Written by: Punit Shukla, Project Lead, Blockchain and Digital Assets, World Economic Forum, Centre for Fourth Industrial Revolution India
Amey Rajput, Fellow, Blockchain and Digital Assets, World Economic Forum, Centre for Fourth Industrial Revolution India
Sid Chakravarthy, Founder & CEO, Statwig
Finding a coronavirus vaccine is key, but finding a way to distribute it on a global scale will be equally crucial. This effort will take building a manufacturing and supply chain capacity larger than ever before, more quickly than ever for vaccine distribution. That success also requires leveraging tools and capabilities – such as blockchain – in a way never seen before in the history of fighting pandemics.
Scale and the challenge ahead
Decades of running immunization programs by UNICEF and Gavi Alliance tell us that vaccine supply chain and delivery takes years to stabilize depending on the geography. For instance, polio immunizations in India took more than a decade to cover 100% of the population’s children – 175 million under age five. The Pulse Polio immunization program was launched in 1995 with the last case reported in 2011.
Additionally, UNICEF, world’s largest vaccine buyer for children, procured 2.43 billion doses of vaccines in 2019 to reach approximately less than half of the world’s children under five for an effort covering a range of diseases (including measles, diarrhoea, pneumonia and polio).
The unique challenge of scale is greater in the COVID-19 pandemic and that challenge is precedent setting. This vaccine must cover every country in every continent and every person in every age group. Assuming the approved vaccine requires just one dosage per individual, at least 7 billion doses of the vaccine will need to be in the hands of healthcare workers. Assuming a 20-30% loss during transit and storage, this could mean close to 10 billion doses in the supply chain. Should the vaccine administration require two dosages per individual, the volume needed could top 19 billion vials.
Building an equitable, responsive system
A supply chain for COVID-19’s vaccine will also be unique. While multiple geo-political, economic and nationalistic interests will influence who discovers the cure, who manufactures it, who funds it and who needs it, the supply chain must be “equitable.” There must be a global consensus on who should get it first, one not based on who can buy it first. Such an equitable supply chain can only be built on a doubtless, openly verifiable, consensus-driven system having immutable integrity of data with no single source of control. To achieve the global optimum, instead of a national or regional optimum, vaccine access will critically depend on an information system with the highest possible integrity, capable of avoiding forces of vested interests. Thus, blockchain and distributed ledger technology will be essential for an equitable COVID-19 vaccine distribution.
Additionally, the COVID-19 vaccine supply chain information system must be built with real-time tracking capability and updates on parameters such as vaccine storage levels, temperature control, stock-outs, quantities of ancillary supplies (diluent, syringes and needles, glass vials, rubber stoppers, plungers, wicks and kerosene for refrigerators etc.). This becomes imperative in calculating the most important parameter, vaccine wastage rate – a key input to anticipate demand, plan manufacturing and supplies, and reducing stock-outs/over-stocks. At the scale of ~10 billion units, estimates of wastage at every stage of the supply chain and its accuracy can be the key in ensuring or denying access to the vaccine for large segments of population. Here again, blockchain will be critical.
Even now in our current scenario, we don’t have accurate estimates of wastage rates. In the absence of national figures, WHO issues Indicative Vaccine Wastage Rates and a tool for estimation. However, the tool itself acknowledges a lack of accurate and appropriate data at the country level, thanks in part to overburdened systems reporting data that are late or incomplete, and the difficulties in identifying a vaccine’s target demographic. A report on immunization information systems by WHO under project Optimize, a WHO-PATH project to facilitate an efficient vaccine supply chain, hints that even the Gavi Alliance has seen its attempts to make financial support proportional to performance targets get limited by questions regarding data variances. For the COVID-19 vaccine, we would need live tracking of every vial with all the storage and handling environment parameters with doubtless integrity and open accessibility by all stakeholders which can only be done with a decentralised open ledger.
Solutions in development
Efforts leveraging blockchain technology have been undertaken across the globe, in context of supply chain at ports, in retail and logistics. Blockchain has been mostly used in these pilot experiments to enable real-time tracking of shipments and shared access of data between consortium members, building trust. The learnings from these pilots can now be utilized to enable a truly global ledger for the COVID-19 vaccine supply chain.
Efforts to leverage blockchain for vaccines are already in development. One UNICEF Innovation Fund and Gavi Infuse portfolio startup, StaTwig, has been building and testing a vaccine supply chain management platform which ensures all stakeholders have complete visibility of all vaccines at national, state and district levels and at different stages of the supply chain. The platform uses QRcodes [Barcodes/Serial Numbers] printed at unit-levels to track the vaccines from the manufacturer to end-consumer on an open source blockchain platform. At each touchpoint in the supply chain, the platform records data such as quantity, temperature record, timestamps, chain of custody and price against the unique QRcode.
The platform supports aggregation and disaggregation so that the number of QRcode scans can be reduced exponentially at pallet, box-levels. This process also simplifies tracking of the products in the extended supply chains which includes last-mile deliveries. StaTwig’s teams have been testing the solution with UNICEF program teams in the Middle East, North Africa and in India as well.
Helpful in these efforts is a recently released Blockchain Deployment Toolkit. Developed by the World Economic Forum Centre for Fourth Industrial Revolution, the toolkit helps in building a “shared truth” in supply chains depending on trust, transparency and integrity, informing the deployment of new use cases.
Still, more needs to be done. Such an effort would require global coordination of digitizing the vaccine supply chains, retraining and digi-skilling of the involved workforce and aligning all the players – manufacturers, suppliers, buyers, frontline health workers and governments towards a consensus to use such a system. Large scale deployment of IoT devices would be required across the whole inventory and logistics, to maintain real-time tracking without too much manual intervention. Since a shared tracking of data may also give rise to concerns around privacy (for both individuals and enterprises alike), privacy preserving techniques would need to be fundamentally coded into the information system.
Such efforts to build an open system to track and trace every vaccine dose accurately and transparently will be required to build a global consortium of vaccine researchers, pharmaceutical companies, manufacturers, distributors, healthcare workers and governments. Blockchain technology allows us to do this at scale, building trust and transparency which will reduce the vaccine wastage rates, eliminate stockouts and ensure a truly equitable distribution of the COVID-19 vaccine to the entirety of human population.
We’ve reached an important juncture in technology evolution where the right tools, resources and optimism are present. Leveraged correctly, it is an unprecedented opportunity to capture the minds of innovators to build a first-ever solution to save human lives around the globe.