Safe delivery of vaccines for mass immunization against Covid-19 is a huge challenge and India will need to significantly increase its cold chain facilities, experts say, as the world’s second most populous nation moves into the next stage of management. of disease and seems towards a preventative.
Given that most leading-edge candidate vaccines are likely to require ‘additional cold’ storage, the private sector could also be engaged in the effective delivery of a preventative when available, suggest several experts and industry insiders.
Some pioneering vaccines are in advanced stages of testing and could hit the market early next year, making the task of ensuring “last-mile connectivity” and ensuring nothing goes wrong before the injection is given more urgent. .
Union Health Minister Harsh Vardhan said earlier this week that the government expects to receive and use 400-500 million doses of vaccine for Covid-19, and cover approximately 20 to 25 million million people for July 2021. The Center has also directed states to solid plan for the storage and distribution of vaccines before October 15.
“Most, if not all, of today’s pioneers require extremely strict cold chains, which makes their implementation immensely difficult for India,” said Satyajit Rath of the National Institute of Immunology (NII) in New Delhi.
The immunologist noted that some Covid-19 vaccines will need storage temperatures that simply cannot be realistically handled in any large-scale Indian campaign.
He said the real problems will arise once the vaccines are ready to hit the market.
Moderna and Pfizer vaccine candidates will require strict refrigeration standards that can hamper the way they are distributed to millions of people across India, according to scientists. Unlike drugs, virtually all vaccines need to be transported at low temperatures, usually between 2 and 8 degrees Celsius, said Raghavan Varadarajan, a professor at the Indian Institute of Science (IISc) in Bangalore.
“The need is to keep the vaccine product cold, whether it is refrigerated or frozen. This is a limitation, especially with a large number of doses, ”Varadarajan told PTI, explaining the particular problems of India, which has a population of 1.3 billion, second only to China.
Many vaccines lose potency when exposed to higher temperatures, he said, and re-cooling them doesn’t help.
So we need what’s called the cold chain handling before use, said Varadarajan, whose team at IISc is working on a “hot vaccine” that can be stored for more than a month at 37 degrees Celsius and doesn’t need a cold chain for storage.
Pawanexh Kohli, founding executive director of India’s National Center for Cold Chain Development (NCCD), agreed that the protocols will require Covid-19 vaccines to be kept between 2 and 8 degrees Celsius, during transport and storage until Delivery. “The Modern candidate vaccine is shipped at minus 20 degrees Celsius and held at 2-4 degrees for seven days. Pfizer’s (vaccine) that requires minus 70 degrees of temperature, ”Kohli, honorary professor of post-harvest logistics at the University of Birmingham in the UK, told PTI.
Both the Moderna and Pfizer vaccines use a synthetic version of genetic material from part of the coronavirus.
The genetic material called messenger RNA (mRNA) causes cells to produce a small part of the virus, which the immune system recognizes as foreign. If the person is later exposed to the real virus, the immune system will attack it.
Noting that RNA vaccines have never been used in humans, Vardarajan said that it is possible that high temperatures can affect these structures and therefore affect the efficacy of the formulation.
While most of the vaccines will be distributed through the Center’s Universal Immunization Program (UIP) mechanism, experts also suggest that the government include private cold chain operators.
India’s large scale UIP is supported by more than 27,000 cold chain functional points, of which 750 (3%) are at the district level and above. The rest are below the district level, according to the government’s comprehensive multi-year UIP plan for 2018-22.
This includes 76,000 cold chain ‘teams’, 2.5 million healthcare workers and 55,000 cold chain employees, according to the plan’s report. Cold chain logistics involves many moving parts, including cold storage facilities that store products waiting to be transported, cooling systems to keep them at a suitable temperature during all aspects of the supply chain, such as warehousing and transport. Gel packs are also often used for medical and pharmaceutical shipments.
About 390 million doses are given annually in nine million sessions across the country to immunize 26 million children and 30 million pregnant women, he said.
Noting that cold storage protocols are well established in India, Kohli said that the public health network has limited capacity.
“Fortunately, the food cold chain has a synergistic use for this purpose and should help in this battle. Existing cold chain companies may need to allocate specific resources in their network, ”Kohli noted.
He added that the food cold chain has the maximum reach, with extensive last-mile connectivity, and will require a small redesign to designate storage space and transport cargo for this purpose.
“Almost every cold chain owner I have spoken to is willing to contribute space and assets to achieve this, should the need arise,” Kohli added.
Kohli also believes that India must restructure itself in order to start and finish the immunization program in a short period of time to be effective.
“Even if the vaccine is ready, the program should not start until the last mile is prepared to administer the vaccine,” he said. According to the World Heat Organization, at the highest levels of the cold chain, that is, in regional primary and intermediate warehouses, the oral polio vaccine should be kept frozen between minus 15 degrees Celsius and minus 25 degrees Celsius. At other levels of the cold chain, vaccines should be stored between 2 degrees Celsius and 8 degrees Celsius.
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