With the vastness and richness of diversity in India, it is necessary and challenging for every nook and corner of the country to have access to healthcare services, especially life-saving vaccines. Adequate distribution of vaccines, particularly across geographically remote and socio-economically underserved areas, is vital to averting outbreaks and avoiding the loss of lives caused by preventable diseases.
Understanding the Last Mile
The ‘last mile’ of vaccine delivery refers to the final leg of the vaccine's journey from the national storage facilities to remote and hard-to-reach communities. In other words, this is the most critical juncture, where problems such as the lack of infrastructure, health facilities, or logistics are traditionally the most chronic. Despite these, India has made substantial headway in improving last-mile vaccine delivery, as reflected in its achievements, such as eradicating Polio and a 90 per cent reduction in maternal and neonatal tetanus.
The country's vast immunisation coverage network has displayed a laudable performance. According to the Ministry of Health and Family Welfare, DPT (Diphtheria, Pertussis, and Tetanus) vaccine coverage has risen from 52 per cent in 1992 to over 90 per cent in recent times.
However, the systemic improvements and enhanced services are still unable to fill the gap to the last mile. This can be seen across different regions of India, including rural areas and a few states, where the National Family Health Survey (NFHS-5, 2019-2021) finds high variations in immunisation coverage rates.
For example, in the case of vaccination, states like Kerala and Tamil Nadu have surpassed the national immunisation rate, yet many fall below the national average in this respect, such as Uttar Pradesh and Madhya Pradesh.
The importance of last-mile delivery of vaccines for remote areas
Usually, marginal and remote communities end up being the most underserved groups when it comes to public health infrastructure - hence, ensuring that these groups have access to essential healthcare services becomes ever-important. As a part of equitable healthcare access, last-mile delivery ensures the vaccines reach the population to its last segment, irrespective of geography or socio-economic strata.
In addition to improved public health, proper immunisation also creates a positive economic impact resulting from the saved health costs and avoided productivity losses, contributing to economic stabilisation and growth. The socio-economic benefits of preventive healthcare underline the utmost importance of "last-mile delivery" for India.
Challenges and Strategies
The national immunisation program in India provides immunisation to 26 million new-borns and 29 million pregnant women every year, making it one of the most extensive immunisation programs in the world, as per the World Health Organization (WHO).
The vast immunisation coverage network in India has gone from strength to strength. According to the Ministry of Health and Family Welfare, DPT vaccine coverage has risen from 52 per cent in 1992 to over 90 per cent in recent years. Also, as a result of the Pulse Polio Immunisation program, the country has been polio-free since 2014.
However, there are still 91 districts where less than 50 per cent of children are fully immunised against preventable life-threatening diseases. Further, almost 4 Crore pregnant women and new born children are not fully immunised. Contributing to this scenario is the challenging geographical diversity of India seen in the rugged terrains of the Himalayas, the remotest of islands in the Sundarbans, and the dense forests of Central India. In addition to the varied topographical range, other barriers to immunisation coverage include vaccine hesitancy and cultural taboos among communities.
To address these challenges, India has implemented several innovative strategies ranging from improvements in the cold chain infrastructure that assure vaccine efficacy during transportation and storage to fostering collaborations with NGOs, international organisations, and the private sector to expand the reach of essential health services to all corners of the country.
WHO estimates that 50 per cent of all temperature-sensitive vaccinations are wasted. This is due to insufficient last-mile cold chain capacity and temperature monitoring. These gaps cause vaccine deterioration, denying mothers and children effective vaccinations. Solutions that strengthen the last mile cold chain, such as Phloton – a smart active cooling device for safe vaccine delivery, will play a critical role in bringing the benefits of immunisation to the isolated and underserved regions of the country.
Immunisation programs are increasingly integrating technologies, such as GPS tracking and data analytics, to optimise delivery routes and monitor vaccine stocks in real-time. In addition, community awareness campaigns and sensitisation of community health workers to address vaccine hesitancy and cultural barriers will further strengthen the country's healthcare efforts.
While challenges remain, India's innovative approaches and commitment to improving last-mile vaccine access promise a healthier future for its people. The lessons learned, and successes posted by India offer valuable learning for countries and global health initiatives keen on ensuring no one is left behind in the war on preventable diseases.
The author is CEO, Enhanced Innovations
