Supply chain strategies to manage vaccination

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Supply chain strategies to manage vaccination

Tuesday, 25 May 2021 | Anita Kumar

Supply chain strategies to manage vaccination

Yes, there are problems but there are also solutions that can be leveraged to add order to the campaign, mitigate bottlenecks and increase supply & distribution

On January 16,2021, the Covid-19 vaccination programme was launched with much fanfare by Prime Minister Narendra Modi. It was touted as the only ray of hope after a year of human suffering. An ambitious project to vaccinate 1.3 billion population in a two-dose regimen, an event of this magnitude had never been attempted in India before. Although India has been one of the largest exporters for vaccines in the last decade, several questions were raised: Does India have the capacity to manufacture 2.6 billion doses? Does India have adequate infrastructure to manage distribution, transportation and storage of vaccines that may require sub-zero temperature? Does India have the trained manpower and facilities at the last mile level (primary health care centres) to administer the doses successfully to its population spread far and wide in the interiors of the country.

The questions were uncomfortable and rightly so as barely four months into the programme, the entire vaccination drivehas been put in peril due to scarcity of vaccines, lack of resources at the primary healthcare level and people's reluctance to get themselves vaccinated. 

This article adopts a supply chain management approach to propose solutions that can be leveraged to add order to the vaccine programme, mitigate bottlenecks and increase the supply and distribution of vaccines. Supply chain management is the facilitation of of flow of goods from the raw material suppliers to the manufacturers, dealers, distributors, retailers and finally to the customer; it is also the management of bilateral and seamless flow of information end-to-end. The principles of supply chain management advocate creating strong networks and integrated relationships between the different echelons of the chain.

Procurement of Raw Materials

Two major constraints to sourcing of raw materials for Covid 19 vaccine were identified as: 1) raw materials and technologies needed for the fight against COVID-19 are under intellectual property protection and therefore inaccessible to many countries 2) US has invoked Defence Protection Act that prevents the export of critical materials to encourage domestic production. The US has assured that it willexpedite export of raw materials, but when is the question. Meanwhile,an international agreement that compels majority of countries to remove or not create trade barriers that disrupt the global flow of raw materials for making vaccines, should be in place.Many petitions have been filed to waive off the patents of Covid-19 vaccines so that production can be expanded rapidly. In this context, it makes sense to invest in the R&D and clinical trials of indigenous vaccine developed in India.Alternate supplier base from other countries such as Russia should be developed to procure and supplement raw materials for large-scale commercial production while strictly adhering to the biosafety standards.

 

Managing Manufacturing Capacity

The manufacturing process of Covid-19 vaccine is complex and requires specialized production capacity. Moreover, adjuvant materials such as consumables, single-use reactors bags, filters, culture media, and vaccine ingredients are needed in large volumes to complete production.India's manufacturing capacity and capability for vaccines was not questioned earlier as the country houses the largest vaccine manufacturer in the world and exports 60 per cent of its production to other countries as part of the UNICEF immunization programme. However, with Covid 19 vaccines, the production capacity has been severely over-estimated for two reasons:1) India manufactures vaccines largely intended for children, therefore it was presumptuous to assume that this high capacity would easily be transferred to making adult vaccines. Moreover,India's decision to export vaccines to the rest of the world was premature as the combined production of Covishield (60 million per month) and Covaxin (five million per month) is insufficient to service domestic demand, leave alone create export surplus.India now needs to invest in expanding the manufacturing capacity along with conducting clinical trials to ensure continuous and seamless production. Rather than relying on one manufacturer, the Union and state governments should consider public-private partnerships, advanced purchase agreements, incentives and benefits with concessional loans to propel vaccine production.

 

Vaccine Mid-Mile Logistics

Although India has escalated its cold chain infrastructure to facilitate smooth transportation of vaccines across the country, it needs to invest further in logistics infrastructure as the vaccines need to bestoredand transported at temperatures 2-8 degrees from the point of manufacture to the point of administration. Temperature integrity needs to be maintained at all times as25 per cent vaccines degrade by the time they reach their destination due to temperature errors. Thus, need of the hour is to create public-private and public-public partnerships to outfit transportation modes, storage hubs, packing stations, dangerous goods handling areas and health centers with freezers.

India's primary healthcare centers which are last mile storage and administration points are ill-equipped to handle these vaccines.Ancillary items like syringes and glass vials need to be madein adequate quantities along with proper training of healthcare workers who can immediately respond to any emergencies.  Verifiable transcript of the vaccine's lifecycle and journey needs to be documented as counterfeiting is rampant in the pharmaceutical supply chain.

The Indian government has done well to launch the Co-Win appand a dedicated 24x7 hotline and this has brought visibility and transparency to the front-end operations, but same visibility needs to be extended to the back-end of the supply chain.

For this, a supply chain info-directoryneeds to be established that can help suppliers and purchasers traverse the volatile and uncertain environment. The info-directiory would serve as a central repository of demand and supply data, including information on the needs of different states and regions, confirmed purchase orders, supplies and manufacturing capacity for input materials and finished products, delivery times, and so on. Moreover, Chain of Custody also needs to be established to ensure tracking of vaccines in the supply chain and prevent counterfeiting of data and systems.

The challenges to vaccinatethe Indian population against Covid-19at the earliest are humungous.The supply scenario in India has been unpredictable for Covid vaccine due to multiple reasons: lack of raw materials, limited manufacturing capacity, inadequate transportation and logistics infrastructure and insufficient trained manpower. On the demand side, although the population numbers are fixed, demand remains uncertain at the micro level due complications suffered by some patients, misinformation regarding the efficacy of the vaccine and new information related to the highly mutant strain of the virus makes matters worse, creating scepticism over the effectiveness of the overall vaccination programme.

The author is Director, CII School of Logistics, Amity University. The views expressed are personal.

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