Delivering Covid vaccine a governance challenge, India should take lead

The pressures of the pandemic have fallen hardest on developing countries with weak governments. They’re struggling to determine who is being infected and why, and to mitigate the economic impact of lockdowns and social distancing measures. If dealing with Covid-19 is stressing those states, however, the effort required to end the pandemic may exhaust them.

Speaking to the Financial Times this week, the Indian vaccine manufacturer Adar Poonawalla — whose Serum Institute of India plans to produce a billion doses of an eventual vaccine, far in excess of any of its competitors — warned that vaccinating “everyone on this planet” poses an enormous governance challenge. He says there’s no “proper plan on paper” for distributing any successful vaccine; Serum may well provide 500 million doses to an Indian government that has no way to get them to people. And India’s infant immunization program has at least given the country some distribution capacity. The problem is worse elsewhere. 

One critical challenge will be storage and transportation. Some of the vaccines that use the new messenger RNA technology will need to be stored at subzero temperatures, as low as minus-70 or minus-80 degrees Celsius. The vaccine being developed by AstraZeneca PLC, which the Serum Institute has licensed, can reportedly be stored in standard refrigerated environments. But even managing a regular vaccine cold chain is enormously difficult.

To anyone with experience of developing-world public health infrastructure, the World Health Organization’s recommendations for managing vaccine transport make for depressing reading. The vaccine alliance GAVI’s briefing on the first-choice storage machinery — ice-lined refrigerators — is equally sobering. Each can cost thousands of dollars. Off-grid, solar-driven refrigerators, which might be needed in countries with unreliable power supply, are even more expensive.

In the developed world, big investments are already being made in scaling up cold-chain infrastructure: UPS, for example, is putting millions of dollars into new “freezer farms” near air hubs in the U.S. and western Europe. Companies are unlikely to make similar investments on spec in the developing world, however. Even countries such as India, which have had some experience and success with “mission” projects in healthcare, might struggle at the expense involved in creating single-use transportation and storage infrastructure, at scale, on short notice.

This is where the economic policy community needs to step in. Getting hundreds of millions of vaccine doses out to the poorest and most remote parts of the globe is in everyone’s interest; in the words of Merck and Co. Chief Executive Officer Kenneth Frazier, “none of us are safe until all of us are safe.” Solutions exist if governments, multilateral agencies, and private capital are willing to explore them.

In India, for example, the government could collaborate with private capital and multilateral lenders to set up a holding company focused on developing, distributing and installing dual-use cold chain infrastructure. India’s National Centre for Cold-Chain Development — yes, it has one — has long argued that there are “synergies” between agricultural, processed-food, and medical cold-chain infrastructure.

Done right, a large network of refrigerated storage and transport created for the pandemic could have wider uses. An efficient cold chain would help permanently raise farmers’ access to markets, reduce wastage and control food inflation.

Of course, this will require ministries to talk to one another, arrange de-risking mechanisms and guarantees, and then rope in possible investors. The effort will be worth it, though: If a mechanism can be evolved in India, other developing countries should be able to replicate it. Without one, it’s hard to see how those nations will escape the pandemic even with a vaccine.