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Case analysis assignment
Case analysis assignment
DISTRIBUTION IN INDIA:
A CASE ANALYSIS
Executive Summary
COVID-19 vaccination development has provided high hopes to India in its fightback
against the pandemic. The development of vaccination is followed by an efficient supply and
distribution strategy, that allows to cope up with the need to achieve Herd’s Immunity. The
vaccination distribution plan includes the storage of the vaccinations at the manufacturing
site, management of, transportation of vaccine to the secondary storage sites, transportation
immunization clinics, and maintaining the optimal environmental settings for the vaccine at
all storage locations and transportation channels. Even with the adequate infrastructure, the
distribution of the vaccine has to address the problems which are related to the strategy
formulation for the distribution plan. Who will get the priority doses, when they have to get
the vaccine, what will be the criteria for the distribution of the vaccine. The major problem
for this concern is the distribution of vaccines in India is to distribute the vaccine to the
different age groups that are living in different regions of the country, engaged in different
professions, and have different awareness levels. This study aims to address the challenges,
and problems that the vaccine distribution project will face. This study also aims to provide
recommendations for the problems and state a contingency plan to back up the efforts for the
same. To support this huge vaccination network there is a need to develop instant cold
storage facilities statewide across India. The vaccine distribution can take years to immunize
the entire population of the country. To supply the population with the vaccine the solution
lies in the framework for distribution has to provide A highly effective transmission-blocking
mortality and years of life lost were minimized in most scenarios when the vaccine was
population, and Formulation of an effective logistic plan for storage, and transportation are
the main issues for the COVID-19 vaccine distribution project in India. The COVID-19
vaccination distribution in India has to be done for the population of 1380 million. To decide
the Before COVIID-19 there was the government mechanism and infrastructure present in all
of the states of India to distribute the drugs, medicine, and vaccine for other virus-based
diseases such a Polio. This infrastructure was old but still active, and henceforth it became an
ideal platform for improvement. The issue of selective vaccine distribution for the entire
population has to be addressed with the distribution of vaccines on a priority basis. India’s
immunization scheme covers childhood vaccinations and has a reputation for running one of
the world’s most successful vaccination programs, catering to the needs of more than 26
million newborns and 29 million pregnant women. However, an adult vaccination drive of
this magnitude is an altogether new experience. Accomplishing this mission entails enormous
challenges, specifically in reaching out to populations in remote areas. The task force
assigned to the vaccine distribution network has to vaccinate nearly 1.4 billion people spread
out over cities, districts, and villages. Administering an average of 3.4 million vaccine doses
per day across a country comprising 28 states and eight union territories presents new
challenges. During the initial phase, the National Expert Group on Vaccine Administration
for covid-19 prioritized healthcare and frontline workers; in the second phase, this has been
expanded to include people older than 60 years and those aged between 45-59 years who
have comorbidities. With the government’s launch of the covid-19 vaccine self-registration
portal, participation has increased. Since March 2021, the government has also allowed the
private sector to join in its vaccination drive to speed up this process. However, complete
vaccination (both doses) has so far been achieved in only 3.1% of the total population.
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The logistics and distribution infrastructure in India was a challenge from the very
beginning as transportation is largely dependant upon the Indian Railways, and private
trucking companies. Vaccine transportation has the same issues, though the Indian Railways
are capable to provide the requisite facilities, it is a question for the private service providers,
will they be able to provide the cold chain logistic facilities for the vaccine transportation and
distribution. The distribution of the vaccine from the manufacturing site to different cold
storage facilities requires a large number of cold chain transport vehicles. This is going to
take a toll on this project as the cost of transportation has to be added to the cost of the
vaccines. Large trucking operators like FedEx or DHL do not have a large presence in India
With just about 30,000 cold storage facilities scattered across the country, the numbers don’t
add up. Anticipating these challenges, the Indian administration launched the Electronic
Vaccine Intelligence Network, a digital platform to manage its entire vaccine stock, logistics,
and cold chain tracking of all the country’s vaccine storage levels. The National Cold Chain
and Vaccine Management Resource Centre has been set up to monitor the process. Placed
under the National Institute of Health and Family Welfare, this government agency provides
technical support for the immunization supply chain. Managing vaccine stocks at thousands
of local inventories and health centers is enormously challenging. In a country that is often
plagued by power cuts and transmission faults, the stakes are higher than ever. The
government of India and state-owned public sector organizations are partnering with private
meet the demand for covid-19 vaccine storage locally. These fridges can hold temperatures at
Different factors can affect the vaccination drive that is so vast. Out of these many
factors, there is time, and budget constraints that are going to play a vital role in this. The
problems that are identified in this study have to be addressed with analysis and investigation
of the causes of the problems, as it will give us the identification of the factors that are
closely associated with the problem. A detailed analysis of the problems identified is
discussed below.
How to decide the priority for vaccination distribution for the entire population
The entire population is susceptible to the infection caused by the pandemic, however,
according to the study of AIIMS, and ICMR the virus is deadly for the age group of 45-60,
but at the same time, it has acute effects on the young people who are suffering from lung,
liver, and respiratory diseases (Shankar et. Al, 2020). The problem to distribute the
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vaccination will face issues, so as the crucial age group is going to miss the rate then the
mortality rate will increase. There is another prospect of this problem if the vaccine is
distributed to the older age group first then the infection could spread among the other age
groups. To put this as simple as it could be the aim should be to immunize the people with the
first dose to lower down the rate of infection, and the priority can be decided based on the
availability of the vaccine doses per day. As per the report of the Serum Institute of India they
can manufacture and supply around 1 million doses per day. Taking this into account the
priority of the vaccine distribution should be targeted, begin with, the most vulnerable group
of the population first, not to mention the frontline workers have to administer the doses with
them to keep the system running. It is recommended that anyone with a congenital heart
disease that leads to pulmonary arterial hypertension, end-stage kidney disease, or cancers
deficiency conditions, and sickle cell anemia should be included in the priority. To formulate
this plan the electoral data available can be used, the plan can be formulated and distributed
to the already established healthcare network in Cities, Districts, and Rural locations
(municipalities, towns, and villages). The cutoff age for the eligibility criteria has to be
over COVID-19, as this is a SARS base NOVEL virus that can change its potential form and
mutate in the presence or absence of the host, the priority is to achieve stage-1 immunity by
injecting the inactivated virus into the human body to self-efficient the host towards any
mutations. This can only be achieved by injecting the entire population, which is a
breathtaking, and lengthy task. Taking the example of Hepatitis-B that took almost 12 years
to get most of the adults and kids vaccinated, the COVID vaccination has to be done for
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everyone. Not to mention there are so many rural locations that are remote, and even
inaccessible by any means of transportation. Indian manufacturers have stated that they can
meet the country’s future needs for COVID-19 vaccines. The manpower and cold-chain
infrastructure established before the pandemic are sufficient for the initial vaccination of 30
million healthcare workers. The vaccine distribution has to be coupled with the hefty
recordkeeping, tracking, and administering of the doses. There will be a provision for self-
registration for vaccination, for those eligible persons who have been missed out from the
rolls for one reason or other, after giving some proof of identity. After vaccinating nearly 300
million of the population in the first phase, the remaining population will receive the vaccine
based on the disease epidemiology and vaccine availability. There will be a national database
found to keep track of the vaccine doses distributed, provide vaccine appointments, the future
availability of the vaccine, and how to keep the gap between the first dose and the second
one, to maintain the supply. The recommended gap should be kept between 12 days-4 weeks
between the first dose and the second dose. India currently has 55,000 cold-chain staff and
2.5 million health workers. It will be the health workers, as first-line responders who are
getting the vaccination initially. The current healthcare infrastructure may not require
additional manpower for administering the vaccine to the healthcare workers. For the second
round of vaccination of the priority groups such as the elderly population, persons with
comorbidities, pregnant women, and children, a much larger number of trained medical and
workload.
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The problem of effective logistics can affect the entire distribution network for the
vaccination program. According to the data provided in the annual report of the World Health
Organization the facility to transport and store the vaccine in the cold chain is not efficient in
India. This is the primary reason for concern that the distribution cannot be delayed due to
this reason. Further, the cost of transportation can significantly add up to the final cost of the
vaccine. This is a time and budget constraint for this project. the storage and transportation of
the vaccines, as this requires very specific temperature regimens. Some of the vaccines under
development and production in other parts of the world require storage temperatures as low
as −80 °C. Fortunately, the vaccines that India has introduced first for distribution in the
airlifting the vaccines in cold boxes with digital temperature tags to four major depots at
Karnal (Haryana), Mumbai, Chennai, and Kolkata, where they will be stored in walk-in
coolers. From there, planes or insulated vans would transport the vaccines to the designated
stores in 37 States/UTs. From these 41 centers, they are further transported to temperature-
controlled facilities at the district-level vaccine stores by the State/UT governments. The
vaccines are stored in ice-lined refrigerators (ILRs) in districts, from where they will be
transported to distribution centers in cold boxes and then in ice-packed vaccine carriers to
vaccination sites. Real-time remote temperature monitoring of 29,000 cold-chain points will
How to decide Age & Expansion of Increasing the Reduced risk Segmentation
the priority Demographics the age group implementation of infection, needs time, and
for time for the decrease in additional cost
vaccination second dose the R0 of the for
distribution virus, implementation,
for the entire susceptible the distribution
population groups might be a
receives problem in
vaccine first remote areas,
risk of exposure
among same
age groups
during
vaccination
This study is based upon the secondary data available on various platforms, hence the
problems identified are reviewed by different researchers to connect them with the situations
on the ground. The outcomes of this study are the recommendations that will act as a baseline
and reference for the vaccine distribution project in India. These recommendations are
discussed below:
Susceptible (S) individuals have never been infected by the pathogen and therefore can
become infected.
Exposed (E) individuals have been infected with a pathogen, but they are not yet infectious,
Infectious (I) individuals are infected and can transmit the pathogen to others.
Removed (R) individuals are no longer able to transmit the disease. This group includes the
Since this virus is one that humans have never been exposed to before, the basic
assumption is that the entire population starts in the Susceptible compartment. The initial
condition is such that infectious individuals are introduced into the population and this
“seeds” the epidemic. Contact rates between individuals combined with the number of
infectious and susceptible individuals in the population are used to calculate the probability
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that a susceptible person and an infectious person come into contact within a finite period.
This probability is then combined with the probability that the contact got infected, to
estimate the rate at which susceptible individuals move into the exposed compartment. Based
on this the Government has to distribute the vaccine as per the demographic division of age
groups as:
• The vaccine doses that are manufactured need to be transported securely to the
different states across the country. This task is significantly valuable as the
distribution of the vaccination to the entire population is coupled with the sufficient
to keep buffer stocks ready in case of emergency need. This creates an increase in the
production capacity that has to be boosted to provide 600 million doses for the
companies across the world are some steps that have to be taken to reach this capacity
and production capability. The entire framework that exists in the country including
city, district, and block-level healthcare system has to be utilized for the distribution
• The healthcare workers are to be trained for the standard operating procedure of the
vaccine, like watching the patient for 30 minutes after vaccination. These healthcare
workers play a vital role in the distribution of the vaccine in the remote locations of
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the country as they are familiar with the terrain and territory itself. More than 2.5
million task force is available for this mammoth task, and millions can be trained. It is
this task to meet the demand of the manpower. The administration has to take steps
• The logistical framework is a big problem, as the availability of cold storage facilities
and cold chain vehicles is limited in the country. The government has to outfit
vehicles with refrigerators that can withstand the hot and humid weather, and
maintain the temperature of 2-8 C0 steadily. Private pioneers in this can be asked to
help develop such systems, companies like Voltas, and Blue Star are the first ones to
be contacted. The transportation will be dependant upon the private service providers,
hence it is recommended to acquire their services using the Electoral machinery that
exists in the country. The identification of the transport operators has to be done
• As a contingency approach, the vaccine import from the other countries has to be
done, so the negotiations and the acquisition of such doses should also be considered
as a contingency plan. Moderna, Pfizer, and Sputnik-V are the recommended vaccines
for this. The supply of vaccines can be secured and stored in the cold storage facilities
established by the government, as well as the local cold storage facilities that are used
to store perishable items can be quickly reconfigured to store them. The digital
platform to enroll, register, and distribute the vaccine among the citizens can be used
to track the distribution of the vaccine. Once the first dose is distributed among the
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