March 08, 2021

The Indian COVID-19 Alliance (TICA) | Distribution Track

By Shilpa Rao, Sofia Imad, Vibhav Mariwala, Rajeswari Parasa, Sridhar Ganapathy, Mahesh Kalsekar, Mrunalini Chaudhari, Rohit Bajoria, Supriya Shinde

India’s COVID-19 Vaccine Campaign - Distribution Preparedness

With a vaccine sector valued at ~Rs. 9500 Crore (USD 1.2 Billion) in 2020 and expected to grow at a CAGR of 18% year on year, India is a global leader in vaccine manufacturing and production. Established in 1978, India’s Universal Vaccination Programme (UIP) is the world’s largest public vaccination program and provides twelve free vaccines against critical diseases to nearly 56 million children and pregnant women annually. However, will this manufacturing capability and immunisation infrastructure hold up to be able to provide the ambitious 600 million doses in Phase 1 by July 31st? What role is the private sector currently playing and looking to play in this campaign rollout? How do states compare in their vaccine rollout readiness?

 

To gain an in-depth understanding of India’s COVID-19 Vaccine distribution preparedness, IDFC Institute partnered with Pharmarack Technologies Pvt. Ltd., a B2B healthcare service provider to assess - vaccine equipment capacities, cold storage capacities, transport and logistical preparedness and state-wise readiness to roll out the campaign. We did this through extensive secondary research and 13 interviews conducted with senior management of top vaccine manufacturers, transportation and logistics companies involved in pharma and vaccine transport, nonprofits and multilaterals working in public health, FMCG companies involved in cold-chain transport and subject matter experts.

 

This webpage highlights a few key data points and takeaways from this study. For more information on sources of information and our inferences, access the full report of this study here. Explore other studies carried out by our TICA team and detailed reports here.

 

 
India’s Current COVID-19 Vaccine Portfolio

Approval timelines are estimated based on expected phase III results publication.

 
Universal Immunization Program (UIP) and its Role in Vaccination in India

In the first round of the National Family Health Survey (NFHS) conducted in 1992-93, only 35.4% of children aged 12 – 23 months were fully immunised. From 1992 to 2015, India has seen continuous growth in vaccination coverage of children. In the fourth round of NFHS conducted in 2015-16, India touched 62% immunisation coverage. The map below uses the data from the NFHS 4 (2015-16) to show UIP vaccination coverage across all states and union territories in the country. Punjab, Ladakh, Goa and West Bengal show the highest vaccination coverage in that order and Nagaland, Arunachal Pradesh, Assam and Gujarat show the lowest coverage under the UIP program.

 

 

UIP State-wise Cold Storage Capacity

India has a total of 4,761 Metric Tonne (MT) cold storage capacity under its UIP program (TICA calculations).  The state-wise breakup of this storage capacity shown below indicates that currently, Maharashtra, Uttar Pradesh and Rajasthan have the highest cold storage capacity. 

 

 

 

Based on this data, using a simple assumption that ~40% of the UIP cold storage capacity or 1,904 MT pan India is being dedicated to the storage of COVID-19 vaccines currently, this would work out to a devoted storage capacity for 228 million doses. In the first 40 days of the vaccination drive in India, 123 Million COVID-19 vaccine doses were administered (MoH data), indicating that doses worth only 5.4% of the dedicated COVID-19 cold storage capacity were utilised over this period.  Only the states of Gujarat and Telangana and the Union Territory of Delhi administered doses near or above the allocated UIP capacity of COVID-19 doses. 

 

This leads us to believe that the availability of cold storage capacity alone is not yet an issue, especially since this calculation does not consider the private pharmaceutical sector’s capacities which are vast on their own (4,07,987 MT across various industries). Hence, most experts believe that COVID-19 vaccines may not require a large cold chain capacity expansion given they are typically consumed within 15 days of transportation to the storage facilities. We would also like to flag that cold storage capacity alone is not the only determinant of successful vaccine delivery.

 

The Vaccine Supply Chain and Transportation Requirements

“In India, vaccine-related cold chain logistics are a well-coordinated activity that follows all stringent government guidelines and this system functions seamlessly with both Government and the private sector playing an equal and important role in the rollout.”

- 10 out of 12 interviewed industry experts agree

 

The overall supply chain of the vaccines in India is divided into the primary and secondary cold chain distribution network as illustrated below with the private sector playing a critical role in the supply chain operations.

 

 

Source: National Health Mission, figure prepared by Pharmarack

 

 

Regarding the Government Operated Supply Chain under the UIP Program, below is the journey of a vaccine from GMSD to the recipient. The UIP vaccine delivery network in India operates through four Government Medical Supply Depots (GMSDs), 53 State Vaccines Stores, 110 Regional Vaccines Stores, 666 District Vaccines Stores, and 25,555 sub-district stores involving 8,187,544 session sites through 259,283 health workers.

 

Source: Prepared by Pharmarack based on stakeholder discussions

 

Our conversations with experts reveal that India’s temperature-controlled transport capacity is between 8 to 10 Lakh Metric Tons of which only 2 Lakh Metric Tons of the market capacity lies in the organised segment dominated by about 10 big players. The current refrigerated road vehicles capacity utilisation for the pharmaceutical industry falls between 75- 80% with nearly 20-25% still available capacity to accommodate the transport of the COVID-19 vaccines. While last-mile access in remote and geographically complex areas will require planning, most stakeholders interviewed exhibited confidence in being able to deliver the vaccines successfully in a phased manner with existing infrastructure alone. Organised temperature-controlled transport players are in a capacity expansion mode to address the task of transporting Covid-19 vaccines across the country - see below for opinions from the market leaders in this space.

 

 

 

TICA’s State-Wise COVID-19 Vaccine Distribution Preparedness Index

We conducted a state-wise geographical disparity analysis to compare the distributional preparedness of each state in its strategy and operations in order to successfully carry out the COVID-19 vaccination drive. We did so based on four different parameters on which we could easily obtain quantifiable data and they touch upon different aspects of vaccine campaign readiness, they are -

 

 

Based on the above scoring method, the relative preparedness of the states in rolling out the COVID-19 vaccination campaign is captured below. Maharashtra, Kerala, Himachal Pradesh, Mizoram, Karnataka, Meghalaya, Chandigarh and Tamil Nadu are amongst the most highly prepared states with an average score of 70. Whereas, UP, Bihar, Puducherry, Lakshadweep and A&N islands are amongst the least prepared States and Union Territories.

 

Below is an interactive tool that our readers can use to explore this index in more detail!

 

 

The full dataset, calculations and assumptions can be found here.

 

Assessing Impact of COVID-19 on Delivery of Routine Healthcare Services

While we are yet to systematically evaluate the short and long term impact of COVID-19 on the delivery of other routine health care and immunisation services, a recent study published by BMJ Global Health that looks at data from National Health Mission and the Nikshay Tuberculosis (TB) database found that in March 2020, over 260,000 fewer children received the BCG vaccine than in January 2020. They opine that the decline was even sharper and fell to just half as many children receiving the BCG vaccine in April 2020, compared to January 2020. Notified TB cases in August 2020 reduced by nearly 50 per cent, as compared to the same month in 2019. The number of patients with TB registered as being on treatment in April 2020 fell to just half the February 2020 levels. By June 2020, over 23,000 fewer patients had completed TB therapy successfully than in January 2020. Other reports suggest that India’s malaria tests have reduced by 32 per cent, and malaria cases have declined by 39 per cent from January to August 2020, as compared to 2019.

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