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In a bid to counter the Covid-19 pandemic, India has embarked on one of the largest vaccination campaigns ever to be undertaken in the world. Although India has a strong and expanding Universal Immunization Program (UIP) for routine immunization (RI), it pales in comparison with the scale of Covid vaccination campaign in terms of the number of individuals to be vaccinated. The success of the vaccination campaign depends on meticulous supply chain and operations planning and accurate estimation of the required budget and resources.
We use a formal supply chain model to estimate i) the total, and additional resources, required to support the Covid vaccination campaign, and ii) the incremental cost, i.e., cost of the additional resources and costs incurred on the use of current resources for performing additional tasks in Karnataka. Following the Government of India, Ministry of Health and Family Welfare’s operational guidelines, we assume that the supply chain infrastructure and resources of UIP will be used for the COVID vaccination campaign. Accordingly, we estimate the magnitude of additional resources (cold chain equipment, transportation vehicles as well as vaccinators and other human resources) required for the Covid vaccination campaign over and above those utilized for RI activities and calculate the corresponding incremental cost of obtaining these resources either from other parts of the public health system or from the private sector.
We conduct our analysis at the district-level across multiple states using publicly available data on cold chain and human resources capacity as well as scale and operation of the UIP and assumptions for COVID vaccination campaign as per the GOI operational guidelines. We focus on the target population of greater than 18 years.
We have developed a flexible modeling approach to calculate the incremental unit costs as well as total additional resources required for conducting COVID vaccination campaign. It can be used by state governments in conjunction with more detailed and granular data to obtain more accurate resource estimates, which can then be used as inputs into NHM budgets.
This framework can also be used to evaluate alternate vaccination strategies and scenarios to counter capacity and supply constraints. To account for that a Linear Program is structured such that the maximum throughput in terms of vaccination capacity is estimated for each district – rural and urban areas. This estimation of throughput can be utilized to estimate how quick the vaccination drive can be completed in a particular district of a state and in a state overall. Also, the maximum capacity estimates clubbed with the details of vaccine supply to a given state helps us understand whether the delay in vaccinating the target population is due to capacity constraint or supply constraint.
Finally, our analysis also informs the decision makers regarding the involvement of private service providers into the health system to achieve the required vaccination goals.
Incremental cost estimation for multiple states
Target population: >18 years
Campaign duration: 6 months
Vaccinator capacity: 100/session
Vaccination rate: 100/session
Derived from LP such that resource constraints are met. (Maximum throughput without hiring/purchasing additional resources)