COVID-19: The logistic challenges of vaccine distribution in India

"The challenges would be both in the logistics of the supply chain and in the health workforce needed to administer the vaccine and monitor the adverse effects. The former may be more easy to solve. Organising the administration of the vaccine to the huge (1.35 billion) population will call for a large health workforce," says Professor K. Srinath Reddy, president of the Public Health Foundation of India. "It will be especially demanding if it is a two-dose vaccine," he added. Experts noted that nothing on the scale of vaccination planned for COVID-19 has been attempted in India before.

"I feel the biggest challenge would be cold chain (management), depending upon what vaccine is to be deployed," leading epidemiologist Shahid Jameel told The Straits Times. "There would be limited capacity in India to store, let alone transport vaccines to all parts of the country if they require minus 20 deg C or minus 70 deg C temperatures. India should go with vaccines that require storage and transport in liquid form (that is, between 4 deg C and 10 deg C) and not the ones that have to be kept frozen," he added.

"We have never had the need to vaccinate our entire population at one go. The national immunisation programmes of countries generally take care of paediatric vaccinations” said an official at a consulting organization.

With nearly 250 COVID-19 vaccines under development across seven different technology platforms, with the WHO reporting 42 candidates in clinical trials, it will be a big logistical challenge to transport over 10 billion doses globally, a white paper brought out by logistics specialist DHL (with McKinsey & Company as analytics partner), has said.

Container ships are the most common and efficient way of transporting goods between continents, but the requirements of vaccines are simply impossible to maintain in that environment. The fallback is expensive air transport. To provide global coverage of COVID-19 vaccines, up to 2,00,000 pallet shipments and 15 million deliveries in cooling boxes as well as 15,000 flights will be required across various supply chain set-ups in the next two years. Potential bottlenecks along the key supply chain can happen in intermediate transport, intercontinental shipment, warehousing, downstream distribution and final short-term storage at the point of use.

Building a partnership network of both public-private and public-public partnerships, identifying and ensuring access to required physical logistics infrastructure, establishing IT-enabled supply chain transparency and creating organisational structures and allocating resources to institutionalise and coordinate the entire response management including plan, partners, infrastructure and IT are solutions to overcome the challenges is required, said the white paper.

A number of the leading COVID-19 vaccines under development will need to be kept at temperatures as low as minus 80 degrees Celsius (minus 112 degrees Fahrenheit) from the moment they are bottled to the time they are ready to be injected into patients’ arms. That will not be easy. Vaccines may be manufactured on one continent and shipped to another. They will go from logistics hub to logistics hub before ending up at the hospitals and other facilities that will administer them. Large parts of Africa, South America and Asia, where super-cold freezers are sparse, could be left out.

“We’re only now beginning to understand the complexities of the delivery side of all of this,” said J. Stephen Morrison, senior vice president at the Center for Strategic and International Studies, a research firm in USA.

In a presentation to the White House coronavirus task force last month, Kathleen Dooling, a disease expert with the C.D.C., said strict temperature requirements “will make it very difficult for community clinics and local pharmacies to store and administer.”

Pharmaceutical company Pfizer has designed a special box to transport its hoped-for vaccine. The boxes, roughly the size of a large cooler, will hold a couple of hundred glass vials, each containing 10 to 20 doses of vaccine. This leads to another problem - glass often cracks in extreme cold.

Planes, trucks, warehouses and health centers will need to be outfitted with freezers. Gavi estimates 10 per cent of health care facilities in poor countries have reliable electricity supplies. In such countries less than 5 percent of health centers have vaccine-qualified refrigerators.

The funding requirement for distribution of free vaccine to all Indians will be huge. Serum Institute of India Chief Executive Officer Adar Poonawalla asked the government whether it had Rs 80,000 crore required over the next one year for distribution of COVID-19 vaccine.

(V Venkateswara Rao is an alumnus of IIM, Ahmedabad and a retired corporate professional)