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Issue 4

A Vaccine isn’t The End – Distributional Challenges Lie Ahead

Pravish Agnihotri

Multiple vaccines for COVID-19 are nearing their release for public usage. But availability is just the beginning. How does the distribution look like in terms of prioritisation and infrastructure? Who gets it first and how will it reach them?

On Monday (9th November 2020), Pfizer announced that its COVID vaccine proved to be 90% effective against coronavirus in its early test results sparking hopes for the arrival of a vaccine before the end of the year. Adar Poonnawala, CEO of the Serum Institute of India also said that a vaccine might be available in India as early as January 2021. As of November, 11 vaccine candidates are in their third phase of testing, all hoping to be available by early to mid-2021. Although the approval of a safe and effective vaccine would be a breakthrough in our fight against COVID, its distribution will continue to be a major challenge, especially in India. 

A worldwide consensus has emerged that the distribution of the COVID vaccine would be done in stages, with those that are most at risk being the first to be vaccinated. However, with extremely limited vaccine supply, the implementation of this consensus becomes murky. The Union Health Secretary, Rajesh Bhushan said in a press briefing that India plans to vaccinate 30 million frontline health workers in its first phase. However, the plan includes only health workers and does not apply to essential workers, who are also at a pronounced risk of contracting the virus. Moreover, the plan also excludes those over the age of 65 and those with comorbidities. If these numbers are taken into account, the vaccines required for those considered the most vulnerable would far outweigh its availability. CDC’s Kathleen Dooling projected that the number of healthcare personnel, essential workers, people above the age of 65 and people with high-risk medical conditions account for more than half of the US population. Once approved, the demand for a vaccine would skyrocket, making vast quantities of doses difficult to obtain. In such a situation, it is unclear how the decision of who gets the vaccine first will be taken. 

Vaccines can only be shipped at tight temperature ranges in order for them to remain effective. The Moderna and the Pfizer vaccines would require a shipping temperature of -20 degrees Celsius and -70 degrees Celsius respectively. The Oxford-Astrazeneca Covishield vaccine and Bharat Biotech’s Covaxin need to be stored at 2-8 degrees Celsius. Efficient widespread distribution of a vaccine would thus require a high-capacity, well-oiled cold supply chain with last-mile connectivity. 

India, under its Universal Immunisation Program, already transports other vaccines at 2-8 degrees to newborns and their mothers. Every year, around 400 million doses of vaccines are administered under the UIP through the help of the existing cold supply chain. Although the government has already begun mapping out cold storage facilities, India would need to significantly ramp up its cold supply chain if it aims to vaccinate its population against COVID-19 along with the existing vaccinations under UIP. Along with sizable government investment, private cold storage facilities and existing food cold chain supplies will also need to be tapped for the distribution of the vaccine. Further, erratic power supply in most parts of India exacerbates the problem of low cold chain capacity. 

Pravish is a student of Political Science, International Relations, Economics and Media Studies at Ashoka University.

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