Technology can ensure a vaccinated future for India's children

By Muqbil Ahmar Modern technology, particularly the Internet of Things (IoT) and real-time monitoring, can reduce losses in high value goods such as vaccines (as well as other materials that degrade quickly) by better identification and resolution of problems of storage and transit than incumbent systems. This is according to a new report from Lux Research that investigates into the ROI or the return on investment for cold supply chains if they switch from existing systems to an IoT-based solution. Vaccines are transported through cold supply chains. India is home to the world’s largest number of unvaccinated children The country has the largest number of births in the world (more than 26 million a year). It also accounts for over 20 per cent of child mortality universally. Although there has been some improvement in the past few years, India still has 7.4 million children that have not been immunized, the largest number globally. Immunization rate is lower than 50% in some of the biggest states such as Madhya Pradesh, Rajasthan, Uttar Pradesh, Bihar, and Assam. In fact, the most populated Indian state of Uttar Pradesh, along with Rajasthan, has a rate hovering around 30 percent. India aims to immunize 27 million new children each year. Nine million immunization sessions are organized each year to target these infants along with 30 million pregnant women for RI, that is routine immunization. The gargantuan endeavour depends on guaranteeing a constant supply of vaccines, which have to be stored at recommended temperatures, right from the manufacturer down to the mother and child. A major challenge to the immunization effort is the technology to predict demand, logistics and cold chain management, as all of these factors lead to inefficient use and high wastage rates. Many states in India lack effective cold chain infrastructure, thus they are unable to ensure that vaccines are stored at optimal temperatures and don’t have proper vaccine management and delivery systems. What is a cold chain? A cold chain is basically a temperature-controlled supply chain with an uninterrupted series of storage and distribution activities which maintain a given temperature range. It is used to help extend and ensure that the shelf life of products such as pharmaceutical drugs, including vaccines, fresh agricultural produce, chemicals, photographic film, etc. is increased. Unlike other goods, cold chain goods (also called cool cargo) can perish quickly and they are always en route to end use or destination, even when held temporarily in cold stores. Apart from maintaining a particular temperature range for preservation (2 to 8 °C or 36 to 46 °F) of vaccines, the cold chain requires to also maintain product-specific environmental parameters including air quality levels (carbon dioxide, oxygen, humidity and others), consequently making the whole process complicated to operate. A sophisticated cold chain is vital in ensuring steady supply of vaccines to far away clinics, particularly in the hot climates of the developing world which are usually served by poorly developed transport networks. Any disruption in a cold chain can have disastrous consequences. In fact, there have been several incidents where vaccines were transported to Third-World Countries with hardly any cold chain infrastructure, leading to the inactivation of vaccines due to excess exposure to heat and other environmental conditions. Patients thought that they were being immunized, whereas in reality they were put at greater risk due to inactivated vaccines that they received. As a result, a lot of attention is being paid these days to the entire cold chain distribution process to help ensure that deadly and crippling diseases can be eradicated from society. Leveraging IoT to fillip India’s vaccination efforts Technology such as the Internet of Things can help in putting together real-time monitoring systems as well as connected platforms to integrate and deploy sensors and track different parameters and make logistics safer and more efficient. Advances in linking cellular and satellite connectivity with geographically spread warehouses and distribution centers as well as hosting the data on the Cloud can ensure round-the-clock availability and analytical insights leading to more optimum utilization. Lux Research analysts developed payback models for real-time monitoring systems for vaccines and biological reagents, among other goods. They concluded that continuous multi-attribute monitors, which include temperature, humidity, door, location, and light sensors, have a payback for vaccines with loss rates more than 0.15%, and for biological reagents at loss rates over 0.045%. Typical loss rates are very high in developing countries in Asia, Africa and South America, sometimes hovering around 10% to 20%, thus making a strong case for using such high-tech solutions. “There is no one-size-fits-all solution in the cold chain monitoring space and companies can implement different solutions on a case-by-case basis, depending on the value of the cargo and loss rates,” said Tiffany Huang, Lux Research Associate and lead author of the report titled, “Keeping It Fresh: Improving Cold Chain Outcomes with Sensor Platforms.” Smart, innovative IoT-driven solutions would include devising and designing smarter containers that are embedded with sensors and provide suppliers with real-time temperature data, light, shock, and humidity. Containers can have self-cooling facility so that the cooling system swings into action once the container becomes too hot. Domestic shipping, which is carried out using trucks and trains, can also be upgraded with such IoT networks. This would be easily implementable as a vehicle can be connected to cellular networks instead of using satellite data. “IoT based solutions can provide the much needed support to India’s efforts at universal immunization of its children by providing smart technologies for the preservation of valuable vaccines,” said Brajesh Sachan, Chief Technology Officer, Deskera, a cloud-based software company, which has also developed Analytics and Big Data solutions. International efforts to improve cold chain logistics Since 2014, the United Nations Development Programme (UNDP) has aligned with the Ministry of Health and Family Welfare to support immunization efforts. The joint venture is supported by GAVI–the Vaccine Alliance. A prime component of the support is in the design and implementation of real-time information on cold chain temperature and vaccine stocks and flows at all points of the supply chain, right from the dispatch from state offices to the Primary Health Centers, where the staff administers vaccines. Other global organizations such as UNICEF, World Health Organization (WHO), Bill and Melinda Gates Foundation, PATH, MCHIP, and UNOPS are also supporting logistics to bolster India’s immunization efforts. Other bodies such as the National Technical Advisory Group, the Immunization Action Group, the Polio Expert Advisory Group, etc. are also involved in solving the problem. The National Cold Chain and Vaccine Logistics Action Plan and the GAVI-HSS (Global Alliance for Vaccine and Immunization) support the National Cold Chain Management Information System (NCCMIS). The Indian government’s Universal Immunization Programme (UIP), which one of the world’s largest programmes of its kind and an integral component of Reproductive, Maternal, Newborn, Child and Adolescent Health (RMNCH+A) approach, is focusing on building robust cold chains to ensure eradication of vaccine preventable diseases such as polio, measles, Japanese encephalitis, Hepatitis B and rubella. Ensuring a robust future for India’s children An effective immunization programme that reduces vaccine-preventable diseases (VPDs) will hugely contribute to achieving the Millennium Development Goals (MDG) which aim at reducing child mortality by two-thirds. After all, the future of a nation rests on the health of its children. With over 10 years of experience in the field of journalism, the author is a technology evangelist and avid blogger.