Now that we are in the second phase of the Covid-19 vaccine deployment in India, the big question still remains: is India’s supply chain ready for the mammoth challenge at hand? The same question is, of course, valid for being asked of other developing countries in Asia and the rest of the world.
The Government of India (GoI) has created large task forces like NEGVAC (National Expert Group of Vaccine Administration for Covid-19) comprising Block-level administrators being overseen by the Municipalities (at the level of District Magistrate / Collector, Municipal Commissioner) and right up to the State Principal Secretary (Health) and Chief Secretary. There has been a lot of thought and deliberations on the implementation, including sourcing and distribution, and finally the order of priority of who gets the vaccine first. Like other countries, this starts with the highest priority being accorded to frontline healthcare workers and then on to the elderly (categorised into above 60 years and between 50-60 years) and finally to the other citizens. The process of sourcing the approved vaccines, end-to-end storage and transport logistics up to the final place of administration is akin to the electoral process in India purely in terms of scale but not of scope or complexity.
Supply chain tracking and controls is through the Co-WIN (Covid Vaccine Intelligence Network) digital platform to track the enlisted beneficiaries and, similar to conducting free and fair elections, can be managed by the GoI appointed Task Force. Another focus area has been on training the task force that administers the vaccine. But how robust is the supply chain planning for a “new product” with “different requirements” than the conventional food grains, fruit, and vegetables that the government has had experience with in the past? The polio and small-pox immunisation, for instance, was a fraction of the scale, and with specific vaccine requirements, so is not truly comparable.
Probably Russia or a similar ally country with geographical distribution challenges may be able to provide solutions for this complexity. However, their weather conditions are far more conducive for vaccine distribution than a tropical country like ours. This also explains the “vaccine of choice” differences amongst countries—BioNTech/Pfizer in the U.K., member countries in E.U., U.S., and Canada, Oxford/Astra-Zeneca in India and other Asian countries, Sputnik V in Russia, and so on.
What makes the supply chain complexity a notch above any other comparable distribution skew (aka Stock Keeping Units or SKUs) is not the scale but the need for a consistent and seamless cold chain transportation and storage logistics capability which is the infrastructure we are lacking in the country, and especially in the hinterlands.
The other twist is the temperature range for the cold chain varies per vaccine—most are provided in a multi-dose vial with a targeted temperature range of two degrees to eight degrees celsius during distribution and -60 degrees to -80 degrees celsius during central warehousing storage. And we all know the friction at the handover—loading/unloading, inter-modal transfers, you get the point. Further, the state-owned FCI (aka Food Corporation of India) or other large state-owned warehouses have limited cold chain storage, and with the support of the private sector, temperature-controlled storage space availability, still falls well short of the actual requirements.
The government confidently asserts that “cold chain assessments and gap analysis have been completed, and there are plans in place for supplying additional cold chain equipment where required” and in the same breath states that “states/union territories must ensure adequate cold chain storage capacity for the Covid-19 vaccine campaign” so we know where that is headed.
Touché. However, it is candid with its observation that “a vaccination programme of this scale will require close monitoring and supportive supervision at all levels to identify bottlenecks and challenges faced at the ground level”.
WHO India through its NPSP network plans to provide technical support to the government at all levels in planning, training, and monitoring for the Covid-19 vaccine introduction activities. It is assisting and brings its experience in global distribution of PPE Kits, but vaccines are a different challenge altogether.
What makes the supply chain complexity a notch above any other comparable distribution skew (aka Stock Keeping Units or SKUs) is not the scale but the need for a consistent and seamless cold chain transportation and storage logistics capability which is the infrastructure we are lacking in the country, and especially in the hinterlands.
UNICEF is assisting with cold chain assessment, planning for need based augmentation, procurement supply and installation of cold chain equipment. Some foundations like the Bill and Melinda Gates Foundation are also involved. International partners helping the government will probably not be involved at the tactical and operational level and hence such micro-planning inputs can be had from supply chain practitioners both within and outside the government.
While the implementation and operational plans seem to be in place, how could supply chain planners help at this juncture since it is still an early phase of the program? Some of the following points need to be taken note of for overcoming the challenges of the cold chain for vaccine distribution across the country as vast and diverse as India:
1) Optimise batches of vaccine skews consistent with transport capacity (standard container sizes of our trucking fleet as well as railway rakes) through safer lanes – this models the optimum batch size with new constraints on such fleet capacity using standard LP solvers.
2) Channel and re-direct the movement of deep refrigerated vaccines skews by truck (and private sector warehouses) keeping the near room temperature vaccines skews by rake to ensure a robust distribution to the State / District / Block level vaccine administration zones.
3) Budget for off-the-shelf RFID + temperature sensors through IoT feeds apart from the serialisation to ensure vaccine “health” and add the SOPs for contamination / potency checks (aka “pharmaco-vigilance” with vial level tracking) due to lack of adherence to the desired temperature zone beyond limits. The expiry validity check of the non-contaminated vaccines through batch barcode scanning done as a one-time exercise by the task force administering the dose.
4) Perform root-cause analytics (using 5 Why’s / Lean or similar Methods) on reasons for contamination. Managing the reverse logistics (aka “recall”) for such contaminated vaccines need to be administered along with the blacklisting of “callous” transportation partners.
5) 24*7 Control Tower (combining people and technology) for continuous monitoring and timely action. Solutions exist like Roambee for such tracking where rules can be pre-configured (temperature zone, safe laning, geofencing, the authorized destination, etc.) in the hardware for outages like point 3 above.
6) Blockchain based end-to-end active vaccine tracking right from manufacturer plant to being administered at a remote corner of India will help. Serialisation and Data Management in such transparent decentralised databases on cloud (and healthcare use case pilots/PoCs being functionally effective like PharmaLedger in EU) is what probably makes Blockchain an automatic choice, despite some implementation complexities.
Views are personal. The author is co-founder & CEO, Visilogix and Assoc. Professor of Supply Chain, JAGSOM.
