Table 2.

Barriers and opportunities related to the optimization of production operations and increasing supply chain efficiencies. CDMO: contract development and manufacturing organization.

B. Operations and supply chain efficiencies
B− Barriers	Source(s)	B+ Opportunities	Source(s)
B1− Difficulties in optimization of production process due to time pressures and complexities of biopharmaceuticals	7, 8, 12	B1+ Incorporating supply chain experts with appropriate technical and management skills into all vaccine supply chain decisions	12, 17
B2− Inefficiencies and organizational challenges between actors in globalized production chains	Logistical expert 10, 11	B2+ Reducing the geographical distance between production stakeholders and manufacturing processes to decrease production timelines	Logistical expert, Fill & Finish CDMO
B3− Logistical challenges due to (ultra) cold chain management	7, 9, 11, 12, 13, 15, 16	B3+ Stimulating the development of a single-dose vaccine with less rigorous storing conditions to reduce cold chain infrastructure complexities	6, 13
B4− Outdated infrastructure and technical equipment in low-income and low-middle income countries	7	B4+ Organizing matchmaking events to exploit undiscovered production opportunities and linking supply chain actors to each other	Taskforce, 6
B5− Lack of human resources to support operational activities (supporting staff, technology transfer, production specialists)	Big pharma representative; 6, 8, 9, 12, 16, 17, 18	B5+ Establishing training facilities and/or educational programs to tackle shortages in (e.g., tech transfer) personnel	Big Pharma representative, 12
B6− Difficulties in technology transfer between partnering manufacturers	Big pharma representative 10, 12