With a vaccine sector valued at ~Rs. 9500 Crore (USD 1.2 Billion) in 2020, India has been touted as the global leader in vaccine manufacturing and production. Its Universal Vaccination Programme (UIP), established in 1978, is the World’s largest routine vaccination program. India is also home to the world’s biggest producer of COVID-19 vaccines. Yet, India is lagging behind its COVID-19 inoculation goals. The government of India expanded the COVID-19 vaccination drive to include all adults, from 1 May 2021. It aims to administer 2.16 billion vaccine doses between August and December. However, state capacity challenges, policy shifts, and the need to speed up the vaccination drive amidst the second wave of the pandemic, have emerged as key challenges in achieving this goal.
This post looks at the difficulties surrounding COVID-19 vaccine distribution in India. What are the infrastructural bottlenecks hampering the vaccine rollout? How are the government and private players handling procurement? And how prepared are local governments to distribute vaccines to the last mile?
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.
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.
“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.
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.