You are Meera Kulkarni, Operations Lead at SuryaHealth Logistics, the not-for-profit that runs the vaccine cold chain for eleven districts of western Maharashtra, India. A measles-rubella catch-up campaign starts in nineteen days, the vaccine has arrived 18% short of plan, and before you plan anything you must say where the network will really fail.
The situation
Wednesday, 4 March 2026. The state's allocation notice confirms what the district health officer had warned you about: central supply arrives 18% below plan. On paper it covers about 172,000 of the 210,000 eligible children. The campaign starts on 23 March and runs for six weeks. The current plan projects 80% coverage; the funder requires at least 90%, and each point is about 2,100 children. On top of that, the three hill blocks trail the urban wards by 19 points, and the funder wants that gap at 8 points or less, without another rupee.
The network has one regional store, 38 cold-chain points and 22 vehicles: 9 refrigerated vans and 13 motorcycles with cold boxes, serving 240 immunisation sessions a week across urban wards, peri-urban clusters and hill villages. Each delivery cycle can move 3,400 vial-equivalents, and no dose may spend more than four hours out of its temperature band. The vaccine comes in 10-dose vials: whatever is left in an opened vial at the end of a session is thrown away. Budgeted wastage is 8%, though it has historically climbed in thinly attended hill sessions.
All campaign logistics must fit inside ₹3.8 crore (₹38 million); an extra cycle dedicated to the remote sites costs ₹0.62 lakh (₹62,000). Cost per dose delivered, counting wastage and failed deliveries, stands at ₹180. A state review has set two alarms: a confirmed outbreak cluster, or coverage below 60% in week three, and the campaign moves to another operator. Your barcode system tracks every dose at every cold-chain point. In your team there are three explanations of where the network will break, and each one leads to a different plan.