Transporting healthcare products by air demands a rigorous logistical approach, and with ever-tightening government regulation. Aviation Business News finds that cold chain logistics must continuously adapt to stringent procedures.

Early this year, DHL Express launched a medical express service between Brazil and the United States for customers in the pharmaceutical and clinical research sector. The transportation solution, piloted in Brazil beginning in November 2018, addresses increased customer demand for faster and more predictable lead times, given the regulatory complexities that can delay exports.

Other players such as AirBridgeCargo (ABC) are big in the market of healthcare cargo. ABC has set a dedicated ‘ABC pharma’ team who are fully engrossed into what the company calls a ‘three-party communication process’ (such as manufacturer to the freight forwarder to airline) to receive information with precise requirements for the transportation of such goods.

“This collaboration facilitated the creation of our internal knowledge system based on direct communication rather than intermediated,” indicates Fedor Novikov, deputy general director, products, at AirBridgeCargo Airlines.

He says delivery is not only about getting the pills, medicine, vaccines, and so on from one point to another; it’s also about creating the perfect ambient environment, shouldered by equipment, digital experience, partners and skilled personnel.

With this solution, ABC can manage various types of pharma shipments, offering required packaging equipment or special temperature containers, even for long-haul flights.

In Dubai, Emirates SkyCargo has an around the clock cargo operations command centre that monitors the flow of cargo across the network and it is able to take corrective measures when a cargo shipment looks likely to miss predetermined milestones during the shipping process.

As Julian Sutch, Emirates SkyCargo manager of global pharma sales, states: “This can be very critical for the pharma and clinical research sectors.”

Additionally, Emirates will also partner with other integrators from Dubai, allowing shippers a wider choice of destinations and services. Emirates SkyCargo has seen considerable growth in the transportation of more sophisticated and complex pharma products including biologics, which are drugs produced from living organisms or which contain components from living organisms.

“As you can imagine, products such as these require the utmost care and attention during transportation in order to ensure their integrity and effectiveness. From an air cargo carrier perspective, we must ensure even stricter temperature control and make sure there are no temperature excursions as the stability of the product is fairly low,” Sutch notes.

There are also increasing numbers of measures introduced by national and international authorities to combat counterfeit drugs, including stricter regulations and steps such as serialisation.

Sutch also observes the growing trend where custom-developed medication is delivered directly to the patients. “This obviously necessitates a new way of thinking about how we transport pharma, but air cargo is in a good position to be able to support this development,” he states.

The medical and healthcare cargo segment entails complying with strict quality assurance standards and ever-tightening government regulation and seemingly, this will present some challenges.

“This might present some challenges for the newcomers who are not familiar with them,” comments ABC’s Novikov. He says their ABC pharma team makes sure that all the regulations and quality assurance standards are met.

“Indeed, it could be troublesome to get that done in the beginning but keep in mind the purpose of these regulations [such as intactness of healthcare and medicinal products], we must comply to bring the benefit to global health. Once you apply a holistic and systematic approach towards problem-solving, it is not a problem, but rather a thorough process.”

As Sutch suggests, there is an ongoing drive from organisations like the World Health Organisation (WHO) and international and national regulatory authorities for additional regulation.

He stipulates that shippers and customers are also increasingly aware of new guidelines and processes and often require the transporting carrier or suppliers to sign SLAs [service-level agreements] which are derived from European Union GDP guidelines to manage compliance and service levels.

Emirates SkyCargo has worked to deliver a standardised service for pharmaceutical cargo in all the markets where it operates. “We’ve had to provide additional training to staff and implement new procedures and audits to meet with this challenge,” Sutch adds.

Delta Cargo is seeing strong demand for pharmaceutical and medical supplies shipment, observes Shawn Cole, Delta Cargo’s vice president. He mentions specifically, the airline’s DASH Critical shipments programme which includes organs and cord blood movements.

“As the focus on health and wellness grows in the US and globally, the demand for medicines and medical-related products increases. Many of these products have shelf lives and need to move quickly with air transportation being a key support,” Cole informs.

Over in the US, Delta Cargo introduced the DASH Critical product in March 2017. The airline says it is the first fully GPS-enabled, same-day product offered by a US freight carrier. The service provides real-time tracking and monitoring of any eligible shipment, and shippers can ship items up until 45 minutes prior to the scheduled flight departure.

DASH Critical is now available from 19 locations nationwide with service to 89 mainland US destinations and Hawaii. “Since its launch, we have seen strong growth in this product which includes organs and cord blood movements.”

DASH Critical shipments have clearly visible, unique pink packaging and include GPS tracking that is proactively monitored by a dedicated team throughout the journey. “This helps to ensure that important shipments are in the right place at the right time throughout the shipping process,” Cole tells.

He says if delivery is impacted by irregular operations, such as limited flying due to bad weather, the monitoring team will proactively contact local airports to help coordinate the export, transfer, and import of all DASH Critical shipments.

In addition, Delta Cargo was awarded IATA’s CEIV Pharma certification in July 2017. With this certification, Delta has created the first CEIV Pharma transatlantic network connecting Atlanta with other existing CEIV Pharma certified partners, stations and handlers in Amsterdam, Brussels, Milan, Paris, and Rome.

Delta Cargo’s joint venture partner Virgin Atlantic Cargo has recently been awarded certification for the transportation of pharmaceuticals by the Wholesale Distribution Authorisation (WDA).

DoKaSch, the temperature-controlled container specialists are also consistently monitoring the developments in pharma transports. Andreas Seitz, general manager of DoKaSch Temperature Solutions tells Airline Cargo Management that actively controlled containers like their Opticoolers are used for temperature-sensitive and high-value pharmaceuticals only, which must strictly be kept within the 2-8°C or 15-25°C temperature range.

“The number of Opticooler containers for our clients is increasing every month to meet the rise in demand for transports by air. With the growing demand for temperature-controlled transports of high-end pharma, we will continue to grow sustainably, focussed on our high-tech active container solutions.”

When speaking about the challenges concerning the strict quality assurance standards and ever-tightening government regulation within the container sector Seitz feels this was and continues to be a huge challenge in the global air cargo industry with its many physical handling and IT stakeholders and interfaces. Not surprisingly, he says the best and most reliable answer is the fully active, electric units supplied by DoKaSch.

Seitz explains that only the electrically powered containers combine strictest temperature management with almost unlimited run time, and they just need a standard power socket during ground time.

In addition, active units are globally applicable irrespective of the shipment lane and season – with very little effort, but very high safety for the user. He says due to their quick and easy preconditioning; active containers are easy to use at any starting point globally.

“The status of the battery can always be checked, and they can easily be recharged anytime up to 100 per cent, which means everybody involved in the handling can be 100% sure about the remaining runtime and can even extend the runtime as long as necessary.

“There is no specific warehouse infrastructure needed during the entire transport. Our Opticooler containers have been designed, manufactured and are maintained to meet the strictest quality assurance standards. They are certified by aviation authorities according to their safety standards, the highest engineering standards worldwide,” Seitz assures.

The transport of human organs is another critical time – and temperature-sensitive freight. Sutch explains the logistics involved: “When transporting live organs, we allow for a late cut off time for the delivery [latest by two hours before the estimated departure of the flight] as we understand that it is not always possible to have a long lead time for such shipments.”

Live organs are transported under a specific product code known as Emirates Pharma AXA, Sutch reveals. He says this ensures that there is guaranteed space availability on the flight and the operations team will also know that the shipment must travel as planned and that there can be no deviations.

For connections in Dubai, the airline also offers quick ramp transfers meaning that cargo can be transferred rapidly from the hold of one aircraft into the hold of the connecting flight without any long delays or diversions.

The transport of human organs is mostly performed by passenger airlines. Novikov explains some of the reasons behind this.

“Firstly,” he says, “these airlines generally have a higher scheduled flight frequency and a wider network, to both domestic and international destinations. Secondly, passenger airlines are more prioritised by airports, which minimises delay and cancellation possibilities, providing extra assurance of seamless delivery of the cargo.

Also, in some cases, the consignment is required to travel with an accompanying passenger in the cabin to ensure it is intact throughout the journey and under strict supervision. All-cargo carriers could be used for this service as a back-up plan under certain conditions.”

Novikov reports 2018 was a good year at AirBridgeCargo with the article achieving an upsurge of more than 60 per cent in pharmaceutical shipments across the network. “For the first quarter, the upsurge tipped over 10 per cent which is in line with our development plans for this year.

“We particularly focus on the development of the temperature pharma sector and we have seen a twofold increase, which is mostly attributed to dedicated steps we have been taking in this area.”

Novikov attributes much of the growth to the reinforcement of the ABC pharma product and the working team but also the continued cooperation with the cargo carrier’s partners and the introduction of the latest IT solutions that enhances the customer’s experience.

“With active development of the ABC pharma product and increasing market demand, we have witnessed remarkable growth especially on the Europe to China trade lane.” Novikov also stresses the relevance of expanding their network of IATA CEIV Pharma and Qualified Envirotainer Provider (QEP) certified stations, this is enlarging the number of temperature-controlled containers for air freight transportation.

ABC also provided its shippers with the ability to request specific equipment to monitor and track each shipment’s environment and ensure the integrity of their pharma products throughout the transportation process.

But most importantly, Novikov says the cargo airline has been organising educational workshops together with its customers and partners to share their knowledge, experience, and best practices.

“This is not to the full extent of know-how but rather peer education to make sure that we are all on the same page with supply chain stakeholders.”