I had an opportunity this week to interview Ran Singh, who is the Acting Director for Asia Pac for Audits and Compliance at GlaxoSmithKline. I met Ran through the 360RX Supply Chain Security Conference, held last year. At this meeting, I spoke on the ability to create “supply chain immunity” through greater preparedness. In our conversation this week, Ran shared with me the current vaccine roll-out plan underway in INdia, which immediately struck me as the most logical approach to vaccine roll-out I’ve seen yet, (certainly a more centralized and coordinated approach than what we’ve 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 with government-backed research groups, was met with widespread criticism from scientists because of the lack of complete data, but the government defends it). The manufacturing capacity for vaccines in India is massive: The Serum Institute produces 50M vaccines per month in a single plant, and can produce 1.5B doses in a year, and together with other plants, can produce up to 3B doses of vaccine every year (for a global population of 7B, this is almost half of the world’s requirements being produced in a single country). India is also donating millions of doses to other surrounding 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 being 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 are 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 to prevent counterfeiting and fraud, and 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 they have rolled out their digital vaccination program. The country has extensive experience in doing so, and have been running a national vaccination program since 1989, and seem to have figured it out. They rely on a mobile app, called COVIN, the Corona vaccine information network. The app will enable authorities right down to the grassroots level to access it 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, people waiting to be vaccinated!
The way the app works is as follows. The first wave of people vaccinated were government workers who are in healthcare, front line workers, sanitation, policy, army, etc., whose information is already stored in the data lake. The government has automatically begun scheduling these folks and assigned them to locations for vaccination, and are coordinating with transportation providers to get the vaccines to these locations (matching supply and projected demand, of course). In the net stage, 300M people will be vaccinated, comprising a population of people who are 50 years and older. To schedule your vaccination, each individual needs to log on to the system, register and fill out questions on their background, age, job, co-morbidities, etc. Don’t want to get the vaccine? No problem – just don’t register! This number is surprisingly small in India, as most of the population believes in vaccinations.
The exciting part is how the system will then queue individuals. AI is used to prioritize individuals based on their individual criteria, and put them in a national queue – that is updated in real time, based on the number vaccinated that day, the volume of vaccines available at a state and national level, 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 get priority 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, and if you can’t make it, 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 left over 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!
The US has a lot to learn from this digital vaccination system. One of the most important factors is leadership. Prime Minister Nagendra Modi is taking the vaccination personally. He is single with no family, and states publicly that he treats every Indian as family. During the vaccine development, he personally 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 claimed 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 the millions of phone calls going to healthcare providers every day, and put a lid on the anxiety and stress being experienced in the American population today. People know they are in line, and know when they will be vaccinated. We all have to be patient and wait, staying safe and masking up in the meantime. Third, the fact that India is a world leader in pharmaceutical manufacturing suggests that countries will likey move towards localized production, at least for vaccines. The pharma 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 their ability as a low cost manufacturer to also help support other countries in need, which is commendable from a global economic standpoint. And it isn’t lost on me that Modi’s approach to help neighbors may strengthen their global access to needed materials or support in future crises that they are not as well positioned for today.