India already has one of the fastest-growing economies in the world, but Prime Minister Narendra Modi’s ‘Make in India’ initiative aims to transform the country into even more of a global manufacturing hub. Long-term success, however, is unlikely to hinge on just government reforms to boost business and encourage entrepreneurship; it will also depend much upon the health of those who are themselves made in India, namely its children and future workforce.
Indeed, it is difficult to talk about how large-scale increases in markets and workforce could be sustainable, without tackling the problems that contribute to the deaths of 1.4 million children under the age of five in India every year, largely from preventable causes, and the much larger burden of morbidity these diseases cause.
Having met Modi, it is clear that the government is aware of this urgent need and has taken great strides, not least through the introduction of Mission Indradhanush. This is a bold initiative targeted at 201 low-coverage districts, aiming to radically reduce the number of children who die or get sick in India by massively increasing access to immunisation. His government is also looking at expanding the number of modern vaccines that India provides in the Universal Immunisation Programme (UIP). But even with this kind of positive push it is clear that huge logistical challenges will make it difficult for India to reach every last child.
‘Make in India’ could hold the key to changing this, thanks to its emphasis on innovation. By applying the same entrepreneurial zeal to encourage innovation in digital and logistics technology, India could help to improve access to vaccines by modernising vaccine supply chains throughout India and across the world.
This potential for global exports has been demonstrated with the country’s now world-leading vaccine industry. India has in recent years become not just one of the world’s biggest consumers of vaccines, but also a leading supplier.
This thriving industry was partly made possible by a strategy to address market failures within vaccine supply and to stimulate the production of new vaccines. This has helped to create an industry that has played a critical role in contributing to global vaccine supply security, as well as a stable and more competitive global market.
Now we have an opportunity to do the same with the manufacturing of critical new equipment and technologies that help transport and keep vaccines safe throughout their supply chains, and to help improve the efficiency of how vaccines are deployed. This would help to close a critical gap between the haves and have-nots in India, by ensuring that vaccine supply chains work efficiently throughout the country.
The issue is one of equity. The fact is, even when you have well-served regions that have seen increases in immunisation coverage rates, such progress can mask pockets of low coverage among marginalised populations. The children who are still missing out are not just the last to be reached; they are also the hardest to reach, living on the very edge of societies.
Far too often the reason these communities are being missed is because of poor, inadequate or even non-existent vaccine supply chain infrastructure and cold chain equipment. This is not just the case in India, but something we have seen in all 73 Gavi-supported countries. With more than 150,000 supply chain points in these countries, currently 20% of facilities that need cold chain equipment don’t have it, and of those that do 20% of the installed devices do not function. Similarly, where equipment does work, in the majority of cases it works very poorly, with 60% running the risk of exposing vaccines to excessive freezing or unacceptably high temperatures. Both extremes can damage the vaccines. We also see poorly designed supply chains, with limited means of tracking data. This makes it difficult to manage and optimise vaccine stock levels, track progress and monitor outcomes.
One of the key objectives of India’s UIP is the rapid increase of immunisation coverage through equitable and efficient services. Therefore, given the potential for vaccine management systems and high-performing cold chain equipment to contribute towards this, ‘Make in India’ is an opportunity too good to miss. It provides a means for India to improve its own immunisation coverage and equity domestically, while positioning itself globally as an innovative leader in immunisation technologies.
Some of these technologies already exist. On a recent field trip to Uttar Pradesh I got to witness first hand a range of hi-tech, yet cost-effective, home-grown solutions that are already making deep improvements to the vaccine supply chain. From the Electronic Vaccine Intelligence Network, a mobile phone-based system that enables real-time vaccines stock management, to a simple SMS-based temperature monitoring system that sends alerts when vaccine cooling systems fail. The latter costs just Rs 8,000, compared to Rs 40,000 of other systems. These kinds of technologies alone will not solve all of India’s childhood mortality and morbidity issues. Increased investment in health and vaccines will also be needed, even more so after 2021, when India’s economic growth will lead to it transitioning out of Gavi-support, meaning immunisation programmes will become fully self-financed.
Even so, investing in technology to improve vaccine supply chains could play an important role in India’s transformation into a manufacturing super power, while saving lives and improving health at the same time. After all, prosperity is nothing without wellbeing, and India’s future very much depends on its children.
Seth Berkley is CEO of Gavi
The views expressed by the author are personal