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
The Serum Institute of India, the world’s largest producer of vaccines by volume, is producing the Covid-19 vaccine developed by AstraZeneca and the University of Oxford at its facility in the city of Pune in western India.
Dhiraj Singh/Bloomberg News
Vaccine vials are cleaned, filled and capped in a fully automated, sterile process at the Serum Institute.
Reuters
Vials of the vaccine moving along the production line at the Serum Institute.
Dhiraj Singh/Bloomberg News
Institute employees stack boxes of vaccine vials.
Dhiraj Singh/Bloomberg News
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.
Vaccination Drive
India uses planes, trucks, scooters and boats to deliver Covid-19 vaccine to every corner of the country.
A vaccine’s 1,500-mile journey to India’s remote northeast
Nov. 11, 2020: Serum Institute of India in Pune (bottled and stored), Jan. 13, 2021: Taken to Pune airport (by truck)
Jan. 14: Aizawl to Lunglei
(by truck and winding road)
March 8: Lunglei to Tlabung (by car),
March 11: Tlabung to Nunsury (on scooter, boat, then on foot)
Jan. 13, 2021: Pune to Kolkata (by plane)
March 11: Administered in Nunsury
Jan. 14: Kolkata to Aizawl (by plane)
Nov. 11, 2020: Serum Institute of India in Pune (bottled and stored),
Jan. 13, 2021: Taken to Pune airport (by truck)
Jan. 14: Aizawl to Lunglei (by truck and winding road)
March 8: Lunglei to Tlabung (by car),
March 11: Tlabung to Nunsury (on scooter, boat, then on foot)
Jan. 13, 2021: Pune to Kolkata (by plane)
March 11: Administered in Nunsury
Jan. 14: Kolkata to Aizawl (by plane)
Nov. 11, 2020: Serum Institute of India in Pune (bottled and stored), Jan. 13, 2021: Taken to Pune airport (by truck)
Jan. 14: Aizawl to Lunglei (by truck and winding road)
March 8: Lunglei to Tlabung (by car), March 11: Tlabung to Nunsury (on scooter, boat, then on foot)
Jan. 13, 2021: Pune to Kolkata (by plane)
Jan. 14: Kolkata to Aizawl (by plane)
March 11:
Administered in Nunsury
Nov. 11, 2020: Serum Institute of India in Pune (bottled and stored), Jan. 13, 2021: Taken to Pune airport (by truck)
Jan. 13, 2021: Pune to Kolkata
(by plane)
Jan. 14: Kolkata to Aizawl
(by plane)
Jan. 14: Aizawl to Lunglei
(by truck and winding road)
March 8: Lunglei to Tlabung (by car), March 11: Tlabung to Nunsury
(on scooter, boat then on foot)
March 11: Administered in Nunsury
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.
The Serum Institute of India stores tens of millions of doses of the vaccine in its Pune warehouse, where they are kept chilled for delivery across the country and around the world.
Photo:
Francis Mascarenhas/Reuters
The first shipments of a vaccine developed by AstraZeneca and Oxford University leaving the Serum Institute.
Photo:
Kalpesh Nukte/Reuters
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
A warehouse in Kolkata serves as a hub for vaccines.
There they are loaded onto trucks for delivery throughout the state of West Bengal.
Pune airport to Kolkata
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 one of India’s most-remote capitals.
Aizawl is perched atop the hills of Mizoram, a state wedged between Bangladesh and Myanmar.
Kolkata to Aizawl
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.
Officials in Aizawl working out how to deliver shots to the state’s many hard-to-reach corners.
The AstraZeneca vaccine can last for six months at ordinary refrigerator temperatures.
“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.
The boxes of vaccine, along with ice packs, go into large coolers that are loaded onto government vehicles.
There are few straight roads in Mizoram state’s capital city of Aizawl, which is built along the crooked hilltops of the region.
On the state’s winding, often unpaved roads, even a short trip can take hours, and during the monsoon season many become impassable.
It takes all day to reach Mizoram’s second-biggest city, Lunglei, the next stop for the vials.
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 a stop in the small town of Tlabung, the vials are loaded into small plastic-foam coolers equipped with shoulder straps.
Aizawl to Nunsury
After almost two months in a freezer used to store all sorts of vaccines, on March 11 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.
The health workers and the cooler of vaccine heading toward the Khawthlangtuipui River.
The last leg of the trip to the river was on foot.
At the river, the only way to reach some villages in this remote region, the workers boarded a boat bound for Nunsury.
Once in Nunsury, they headed for the primary school.
And there they set up their makeshift vaccination center.
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 Sulochana Chakma’s shot was marked with the time and date it was pulled out of the cooler.
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.
In the village of Nunsury, people wait to receive their vaccine.
India has built a nationwide vaccination registration and recording system that works on smartphones. To get a shot, people show their IDs, are registered and have a photo taken.
Before their injection, people are told that certain side effects are normal and that they shouldn’t spread rumors if they think they are experiencing them.
Local teacher Sulochana Chakma said she found out about the vaccination when it was announced over the village loudspeaker.
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.”
The team at lunchtime.
The health workers packed up and headed back to the boat.
—Photographs and video by Sumit Dayal for The Wall Street Journal, unless otherwise noted
Write to Eric Bellman at [email protected]
Corrections & Amplifications
India is now regularly delivering about 2.5 million doses a day. An earlier version of this article incorrectly said 3.5 million doses. (Corrected on April 25, 2020)
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