“There was a patient waiting for that shipment — and that patient had already been prepped through chemotherapy.”
Stephanie Makison, Director of Personalized Supply Chain, Europe, World Courier
Stephanie Makison is Director of Personalized Supply Chain, Europe at World Courier, where she has spent six years building the company’s advanced therapy logistics function. She spoke with PharmaSource at the Advanced Therapies Congress in London in March 2026.
Stephanie shares what the current Middle East crisis has highlighted about the fragility of advanced therapy supply chains — and why the industry’s approach to logistics planning needs to change well before a shipment is ever packed.
The ongoing military conflict in the Middle East, which began on February 28, 2026, has resulted in the closure or severe restriction of airspace across multiple countries in the region, including Bahrain, Qatar, Kuwait, the UAE, and Saudi Arabia. For the pharmaceutical industry, this has created a category of supply chain disruption that contingency plans rarely account for: a known patient shipment, already in transit, with no viable route to its destination.
For autologous cell therapies in particular — where the dose is manufactured from a specific patient’s own cells, the patient has already begun preparatory chemotherapy, and the treatment window is fixed — a diverted flight puts a critically ill patient’s treatment at direct risk.
Stephanie describes what happened to one such shipment during the early days of the conflict. A consignment destined for Israel, which had already been dispatched from the United States, was unexpectedly rerouted to Athens and then returned to the US. Her team identified the diversion through real-time location monitoring and immediately began working through contingency options.
“We were like: what’s it doing in Athens? We need to get it back. How long has it been sitting? When was that unit conditioned? When was the shipment packed? When was it dispatched? How long has it been in the air? How much validation time do we have left? What are the dry ice levels? All of that comes into play.”
The team managed to recover and charter the therapy back to the region to get it into Israel and to the patient thanks to World Couriers’ expertise and extensive network. In the last couple of weeks, Stephanie has also seen shipments destined for Doha rerouted unexpectedly and again, the team managed to implement successful recovery and contingency strategies.
The Non-Negotiable Nature of Autologous Supply Chains
What distinguishes autologous cell therapies from almost every other pharmaceutical product category is the absence of any buffer. There is no warehouse stock to draw from, no alternative batch, no option to reschedule the patient once their conditioning regimen has begun.
“These shipments have been manufactured specifically for that patient, who has a very small time window for that surgery to happen,” Stephanie explains. “They’ve already been prepped, their treatment has been planned. This is non-negotiable.”
The practical implications of a diversion extend beyond the shipping container. The team must simultaneously track cold chain integrity — how long the validated shipping system will hold temperature, and at what point the product itself is no longer viable — while navigating customs clearance in whatever country the flight has landed in, locating charter capacity on short notice, and communicating with the client about a patient who is waiting for information.
World Courier operates monitoring teams around the clock with offices in over 52 countries, which gives it the network to physically retrieve and re-route the Doha shipment. But Stephanie is clear that the company’s ability to do so was the result of deliberate infrastructure investment, not something that can be improvised in the moment.
“Because of the way our staff and all our employees are trained, everybody kicks into action and is proactive. Everybody has a recognized way of working and a plan. We need to recover that shipment, maintain its temperature, get it back to somewhere where we can replenish or change over shipping containers to keep that chain of integrity — and then get it on its way again.”
World Courier, part of the Cencora organization, provides specialty logistics services for advanced therapies across more than 52 countries, with 24/7 shipment monitoring and cold chain management capabilities.
Logistics Is Still Being Treated as an Afterthought
The immediate crisis has focused attention on what happens when airspace closes without warning. But Stephanie’s broader argument is that the structural vulnerability of advanced therapy supply chains precedes any geopolitical event — and is largely self-inflicted.
Drug developers, particularly those in the early clinical phases, consistently delay engagement with logistics providers until programs are already underway. By that point, route design, shipping system selection, and country-specific regulatory requirements have often been decided by default rather than by deliberate planning. The cost of revisiting those decisions mid-program is high, and the room to build contingency is limited.
“Logistics is never considered until you’re well into clinical trials, which really introduces more problems and costs,” she says. “Please start to consider your logistics provider as an equally critical part of your drug development process. Logistics isn’t just the thing you consider right at the end when you need to get it to the patient. We bring a lot of expertise to the table.”
The specific gap she returns to is contingency planning. Most programs in early development are built around a single preferred route, a single validated shipping system, and a single logistics provider. When any one of those fails — and in the current environment, there are multiple concurrent reasons why they might — there is no pre-approved alternative to fall back on.
“You should never just have one option, whether it’s a shipping system, whether it’s a route, whether it’s a provider. You should always have a back-up. An 80/20 rule. Because then you’ve always got contingency. A lot of people don’t do that. That’s where we start to fall down.”
Where Technology Helps — and Where It Falls Short
World Courier uses real-time location monitoring, 24/7 control towers, and digital alerting systems as core operational infrastructure. These tools are what enabled the team to identify the Doha diversion quickly and begin working on recovery options while the product was still viable. Stephanie is not skeptical of automation in principle.
Her concern is with the specific category of AI-based tools that are being positioned as decision-makers for logistics routing, rather than as decision-support tools for trained teams.
Her team had been testing a new platform designed to automate lane mapping. In the days following the outbreak of the conflict, with multiple regional airspaces closed, the platform was still generating routing options that included flights to Tehran.
“We discovered that, you could still theoretically book a flight to Tehran for a product. We know the reality of that is you’re not going to be able to book a flight to Tehran this week.”
The problem is not that the platform was poorly designed. It is that no automated system can fully account for the speed at which operational realities on the ground can change, nor the specific constraints of a patient-tied shipment that cannot be recalled and restarted. As Stephanie puts it, quoting a speaker at an EMEA webinar recently: “AI is still stupid as it doesn’t yet fully know what it doesn’t know. Humans need to teach AI in the beginning.”
Allogeneic Therapies: Different Logistics, Not Simpler Ones
As the pipeline of allogeneic cell therapies matures, there is an assumption in some quarters that moving away from patient-specific manufacturing will simplify logistics. Stephanie does not share that view.
The scalability benefits of allogeneic products — the ability to treat multiple patients from a single batch — are real. But they bring a different set of logistics requirements rather than a reduced set. Cryogenic storage capacity, cold chain transport from centralized storage to dispersed treatment centres, and country-specific handling regulations are all present in allogeneic logistics, as they are in autologous. The distribution model shifts from a single high-stakes individual shipment to a multi-site network — which adds scope and coordination complexity.
“There are huge benefits in terms of the scalability and the number of patients which can be treated from a single batch. But it brings different logistical challenges and complexities. You’ve still got the logistical implications of transporting cryogenic temperature shipments from the storage centre to the patient site or the treatment centre.”
Cryogenic storage infrastructure across Europe is already under pressure. Developers who are currently in mid-stage clinical development with allogeneic products and have not yet mapped their commercial distribution model are likely to encounter capacity constraints when they need it most.
Actionable Takeaways
- Engage your logistics provider at the preclinical stage. Route feasibility, shipping system qualification, and country-specific regulatory requirements should be assessed before IND filing, not after your first clinical site is activated.
- Design contingency into your supply chain from the start. A validated back-up shipping system and at least one alternative air route for each key lane should be in place before the first patient shipment. The 80/20 model is a practical starting point for programs that cannot justify full dual-sourcing.
- Define your patient communication protocol and make sure your logistics partner is part of it. When a shipment is diverted, clinical operations teams need real-time information. Agree in advance on escalation pathways and communication timelines.
- Audit any AI-assisted routing tools against current operational conditions. Automated lane-mapping systems should be reviewed and updated when airspace conditions change. They should support human decision-making, not replace it, for patient-critical shipments.
- If you have an allogeneic program approaching late-stage clinical development, start your commercial distribution planning now. Qualified cryogenic storage in Europe is finite, and securing and qualifying new storage capacity can be time-consuming.
The disruption to advanced therapy supply chains caused by the current Middle East conflict is acute and ongoing. But what Stephanie’s account makes clear is that the underlying vulnerabilities — programs designed around single routes, single shipping systems, and logistics providers brought in too late — existed before the conflict began. The conflict has exposed them, not created them.
The advanced therapy field has invested heavily in the science of manufacturing these products. Matching that investment with equivalent rigour in supply chain planning is what determines whether those therapies reach the patients they were designed for.
