By 
NEW DELHI: The results from late-stage trials of Pfizer and Moderna coronavirus vaccines showing almost 95% efficacy has brought a sense of relief to a world ravaged by the coronavirus pandemic. However, experts believe that the task to eradicate the virus has just begun.
“We’ve done the route into the bottom of the mountain, the long trek to get to the start. Now we’ve got to get the data about the vaccines in front of regulators for them to scrutinise it and approve the first vaccines. And then we’ve got that huge effort to climb up to the top where we’ve got a vast majority of those who are at risk vaccinated,” said Dr Andrew Pollard, an expert in pediatric infection and immunity at Oxford.
The task of immunising over 7 billion humans located in some of the remotest parts of the world would be a challenge for health agencies. The immunization programme could stretch into years before every single human on this planet is vaccinated.
In India, this could take upto 4 years. According to Serum Institute of India (SII) chairman Adar Poonawalla, every Indian can expect to be vaccinated no earlier than 2024.
The distribution of vaccines, especially in logistically-challenged economies such as India, would prove to be a mammoth task. Almost all vaccines, unlike drugs, need to be transported at varying cold temperatures prior to their use, as exposure to high temperatures affects their potency.
The SII claims that its vaccine can be stored at a temperature of 2 to 8 degrees Celcius thus making it a viable option for India where cold chains are not easily available.
Pharma major AstraZeneca will manufacture the coronavirus vaccine developed by a team of scientists at the University of Oxford. SII had entered into a manufacturing partnership with AstraZeneca to produce and supply one billion doses of the Covid-19 vaccine.
However, India would need more than one company to meet the need of vaccinating every of its 1.3 billion citizens — a majority of whom are living in remote villages and regions frugally connected with the outside world.
Pfizer vaccine for instance needs to be stored at -70 degrees Celsius. “It is going to be a huge challenge as far as the Pfizer vaccine is concerned, considering that it needs a cold chain of minus 70 degrees Celsius,” AIIMS Director Dr Randeep Guleria said.
Moderna vaccine can also remain stable for 30 days at 2 to 8 degrees Celsius. The indigenously developed Covaxin and the Novavax too can be stored at above zero temperatures. Refrigeration is needed even to maintain these temperatures.
In India, where summer temperatures reach in excess of 45 degrees Celsius and where refrigeration-based transport systems are very limited and localised to urban areas, the last-mile distribution of vaccines will pose a serious challenge.
How the government plans to distribute Covid-19 vaccine
Last month, emphasising the need to ensure speedy delivery of Covid-19 vaccine even in the remotest areas, Prime Minister Narendra Modi directed his government to deliver and administer the shots on the lines of elections conducted in the country, involving all levels of government as well as civil society. The PM stressed the entire process should have a strong IT backbone and the system should be designed to have a lasting value on the healthcare system.
The central government has modified an existing vaccine intelligence network to monitor its appropriate usage and distribution.
Union health minister Harsh Vardhan said that a meticulous plan is underway to implement the vaccine administration process and in that regard, the government has developed Covid Vaccine Intelligence Network (COVIN).
Vardhan said that tentative guidelines have been formed to administer the vaccine to priority groups keeping the scientific approach as the ground. He also reiterated that India will procure upto 500 million doses of vaccines by July 2021.
The government has divided the prioritization under four groups. The first are healthcare workers, then people above 65 years of age followed by people aged between 50 and 65 and lastly, people below 50 years with underlying conditions.
“First of all, the priority has been chosen on the basis of scientific and medical grounds. Because we are a country of 135 crore people. For such large numbers of people, nobody can arrange large quantities of doses of vaccines in a single go. Hence, with discussions with the health experts, we have formed the priority groups,” Vardhan added.
Currently, five vaccine candidates are currently undergoing clinical trials in India and are in different stages of trials. These include vaccines developed by Oxford University – AstraZeneca, Bharat Biotech, Cadila, Biological E – Baylor College of Medicine and Gamaleya Research Institute, Moscow.
Bharat Biotech Ltd and Indian Council for Medical Research (ICMR) began phase-III trials of Covaxin. Serum Institute of India (SII), which inked a deal with Oxford-Astrazeneca for manufacturing their vaccine candidate has finished enrolment for Phase-III Covishield vaccine, supported by Indian Council of Medical Research (ICMR).
SII has already manufactured 40 million doses of the vaccine, under the at-risk manufacturing and stockpiling license from Drugs Controller General of India (DCGI). Meanwhile, Ahmedabad-based Cadila Healthcare is currently finishing phase-II trials of its vaccine candidate.
Airlines and airports ramps up facilities
Meanwhile, several Indian airlines and airport operators have started preparing for the mammoth task of taking Covid vaccines across the country.
While meeting Pfizer’s minus 70 degrees Celsius requirement for its vaccines will be “difficult”, they are gearing up to set up cold chain storage for the jab job that needs to be done on an unprecedented scale of several crore shots to even begin with.
The GMR Group, which operates Delhi and Hyderabad airports, says the air cargo units of both these places are getting ready to “play a pivotal role in the distribution of vaccines through state of the art time and temperature-sensitive distribution system” with cool chambers ranging from +25°C to -20°C.
SpiceXpress has tied up with global cold chain solution providers to perform seamless cold chain operations.
