How India can meet the Covid vaccine distribution challenge

Covid-19 vaccine has been the most anticipated product launch ever, and going wrong in the supply chain for this one is not an option. As billions of people eagerly await vaccination over the coming months and years, it will arguably be the most complex large-scale logistical exercise the world has ever witnessed.

India, as the largest global supplier of drugs and producer of 60 per cent of the world’s vaccines, is known as the “pharmacy of the world”. Today, the country is playing an increasingly important role in the development, manufacturing and, possibly, the distribution of this all-important vaccine.

Yet, the irony is that while India is one of the world’s biggest vaccine-producing nations, it faces one of the greatest global challenges in getting its 1.3 billion people immunised. India has a highly effective immunisation programme for babies and pregnant women but there is nothing in place for the rest of the population, particularly for the elderly who are the most vulnerable to coronavirus.

The healthcare system, already overburdened, has been pushed to the brink by the pandemic in many locations, especially the remote areas of the country.

Temperature-controlled storage

Covid vaccines will need to be distributed via temperature-controlled cold chain, as they are highly sensitive and require constant quality checks. Cold-chain logistics are particularly difficult in countries with warmer climates like India.

According to a report by the International Air Transport Association’s Centre of Excellence for Independent Validators in Pharmaceutical Logistics, 25 per cent of the vaccines are degraded by the time they arrive at their destination and temperature errors cause losses of around $34.1 billion annually.

Some of the vaccines being developed might need to be stored at up to -70 degree Celsius. While India has a 28,000-unit cold storage network that is used for the government’s universal immunisation programme, experts and logistics firms highlight that no company had the capability or capacity to transport vaccines at colder than -25 degrees Celsius.

An estimation of the cold-chain space needed for vaccines has been made considering 18 per cent of the population would need to be covered within six months. The Union Health Ministry has already initiated a cold chain augmentation plan to address the additional cold-chain space required for the vaccine. According to sources, there will be a temporary requirement (2-3 months) of surge capacity for large cold storage at the State and regional levels to store and distribute large incoming quantities of the vaccine.

The government is also re-purposing a digital platform used in the Universal Immunisation Programme to track movement of Covid-19 vaccine stocks. This will help trace those who are to receive the shots and ensure last-mile vaccine delivery.

Under Mission Indradhanush, the government has already ramped up its immunisation capability with an elaborate cold storage chain for inoculating children from 12 diseases. However, for a successful rollout of the Covid vaccine programme, the government would have to seek private-sector help to ensure the entire population is covered. Even if the government keeps with itself the responsibility of inoculating the vulnerable groups, it does not have the reach to inoculate people in remote parts of the country.

Quality assurance

A chain of custody will need to be maintained at every step of the supply chain — to ensure a verifiable transcript of the vaccine’s lifecycle and journey. And traceability is a must considering the long history of counterfeiting in the pharmaceutical supply chain. Considering the unprecedented demand for Covid vaccinations, every dose will need to be tracked and verified to ensure counterfeits aren’t being delivered to vulnerable populations.

However, the next question is: How will the vaccine be tracked? Blockchain could provide the answer. Blockchain offers a way to record transactions on a distributed ledger for security, transparency, and accuracy. The tamper-proof nature of blockchain enables all parties in a supply-chain network to record transactions at each stage of the product’s journey, and is a powerful tool to prevent real doses being replaced by counterfeits along the pharmaceutical supply chain

But blockchain alone isn’t enough. In order for it to stop fraud, it has to go hand-in-hand with advanced technology such as sensors and interconnected IoT (Internet of Things) devices. For example, a delivery driver transporting the vaccine could attempt a pass-off on the side of the road. A sensor installed on a delivery truck can tell when the truck stops or detect when the door opens.

That data is then recorded on the blockchain ledger, which would flag an issue with the shipment. Thus blockchain and IoT technology together would prevent ineffective counterfeit products being administered to the population and prevent real doses from being sold (at a premium) on the black market.

Administration of the vaccine

Unfortunately, the last leg of the vaccine’s journey might be the trickiest. Similar to the issues some markets have faced in Covid testing, determining the sites for administration of the vaccine will be a huge challenge. Currently, India’s universal immunisation programme (UIP) targets 26.7 million newborns and 29 million pregnant women every year — together making up 4 per cent of the total population.

These people receive about 390 million doses of vaccines, over nine million sessions, every year. In this scenario, to administer 400-500 million doses of a Covid vaccine by the first two quarters of 2021, India needs to ramp up its existing infrastructure significantly. This capacity-building entails strengthening the vaccine cold-chain network, increasing the stock of ancillary items like syringes and glass vials, and training healthcare workers. Otherwise, the Covid vaccine may not be made accessible to people who need it the most.

In an effort to administer the vaccine, the databases of healthcare and frontline workers and procurement of syringes and needles, among other items, are in advanced stages of preparation.

The post-launch challenges

Distributors will also need to consider the possibility of recalls, which will heavily burden an already over-taxed supply chain. Since it’s logistically impossible to vaccinate everyone in a first wave, distributors will need to develop standalone strategies for multiple waves. With many companies still relying on decades-old technology, the distribution of the vaccine will witness a never-seen-before demand and complexity.

The ageing back-office systems that many logistics companies are relying on are not capable of managing the scale and complexity of the task at hand. This is why many organisations are turning to flexible and scalable SaaS applications for supply chain and rearchitecting their operations to be able to leverage innovative technologies like Artificial Intelligence, Internet of Things and blockchain to improve efficiency.

The writer is Vice President, Product Development-Applications, Oracle

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