Taking Healthcare to the Last Mile

By Ikyatha Yerasala

Emvólio, a portable battery-powered temperature-regulated carrier for transport of the COVID vaccine, created by Manipal-based Blackfrog Technology is solving major crises in last mile delivery of vaccines in India.

Hundreds of people from remote villages in northeast India eagerly await the COVID vaccination. While await their jab, the ice box transporting the vaccines faces massive fluctuating temperatures causing the ice to melt, rendering the vaccines impotent, leading to a massive wastage during the last mile delivery – this isn’t an imaginary scenario. The World Health Organisation (WHO) estimates 50 percent of vaccines lose their potential before they are administered, often due to disruption in cold chain supply. In May, in response to a Right to Information (RTI) query, shared by the Ministry of Health and Family Welfare (MoHFW) revealed that India had wasted 4.6 million doses since January.

Enter Blackfrog’s distinctive product Emvólio, a portable, battery-powered medical-grade refrigeration device that maintains a pre-set temperature up to 12 hours, ensuring efficient delivery of vaccines in the last mile. Blackfrog’s Emvólio has reached a number of remote places and is solving important crises in last mile delivery of vaccines and has features that make it more efficient than traditional ice-boxes, which do not address temperature control or monitoring.

When it comes to battery-powered devices, a group of researchers conducted a study and concluded that the costs of wastage in the context of just rural India of the ice-based system is USD 7,512,930 and that even at a unit cost-price of USD 2000 (INR 1,47,420) for an iceless, battery-powered carrier, the cost-benefit ratio that avoids this wastage would be 0.28, indicating that it is cost beneficial.

The Beginning

The brainchild of Mayur Shetty and Donson D’souza, Blackfrog Technologies started off as an engineering design firm and transitioned into vaccine supply chain in 2017. In late 2016, the company shifted towards work that involves improving the immunization supply chain.

Mayur Shetty

Donson D’souza

“With cold chain management being one of the biggest problems in vaccine delivery, vaccines require tight and strict temperature control. They’re critical biologicals that need care and vigilance up until they’re administered. We're not trying to fix a broken system – we’re trying to bring about a system which is non-existent right now,” says Mayur Shetty, CEO, Blackfrog Technologies.

Emvólio’s USP

Both the Indian vaccines Covaxin and Covishield strictly require temperature between 2 and 8 degrees Celsius (35-40 deg F), and are freeze-sensitive. Considering there’s no temperature control or monitoring done in the ice-box mode of delivery, which is the usual mode of transport when delivering vaccines, Blackfrog developed a precision refrigeration system.

Emvólio is a portable active cooling (battery-powered) device that delivers vaccines and other biologicals like blood, serums, viral culture which require to be kept strictly between 2°C and 8°C for more than 12 hours.  

With strict maintenance of a preset temperature, they’re able to ensure that vaccines don’t go to waste, are potent and not thermally degraded on the way to the user. “Over three quarters of vaccine wastage after thermal degradation happens in the last mile. We've now adapted our solution for the next generation vaccine carrier for COVID-19 vaccines too,” adds Mayur.

Combatting Vaccine Wastage

As as R & D firm, Blackfrog started doing ground-level research, but along the way, they made startling discoveries. “We understood other supply chain problems like ergonomics of traceability, cross contamination and sterilization before creating Emvólio. We discovered that more than it being a straightforward cold chain management issue, the actual problem lies with service delivery," says Mayur.

Vaccine wastage has two aspects it. “Vaccines must be stored between 2 to 8 degrees, so they usually end up freezing the vaccines, because they're not able to tell exactly how to balance it at these degrees. The way to determine if the vials are frozen is by conducting a sheet test, which is usually not carried out. So they end up administering the vaccine anyway, assuming it works, which is a huge risk. Ice melts after some hours and the temperature already crosses 8 degrees rendering the vaccines non-reusable,” he explains.

With Emvólio’s long lasting temperature control, if the vaccine is not being used, one can bring it back safely. “If the vaccine is transported from a primary health center to a remote sub-centre and there are 30 to 50 vials of it and around 200 people show up in a day, we’re able to plug it in and operate as a standalone refrigerator and reuse it the next day,” shares Mayur.

Overcoming hurdles

Launching a portable carrier that has a breakthrough technology is a mammoth task, and the time spent on R & D was massive for the Blackfrog team.

“Since it’s a medical device, the gestation period is quite long. R&D took us about four years and it also took us time to get the device perfectly compliant with all of the medical standards. Also, manufacturing during the pandemic was bombarded with supply chain disruptions. Components weren’t reaching us on time and we faced logistical problems. There were a few technological errors to combat as well. Our aim is to create awareness that one should not accept substandard healthcare delivery,” states Mayur.  

Reaching remote India

Emvólio is currently live in five Indian states. But the device is being used more in the northeastern part of the country, which has an abundance of mountainous areas which are prone to landslides and power failure. Down south, in Karnataka, the company is working with private hospitals, specifically on the outskirts of Mysore, at Sargur. "We’ve been working here on routine vaccine delivery for over two years now,” says Mayur.

Apart from the COVID vaccine, since 2019 November, the company has been working on polio, MMR and other routine vaccine deliveries to a local tribal community from a hospital called Swami Vivekananda Youth Movement hospital to immunize the locals. “What’s heartening is that they have a tangible vaccine savings of about Rs 13,000 every month now, thanks to our technology. Earlier 20 kids were vaccinated in a day. But now, the number is upto 60,” reveals Mayur. 

Ready to scale up

Currently, 300 units of Emvólio are being produced per month. By the end of 2021, Blackfrog intends to move to a new facility where they will be able to produce about 1500 units per month. “We’re also looking at Middle East and Indian subcontinents such as Sri Lanka where vaccine delivery is a challenge,” says Mayur.

Backed by the Indian Government, which is a supportive partner and a stakeholder in the entire mission, Mayur reveals, “They have been funding and promoting us in every possible way. Immunization is a public health issue, and India has had a very successful universal immunization program in the last seven years. It’s termed as one of the most impactful in the world and has been praised by WHO too. Immunization is the way to go ahead right now, especially with the pandemic, where we have to get majority of our adult population immunized so that we can get ahead of the pandemic. This will happen only if safe, efficacious vaccines reach the masses. We want to ensure that happens.

Blackfrog works with non-profits like SELCO Foundation, and is backed by Hitachi ABB power grid and the HDFC group. “They’re procuring from us and implementing with the public health system right now. India would require between 30,000 to 40,000 units of our product, so we’re scaling up our production capacity,” adds Mayur.