COVID-19 VACCINE

DISTRIBUTION IN INDIA:

A CASE ANALYSIS

Aditya Pratap Singh, ID-3122859

Course: Project Management Diploma

Section: Case Analysis for Project Managers

Due Date: July, 22, 2021

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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

of vaccine to the distribution center, storage of vaccinations at the distribution centers,

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

vaccine prioritized to adults ages 20 to 49 years minimized cumulative incidence, but

mortality and years of life lost were minimized in most scenarios when the vaccine was

prioritized to adults greater than 60 years old.

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Statement of the problem

Deciding on the priority in vaccination doses, Distribution of vaccine to the entire

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

companies to cover all eventualities. Customized refrigerators are being manufactured to

meet the demand for covid-19 vaccine storage locally. These fridges can hold temperatures at

2-8°C for several days in the event of a power outage.

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Problem Nature Recommendation

Priority in vaccination Short-term Priority should be provided

doses based upon the SEIR model
(susceptible, exposed,
infectious, recovered)

Distribution of vaccine to Long term Use of distribution strategies

the entire population based upon the established
framework with previous
vaccination programs.

Formulation of an Long term Calibration, and extension of

effective logistic plan for existing storage facilities,
storage, and collaboration under Public-
transportation Private Partnership Model
for transportation, training,
and distribution.

Causes of the problem

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

such as lymphoma, leukemia, myeloma, decompensated liver cirrhosis, primary immune

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

determined as of January 01, 2021.

Distribution of vaccine to the entire population

The entire population of India has to be vaccinated to completely achieve immunity

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

paramedical staff experienced in vaccine administration will be in place to handle the

workload.
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Formulation of an effective logistic plan for storage, and transportation

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

country require a storage temperature of 2–8 °C only. Vaccine manufacturers will be

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

be done through COVID Vaccine Intelligence Network (Co-WIN) vaccine delivery

management system, a cloud-based digitalized platform.

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Decision criteria & alternative solutions

Problem Decision Alternative Alternative Positives Negatives

criteria solution 1 solution 2

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

Distribution Timeframe Manufacturing Classification Faster States can be

of vaccine to for vaccine in the of states as per manufacturing rigid to provide
the entire distribution & major states of the risk of of vaccines, facilities,
population immunization India, taking infection as Maximum disagreement
North, South, Red, Orange & coverage for on terms and
& North-East Yellow zones immunization conditions for
corridor for for the in less time, the distribution
manufacturing distribution of cost of the vaccine.
& distribution. vaccines. reduction, An extended
For each Lockdown can vulnerabilities lockdown may
manufacturing be extended for can be easily result in an
unit, a buffer these areas to identified. economic
stock of 30 further reduce slowdown for
million doses the infection the areas.
should be kept till enough
ready. vaccines are
stockpiled
Formulation Cost for Extensive use Extension of Faster Transportation
of an effective logistic of Indian present distribution, costs may be
logistic plan facilities and Railways for infrastructure collaboration increased for
for storage, time for the long-range by with small repetitive and
and end to end transportation. collaborating vendors will long-term use.
transportation transportation Private with delivery be cost- Public services
players who vendors such effective. may be affected
have cold as GATI, E- Railways can if railways are
chain wagons Kart for small provide large used for the
have to be vehicles that movement, extended
partnered in can be easily they have
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this. Use od outfitted with similar distribution of

dedicated refrigerators. experiences vaccines.
freight previously.
corridor
network

Recommended solution, implementation & justification

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:

• The distribution of the vaccine can be done following the Susceptible-Exposed-

Infectious Removed (SEIR model):

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,

because of the latent period of the disease.

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

recovered individuals and the fatalities.

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:

[Link]. Age Priority priority Time

group for Dose for Dose gap (2nd
1 2 dose)
1 60 years High High 4 weeks
above
2 40-60 High High 4-6
years weeks
3 20-40 Medium Medium 6-8
years weeks
4 Below low low 8-12
20 years weeks

• 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

manufacturing capacity and to transport it in time. The companies manufacturing has

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

domestic use of the country. Technology transfer, mergers with pharmaceutical

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

of the vaccine and immunization to the last citizen of India.

• 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

recommended to hire healthcare students practicing in colleges and universities for

this task to meet the demand of the manpower. The administration has to take steps

for the identification of such with the educational institutions.

• 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

nationwide to provide sufficient logistic facilities for the task.

• 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

population then the second phase can begin.

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References

Bagcchi, S. (2021). The world’s largest COVID-19 vaccination campaign. The Lancet

Infectious Diseases, 21(3), 323. [Link]

Cardinali, D. P., Brown, G. M., Reiter, R. J., & Pandi-Perumal, S. R. (2020). Elderly as a

High-risk Group during COVID-19 Pandemic: Effect of Circadian Misalignment, Sleep

Dysregulation and Melatonin Administration. Sleep and Vigilance, 4(2), 81–87.

[Link]

Foy, B. H., Wahl, B., Mehta, K., Shet, A., Menon, G. I., & Britto, C. (2021). Comparing

COVID-19 vaccine allocation strategies in India: A mathematical modelling study.

International Journal of Infectious Diseases, 103, 431–438.

[Link]

Gulia, K. K., & Kumar, V. M. (2020). Reverse quarantine in Kerala: managing the 2019

novel coronavirus in a state with a relatively large elderly population. Psychogeriatrics, 20(5),

794–795. [Link]

Kumar, V. M., Pandi-Perumal, S. R., Trakht, I., & Thyagarajan, S. P. (2021). Strategy for

COVID-19 vaccination in India: the country with the second highest population and number

of cases. Npj Vaccines, 6(1). [Link]

Saikia, D., Bora, K., & Bora, M. P. (2021). COVID-19 outbreak in India: an SEIR model-

based analysis. Nonlinear Dynamics. Published. [Link]

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Kumar, A., Kirtana, J., Kumar, S., Singh, A., Shankar, S., Sharma, A., Kumar, A., Kaur, R.,

Khan, M., Ranjan, P., Sethi, P., Chakravarthy, A., Srivastava, A., & Wig, N. (2020). Mild

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[Link]