Yet, this is a time for introspection and self-criticism. We need to ask ourselves if we could have gone ahead faster and implemented faster. We also need to learn from the rotavirus experience what we need to do for immunization programs in general, and for specific vaccines as needed. While our vaccine and vaccination challenges are complex, our programs can be broken down into components in a pipeline. Each component can be analyzed and we can chart out where and how we can do better. Reality is far more complex, dynamic and unpredictable but such an approach and a constant self-appraisal can help in strategic development and implementation.

We can divide the components in the pipeline into research, the ‘valley of death’ that needs to be crossed to take vaccine development into trials, manufacture, implementation and monitoring. While a detailed analysis is needed, I outline aspects that need attention, and try and point to realistic routes to address these problems. In each of these components, we can analyze our strengths, weaknesses and, very important, the efforts needed to address the problem. These components and the current situation are broadly and qualitatively summarized in Table I. A constant and critical mapping of each cell in the table, for each vaccine candidate, is needed. As a research funder, not directly involved in deep-downstream implementation (a responsibility of central and state health ministries), this dynamic mapping could be anchored by a partnership of the Department of Biotechnology (DBT) and the Indian Council of Medical Research (ICMR). Such a ‘landscaping’ unit, organically connected with our reality is an effort which the DBT will put in place. Indeed, some such structures are already in place; learning from their successes and weaknesses, and coordination with them can itself help develop a more effective aid to those who need to take decisions and monitor performance.

TABLE I The Components in the Implementation Pipeline

This simplistic table (Table I) suggests that we have bottlenecks at every stage in the pipeline. This may lead us to the view that the pipe will have a poor flow rate or be clogged. This would be wrong. There are ways to clean pipes by addressing challenges, even as the pipeline continues to work as it does. Our being more active in being aware, in an integrated manner, of our strengths and weaknesses (columns 2 and 3), and using this awareness to address solutions (column 4) is the only way to bring vaccines to the Indian people. In this effort, the DBT has a special role. It is removed enough to be able to think unhurriedly and objectively, and it is connected enough to help develop and implement urgent solutions. The model was developed with the end-to-end engagement with the indigenous rotavirus vaccine. We have learned from the experience and need new challenges.