The 50-50 problem: How segregating the vaccines gave rise to supply chain bottlenecks

In pulling off the world’s largest immunisation drive, the country had hit just the right notes when it started. However, since the Centre’s decision to split the two vaccines- Oxford-Astrazeneca’s Covishield and Bharat Biotech’s Covaxin – for its mass inoculation drive, the country now faces fresh supply chain disruptions in consequence of it.

The country-wide distribution of covid-19 vaccines across every corner, is undoubtedly the world’s largest immunisation drive, with its fair share of ordeals and responsibilities. However, ever since the Union government came up with the idea of decentralising vaccine procurement from May 1, it has now presented fresh bottlenecks along the vaccine supply chain.

As shared by concerned government sources as well as companies associated with the vaccine drive, the decision to split the vaccines has led to logistical difficulties during procurement by individual hospitals or chains and different states, in contrast to the earlier integrated hub-and-spoke model.

In addition to managing procurement of vaccines, private healthcare providers and state governments now face the tumultuous responsibility of organising the logistics. New pathways are being built for the safe transit of the vaccines, from manufacturing units to the recipient, translating into potential delays and higher costs for end-consumers.

Logistics efficiency before May 1: The hub-and-spoke model

The logistics in the earlier exercise had utilised the state-owned universal immunisation programme (UIP) infrastructure, which had a robust network of around 29,000 cold chain points across the country for vaccine storage at recommended temperatures.

Prior to May 1, for the vaccine makers, the process of shipping supplies only began once it received an order where the only buyer was the Central government.

The exercise would start off with a 1-millilitre vial that AstraZeneca handed over to Pune-based Serum Institute of India (SII) in early May 2020, which would go through a process to produce millions of doses in one go, and the vaccine thus extracted would be filled into 10-dose vials. Batches of these vials, packed in ice boxes and loaded onto refrigerated trucks, would then be taken to the Pune airport and loaded on to different flights as per a distribution plan prepared in New Delhi on the basis of inputs from states and other population-based criteria.

Likewise, a similar process ensued for Bharat Biotech for its Covaxin at four facilities in Hyderabad and Bengaluru. It would also pack its Covid-19 vaccine into 10-dose vials before sending them out.

Prior to the beginning of the immunisation drive on January 16, vaccines from SII and Bharat Biotech were carried in the cargo hold of commercial flights like IndiGo, SpiceJet, GoAir, Vistara and Air India. Further shipments traveled by road using services of companies like the Transport Corporation of India that would carry the vaccines in refrigerated trucks to some of the Central government’s larger depots in key hubs like New Delhi, Mumbai, Karnal, Kolkata and Chennai. This was done to curb transportation charges, as air transport was expensive.

The hubs of the Centre’s hub-and-spokes system were  comprised of Government Medical Store Depots (GMSDs) or the “primary” vaccine storage facilities operated by the Directorate General of Health Services (DGHS).

The vaccines would travel from these GMSDs in refrigerated trucks or insulated vans to vaccine stores in various states. The hub-and-spokes model would continue down the chain, while the Centre’s role ceased here. Henceforth, from the State depots, the stock would be divided and distributed to regional or district vaccine stores. The doses would further be carried to Primary and Community Health Centres as well as private hospitals, either to be administered there or further be carried by staffers in ice boxes to their eventual vaccination sites.

The hub-and- spoke model enabled the vaccines to reach far-flung areas such as the Northeast. The vaccines would first reach the closest hub — Kolkata, in this case, to be further transported by regional flights. The government’s cold chain network was utilised till the vaccine vials were taken to their vaccination centres.

The vaccine drive: Post May 1 challenges

Under the current phase of vaccination, the Centre will receive only 50 per cent of what the companies produce, which it will allocate to to States and Union Territories “based on the criteria of extent of infection (number of active Covid cases) and performance (speed of administration)”, the Health Ministry has said. “Wastage of vaccine will also be considered in this criteria and will affect the criteria negatively,” it said on April 19.

This has led to heightened pressure on the vaccine makers as they are now expected to also meet orders being placed directly by states and private entities, which will not require them to significantly alter their logistical requirements, but will also be much more exacting. This could add to the complexities in the vaccine’s journey and pull back India’s inoculation drive, opine experts.

For vaccines procured by the Centre and distributed to states, the hub-and-spoke model used earlier is expected to continue, but for order directly placed by states may no longer have the comfort of starting off at a larger vaccine depot. These orders will also have to be streamlined in a way that the State depots are able to efficiently handle their storage at optimal temperature conditions to preserve the safety and potency of vaccines.

Private hospitals, too, will have to collaborate with vaccine makers as well as cold chain firms to procure and store the doses they will be administering — especially given that nearly 600 million people between 18 years and 44 years only are eligible to receive their jabs at private facilities for now.

Vaccine manufacturers already have arrangements with general sales agents to ship their products. Depending on factors like price, availability and timing, these agents decide the flights or other means of transportation, through which vaccines are to be shipped.

With the opening up of vaccines sales for manufacturers, states and private healthcare entities may no longer enjoy the cost effectiveness they earlier enjoyed due to economies of scale, owing to centralised procurement by the Union government.

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