STUDY OF VACCINE SUPPLY CHAIN FOR SUSTAINABLE DEVELOPMENT OF CHILD IMMUNIZATION PROGRAM IN INDIA

Abstract

Globalization has created a new opportunity for developing countries and has benefited almost every aspect of human life. It has helped India in many aspects, due to which it has become one of the world’s fastest-growing economies. Since the last decade, India has made enormous developments in various sectors such as service, pharmaceuticals, education, software, etc. The pharmaceutical industry that discovers, develops, manufactures and market drugs are considered as one of the key contributors to the growth of India’s GDP. The Indian pharmaceuticals market is the third largest in terms of volume and thirteenth largest in terms of value and accounts for 3.1 – 3.6 percent of the global pharmaceutical industry in value terms. It is expected to grow to US$100 billion by 2025. One of the key products of the pharmaceutical industry is the vaccine, which plays an important role in saving human lives. Despite being one the largest supplier of vaccines, India is still struggling to vaccinate its children with lifesaving vaccines. One of the primary causes of low child immunization rate in India is the inefficiencies in the vaccine supply chain (VSC), which hampers the delivery of vaccines to the health centers. Therefore, it is important that the universal immunization program (UIP) India gives proper attention to its VSC so that the opportunity to vaccinate a child is not missed because of the unavailability of vaccines. Thus, the main objective of this work is to study and analyze the supply chain of basic vaccines, required to immunize children in India. The study findings will provide important solutions to help UIP India to measure and improve vaccine supply chain performance (VSCP). Improvement in VSCP can help in delivering vaccines efficiently and effectively to the health centers so that no child remains unimmunized and sustainable child immunization programs are built in India. To achieve this objective, first, the key issues in the supply chain of basic vaccines have been identified. To do so, a field survey and a thorough literature review were conducted and then using expert’s opinions through the Delphi technique, twenty-five key issues have been finalized for the study. By employing interpretive structural modeling (ISM) and fuzzy matrix crossreference multiplication applied to a classification (FMICMAC) approaches and using senior expert’s opinions, critical factors of vaccine supply chain having maximum impact on VSCP improvement have been identified. Next, these twenty-five issues have been categorized into five main domains of issues viz: economy, operational, management, social, and environmental and then using fuzzy analytical process (FANP) methodology, these five main domains, and twentyfive issues have been ranked according to their level of importance. In addition, a sensitivity analysis has been performed to validate the results of the FANP. v After analyzing and identifying the important issues, one of the critical issues i.e. vaccines shortages that are faced by the immunization programs across the globe has been discussed. Using field survey, literature, and expert’s opinions, ten causes or criteria for basic vaccine shortages and twelve solutions or alternatives that can help to overcome the shortage problems have been presented. With the help of the analytic hierarchy process (AHP) method, the weights of the criteria’s have been computed and then using criteria weights, the final ranking of the alternatives have been obtained using complex proportional assessment of alternatives with grey relations (COPRAS-G) approach. In the end, a simulation has been to validate the results. Through the study of the VSC issues, it has been found that UIP India is still operating through the conventional vaccine supply chain system to deliver vaccines, which is one of the main reasons for the birth of VSC issues and low efficiency of UIP. Therefore, the focus of the VSC designers should be on moving from the conventional vaccine supply chain system to the direction of the next-generation vaccine supply chain system (NGVSCs) to improve vaccine delivery performance. Hence, a framework that employs an integration of fuzzy analytical hierarchical process (FAHP) with fuzzy multi-objective optimization on the basis of ratio analysis (FMOORA) methodologies to simultaneously propose ten solutions to the identified fifteen barriers have been presented to help decision-makers design NGVSCs. In addition, a sensitivity analysis has been done for measuring the robustness of the ranking of the solutions. Subsequently, through the framework of NGVSCs, a well-performing vaccine supply chain can be designed. Hence, it is important for the decision-makers to maintain this performance and further improve it for the continuous improvement of the VSC system. In this regard, to help decision-makers measure, monitor, and improve the performance of the supply chain, the key performance indicators (KPIs) of VSC system have been identified using exploratory factor analysis (EFA) in the four dimensions of the balanced scorecard (BSC) approach viz: learning and growth, internal process, customer, and finance. Then using structural equation modeling (SEM), a theoretical framework has been shown that demonstrates how the UIP India can utilize its vaccine supply chain KPIs for the sustainable development of child immunization program. Moreover, Two-Way assessment has been performed to further improve VSCP in order to improve sustainability. The results of the Two-way assessment have been validated with DEMATEL. To sum up, some suggestion in the conclusion section has been presented that will help UIP India and immunization programs of other developing countries to efficiently and effectively manage the child immunization programs so that no child misses’ vaccination dose and sustainable child immunization programs are built.