India eagerly awaits the next phase of recovery from the COVID-19 pandemic as the vaccine rollout begins on January 16. The Government plans to inoculate 300 million Indians with the vaccine during the first two quarters of 2021, and the first batch of vaccines has reached different parts of the country. As these temperature-sensitive vaccines must be stored between 2 to 8 degrees Celsius, they require an extensive cold chain infrastructure. However, the existing immunisation infrastructure needs to be ramped up two to three times to meet the vaccination drive targets1. Further, ensuring the efficacy of vaccines requires routine cold chain servicing and maintenance by skilled technicians. To optimise preventive maintenance of cold chain systems2, the World Health Organisation (WHO) advocates for a national cold chain equipment maintenance policy. Skilled and regular servicing can extend the life of the equipment, improve its functionality, and reduce the entire cold chain's downtime that could affect the vaccine's efficacy. Therefore, boosting skilled service technicians' availability holds the key to cold chain management and equipment optimisation.
The cold chain
A temperature-controlled storage and transportation network—the cold chain—comprises deep freezers, ice-lined refrigerators, solar refrigerators, vaccine carriers, refrigerated vans, and similar equipment. This supply chain ensures that vaccines are stored and transported within the prescribed temperature range from manufacture until administration. Currently, India has 76,000 cold chain equipment, 700 reefer vans for vaccine storage at about 27,000
cold chain points3.
A vaccine distribution structure in a routine immunisation program needs an efficient cold chain infrastructure and maintenance at each level
Source: (Analytics 2020)
Servicing and maintenance of cold chains is key to India’s vaccine rollout
The vaccine rollout presents a unique and timely opportunity to make the necessary investments in the refrigerant-based servicing sector to develop sustainable healthcare infrastructure and enhance employment opportunities. Therefore, what are the immediate steps needed for developing the servicing sector?
- Target jobs for people living in rural areas through the cold chain servicing sector. For efficient, last-mile delivery of the vaccine, training and offering employment to the servicing technicians in rural areas would be crucial.
- Identify, equip, and certify existing and emerging service technicians dedicated to the cold chain. Some recognised institutions already provide specialised training on servicing cold chains, focusing on good servicing practices, handling different types of gases and alternative refrigerants, and conducting leak tests.
- Create a database of all technicians to help in formalising the servicing sector. As training and certification get systematically mandated over time as per goals enshrined in the India Cooling Action Plan (ICAP), the technicians would be able to attract better wages, access social security benefits due to their formalisation into the economy, and their standard of living and working would also improve4.
Periodic maintenance and servicing would minimise chances of equipment failure and ensure timely delivery of the COVID-19 vaccine to maintain its efficacy. Further, making cold chain infrastructure and servicing available in the remotest parts of the country would guarantee health equity. The co-benefits of efficient servicing by skilled technicians also include preventing leakage of environmentally damaging hydrofluorocarbons (HFC)-based refrigerant gases used in cold storages. Therefore, India must utilise this opportunity to reflect on its cold storage infrastructure. It needs significant development to address tail-end risks such as the ongoing pandemic and climate change. We need to ensure that a long-term strategy with the potential to address multiple development challenges facing the country today is put in place for the sector as a whole.
Srishti is a Consultant and Shikha Bhasin is a Programme Lead at the Council on Energy, Environment and Water (CEEW) Send your comments to [email protected]
1 Shahidi, Tauseef, and Nikhil Rampal. 2020. “India’s Vaccine Distribution Challenge, Explained in Five Charts,” 2020.
https://www.livemint.com/news/india/india-s-vaccine-distribution-challenge-explained-in-five-charts-11607106132744.html.
2Vaccine, W H O, and Management Handbook. 2017. “HOW TO DEVELOP A REPAIR AND MAINTENANCE SYSTEM,” no. March.
https://apps.who.int/iris/bitstream/handle/10665/255751/WHO-IVB-17.05-eng.pdf?sequence=1.
3 ET Health World.Com. n.d. “Ramping up Cold Storage Facilities Critical as India Preps for Covid-19 Vaccine.”
https://health.economictimes.indiatimes.com/news/pharma/ramping-up-cold-storage-facilities-critical-as-india-preps-for-covid-19-vaccine-experts/78550153.
4 Bhasin, Shikha, Chaturvedi Vaibhav, and Gorthi Apurupa. 2020. “Certification System for India ’ s Refrigeration and Air-Conditioning Servicing Sector,” no. July.
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Cell, Ozone, and Climate Change. 2019. “INDIA COOLING.”.
http://ozonecell.in/wp-content/uploads/2019/03/INDIA-COOLING-ACTION-PLAN-e-circulation-version080319.pdf
Foundation, Melinda Gates. n.d. “IN - DEPTH ANALYSIS OF COLD CHAIN , VACCINE SUPPLY AND LOGISTICS MANAGEMENT FOR ROUTINE IMMUNIZATION IN THREE INDIAN STATES : Supported by And,” 1–65.
http://inclentrust.org/inclen/wp-content/uploads/Cold-Chain-Full-Report.pdf
Vaccine, W H O, and Management Handbook. 2017. “HOW TO DEVELOP A REPAIR AND MAINTENANCE SYSTEM,” no. March.
https://apps.who.int/iris/bitstream/handle/10665/255751/WHO-IVB-17.05-eng.pdf?sequence=1.
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Analytics, Nexleaf, Basel Agency, and Alvin Jose. 2020. “Cooling for All : The Role of Cold Chain in Delivering a COVID-19 Vaccine,” 1–13
https://www.seforall.org/system/files/2020-11/Medical-Cold-Chains-Briefing-Note-SEforALL.pdf
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http://www.cips.org.in/documents/2014/20th_March/Dr-Vitthal-Bandal.pdf.
“COVID-19 Vaccine Could Revolutionize Cold Storage around the World.” 2020. br /> https://www.unenvironment.org/news-and-stories/story/covid-19-vaccine-could-revolutionize-cold-storage-around-world.
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