Q. What would be the first step basic to start mass vaccination?
A. A mass vaccination exercise will require diligent planning and like all successful supply chain strategies, the basic step must be to first identify the destination points. After terminal inoculation centres are known, the strategy will be to work backwards to distribution depots, a regional store or the source manufacturer. The long haul from source to distribution depots will be planned as a bulk movement and from depot to inoculation centres in smaller tertiary shipper boxes. Each shipper box can carry 5,000 to 10,000 doses so that can be replenished every few days or weekly. The identifying of first recipients is just a diversion and efforts should be applied to identify vaccine givers and inoculation centres. The vaccine givers should be the first recipients, and they should receive their dose at least two weeks before they start inoculating the others in their zone.
Q. How the distribution of vaccines will be done to make the process smooth?
A. The first concern will be to administer the vaccine in a socially distanced environment. A vaccine taker should not run the risk of picking up Covid-19 even while waiting to receive the vaccine. Therefore, existing movie halls, restaurants, schools and convention halls should be designated as vaccination centres. Luckily, they are all under-occupied or empty, most already have cold rooms which can hold the vaccine at 2°C to 8 °C for a couple of days.
Railway coaches can be compartmented and quickly converted into inoculation centres, and a vaccine train can be deployed in each region to service rural areas as it moves from village to village. Similarly, a group of vaccine buses can be used as mobile inoculation centres. The same infrastructure can be used at multiple locations. A one-way flow of people must be maintained and crowding must be avoided. Further, to ensure that a schedule is maintained, a ‘vaccine deposit’ can be refunded if the recipient will abide by the programme. Another option is to offer coronavirus insurance for a year if the discipline of schedule is kept. Lastly, the actual distribution of the vaccine should be matched against return logistics of used syringes and vials from each location, to safely manage the medical waste that will be generated and as a double check avoid incorrect reporting.
Each vaccine taker should be marked with indelible ink like it is done after voting and as a sign of social responsibility. Aadhaar linked digital records should also be kept.
Q. What procedure should be followed for storing vaccines?
A. Storage should only be to buffer the supply, with the agenda being to maintain a high throughput of vaccines. After all, the vaccines are not being made to be stored but to be distributed. Any storage, in-situ or in transport, should be monitored for three parameters: for time and location through GPS, for temperature through data loggers and for excursions through thermos-chromic labels. The first would apply to the basic article of carriage, the second to tertiary packaging or individual boxes, and the third to individual vials. This will ensure a very high level of safety in the distribution network and mitigate risks. Usually, any vaccine movement is monitored similarly, and in this case, will probably require more close monitoring.
It will be imperative that the temperatures are maintained within the set parameters. Either within the range of 2°C to 8 °C, or below -20°C and/or below –70 °C depending on the vaccine. We must also keep in mind that in cold climates such as Jammu and Kashmir space may need to be heated to maintain the desired temperature. So, it is not always refrigeration for cooling but could also require heating. Data loggers will be important so that out-of-range parameters are flagged off and that batch can be discarded.
Another option is to store the vaccine in thermal shippers with passive cooling, and inside actively refrigerated space (like cold rooms and reefer trucks). A far higher level of redundancy will be in-built in case of a cooling failure. This is not too dissimilar to ice-lined refrigerators where the refrigeration system is buffered with the passive cooling system.