India is preparing for a massive COVID-19 vaccine rollout in the coming months, as early as January in fact, going by Serum Institute of India CEO Adar Poonawalla’s recent comment. This will happen at a scale that the country has never seen earlier. Imagine vaccinating 1.3 billion people over the next year or two -- and ensuring that the entire process runs smoothly. A gargantuan task just considering the volumes of data that needs to be collected and followed up, and then the whole cycle needs to be repeated for the second dose of the vaccine.
At this juncture, when the Centre and States have to work together with multiple stakeholders including hospitals, pharmaceutical companies and others in the supply chain including cold chain, technology does come in handy. Countries worldwide are using technology and are partnering with private technology providers to ensure that the vaccination process is smooth.
India is no exception. Prime Minister Narendra Modi earlier announced that CoWIN Software would be used for vaccine distribution in the country.
So what is CoWIN Software?
CoWIN (COVID-19 Vaccine Intelligence Network) is a repurposed version of eVIN (Electronic Vaccine Intelligence Network), an indigenously developed platform in partnership with the United Nations Development Programme (UNDP) and the Ministry of Health and Family Welfare.
Frequently Asked Questions
A vaccine works by mimicking a natural infection. A vaccine not only induces immune response to protect people from any future COVID-19 infection, but also helps quickly build herd immunity to put an end to the pandemic. Herd immunity occurs when a sufficient percentage of a population becomes immune to a disease, making the spread of disease from person to person unlikely. The good news is that SARS-CoV-2 virus has been fairly stable, which increases the viability of a vaccine.
There are broadly four types of vaccine — one, a vaccine based on the whole virus (this could be either inactivated, or an attenuated [weakened] virus vaccine); two, a non-replicating viral vector vaccine that uses a benign virus as vector that carries the antigen of SARS-CoV; three, nucleic-acid vaccines that have genetic material like DNA and RNA of antigens like spike protein given to a person, helping human cells decode genetic material and produce the vaccine; and four, protein subunit vaccine wherein the recombinant proteins of SARS-COV-2 along with an adjuvant (booster) is given as a vaccine.
Vaccine development is a long, complex process. Unlike drugs that are given to people with a diseased, vaccines are given to healthy people and also vulnerable sections such as children, pregnant women and the elderly. So rigorous tests are compulsory. History says that the fastest time it took to develop a vaccine is five years, but it usually takes double or sometimes triple that time.
The Union health ministry, in partnership with the UNDP, has been running the Universal Immunisation Programme through eVIN since 2015. Its functions include digitisation of vaccine stocks and offering real time monitoring of cold chains through an app.
Over the last five years, eVIN has digitized stocks in 27,000 vaccine storage centres across all districts of 29 states and 7 union territories in the country. It also monitors storage temperatures of nearly 50,000 temperature loggers. It has built a capacity of nearly 37,000 government personnel for vaccine and cold chain logistic management on eVIN, who are deployed in every district for constant supportive supervision.
These capabilities should come in handy as the platform is now repurposed for the COVID-19 vaccination drive. Data collection for the first round of the vaccination drive has already begun.
The first step
The Centre had written to the States and Union territories to collect data on healthcare workers, who would be among the first to be administered the COVID-19 vaccine. Once the drive starts, people can self-register as well through the CoWIN mobile application.
The data would be uploaded to the CoWIN Software to keep a tab on patients who would need to be vaccinated and later data about those would need to be administered a second dose of the vaccine. Also, patients who displayed side effects need to be logged and monitored at an individual level. This cycle would be repeated till over 130 crore Indians get their second dose of the vaccine.
To handle them, the CoWIN software has to be technologically robust.
What kind of technological needs are we talking about?
Hirak Kayal, Vice President – Cloud Applications, Oracle, said in an interaction with Moneycontrol that the next year or two would see supply chain networks facing one of their biggest challenges. “Scalability in the supply chain is the biggest ever challenge to be faced across the entire supply chain, but especially shipment and distribution.”
This is for a couple of reasons. While the cold chain storage networks have been ramped out over the last several years through various immunization programmes, the numbers are far less than what we are looking at in relative terms. eVIN digitized the Universal Immunization Programme, one of the largest public health programmes that targeted children and pregnant mothers. According to National Health Mission, the programme covers 2.67 crore children and 2.9 crore pregnant women annually.
In case of COVID-19, we are talking about 130 crore people across the country in the next year or two, an exponential increase in the number of people that would be covered under the vaccine.
Two. Various types of COVID-19 vaccines that would be administered. So far there are at least four vaccines in the race: Moderna, Pfizer, AstraZeneca-Oxford and Sputnik, and they need to be stored at various temperatures ranging from -70 degrees to refrigerated temperatures.
Here, Kayal said, technology would play a significant role. How? Through a combination of sensor-driven IoT enabled systems along with blockchain and other emerging technology.
IoT and other emerging technology
Vaccines need to be monitored at every step, right from shipment, during transport and storage, which could include multiple hubs, and the final administrative section where the vaccine would be injected to the individual.
“At every point, temperature conditions need to be monitored and it is essential for the government and stakeholders to ensure that the temperature is maintained,” Kayal explained.
For instance, Moderna vaccines should be stored at -25 to -15 degree Celsius. Pfizer vaccines should be maintained at -70 degree Celsius. The AstraZeneca-Oxford vaccine, which would be distributed by Serum Institute of India, and Russia’s Sputnik V could be stored at fridge temperature at 2-8 degrees.
Monitoring them individually at each phase of transport and storage is humanly impossible. According to Kayal, the only solution is technology, through IoT that is sensor-driven, which can help constantly monitor the data in real time where the vaccine is being transported.
But that alone would not be enough. The technology should be combined with blockchain, artificial intelligence and machine learning.
This is how the system should work. The sensors can read the temperature, and whenever there is a change it can send a system alert to cancel that said batch of vaccines and automatically place an order for the next shipment as a replacement.
The next part is post-vaccination. The system should log the impact of vaccines before administration, during and post and log adverse effects if any on an individual basis, pointed out Karthikeyan Natarajan, COO, Cyient, in a recent interaction.
This data is highly important as it would be studied for research purposes.
In each of these steps, not just the government, other stakeholders such as pharmaceutical companies, healthcare providers and logistics players would have to work in tandem.
All the data collected are stored in cloud, private or public or the stakeholders’ on-premise infrastructure. These would be accessed by multiple agencies remotely.
Sunil Gupta, co-founder & CEO. Yotta Infrastructure, a data centre solutions firm, said that at every step the data that would be generated is huge and in a scenario where there is not much clarity on how much storage would be needed, role of hyperscalers (cloud players like AWS or Google Cloud) and third party data centre providers like Yotta would be important.
“(Because they) give you unlimited scalability and pay them only for as much infra as you would use,” Gupta pointed out.
But just storing data would not be enough. Considering the sensitivity of data, security would be of prime importance too.
Last month, Pfizer’s vaccine data stored in the European Medicines Agency was breached. In October, Hyderabad Dr Reddy’s Laboratories’ data servers in the US, UK, Brazil, India and Russia were breached and the firm shut down its production. Another pharmaceutical major Lupin, too, reported a cyberattack that affected some of its IT systems. Hence, the data stored should have the highest level of protection, Gupta added.
The other issue is the network connectivity and ensuring that there is no downtime. Outages such as that happened with HDFC Bank, where there was an issue with one of its data centres leading to downtime in its services, would be a no-no considering that critical nature of vaccine distribution. There should be adequate power supply and backup for the process to continue.
Stable internet connectivity is yet another challenge. While cities have better connectivity, the same cannot be said for rural areas. If the entire vaccine rollout hinges on CoWIN digital infrastructure, it should be made accessible in areas with lower bandwidth connectivity as well.
So, can CoWIN cater to the needs of the massive COVID-19 vaccine rollout?
In its current avatar, it's not yet clear if CoWin is up to the task at hand.
As Kayal pointed out, eVIN that was rolled out in 2015 has certain technology infrastructure. However, it is not clear if it has the modern technology needed to handle such a scale of operations that would use blockchain, IoT, AI, and ML.
An email sent to the UNDP asking how different CoWIN is compared to eVIN, and if there are partnerships with private tech players in the pipeline did not elicit any response.
Salil Parekh, CEO, Infosys, responding to Moneycontrol's query as to whether the company is in talks with the government for usage of its vaccine management solution, said: "“On that, I don’t want to make any specific comments but our solution is available for anyone to use and we have discussions with many jurisdictions.”
Oracle, which works with government agencies in countries like the UK and US to help manage COVID-19 vaccine programme, and has also been involved with the Indian government on other projects, too, did not disclose if it is in talks with the government.
This is probably where the startup challenge comes in -- and i might make all the difference. On December 23, Union IT minister Ravi Shankar Prasad announced a startup challenge to strengthen the CoWINt system by use of emerging technologies. It is also to "address the likely limitations associated with a complete and effective vaccine distribution system (VDS) and its seamless administration across India," according to a statement.Startups have time till January 15, 2021 to apply for the challenge. It has seven key focus areas, where CoWIN's limitations could lie.