By Eric Bellman and Sumit Dayal for The Wall Street Journal
India is simultaneously battling the world's fastest-growing
surge of infections and carrying out one of the most logistically
complex vaccination campaigns. New Delhi has set a target of
vaccinating 300 million of its more than 1.3 billion people by the
fall.
Some of those doses will be transported hundreds of miles--by
truck, plane, scooter, boat and even on foot--before being injected
into the arms of people living in small, remote villages. Along the
way, each dose must be tracked and kept chilled. The enormous
challenge has become all the more urgent as infections have
skyrocketed in recent weeks. Here is the story of one dose's
1,500-mile journey.
PUNE, India--A half-milliliter dose of a vaccine developed by
AstraZeneca PLC and the University of Oxford began its life here in
a 1,500-liter metal tank, along with millions of others in batch
number 4120Z017, months before it was approved for use.
The tank--one of the bioreactors used to grow the cells to make
vaccines--produces millions of doses at a time. Bioreactors are the
workhorses of the Serum Institute of India, the world's largest
vaccine maker. The Institute started making and stockpiling doses
as soon as it got the formula and tiny seed vial of material used
to grow the vaccine from AstraZeneca in May.
PUNE: Born in a Bioreactor
From the bioreactor, the dose on Nov. 11 was put in a 10-dose
vial that was then sealed with a stopper and stacked with millions
of others on the giant purple-and-white shelves of a warehouse kept
at around 40 degrees Fahrenheit.
After weeks in storage, the dose would travel 1,500 arduous
miles to a remote village in the country's northeast before being
injected into the shoulder of a schoolteacher, some 120 days after
its emergence from the bioreactor--another small victory in one of
the world's most ambitious and logistically challenging vaccination
campaigns.
The campaign has gained urgency as the coronavirus has surged in
India, with daily new cases surpassing 300,000 last week. India is
now regularly delivering more than 2.5 million doses a day.
The AstraZeneca vaccine wasn't approved for use in India until
Jan. 2. The dose sat on the shelf for another week, until it was
separated into an ice-pack-lined plastic-foam box containing about
1,000 vials and loaded onto an insulated truck.
From there it took a 30-minute drive to the Pune airport, one of
millions of doses headed to different corners of the country. On
the afternoon of Jan. 13, it was loaded into the cargo area of a
regular passenger flight operated by India's largest airline,
IndiGo, which has joined forces with the government to help deliver
vaccines across the country. In Kolkata, it was transferred to
another passenger flight operated by government airline Air
India.
The dose was among the first deliveries in the country, leaving
Pune days before India launched its nationwide vaccination program
on Jan. 16. It stopped only briefly at Kolkata airport before
moving on, but most of India's vaccines stop at regional
distribution centers as part of the hub-and-spoke system it is
using to reach across the country.
KOLKATA: Distribution Hub
The warehouse in the Central Family Welfare Stores in Kolkata,
for example, which has been managing India's regular child
vaccinations for years, takes care of Covid-19 vaccine deliveries
for that state. On a recent Saturday, it was bustling as workers
set up shipments across the state of West Bengal and tried to make
way for the growing number of vaccines arriving every week.
India has given more than 140 million shots already and plans to
vaccinate more than 300 million by fall. While in shots delivered
it trails China and the U.S., India has set a higher target--and in
a country with a large percentage of people living near the poverty
line and in rural areas.
"This is about reaching all of India. Nobody can be left
behind," said Vivek Paul, one of the leaders of New Delhi's
vaccination efforts. "We are looking at extinguishing the pandemic,
not just controlling it."
After an overnight stay in Kolkata, the AstraZeneca dose was
loaded onto another commercial flight for the 400-mile flight to
one of India's remotest state capitals, Aizawl.
AIZAWL: Land of the Hill People
Aizawl is the capital of Mizoram ("land of the hill people," in
the local language), a northeastern state wedged between Myanmar
and Bangladesh. Over the centuries, its citizens have settled on
the hills for protection. Now the winding ridges that make up the
capital bristle with buildings like a little Hong Kong in the
middle of a jungle. There is little level land anywhere--even pigs
are kept on hill-hugging bamboo platforms held up with stilts.
Of Mizoram's nearly 1.5 million people, many live in distant
villages that are hard to reach. Trips between places less than 100
miles apart in a straight line can take 10 hours, often along
narrow dirt roads that wind through the mountains. The state is
rushing to provide shots before rainy season starts in June, making
roads impassable.
"We have to finish as much as possible before the monsoon," said
Eric Zomawai, the deputy director of the state's health department.
"We get landslides and in spite of everything we have to
manage."
The dose landed in Aizawl on Jan. 14 around noon. It was quickly
packed into a smaller plastic-foam cooler with fresh ice packs and
a credit-card-sized temperature monitor to ensure it stays between
around 35 and 45 degrees for the next leg journey--a long and
winding eight-hour drive to the rural district headquarters of
Lunglei.
There the dose had another long wait--this time, for the
distribution system to catch up with the supply. In the initial
stages of the vaccination drive, there were technical glitches with
the smartphone app-based system used to choose, notify and register
people for vaccinations. Meanwhile, in parts of Mizoram and across
India fewer people than expected were showing up for their
shots.
NUNSURY: Shot in the Arm
After almost two months in a freezer used to store all sorts of
vaccines, on March 11 dose it was packed into a small plastic-foam
cooler equipped with a shoulder strap. A local health official
slung it on her back, got on a scooter and drove it down to the
Khawthlangtuipui River, which runs to the border between India and
Bangladesh. She and four other health officials jumped in a long
wooden boat to go downstream to the village of Nunsury.
Nunsury is little more than a riverside cluster of simple,
single-story homes, some built of bricks, others of bamboo, most
roofed with corrugated steel. Most citizens are fishermen or
farmers. Around 10 of the oldest people in the village were the
first to arrive at the makeshift vaccination center, set up in the
village grade school. They all show their IDs and wait their
turn.
Establishing age has been a big problem. Until May, the vaccine
is being offered only to people at least 45 years old, but in the
far corners of Mizoram, official birth certificates weren't given
out until the 1980s, said Lalhnunmawii, a local medical officer who
goes by one name.
"Some people here are illiterate, so their ages are just what
they imagine," she said. "They don't know their exact ages."
The vaccine-distribution app that suffered glitches early in the
campaign has a separate problem in this remote area: lack of
connectivity. Health workers have to keep records on paper and
transfer them when they are back in an area with a network. In some
districts of Mizoram, cellular networks are so scarce that it is a
full-time job for people to drive hours to a spot where they can
update the database.
The vial containing the dose was pulled from the cooler and
marked with the time and date: "9:20 11/3/21." Once opened, a vial
has to be used within four hours.
Teacher Sulochana Chakma was among the first 10 people in line
for shots. Before the injection, health workers told her that if
she feels any side effects, she should notify a government
hospital.
With false vaccine scare stories circulating around the country
via WhatsApp messages, state officials have stressed the importance
of not spreading rumors and fear. One small group in Mizoram was
even claiming using the vaccine was un-Christian, a big problem in
the Christian majority state.
After getting her shot in the arm, Ms. Chakma waited quietly for
30 minutes, sitting a safe distance from others on well-worn wooden
benches built for small children.
She hadn't been notified to show up for her shot by text, as the
government had originally planned. The system was scrapped after
proving unreliable. Instead, older people were called by a
loudspeaker atop a tower, which is usually used to notify villagers
in an emergency.
"Yesterday they announced in the afternoon time, then again in
the evening and then again in the morning," she said. "It's free
and from the government, so we are happy to get it."
Photographs and video by Sumit Dayal for The Wall Street
Journal, unless otherwise noted
Write to Eric Bellman at eric.bellman@wsj.com
(END) Dow Jones Newswires
April 25, 2021 05:57 ET (09:57 GMT)
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