While a bulk of the vaccines will be distributed through the Centre’s Universal Immunization Programme (UIP) mechanism; experts also suggest that the government rope in private cold chain operators. Pawanexh Kohli, the founding CEO of India’s National Centre for Cold-Chain Development (NCCD), agreed that protocols will require COVID-19 vaccines to be kept between 2 and 8 degrees Celsius, while in transport and storage until delivery.

Some vaccine frontrunners are in advanced stages of trial and could hit the market by early next year, making the task of securing ‘last mile connectivity’. Union Health Minister Harsh Vardhan said that the government expects to receive and utilize 400-500 million vaccine doses for COVID-19, and cover approximately 20-25 crore people by July 2021. The Centre had also reportedly directed states to make a robust plan for vaccine storage and distribution.

Satyajit Rath from New Delhi’s National Institute of Immunology (NII), “Most if not all the current frontrunners require extremely stringent cold chains, making them immensely challenging for India to implement.” The immunologist noted that some COVID-19 vaccines will need storage temperatures that simply cannot be realistically managed in any large-scale Indian campaign.

Vaccine candidates by Moderna and Pfizer will require stringent standards for refrigeration that may hamper how they are distributed to millions of people across India’s length and breadth, according to scientists. “The Moderna vaccine candidate is shipped in minus 200C and held at 2-4 degrees for seven days. The Pfizer (vaccine) that requires minus 70 degrees temperatures,” Kohli, honorary professor of post-harvest Logistics at the University of Birmingham in the UK, told PTI. Both the Moderna and Pfizer vaccines use a synthetic version of genetic material from part of the coronavirus.

Raghavan Varadarajan, professor at the Indian Institute of Science (IISc) said, unlike drugs, virtually all vaccines need to be transported at cold temperatures, usually between 2 and 80C, said in Bengaluru. “The necessity is to keep the vaccine product cold, either refrigerated or frozen. This is a constraint especially with large numbers of doses.”  Many vaccines lose potency when exposed to higher temperatures, he said, and re-cooling does not help. Thus we need what is called the cold chain of handling before use, whose team at IISc is working on a “warm vaccine” that can be stored for over a month at 370C, and needs no cold chain for storage. Noting that RNA vaccines have never been used on humans, he said it is possible high temperatures can affect these structures and thus affect the efficacy of the formulation.

The vast scale of India’s UIP is supported by more than 27,000 functional cold chain points of which 750 (3 percent) are located at the district level and above. The rest are located below the district level, according to the government’s comprehensive multi-year UIP plan for 2018-22. This includes 76,000 cold chain ‘equipment’, 2.5 million health workers, and 55,000 cold chain staff, the plan report said. Cold chain logistics involves many moving parts, including cold storage facilities that store products waiting to be transported, cooling systems to keep it at an appropriate temperature during all aspects of the supply chain such as storing and transporting. Gel packs are also often used for medical and pharmaceutical shipments.

Noting that cold storage protocols are well established in India, the public health network is limited in capacity. Luckily, the food cold chain has synergistic use for this purpose and should assist in this battle. Existing cold chain enterprises may need to allocate specific resources in their network. Kohli added that the food cold chain has the maximum reach, with extensive last-mile connectivity, and will require minor redesign to designate storage space and transport load for this purpose. He adds, almost every cold chain owner, I have spoken to is willing to contribute space and assets towards this, should the need arise.

According to the World Health Organisation, at the higher levels of the cold chain, i.e. at primary and regional intermediate stores, the oral polio vaccine must be kept frozen between – 150C and – 250C. At other levels of the cold chain, the vaccines should be stored between 20C  and 80C.