A delayed parcel is an inconvenience. A delayed patient-specific cell therapy can be an unusable treatment — and that difference is redrawing the commercial logic of healthcare logistics, according to Nick Gennari, President of Healthcare and Life Sciences at FedEx.

Speaking to Air Cargo Week, Gennari argued that personalised medicines, biologics and cell and gene therapies have pushed logistics from the last step of the supply chain into the healthcare infrastructure itself. "For many advanced therapies, logistics has become part of the treatment," Gennari said. "If you're moving a personalised medicine or a cell therapy, maintaining the right temperature, protecting the chain of custody, and responding quickly if something changes all help preserve the therapy itself."

What has changed for healthcare supply chains?

The old model — make the medicine, box it, deliver it to the hospital — is breaking down on two fronts at once:

• Decentralised care. More treatment now takes place in patients' homes, local clinics and community settings. As Gennari put it: "That means we're helping move individual therapies to individual patient's homes in addition to hospitals and offices, often under very strict time and temperature requirements. That's a very different logistics challenge."
• Product complexity. Biologics, personalised medicines and cell and gene therapies carry strict temperature requirements, short delivery windows and, in some cases, a single intended recipient. There is often no option to simply ship a replacement.

The pharmaceutical industry has spent decades advancing the science. Gennari's point is that the infrastructure has not kept pace: "Breakthrough therapies only make a difference if patients can actually receive them. As treatments become more specialised, healthcare companies need supply chains that are as advanced as the medicines they're developing."

Why prediction is replacing reaction

Cell and gene therapies have shifted the operating model from reactive to predictive. Sensor data, shipment tracking and machine learning can flag a potential delay or temperature excursion before it becomes a failure.

But Gennari was clear that technology is only half the answer. Someone still has to act on the warning — rerouting the shipment, locating validated cold storage or deploying a specialist recovery team.

"When you're moving a treatment that's made for a single patient and has a very limited window to be delivered, there isn't much room for error," he said. "These therapies have shown the entire industry that you can't wait for a problem to happen before responding."

Resilience is back on the agenda

The pandemic exposed how fragile healthcare supply chains become when manufacturing, transport and borders fail simultaneously. Since then, pharma companies have pursued alternative manufacturing locations, regional production, better shipment visibility and reduced dependence on single sites.

The trade-off is cost. An efficiency-optimised chain is cheaper in normal conditions but far harder to recover when something breaks. In healthcare, the cost of failure also looks different — a disrupted shipment may mean a missed appointment, a delayed treatment or a therapy that can no longer be used, not merely a replacement charge. That changes the business case for investment in quality systems, visibility and contingency planning compared with conventional freight.

"For many years, efficiency was the primary objective. Today, resilience has become equally important," Gennari said. "Healthcare organisations recognise that supply chains must continue operating through disruptions while maintaining product quality and patient access."

He flagged geopolitical uncertainty, severe weather and regulatory complexity as persistent vulnerabilities, with data, predictive technology and real-time visibility as the tools to adapt quickly.

From shipments to supply chain design

The sharpest shift is in what pharma customers now expect from logistics providers. FedEx has responded with FedEx Life Sciences, a unit that combines healthcare quality, engineering, intervention teams and sales.

"Our conversations with customers are very different today than they were five years ago. We're spending less time talking about moving individual shipments and more time helping customers solve broader supply chain challenges, including the movement of APIs across borders," Gennari said. Customers are asking how to reduce product loss, improve resilience, support changing manufacturing patterns, enable direct-to-patient delivery and make their supply chains smarter.

"Customers increasingly need logistics providers with specialised quality expertise, standardised global processes and advanced digital capabilities, not just transportation capacity," he concluded.

For forwarders and carriers in the healthcare vertical, the message is that speed alone no longer wins the contract. The differentiators are validated cold chains, intervention capability and a role in designing the system itself — and as personalised therapies and decentralised care keep growing, those expectations will only tighten.