The lack of ultra-cold freezers needed to store and distribute potential vaccines in the pipeline may seem like an obstacle in India’s race to defeat the coronavirus. But with the capability of distributing hundreds of millions of vaccines every year, no challenge is insurmountable. Even as we speak, logistics and cold chain companies continue boosting capacities as they prepare to distribute COVID-19 vaccines across the country from next year, while the government has already begun the mammoth task of mapping India’s existing cold chain capacities.
Maintaining the cold chain for coronavirus vaccines won’t be easy even in the richest of countries, especially when it comes to those that require ultra cold temperatures of around -70°C (-94°F). Investment in infrastructure and cooling technology lags behind the high-speed leap that vaccine development has taken this year due to the virus.
With the pandemic now in its tenth month, logistics experts warn that vast parts of the world lack the refrigeration to administer an effective vaccination program. This includes most of Central Asia, much of India and Southeast Asia, Latin America except for the largest countries, and all but a tiny corner of Africa.
To uphold the cold chain in developing nations, international organisations have overseen the installation of tens of thousands of solar-powered vaccine refrigerators. Keeping vaccines at stable temperatures from the time they are made until they are given to patients also requires mobile refrigeration, reliable electricity, better roads, and above all, advance planning.
As with most logistics, the last kilometer (mile) is the hardest part of delivering a coronavirus vaccine to the people who need it.
Planes, trucks, cold storage units will have to equip themselves to transport and maintain vaccines at such low temperatures and glass vials, containers with the vaccines will also need to be packaged to withstand such icy conditions. A huge quantity of dry ice will also be needed. Vaccine storage and transportation might just be the biggest pandora box of issues as vaccine production and safety trials culminates.
Is India prepared?
Amidst the cheer across the world sparked by the talks of completion of Pfizer’s experimental COVID-19 vaccine on November 09, the announcement has injected more doubts than relief into many in India.
The widespread fear is, to store and distribute the vaccine that needs temperatures matching an Antarctic winter, would be a logistical nightmare for India, with heat waves exceeding 50°C (122°F), patchy power, and 1.3 billion people.
While the government continues to map cold chain capabilities for a COVID-19 vaccine roll out next year, some industry experts feel that the current capacity will have to at least be doubled.
A cold chain augmentation plan to address the additional cold chain space required for the vaccine has already been initiated by the Health Ministry.
The exercise to map out cold chain facilities is being conducted at a massive scale, with a national expert group reportedly talking to public and private sector firms from pharma, food-processing and agro-business sectors to identify cold storages or fridges at the taluka level that can stock and distribute the vaccine. Food tech firms like Swiggy and Zomato had also been called-up to identify refrigeration facilities at the district level and for last-mile delivery.
Under the National Expert Group on Vaccine Administration for COVID-19 that is chaired by Dr VK Paul, Member (Health), Niti Aayog, there are subgroups looking into various aspects of vaccine development, procurement and distribution, including one that looks at cold chain requirements.
“The subgroup has already mapped the existing cold chain that is presently being utilised under the immunisation programme of the government, and it has also made a projection of the additionality that will be required. Presently, that group is engaged with mapping the private sector facilities where with minor modifications they could be converted to serve the needs of supplementing the cold chain equipment. So, that is how things are currently developing,” Rajesh Bhushan, Union Health Secretary hadsaid in a report.
Earlier in October, the central government had asked all states and UTs to come up with a plan that will ensure cold supply for the coronavirus vaccines. Union Health Minister Harsh Vardhan in his address to the people had informed that the health ministry is expecting to receive as well as utilise around 400-500 million vaccine doses for the COVID-19 infection.
Given the demand, India’s existing Universal Immunisation Programme (UIP) infrastructure– which will be used to vaccinate the priority groups identified by the government may need more private sector involvement.
Real-time tracking of vaccine movement- from procurement to storage, to delivery and distribution is being planned using the electronic Vaccine Intelligence Network (eVIN) that is used for the immunisation programme. This cloud-based application tracks realtime stock positioning and supply route based on the information fed by ground staff.
India has about 27,000 vaccine storage centres across all 700 plus districts that are connected through eVIN; with at least 50,000 temperature loggers to monitor storage temperatures as accurately as possible for at least 40,000 frontline workers to manage logistics.
“We already have a well-oiled machinery in place as far as vaccine delivery is concerned with a robust national immunisation programme running. That will be made use of for COVID-19 also. Apart from polio there are other vaccines needing cold storage like the measles vaccine. It won’t be a problem,” said Dr Paul.
“We are parallelly making arrangements for putting in place procurement and distribution logistics of COVID-19 vaccine as and when it is available for use. We will be prepared to ensure it is delivered to all,” he added.
According to Credit Suisse analysts India would need about 1.7 bn COVID-19 vaccine doses to vaccinate a majority of its adult population. The target is to administer 500 mn doses (or 250 mn people) by July next year. The key vaccines the country is banking on are from AstraZeneca, Novavax and Bharat Biotech and the earliest efficacy data is not expected before November-December 2020.
As for the cold chain infrastructure, India’s current immunisation programme handles around 600 mn doses and the private sector has a capacity of about 250-300 mn doses. With this, the potential vaccinations reach 550-600 mn doses annually, claims Credit Suisse. Add to this, manpower required to give the jab would be around 100,000 people. Mass inoculation of India’s population is likely to be achieved only by end of 2023, analysts feel.
The government has already started preparing database of priority beneficiaries and has issued advisory at district and state levels to prepare database and upload to COVID-19 Vaccine Beneficiary Management System. The database of healthcare workers is expected to be ready soon; database of people above 50-years and frontline workers is ready. Challenge is in preparing the database of people with co-morbidities where data is currently limited to screening of people at 48,000 health centres.
Syringe and vial makers are already in ramp up mode and India is unlikely to face any supply constraint at least in the first half of 2021. In the cold chain, analysts feel the storage is not the issue, but transportation is.
Some of the vaccine candidates might require cold chain temperature range of -60 to -80°C unlike traditional cold chain temperature required for other candidates. For this, the support of the private sector that maintains such facilities is likely to be sought.
While private firms wait to be roped in, they have already begun preparing for such a scenario. From planning to convert food processing refrigerated units into vaccine storage facilities to ramping up the vehicles to transport them, private cold chain and distribution firms have begun preparing capacities ahead of India’s July 2021 target to begin immunising its population against COVID-19.
Vaccine candidates by Moderna and Pfizer will require stringent standards for refrigeration that may hamper how they are distributed to millions of people across India’s length and breadth, according to scientists. Unlike drugs, virtually all vaccines need to be transported at cold temperatures, usually between 2 and 8°C, said Raghavan Varadarajan, Professor at the Indian Institute of Science (IISc) in Bengaluru.
The necessity is to keep the vaccine product cold, either refrigerated or frozen. This is a constraint especially with large numbers of doses, Varadarajan had told the PTI, explaining the particular problems of India that has a population of 1.3 billion, second only to China. Many vaccines lose potency when exposed to higher temperatures, he said, and re-cooling does not help.
Thus we need what is called the cold chain of handling before use, said Varadarajan whose team at IISc is working on a warm vaccine that can be stored for over a month at 37°C, and needs no cold chain for storage.
Pawanexh Kohli, former founding CEO of India’s National Centre for Cold-Chain Development (NCCD), agreed that protocols will require COVID-19 vaccines to be kept between 2 and 8°C, while in transport and storage until delivery. The Moderna vaccine candidate can be shipped in -20°C and held at 2-4°C for seven days. The Pfizer vaccine requires -70°C, Kohli, who is also part of the CARUNA platform, which is assisting the government in its COVID-19 efforts, had said to the PTI.
Kohli said the problem could be effectively tackled through extensive use of dry ice. “Dry ice in a designated box can retain temperatures at -70°C for 24-48 hours.”
However, Kohli asserted that the major challenge was not cold storage but multiplying the delivery points of the vaccine, ranging from local pharmaceutical shops to even hamburger and pizzeria outlets having functional cold rooms.
Batting for a mass cluster-based vaccination approach, he said prioritising the vaccine for frontline workers would run the risk of allowing the novel coronavirus to mutate against the vaccine. “The biggest fear is that the vaccine may prove ineffective against a future strain of the virus. Therefore, the deployment of the vaccine should be extensive and expansive,” Kohli said.
The vast scale of India’s UIP is supported by more than 27,000 functional cold chain points of which 750 (3 per cent) are located at the district level and above. The rest are located below the district level, according to the government’s comprehensive multi-year UIP plan for 2018-22. This includes 76,000 cold chain ’equipment’, 2.5 million health workers, and 55,000 cold chain staff, the government’s plan report said.
Cold chain logistics involves many moving parts, including cold storage facilities that store products waiting to be transported, cooling systems to keep it at an appropriate temperature during all aspects of the supply chain such as storing and transporting. Gel packs are also often used for medical and pharmaceutical shipments. Approximately 390 million doses are administered annually at nine million sessions held across the country to immunise 26 million children and 30 million pregnant women, it said.
Noting that cold storage protocols are well established in India, Kohli said the public health network is limited in capacity. Luckily, the food cold chain has synergistic use for this purpose and should assist in this battle. Existing cold chain enterprises may need to allocate specific resources in their network, noted Kohli.
He added that the food cold chain has the maximum reach, with extensive last-mile connectivity, and will require minor redesign to designate storage space and transport load for this purpose. Almost every cold chain owner I have spoken to is willing to contribute space and assets towards this, should the need arise.
Kohli also believes that India must restructure with purpose to start and finish the immunisation programme within a short time period to be effective. Even if the vaccine is ready, the programme should not be commenced until the last-mile for administering the vaccine is prepared, he said.
Operators beef up capacities
Blue Star Ltd, which has a 70 per cent market share in pharma cold chain products in India, says there has been a surge in the demand for medical refrigeration systems.
“Blue Star has seen a 30 per cent surge in demand since March this year as the Centre, state and private players have started augmenting capacity. We were trying to ensure that there was no shortage in the supplies of refrigeration systems and was stocking up on the necessary raw materials,” B Thiagarajan, Managing Director of Blue Star had said.
Thiagarajan is of the view that India already has a robust vaccine distribution system. Manufacturing units have enough cold storage capacity, and the vaccines can move from here to the government distribution chain that includes central government medical depots, state level medical depots, regional or district level centres and primary health centres, he said.
“The government distribution chain is well-equipped with walk-in cold rooms or freezer rooms, deep freezers, and ice-lined refrigerators (ILRs). Last-mile vaccine transporters or shippers are capable of maintaining the temperature up to 48 hours before administration,” Thiagarajan added.
The commercial refrigeration manufacturer has set aside raw material to cater to demand for new cold rooms, it added. “In addition to our regular production, we have kept raw material ready for cold rooms. Even if the demand quantity doubles versus our regular supply, we are ready. We have planned additional shifts between December 2020 and April 2021,” informed Thiagarajan.
Logistics players like Coldman, too, are in ramp up mode. “While our current client profile mainly includes brands from the food industry, we are in advance discussions with pharma players regarding offering of Built to Suit (BTS) solutions,” said Sanjay Sharma, Vice President- Corporate Sales and Distribution, Coldman Logistics.
“Companies often look for customised solutions through strategy alignment from beginning of the relationship until closure– to conceptualising, designing and offering BTS solutions, incorporating delta for flexibility. This is where we have a distinct edge over other players who usually deliver off-the-shelf solutions,” added Sharma.
“Given the trust and demand coming from our clients, we are planning to add 50,000 pallet capacities in the next two years. And going by the assumption that 15 to 25 grams would be the estimated weight of each vaccine, we should be able to store and distribute almost 50 crore doses in our existing capacities spread across the country, even in the Northeastern states of India,” he added.
According to Sharma, Coldman has been approached by top COVID-19 vaccine manufacturers to prepare a plug-in kind of solution for storage at -25°C, suggesting that the candidates being developed in India wouldn’t require ‘ultra-cold’ temperatures. “Our large fleet of primary and secondary vehicles is designed to offer temperatures ranges from -25° to +25°C, in a way enabling us to align our fleet to any demands.”
“We have certain smaller cold rooms that can store a million doses at -40°C also but not in a huge volume. Since the government will have a continuous vaccination programme, so once in a fortnight those one million doses can be rotated. So probably in a month, two million doses can be handled at -30 to -40°C,” he said.
Snowman Logistics is also boosting capacities. The company is also training manpower to handle vaccines that will need to be stored and transported at very low temperatures.
Snowman Logistics runs 31 cold storages across 15 cities and plans to expand its capacity to 33 cold storages in 17 cities over the next three months. This translates to 120,000 pallets, with each pallet being able to store 6,000 vaccines.
“All our cold storages can technically store at temperatures of up to -30°C and with minor modifications this can be taken to -40°C as well. However, most vaccine developers are talking of 2-8°C or at most -18°C. If that is the case, there is good capacity available in India,” Sunil Nair, Chief Executive Officer at Snowman Logistics said.
“Our company’s capacity utilisation is at 85% now. We expect COVID business. When the vaccine arrives, the volume would be good enough to involve private entities,” Nair asserted.
Snowman Logistics has undertaken an exercise to understand what would be required if the firm had to convert over 30 of its cold chain units for storing food into a vaccine storage facility. “We have mapped out our capacity in the country and other capacities by other operators to find out what capacity is available immediately. While there is no clarity on the packaging for these COVID-19 vaccines, going by a thumb rule of around 7,000 doses on a pallet, Snowman has the capacity to store around 650 million doses. With the same assumption, our network partners would have another 400 million dose capacity,” said Nair.
“At the same time, we have also involved our technical team in terms of finding out if we have to convert a food facility into a pharma facility, what it takes for us. Those sorts of things are (now) done…if the vaccine comes to 2 to 8°C, which is what is being talked about, we can quickly convert these facilities–it is just a setting that we need to change, and it will get converted (for storing vaccines),” Nair added.
According to Nair, such a conversion would help the firm ‘fully prepare’ to engage in the primary and secondary leg of distribution of a COVID-19 vaccine ‘anywhere’ in the country. “What the government will have to look at is how the last-mile will happen.”
JWL Cold Store currently has over 16,500 pallet positions exclusively for pharma shipments, along with dedicated refrigerated transport services for pharmaceutical cargo. “Currently, 50 per cent of our cold chain volume represents pharma and we are focussing on getting more of the industry,” said Raaj Jobanputra, Director of the cold chain warehousing and distribution company.
“We have over 37,000 refrigerated pallet positions and 12,000 ambient pallet positions, catering to both pharma and food segment. We have separate dedicated cold storages to store pharmaceutical and food products. Each of our facilities are Food Safety and Standards Authority (FSSAI) recognised, Food Drug Administration (FDA) registered, GDP compliant, ISO 9001 certified, and above that, we have obtained Authorised Economic Operator (AEO) status,” Jobanputra said.
“Our facilities are situated in Mumbai and Bengaluru and our transport includes both primary and secondary movements. Our fleet of over 50 vehicles serves our customers across India,” he added.
According to Jobanputra, two to three different storage conditions are required in pharmaceuticals, while food segment requires storage conditions under five temperature zones. Slightest deviation in temperature is not acceptable in both segments. As such, we have created exclusive facilities for both segments, besides considering the cross-contamination possibilities. We are privileged to be associated with varieties of happy customers across both pharma and food segments, said Jobanputra.
“At present, our facilities are built to maintain temperatures between -25° to +30°C. We are exploring further opportunities to create specialised facilities to store highly-sensitive vacancies at temperatures as low as -80°C,” he added.
Logistics firm DHL Express India is in the middle of scenario planning, R S Subramanian, Senior Vice President and Managing Director of the company had told to the Mint.
“The packaging of the vaccine and staff training would need to be tweaked, depending on the technology platform chosen in India. We already do temperature-controlled movements for pharma and clinical research customers. All packing material companies engage with DHL. We are in touch with people who can move temperature-controlled shipments in addition to our capacity,” Subramanian said.
Ketan Kulkarni, CMO and Head- Business Development at Blue Dart Express said that his company was beefing up infrastructure with its ‘pre-existing specialised Temperature Controlled Logistics (TCL) to combat the pandemic’.
“Blue Dart has already started arranging for all that is needed for raising capacity— packaging materials, availability of data loggers, insulated shippers, walk-in cold rooms, coolant, network reach, manpower preparedness, investments in technology and so on. We have pharma grade conditioning rooms in Mumbai, Chennai, Hyderabad, Ahmedabad, Pune, Kolkata, Delhi and Bengaluru. These are located close to the Blue Dart Airport Stations, which decreases the turnaround time and helps in speedy delivery,” Kulkarni said.
Storage stock rise
Amid increasing need to store the COVID-19 vaccine, with many large institutional players already evaluating options, cold chain warehousing is expected to witness significant growth over the next few years, says experts.
“There is very high interest for both Greenfield and Brownfield warehouses from existing players and new ones,” said Saurabh Bakliwal, Managing Director and Partner, Boston Consulting Group. “India will need a significant ramp-up in its cold storage facilities for the safe delivery of vaccines for mass immunisation.”
According to global property consultant CBRE, the overall cold storage stock in the country is estimated to reach 1,400-1,500 million sq ft by 2023. The overall cold storage capacity in 2019 stood at 37–39 million tonnes and is expected to double to 70–75 million tonnes by 2023.
States including Uttar Pradesh, West Bengal, Gujarat, Punjab, Andhra Pradesh, Bihar, Madhya Pradesh, Maharashtra, Haryana and Karnataka accounted for 91 per cent of the total capacity in 2019.
As per a Crisil Research report, the Indian Cold Chain Industry is growing at a 13 per cent -15 per cent CAGR and is set to reach Rs 47,200 crore by 2022, compared to the 11 per cent – 13 per cent CAGR in 2017, which amounted to Rs 24,800 crore.