By: Rob Handfield -- Professor of Supply Chain Management, North Carolina State University
14 February, 2021
(This is a follow up to the earlier article that deals with Vaccine Supply Chain Challenges. Please click here to read)
I had an opportunity to interview Ran Singh, who is the Acting Director for Asia Pac for Audits and Compliance at GlaxoSmithKline. I met Ran during the 360RX Supply Chain Security Conference, which was held last year, where I spoke on the ability to create “supply chain immunity” through greater preparedness. During our conversation this week, Ran shared the current vaccine roll-out plan underway in India, which immediately struck me as the most logical approach to vaccine roll-out I have seen yet. (Certainly a more centralized and coordinated approach than what we have observed so far in the United States).
To begin with, it helps that India is one of the largest manufacturers of vaccines in the world. India’s domestic vaccine program administers one of two shots: the AstraZeneca Plc vaccine, manufactured by the Serum Institute of India Ltd, and the COVAXIN shot developed by Bharat Biotech International Ltd, a private company based in Hyderabad. (India’s approval of the Bharat Biotech shot, which was developed by government-backed research groups, was met with widespread criticism from scientists because of the lack of complete data, though the government defends it).
The manufacturing capacity for vaccines in India is massive. The Serum Institute produces 50 million vaccines per month in a single plant, can produce 1.5 billion doses in a year, and 3 billion together with other plants (for a global population of 7 billion, this is almost half of the world’s requirements being produced in a single country).
India is also donating millions of doses to neighbouring countries that cannot afford a vaccine, including Nepal, Bangladesh, Sri Lanka, Myanmar, and other poor regions. They are also supplying Brazil and South Africa commercially with vaccines. This is commendable, given that many of these regions are overlooked in the rush for Western countries to be vaccinated first. Both vaccines can be transported at 22.8 degrees centigrade (which is about -9 farenheit), so there is no abnormal cold chain requirements. Both require the same transport conditions, which is good because India is a subtropical country.
There are very secure channels for preventing counterfeiting and fraud. The country has contracted with private jets, air force carriers, and other air lift resources to ensure rapid distribution. There are huge penalties in the contracts for missing shipments, and armed guards accompany the largest shipments, with very robust controls.
The most interesting part for me about what India is doing, however, is how it has rolled out their digital vaccination program. The country has extensive experience in doing so, and has been running a national vaccination program since 1989. They plan to use a mobile app, Co-WIN, the corona vaccine information network. The app will enable authorities, right down to the grassroots level, to gain access to and update data in real-time to notify people about where they are on the priority list, where their shots are scheduled to occur, who will administer them, and any updates based on current capacity. The app synthesizes data from state agencies, the central vaccination health ministry, manufacturers of the vaccines, and, of course, the people waiting to be vaccinated.
This is how the app works: The first wave of people vaccinated were government health care workers, front line workers, sanitation, policy, army, etc., whose information are already stored in the data lake. The government has automatically begun scheduling these folks, assigned them to locations for vaccination, and is coordinating with transportation providers to get the vaccines to these locations (matching supply and projected demand, of course). In the net stage, 300 million people will be vaccinated, comprising a population of people who are 50 years and older. To schedule their vaccination, each individual needs to log on to the system, register and answer questions on their background, age, job, co-morbidities, etc. Don’t want the vaccine? No problem. Just don’t register! This number is surprisingly small in India, as most of the population believes in vaccination.
The exciting part is how the system will then queue individuals. AI is used to prioritize individuals based on individual criteria. It puts them in a national queue that is updated in real time, based on the number vaccinated that day, the volume of vaccines available at state and national levels, and is spread out for four months into the future. So, if you are an elementary school teacher and are going back to teach kids, you will be prioritized over a housewife or young person who has already contracted COVID in the past. Each person is assigned a time slot at a vaccination site that is nearby. You can reschedule or change to another location without losing your spot in line. Another really cool feature is that individuals can also be put on a wait list for vaccines. If at the end of the day, a particular vaccination site has leftover vaccines, the system will go to the wait list for that day, and contact individuals to see if they can show up on short notice to get vaccinated!
Many countries have a lot to learn from this digital vaccination system, especially leadership. Prime Minister Narendra Modi personally monitors the vaccination program. During the vaccine development stage, he held calls with the owners of the vaccine companies on a daily basis, to understand the progress and to keep the public informed. Some even claim he “micromanaged” the vaccine, but it is rolling out at a good rate. Of course, glitches are bound to occur, but, so far, the system design seems robust.
There are several attributes of this approach that are important. First is global equity, and the fact that a fair and transparent system for prioritizing people for the vaccine is being employed. Everyone knows where they stand.
Second, is a lesson from Queuing Theory 101: manage people’s expectations of where they are in line! By putting people in a queue, you avoid millions of phone calls to healthcare providers, and put a lid on the anxiety and stress being experienced by the American population today. People know they are in line and when they will be vaccinated. We all have to be patient, stay safe, and mask up in the meantime.
Third, the fact that India is a world leader in pharmaceutical manufacturing suggests that countries will likely move towards localized production, at least for vaccines. The pharmaceutical industry would do well to pay attention as many of them have moved to centralized production and distribution facilities. It may be time to put the car in reverse and move back to local production facilities.
India has leveraged its ability to manufacture at a low cost to help other countries in need, which is commendable from a global economic standpoint. For instance, India has given out 5.5 million vaccines to other nations for free: Bhutan (150,000), Maldives (100,000), Nepal (1 million), Bangladesh (2 million), Myanmar (1.5 million), Mauritius (100,000), Seychelles (50,000), Sri Lanka (500,000) and Bahrain (100,000). India also plans to gift another 100,000 vaccine doses to Oman, 500,000 doses to CARICOM countries, 200,000 doses to Nicaragua, and 200,000 doses to Pacific Island states.
It isn’t lost on me that Modi’s approach to helping neighbours may strengthen India’s global access to needed materials or support in future crises that they are not as well positioned for.
(Note: Dr. Rob Handfield is a Co-Founder and Director Emeritus of Beroe Inc. A version of this article first appeared in NCSU’s Supply Chain Resource Cooperative website)