Covid-19 vaccine distribution– A daunting task, but there is a way out

The unprecedented pandemic and the havoc wrecked by COVID-19 have brought the leaders of scientific community all over the world together and the sharpest of the minds have been relentlessly working towards a solution to address this.

A unique Global initiative -COVAX, with 172 countries joining hands has the world’s largest and the most diverse portfolio of COVID-19 vaccines. WHO, EC and France, the Bill & Melinda Gates Foundation & the Global Fund have launched ACT- Access to COVID-19 Tools Accelerator, a ground breaking global collaboration with an objective to have two billion doses available by end of 2021?

As per the latest report, we can expect the first clinically approved Vaccine coming out from the joint research of Pfizer and BioNTEch by mid Dec, potentially for emergency use. Another front runner vaccine candidate Moderna is also in the process of applying to FDA (US) for Emergency authorisation. In India, Serum Institute of India has reached phase three stage of conducting clinical trial on Covishield developed by Astra Zeneca & Oxford University.

The first two vaccine candidates ready for clinical use from Pfizer/Biotech and Moderana will most likely require two doses for complete protection. Meaning thereby, that if the entire global population is to be immunised, 14 billion doses have to be delivered under controlled temperature to each nook and corner of the globe. This is a gigantic challenge; the problem is further compounded as both the vaccines are manufactured using mRNA technology requiring transportation and storage at –70 degree Celsius in case of Pfizer vaccine and -20 degree Celsius in case of Moderana vaccines. Added to this would be the syringes and the safety boxes for disposing syringes and needles, creating a war like situation for making logistic arrangement.

In India, on a single dose for the entire population,1.3 billion dosage have to delivered under ultra- cold temperature. Even in the cities connected with air, logistics and safety are challenging due to inadequacy of the airports in terms of requisite cold storage and the safety issues. The task of delivering up to the last mile in difficult terrain like North East Regions and Himalayan belt is really daunting.

Assuming that, initially only the priority population group comprising of elderly, children and front-line health workers are to be vaccinated, say about 250 million individuals (as per the recent statement made by the Health Minister), the number of doses to be transported, delivered and stored till actual use roughly works out to 500 million, a formidable task. Successful execution will require careful planning, skilled persons and reliable health infrastructure.

Here are the possible solutions and options to be explored:

1. Immediate assessment of the Public Health System right from the District level up to the Public Health Centres/ Sub Centres for their efficiency and capabilities in terms of cold chain should be done and ramping up the cold chain facilities. Fortunately, we have around 25000 Public Health Centres and around 1,60000 Subcentres functioning in the rural areas of the country supported by one lakh Accredited Social Health Workers (ASHA) and 2.35 lakhs Auxiliary nurse midwife (ANM).
These ASHA and ANM, the backbone of rural healthcare, need to be extensively trained on handling COVID -19 vaccine under cold chain, this would require specialised training if the mRNA vaccines are to be rolled out as the first batch of successful vaccine candidate.

2. Airlines cargo staff have also to be trained and sensitised to give top most priority in seamless transportation of the vaccines.

3. Drone can be used to deliver COVID vaccines in hard to reach areas, African countries like Ghana and Rwanda have been using Drone services to deliver life saving drugs and vaccines supported by GAVI- the Global Vaccine Alliance.

4. To encourage innovation in cold chain equipment such as battery-operated cool boxes or low-cost battery powered freezers, cryogenic equipment- Start-up challenges under Atam Nirbhar Bharat, Start-up India and at various Incubation Centres in Institutions like IIT, IIS, IIM should be organised with reward and funding. In fact, this should be announced by the Government right now as we are racing against time.

5. Monitoring and tracing devices like RFID and temperature sensors (Vaccine Vials Monitors), chemical indicator label can be put on each box of packing if not on all the vials to ensure delivery of the same to the right place and under right temperature

6. Air ambulance available in private sector can be deployed to carry vaccines in difficult areas but requiring sizable quantity.

7. This is the apt time for adopting digital technology such as Blockchain for managing the entire supply chain, traceability and multilevel transaction.

8. A coalition of private players, those in the business of logistics including air cargo, cold chain warehousing, pharma and diagnostics companies, companies in FMCG & Dairy Sectors having experience in cold chain management should come forward and be a part of this national mission of protecting citizens from COVID- 19.

9. Grand Challenges India, a coalition of Department of Biotechnology, Linda & Bill Gates Foundational and while working for scientific aspects of COVID -19 can too work on logistic and infrastructure challenges for implementing universal vaccination program in India.

Of course, the advantage and learning from this pandemic would be huge in terms of creating a highly effective logistic infrastructure in place at global, national and regional level with preparedness to go for vaccination in such exigency.
The unknown and strange pathogens have the danger of resurfacing again. With some countries in Europe announcing second lock down, we are already witnessing this. We should not be caught unaware being unprepared in terms of health and logistics infrastructure for implementing universal immunisation.