However, distributing the vaccines in India’s first mass vaccination campaign for adults could be a daunting task. It will require expanding India’s existing cold chain capacity at breakneck speed, especially in some of the most densely populated parts of the country, where such infrastructure is very limited. It will also require addressing the gaps in India’s existing vaccine distribution network, which a report from the Health Ministry noted a couple of years ago.
India’s health minister has said the government is aiming to inoculate the 300 million most vulnerable people by August 2020. This translates to 600 million doses through August, a target that may be difficult to achieve given the status of India’s cold storage infrastructure such as warehouses and refrigerated. vans.
It may be possible to deliver 550-600 million doses over the course of 2021 alone, given bottlenecks in India’s cold chain infrastructure, Credit Suisse’s Anubhav Aggarwal and Sayantan Maji wrote in a report on the vaccination plan. from India last month.
The estimates are based on the assumption that the infrastructure for the current immunization program in the country will be leveraged for the covid vaccination plan even while maintaining the regular immunization program. In addition, private companies in the cold chain will be used to distribute approximately half of the doses needed (300 million over the course of next year). These estimates seem reasonable, said Sunil Nair, chief executive of Snowman Logistics, India’s largest private cold chain company. The snowman himself could organize the storage of 100 million doses, he added.
India’s vaccine distribution network is operated through four government medical store depots (GMSDs) in Karnal, Mumbai, Chennai and Kolkata, which source vaccines from manufacturers. Approximately 53 state vaccine stores source their supplies from these GMSDs or directly from manufacturers. State vaccine stores then distribute vaccines to regional, district, and sub-district cold chain points via insulated vans.
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India currently has around 27,000 cold chain points, 76,000 cold chain teams, 700 reefer vans, 55,000 cold chain handlers and 2.5 million health workers as part of its vaccine logistics network.
To meet the goal of the first phase of the covid vaccination campaign, the distribution capacity of the public sector will need to be expanded 2-3 times. Increasing this capacity is not the only challenge. The gaps in the existing supply chain are an equally great challenge. India’s vaccine management has improved over the years thanks to a real-time supply chain management system known as the Electronic Vaccine Intelligence Network (eVIN). As of August 2020, it had been rolled out in 32 states and union territories, and will be useful during the covid vaccination campaign.
However, the latest available audit of the vaccine chain conducted by the health ministry in 2017-18 shows that bottlenecks still exist. 26% of eVIN cold chain points reported stockouts during the evaluation period. More than a fifth of the facilities reported vaccine waste.
India ranked within the 51-75 percentile range of 89 countries for effective vaccine management according to a global analysis by WHO-UNICEF in 2018. It performed relatively poorly when it came to following required vaccine arrival procedures and using the MIS system to estimate the demand for vaccine, syringe, etc.
What adds to the vaccination challenge is the disparity between states in the distribution of cold chain points across the country. For example, approximately 4 points of the cold chain serve 100,000 people in Gujarat, while there is only one cold chain for the same number of people in Jharkhand. Jharkhand, Uttar Pradesh, and Bihar are among the least served states when it comes to cold chain infrastructure.
It will not be easy to fill those gaps given that most of the private sector cold chain network is concentrated in the larger cities and towns, said Gagandeep Kang, a virologist at Christian Medical Center, Vellore.
An official from the union’s Ministry of Health responsible for managing the vaccine management campaign declined to comment on this issue. A senior official at the Jharkhand Health Ministry said the state has identified 30 new cold chain points to expand its distribution network. It also expects to receive 148 ice-lined refrigerators and 57 freezers from the central government by the end of this month, the official said, on condition of anonymity. The government plans to allocate its existing resources from the universal immunization program as much as possible towards the covid vaccination campaign, but without interrupting the regular immunization campaign, he said. Despite this expansion, Jharkhand will continue to lag behind more urbanized states like Gujarat, and will have to cope with its limited resources.
Uttar Pradesh, another state with cold chain constraints, plans to increase storage capacity by 2.5 times, according to Rakesh Dubey, director general of the state’s department of family welfare. The central government has set up cold chain equipment such as cold rooms, refrigerators, ice-lined refrigerators, freezers, etc., and is installing them, he said. The state government is examining the feasibility of using reused refrigerated vans from other industries, he added.
The unique requirements of the upcoming immunization campaign pose another layer to the distribution challenge. Identifying recipients, making sure they show up on vaccination day, and administering a second dose after a month would require a lot of planning at the micro level, said Neeraj Jain, country director for India at PATH, a global nonprofit organization. working with countries around the world to advance immunization and public health.
In addition to distribution and delivery challenges, two key issues would be vaccine uptake and tracking, Kang said.
“Vaccine uptake requires confidence in vaccines and the delivery system, and we seem to be leaning that vaccines are the ultimate solution (which they may not be) to vaccines that are developing so rapidly and with many shortcuts, so they must necessarily be unsafe and untested (which is not true), “Kang said.” Additionally, documentation of vaccination and monitoring and investigation of vaccine safety events are essential components of monitoring that have traditionally been poorly done. Therefore, thinking about external monitoring or support mechanisms will be useful. “
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