Abstract

THE LAST MILE IS THE HARDEST: VACCINE EQUITY, MANUFACTURING RESILIENCE, AND INDIA'S ONE HEALTH MODEL AFTER COVID-19

Saranya Tadimeti*, Harish Guggila

Abstract

Scientific speed is necessary but insufficient for public-health impact: vaccines save lives only when they are manufactured at scale, distributed equitably, delivered through functioning systems, and accepted by the populations they protect. This review examines the access side of the post-COVID-19 vaccine transformation, with India as its analytical anchor. Following PRISMA-ScR guidance, literature from PubMed, Scopus, and Web of Science (2000–2025, focus 2019–2025) and institutional sources (WHO, CEPI, Gavi) the data was synthesised across manufacturing, equity-financing, One Health, life-course, delivery-systems, and hesitancy domains. The 2021 export pause exposed a ―single-hub‖ vulnerability that catalysed decentralisation, including the WHO Mrna technology-transfer hub (2023). India‘s One Health manufacturing—exemplified by Indian Immunologicals Limited‘s integrated human–animal portfolio for rabies and foot-and-mouth disease—illustrates source-control of zoonoses. We further examine life-course immunisation amid demographic ageing, India‘s delivery architecture (Universal Immunisation Programme, Mission Indradhanush, Co-WIN/U-WIN, and ASHAs), and the SAGE framework for vaccine hesitancy. Persistent constraints, like financing, TRIPS and know-how asymmetries, adultschedule integration, and a projected 18-million health-worker shortfall by 2030—underscore that platform speed must be matched by equitable governance and last-mile systems.

Keywords: Vaccine supply; One Health; Life-course immunisation; Advance Purchase Commitments; Vaccine equity.