of winter storms
experienced so far this year. UPS was 100 percent on time by day in
December and 99.96+ in January for on time by day.
Vaccine Security. Vaccine security is an important issue that must
be addressed as part of the logistics process for vaccine distribution.
Earlier this month, Interpol issued a global warning alerting its
members that organized crime networks could attempt to steal doses of
the vaccine.
Question 2. What security and tracking measures are in place for
vaccine shipments to ensure that vaccine shipments reach their
destination?
Answer. A number of both physical and technical security measures
are in place for vaccines. Security escorts are leveraged for ground
movements to our air hubs. Private armed security is used when vaccines
are on UPS property for longer durations. UPS monitors each movement of
the vaccines using our Sentry devices, which provides real-time GPS
tracking. We have separate devices for temperature and other discrete
data points. These asset/network tracking tools are used by UPS's
Command Center. Each vaccine delivery is forecasted in advance down to
the specific driver making the delivery. The UPS Command Center
monitors the progress and close out of each vaccine shipment daily. UPS
has eyes on these shipments at various levels through the entire chain
of custody.
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