As the ‘reefer’ trucks roll out of Serum Institute in Pune and Bharat Biotech at Hyderabad to reach the vaccine to different parts of the country, the nation is gripped with a renewed hope that end of the pandemic may just be near. Only a day remains before India begins its mass inoculation campaign against Covid-19, the largest and most ambitious such programme in the nation’s history. In fact, as per government sources, over 300,000 healthcare workers will be vaccinated, spread over 2,934 sites across the country.
But for a campaign of this magnitude, a pertinent question to ask would be whether the country possesses adequate infrastructure for a successful roll-out, with minimum hiccups. And this infrastructure contains multiple components.
To begin with, the movement of the vaccine from the manufacturing centre to the session site (where it is administered), is a lengthy and complicated affair. As per experts, the trucks coming out of the manufacturing centres, carrying the vaccine vials in them, are all being tracked electronically.
These transport trucks are all connected through a software which can show the live location of the valuable cargo at any given time. The trucks will deposit the vaccines into regional vaccine stores of states, and from there, the vaccine will then begin moving to the district stores and, eventually, to their final destination—the primary health centres. It is from these primary health centres that the vaccine will eventually be transported to sub-centres and outreach vaccination sites.
In fact, one of the big fallouts of the Covid-19 pandemic has been in the logistics sector, in particular for trucking companies. As the national lockdown was announced, it left scores of trucks ferrying goods to be stranded on the roads. In such a scenario, the demand for software needed to track every movement of the trucks shot up.
One such firm which benefited from this surge in demand was Hyderabad-based LogisticsNow, a four-year-old logistics intelligence platform provider. Its platform, called Lorri, boasts of covering more than 650 transporters, with a freight spend of ₹10,000 crore. “There are 1,000 ‘reefer trucks’ capable of carrying vaccines, and all of them are on Lorri,” says Raj Saxena, founder and CEO, LogisticsNow.
Saxena points out that when the vaccines are being transported in trucks, the storage temperature should be at least two degrees lower compared to when the vaccines are stationary. “All these issues throw up massive challenges for the trucks, plus you need special kinds of trucks to ferry these vaccines, at a lower temperature. Which is when intelligence platforms—like Lorri—become useful. Because using this technology, trucking companies can keep track of where their trucks are, at what point in time, and so on,” Saxena says.
Then there is the problem of data. The amount of vaccine that will move to the sites will depend on the number of beneficiaries, which, as of now, are the healthcare personnel of the area. As of now, data of 30 million workers has been uploaded, from both the public sector and the private sector. In fact, in many ways, this accumulation of data is a crucial step.
According to doctors at the primary health centres, the process of collecting data about potential beneficiaries started months before the vaccine candidates were even approved. “We were asked by the government to give the data of healthcare workers in every state almost two months ago,” says Dr. Bishnu Panigrahi, group head, Medical Strategy and Operations, Fortis Healthcare. That is how deployment of the Covid-19 vaccine was planned. Gurugram, for example, has a total of 31,605 listed healthcare workers; some 4,600 are in the public sector, while the rest are private healthcare personnel.
Cold chain infrastructure
India has a robust cold chain infrastructure in the public sector already and all of it will come into play. According to data from the Ministry of Health and Family Welfare (MoHFW), as part of the country’s universal immunisation programme (UIP), there are already more than 27,000 cold chain points available with the government.
Moreover, the government can also use the capabilities available under Project Indradhanush, which was launched in 2014 with the express aim of immunising women and children. All essential vaccines are given in various outreach programmes through the year, as part of routine immunisation. Suman Saini, the pharmacist in charge of maintaining the cold chain infrastructure at an urban primary health centre (PHC) in Gurugram's Wazirabad points out that routine vaccination sessions occur throughout the year.
According to her, at least 33 vaccination sessions happen in a month, in addition to special drives, like the MMR campaign or the pulse polio vaccination drives, occur on top of that. And, although the Covid-19 vaccine has additional protocols, the head of the Wazirabad PHC, Dr Ashima, is confident of sessions running smoothly. A reason for this confidence could be the multiple dry runs driven by the chief medical officer of Gurugram, Dr. Virender Yadav. As per this PHC, the vaccination sessions will be held three times a week—Monday, Thursday, and Saturday—so as not to disturb routine health work of the PHC.
The PHC boasts of a deep freezer and ice-lined refrigerator to store vaccines with temperatures between 2-8 degrees. Saini maintains stock, keeps an eye on temperature and ensures that it is working with no hiccups.
But a large part of this intricate cold chain network could not have been possible without the involvement of the private sector. And in this Godrej Appliances has led the way. The company has already received orders worth around ₹150 crore from both the central government as well as various state governments, mainly for the purpose of providing cold chain solutions.
By mid-December, in anticipation of the eventual roll-out, the company had started ramping up its medical refrigeration production. In fact, it is the only company in India which bagged the prestigious WHO-PQS certification (a quality certification given by the World Health Organization). “We offer solutions that will keep a vaccine secure even with no power up to three days,” says Jaishankar Natarajan, head, New Business Development, Godrej Appliances. According to Natarajan, Godrej is able to offer solutions from a 225 litre deep freezer to a portable bag with a capacity of eight litres, meant mainly for the mobile anganwadi workers who walk from village to village.
“We have small refrigerated vans, mobile deep freezers and storage points. We have a solution where the ILR can maintain a flat four degrees temperature so that the vaccine remains safe for up to 10 days without power,” Natarajan adds.
The software unity
But physical infrastructure alone won’t be enough. So, from the very beginning, India added a digital element to it. In fact, digital involvement in healthcare has been around for some time. Its impact, for example, was visible in the government’s vaccination programme. eVIN, the electronic Vaccine intelligence network for managing the massive vaccination programmes, was introduced in India in 2015 in collaboration with the United Nations Development Programme (UNDP) and MoHFW. It has been running smoothly for five years and is considered to be one of the most successful in the world.
The eVIN network tracks the movement of vaccines from the manufacturer to the states, districts, and blocks. It tracks the cold chain, its machinery, preparedness, inventory, and the state of readiness on a dashboard. This programme, implemented in 34 states and Union territories, covers over 720 districts. The state governments have been tracking outcomes of the programmes and upgrading its healthcare infrastructure. Therefore, for all health workers, including Saini, using eVIN is a matter of procedure. And as for Co-Win, adapting to it was a cakewalk.
Covid-19 Vaccine Intelligence Network (or Co-Win) is the digital platform developed as the software to work along with eVIN with the help of UNDP. It is a comprehensive cloud-based IT solution for planning, implementation, monitoring, and evaluation of Covid-19 vaccination in India. It is the end-to-end solution which has utilities for the entire public health system, from the centre up to the vaccinator. The system allows the creation of users (administrators, supervisors and vaccinators), registration of beneficiaries (bulk uploads and individual registration) facilities/ planning unit and session sites followed by planning and scheduling sessions, and finally implementation of vaccination.
Since the time the National Expert Group on Vaccine Administration for Covid-19 (NEGVAC) was set up to prepare protocols to be followed for the vaccination of the nation and it presented a comprehensive strategy using the massive infrastructure related to Universal Immunisation Programme(UIP), Indradhanush, and the election machinery, the healthcare infrastructure of the country has been gearing up to this day.
On January 16, the roll-out begins.