The development of vaccines against Covid-19 in a remarkably short time, in less than a year, has been a great achievement of science. However, the same speed has led to safety concerns and distribution challenges.
Big Challenges in Vaccine Distribution
One distribution challenge is maintaining the right conditions for vaccine storage and transport. Pfizer has sought emergency use approval of its RNA-based vaccine based on its efficacy data in other countries. With a requirement of ultracold temperatures (-80 degree C) for storage and transport till it reaches the vaccinee, use of the Pfizer vaccine will be the most logistically challenging. Phase-3 trials for Covaxin, manufactured by Bharat biotech, and Covishield, manufactured by SII (Serum Institute of India, have already begun in India. The distribution of these vaccines, which can be stored for up to 6 months at 4-8OC, can make use of the existing cold-chain resources present for other vaccines in the Universal Immunisation Program (UIP).
However, the sheer volume of the vaccine needed means that storage, tracking and transport infrastructure will need to be expanded considerably.
While these are significant challenges, the success of UIP gives us reason for cautious optimism. Creative approaches are needed to meet the needs of the massive vaccine volume. For example, imaginative ways to recruit the cold chain structure meant for other products (such as in the food industry, research labs, veterinary goods) up to par with for vaccines are needed. Once the vaccine is available to the general public, the priority should be to vaccinate the most densely populated areas. This would curb virus spread rapidly and substantially. Last mile connectivity for vaccine delivery is not an issue that needs immediate attention but establishing efficient countrywide distribution protocols now would facilitate the management of future pandemics. Last mile delivery is not unsurmountable – food delivery services are a model to emulate – they are privatised, have been ramped up quickly and have managed to reach poorly-connected homes.
Possibly, a well-regulated vaccination-at-home service where the vaccine is transported in small batches might serve multiple needs in addition to reaching areas that have poor last mile connectivity. It would make the vaccine easily accessible to slum dwellers in urban parts, areas without a primary healthcare centre close by and for senior citizens or vulnerable people who are unable reach their local health care centre.
In light of the socio-economic disparity in India, equitable distribution of the vaccine is another concern. A single vaccine or manufacturer may not be able to meet the needs of the entire country immediately and with nine vaccines at various stages of testing, plans to deploy multiple vaccines seem evident. Costs for these are estimated to range from $3-6 per dose for the SII or Bharat Biotech vaccines, to $20-37 per dose for the Pfizer-BioNTech and Moderna mRNA-based vaccines. Thus, vaccination, even with more affordable vaccines, will be less accessible to low-income individuals where daily wages tend to be around Rs.100 ($1.4).
While a cost-free vaccination to everyone would be ideal and could be funded by public charitable trusts such as the PM cares fund. Another hurdle will be to reach a section of the demographic that suspects “western” medicine and tends to rely on fake or unproven medical products. In this, open communications with the populace about the vaccine by ASHA (Accredited Social Health Activists) workers, trained volunteer citizens and schools in an engaging manner would be very important.
Finances for the Vaccine
Addressing the challenges in vaccine distribution would need substantial expenditure. For a comparison, in the year 2012, $10 million (~Rs.70 crore Rupees) was required for cold chain equipment for the UIP that covered routine immunizations for ~156 million beneficiaries (Source: Chatterjee et al, IJMR, 2016 and nhp.gov.in).
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Personnel, training, transport, maintenance of cold chain equipment and communications/outreach efforts cost approximately $70 million (~Rs. 500 crores). The distribution cost of a new COVID19 vaccine, would likely exceed these by several fold. Any gap in funding after government financing needs several sources to step up.
Private bodies involved in vaccine manufacture or healthcare could provide trained personnel, subsidized or pro bono storage, transport services in partnership with the government. The COVID19 vaccine manufactured by Pfizer was recently approved and would be the first human mRNA vaccine in the world.
Authorising this vaccine in India could be of mutual advantage if the companies involved finance the infrastructure needed thus elevating the supply chain in the country and paving the way for other such vaccines to be marketed. Organisations could offer vaccinations for employees instead of festival-related annual gifts or to compensate for the travel allowances that were largely unclaimed last year.
India is a country where we often rely on “Jujgaad” or “hacks” in our daily lives – non-conventional, frugal innovations and ideas need to be encouraged to meet the unique vaccination challenges our country poses.
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