India hopes to start rolling out a COVID-19 vaccine by March 2021, but it faces a steep challenge: cold chain and distribution infrastructure.
The nation with the world's second-highest infections plans to use the existing cold chain network in place for its Universal Immunization Program, said Rajesh Bhushan, secretary to Union health ministry, in an email interview. But that infrastructure is geared to only immunise children and pregnant women -- vaccinating India's 1.3 billion people will require its capacities to be significantly scaled up, experts say.
"The entire existing cold chain capacity is inadequate for existing vaccination programs," said T Sundararaman, New Delhi-based coordinator of the People's Health Movement, an organisation that works with academics and civil society. "Your investment in cold chains needs to be to the order of five to 10 times what you're doing now. That level of cold equipment -- to procure, to distribute, to allocate, to function, to train itself is a big undertaking."
The government has said it's looking at the various vaccines being manufactured both domestically and abroad -- including those being developed by Pfizer Inc and Moderna Inc -- in addition to AstraZeneca Plc's shot to be produced by the world's largest vaccine maker Serum Institute of India Ltd.
While the availability of a vaccine is subject to the results of ongoing trials and licensing by the Drugs Controller General of India, "if all goes well" India expects a vaccine to be available in first quarter of 2021, Mr Bhushan said. He didn't give details of how much India plans to invest in providing shots to its people.
"An assessment of cold chain storage space has been carried out across the country for enhancement and augmentation for Covid-19 vaccine," Mr Bhushan said in his email. "Necessary actions have also been initiated to strengthen the existing cold chain system."
His office hadn't immediately responded to a follow-up email seeking details of the plan. A spokeswoman for the health ministry also did not immediately respond to questions asking what steps are being taken to augment cold chain capacity.
Even companies vying to distribute the vaccine have raised concerns about India's capacity.
"We are talking about distribution of around two billion doses of vaccine throughout the country," Sunil Nair, chief executive officer at Snowman Logistics Ltd, one of the largest manufacturers of cold chain equipment in the country told BloombergQuint. "With the current immunization program of the government, only 20-25% of the overall volume can be distributed."
The Pfizer shot needs to be stored at ultra-cold temperatures of -70 degrees celsius and thawed and injected within five days. Moderna has said its vaccine can be stored at refrigerator temperatures for close to a month but needs freezer storage for longer periods.
With over nine million reported infections and nearly 134,000 deaths, ensuring large scale delivery of a vaccine is a priority for Prime Minister Narendra Modi as India struggles to revive its economy that has slipped into a recession.
The government-run national immunization program currently targets 26.7 million newborns and 29 million pregnant women every year, according to government data. While the existing cold chain is funded and managed through public finances, ramping up capacity to meet the needs of a vaccination program that will target its entire population will also need to rely on private players.
Along with Snowman Logistics, Deutsche Post DHL-owned Blue Dart Express, Allcargo Logistics and Mahindra Logistics are among those competing to transport vaccines across India, the Economic Times reported Thursday.
India has "some infrastructure" to move and store vaccines at -20 degrees, Snowman's Nair said. "Will that be sufficient? I doubt."