India's struggle with a cold chain for Covid vaccine stems from the fact that despite one of the large cold chain capacities in the world, there are not many large participants with capacity exceeding 5,000 tonnes.A research by BofA Securities also found that on top of this, very few are pharma-compliant as per WHO norms.Despite a large capacity, capacity to transport ultra-low temperatures at minus 80 degrees Celsius is not there and cannot be created in such a short span of time. Although there are certain experts who have said use of dry ice in designated box can retain such low temperatures for 24-48 hours and could be put to use. However, even temperatures like minus 18 to minus 20 degrees Celsius are a challenge as such capacity is not sizeable.Certain food items are stored at such temperatures but the players will have to make those facilities pharma compliant and it will take a few months at least to do that. But this is doable.The report said however what is delaying such activity is which vaccine is getting approved and in what presentation that is not known. A single dose vial or multi dose vial may have different requirements. For filled-up 2ml vial that weighs 200 gms, 40,000-50,000 vials can be carried by one reefer which has 7 tonne capacity. So for overall 400mn doses as per industry forecasts, India may need 30,000 tonne of transportation capacity which is 11,500 vehicles.The type of vaccine will also create different need for cold chain capacities as discussed before. Pfizer's and Moderna's mRNA vaccine needs extreme cold temperatures for stability whereas AstraZeneca (AZN)/Oxford can be stored, transported and handled at standard refrigerated conditions between two to eight degrees Celsius. India may be well prepared to handle AZN vaccine as most other vaccines in its immunisation schedule carry similar temperature sensitivities.
Less visibility on future use of capacity making private players question return on investment on such exercise. Many private companies are waiting for clear directives from the government and pharma companies. There is no clarity on where to create capacity and how much.While most manufacturing may be in areas like Ahmedabad (Cadila), Pune (Serum Institute of India), Hyderabad (Bharat Biotech, Biological E, Dr Reddy's) and Telangana (Aurobindo), some can even happen at other locations like Himachal Pradesh (Akorn sterile site which Biological E bought), the report said.The cold chain market in India is very fragmented with over 3,500 companies and of these very few are pharma compliant as per guidelines by the World Health Organisation (WHO).As per the research by BofA Securities, organised participants contribute only 8-10 per cent of the overall market. Only a handful number of participants have a capacity of more than 5000 tonnes, and of these, very few are pharma compliant keeping in mind guidelines as set by WHO. Nonetheless India has strong vaccine distribution system which will give some leverage to conduct a massive vaccination programme for Covid 19.India boasts of running largest UIP (universal immunisation programme) in the world that administers 600 million doses annually."And with the Covid-19 vaccine, there is an even larger exercise ahead - almost 16 times UIP size in terms of the number of people to be vaccinated," the report said.As per study by INCLEN Trust International - vaccine cold chain network in India includes four Government Medical Store Depots (GMSDs) located in Karnal, Chennai, Mumbai and Kolkata, 39 state vaccine stores, 123 divisional vaccine stores, 644 district level stores and 22,674 PHCs (primary healthcare centres) stores.India is repurposing eVIN (electronic vaccine intelligence network) for use for Covid-19 vaccinations. eVIN system provides real-time information on vaccine stocks and storage temperatures across all cold chain points. The system may now be added with a feature to identify vaccine beneficiary to be vaccinated.
Using digital technology, the government aims to ensure last mile vaccine delivery with minimal wastage and maximum potency.Despite large capacity, the sheer demand for vaccine storage can drive incremental investment in vaccine cold chain. Snowman Logistics is investing Rs 700 million in two new facilities and for expanding existing ones. Per company, current capacity can handle 100 million doses and with expansion plus partnership, this could be scaled up to 300 million doses. It has 300 refrigerated vans, plans to deploy 200 of those for vaccine distribution.Blue Dart is also adding capacity and is capable of handling some very stringent temperature requirements. Other companies like Gati, TCI Express, Coldstar, Coldex, Western Refrigeration and Mahindra Logistics have also been active in discussion.As per the report, total cold storage capacity for India is estimated to be between 35-37 million tonnes. Total number of cold storage in India is 8,200 across multiple points. Almost 50 per cent of this is in Uttar Pradesh and 80 per cent concentrated in seven states of India.CRISIL expects cold storage industry to grow at a CAGR 12-15 per cent over FY19-23. A large part of current storage is for agricultural produce with potato having major occupancy (almost 68 per cent of the total capacity). New trends indicate emergence of multi product cold storage facilities to increase occupancy and profitability.Cold chain is key for any immunisation programme. The idea is to deliver the vaccine or other immunological products to the right people at the right place and in the right time under controlled conditions to ensure the product potency. In order to achieve this, cold chain management (CCM) requires standardized equipment and procedures.