India saw a 62 percent drop in the incidence of measles, from 2017 to 2021. Suddenly, though, in 2022, an alarming outbreak affected over 10,000 children and killed 40. Attributed to disruptions caused by Covid-19 to immunisation services, it is a stark reminder that vaccines keep us healthy and safe.
As the saying goes: it isn’t just vaccines but vaccination that saves lives. Fundamental to the success of vaccines is the maintenance of their quality and ensuring their effective delivery through strong cold chains. For a vaccine to be administered, it must travel through a temperature-controlled supply chain, from the manufacturing unit to the vaccination site. Disruptions and overexposure to the elements, at any point, can impact its potency be it overexposure to heat, cold, or light.
Despite India’s impressive improvements in cold chain management, gaps in implementation remain, including low and non-standardised storage, use of refrigerators for multiple purposes, frequent power cuts, fluctuations, and inadequate last-mile access. India needs to build on its vast accomplishments and pursue innovations or solutions in these areas to make sure that vaccines reach the last mile, including far-flung areas where the power supply is erratic or absent. Recent examples show how such efforts drive promising results.
For instance, the introduction of eVIN in 2015 has been transformational in providing real-time tracking information on vaccine stocks, flows, and storage temperatures across all cold chain points in India, saving millions of vaccines from wastage. Two years ago, it served as a precedent for CoWIN, which powered India’s ambitious Covid-19 vaccination drive. Both eVIN and CoWIN incorporate cold chain points to the last mile. Today, it has helped us to create U-WIN — a platform that digitises India’s Universal Immunisation Programme.
Manufacturers are integrating digital tools such as remote temperature monitoring systems into their cold chain equipment, allowing administrators to reduce vaccine spoilage. Solar-powered cold chain equipment is also proving to be crucial for sustainability and servicing off-grid communities with infrequent or no power supply. This must be honed to deliver the efficiency required for India’s immunisation program, which caters to an annual birth cohort of 2.67 crore children and 2.9 crore pregnant women.
We must continue to upgrade our technology and standards to ensure safe vaccine delivery to the last mile. Advancements should be shared with everyone involved in the cold chain to provide them with the necessary resources, knowledge, equipment, and data for successful vaccination and a healthy India.
Need for Standards
Guidelines exist to address equipment failure and power outages that could compromise vaccines. Standards also exist that mandate the use of certified cold-chain equipment (refrigerators, storage boxes etc.) to ensure vaccines remain safe and effective.
But ultimately, cold chain is an ecosystem, which lies in the hands of diverse stakeholders, each playing a crucial and synergistic role in creating a conducive environment for vaccine management. From pharmaceutical industries that manufacture vaccines and decide storage temperatures, to regulators and policymakers, to providers who handle the vaccine at the ground level; we must all do our bit. As we look forward, we can classify and register vaccine cold chain solutions as medical devices to ensure that vaccine refrigerators, freezers, and storage boxes conform to the necessary safety and health standards.
As India showcases its strength as ‘Pharmacy to the World’, we must bridge remaining gaps within our cold chain ecosystem and build resilient health infrastructure. Optimising our cold chain system will not only increase pandemic preparedness but also help introduce new vaccines. We must seize the day.
The writer is Chair of the Program Advisory Committee at the National Institute of Health & Family Welfare, and Former head (Community Medicine) Sub Dean at the Maulana Azad Medical College and Associated Hospitals. Views are personal.
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