India’s eVIN App Improves Efficiency of Vaccine Systems and is now Having an Impact in Indonesia

Kirti Pal, an Auxiliary Nurse Midwife (ANM), at work during an immunization drive, in Sitapur district, Uttar Pradesh. UNDP Photo.

Back when he was a medical student, in 1973, someone plastered a sticker outside Santosh Shukla’s hostel accommodation, it read: “You can get ideas from this room.”

About 30 years later in 2002, Santosh Shukla’s mind was racing for ideas. A polio epidemic was spreading across India, affecting hundreds of children. Now a pediatrician, he was among 50 doctors selected to halt the spread of the virus.

He says, he was sent straight into the hot zone: the districts of Azamgarh, Ghazipur, and Mau, in the state of Uttar Pradesh. The districts were the perfect crucible for the virus; a mix of poverty, illiteracy, a growing population, and an over-burdened public health system.

There were entire villages that would not permit him and his team to administer the vaccine. It was a time for ideas and improvisation, says doctor Shukla. He would find a village influencer, coax and negotiate, and use the person to break through the barriers of ignorance and superstition. In two years, his team halted the spread of the virus.

From the time he attained his medical degree, immunization held a special fascination for doctor Shukla. While he achieved much success in his field, one problem continued to vex him and other medical practitioners. To ensure no child was left unimmunized, they were looking for a way to better monitor vaccine supplies, to administer them in time, and to track the cold chain process in real time. The cold chain is a series of steps that includes, refrigerated production, storage, and distribution activities, along with necessary equipment and logistics, to maintain vaccine stocks at a specific temperature range.

Despite improvements in the health sector, millions of children in India still go unimmunized. The factors limiting vaccinations include large mobile and isolated populations, low demand from communities who fear side effects, and lack of a quality supply chain that leads to a huge waste of vaccines; a challenge for developing countries across the world.

As a State Immunization Officer in Madhya Pradesh, doctor Shukla struggled to manage the vaccine cold chain, from the state’s crowded cities to its remotest corners.

Then in 2014, India’s Ministry of Health and Family Welfare designed and implemented an innovative pilot project called the Electronic Vaccine Intelligence Network (eVIN), to support the country’s Universal Immunization Programme. eVin digitized vaccine stocks and provided real-time information on vaccine quantities and storage temperatures.

The results of the pilot project conducted in Bareilly and Shahjanhanpur districts, in Uttar Pradesh, were dramatic. The mobile cloud-based app allowed health workers to update information on vaccine stocks through their smartphones, following immunization sessions. This allowed health officials to track vaccine stocks and the cold chain process in real-time.

Now, officials could monitor vaccine stocks and flows and check the temperature of the cold chain, even in remote villages, thousands of kilometres away. It was a solution that doctor Shukla and his colleagues had long sought after.

A mother and child wait for their turn at an immunization session, in Sitapur district, Uttar Pradesh. UNDP Photo.

But to expand eVIN would require technical expertise and a support network that could manage vaccine cold chain points across India. The UN Development Programme presented the government a plan to manage and strengthen those systems. And it began working closely with state governments and health officials, to improve and upgrade the app.

With support from Gavi — The Vaccine Alliance — UNDP has rolled out eVIN in more than 500 districts, across 21 states and union territories, in India. The agency has trained more than 30,000 government staff — including vaccine store managers and cold chain handlers — on the mobile and web-based app. The programme is set to expand even further, across all 36 states and union territories.

Monitoring vaccine stocks has led to massive savings, in the millions of dollars, as it has allowed medical teams to use vaccines before they expire. Almost all vaccine cold chain points are now equipped with essential antigens — substances that induce an immune response in the body. In addition, eVIN has led to better procurement, improved policy-making in vaccine delivery, and planning for new antigens, to strengthen the vaccine supply chain.

The success of the programme in India has gained widespread attention. Now, UNDP is sharing eVIN’s success, by introducing it to other countries.

In Indonesia, a UNDP supported pilot programme — dubbed SMILE — is underway in two districts: Bogor, in West Java, and South Tangerang, in Banten. The pilots have been running successfully, with an over 90 percent reduction in vaccines running out of stock.

Since its inception, in July 2018, SMILE has recorded high user satisfaction, and adoption of the application. Management of the vaccine cold chain has significantly improved, with a dramatic reduction in data entry errors. It has resulted in vaccine coverage for over 800,000 infants, school-aged children, and women of reproductive age, across the districts of Bogor and South Tangerang.

The success achieved during the pilot has prompted the Jakarta Provincial Health Office to expand SMILE to 6 new districts. More countries are considering adopting eVIN, they include Afghanistan in South Asia, and Malawi and Sudan, in Africa.

This story was originally published in Creating Connections: South-South and Triangular Cooperation in Asia and the Pacific (UNDP, 2019).