India is set to chart pathways and lead by example with PM Modi’s recent inauguration of the vision “One Health for All”. It focuses on the intersection of climate change and health. The science is clear—a recently released IPCC synthesis report
warns that with every increment of delayed climate action, the gap to stay within 2 degrees Celsius of pre-Industrial temperatures is widening and its multitude of impacts on humans are becoming more severe. However, what is even more concerning is that the healthcare system itself, which majorly relies on the medical cold chain, has significant potential to increase global warming due to its massive energy demands and powerful fluorinated greenhouse gas emissions. According to the Global Road Map for Health Care Decarbonization
, Green Paper One, India has the seventh-largest absolute health sector climate footprint in the world (39 Mt CO2e). Greening solutions of the medical cold chain provide, therefore, a new and urgent impetus to accelerate progress towards net zero and to build a health system that is resilient to uncertain climate disruptions.
The cold chain infrastructure is a temperature-controlled storage and transportation network, which comprises deep freezers, ice-lined refrigerators, carriers, refrigerated vans, and similar equipment. This chain ensures that medical supplies are stored and transported within the prescribed temperature range from manufacture until administration. India’s expansion as the global hub of healthcare with its market size for pharmaceuticals expected to reach US$130 billion by 2030
will lead to a sizeable increase in energy demand. The amount of cooling required in refrigerants to transport medical supplies will grow significantly, while capacities to meet such demand continue to be based on unreliable fossil fuel-centric electricity grids, harmful chemicals, and expensive diesel-powered generators.
According to the Global Road Map for Health Care Decarbonization, Green Paper One, India has the seventh-largest absolute health sector climate footprint in the world (39 Mt CO2e).
As a country committed to reducing its emission intensity by 45 percent by 2030 and achieving net zero by 2070, developing green and sustainable cold-chain solutions is not an option but an imperative. But, how can India lead in providing a template for the development of a low-carbon medical cold chain? This Environment Day, India can focus on adopting an actionable framework that will ensure the creation of an agile, green and resilient medical supply chain for tomorrow.
Amongst the seamless distribution of medical supplies, refrigerated transport plays a crucial role. These reefers or trucks carry Transport Refrigeration Units (TRU) that are powered by integrated diesel-fuelled motors/ engines, to maintain the prescribed temperature range for vaccines while being transported. According to a report by Dearman
, conventional TRUs consume up to 20 percent of the truck’s fuel and emit high levels of air pollution—29 times as much particulate matter (PM) and six times as much nitrogen oxide (NOx) as a modern diesel HGV engine
. Moreover, leaks of TRU refrigerant gases have a grossly disproportionate impact on greenhouse gas emissions. The most commonly used ‘F-gas’ is almost 4,000 ti
mes more potent than CO2
. In addition, India’s transport sector emits the third highest greenhouse gases across sectors. In the absence of a cleaner alternative, the paradigm shift towards a greener future is bleak. An effective way to transition and ensure greater environmental sustainability is replacing each diesel-powered TRU with sustainable, green/clean cooling technologies. Adapting liquid nitrogen evaporation or cryogen-based systems will not only ensure zero-emission cold transport services but offer a cleantech-based ‘sustainable’ model for cold chain infrastructure.
Electric vehicles (EVs) are increasingly being introduced in urban freight or last-mile delivery services in Indian cities. An ideal alternative for the distribution of medical supplies within close range would be substituting insulated vans with small EVs with battery-powered refrigeration units that have zero tailpipe emissions, are fossil-fuel-free, and have higher energy efficiency. According to a study conducted by The Energy and Resources Institute (TERI) in association with Shakti
Sustainable Energy Foundation (SSEF) in 2020, higher EV penetration in the small commercial vehicle segment can lead to up to 14 percent reduction in CO2 emissions by 2030.
An ideal alternative for the distribution of medical supplies within close range would be substituting insulated vans with small EVs with battery-powered refrigeration units that have zero tailpipe emissions, are fossil-fuel-free, and have higher energy efficiency.
Besides refrigerated transportation, the cold storage of vaccines poses another critical challenge. Vaccine storages use refrigerants, such as hydrofluorocarbons (HFCs) like R134a, R404a, and R407c, that have high global warming potential (GWP). HFCs are far more potent than CO2
as greenhouse gases. As the need for refrigeration expands, replacing conventional refrigerants—based on greenhouse gases with high global warming potential—and transitioning to more climate-friendly refrigerants across the stationary and mobile cold chain will play a critical role in minimising the carbon footprint.
Emerging best practices in the sector will support this effective, seamless transition. As a case in point, B Medical Systems (BMS), one of the world’s leading manufacturers of medical refrigerants are pioneering this solution through their innovation. BMS’s medical refrigerators help maintain the optimum temperature range down to -86℃, which could maintain the temperature to preserve medical supplies, despite intermittent power outages. In the event of power outages, this refrigerator retains its temperature for as long as two days. In regions without electricity supply, the equipment can be teamed with solar power to deliver the same result. Made in India, these refrigerants use eco-friendly hydrocarbon-based refrigerants to deliver maximum energy efficiency. Scaling up such impact ventures would lead to policy measures ensuring greater uptake of sustainable devices. Prioritising natural refrigerants will result in direct emissions savings of 50 million tonnes of CO2e per year by 2030 in India. This accounts for more than 50 percent of the current emissions from HFC use
Moreover, as India is committed to the Montreal Protocol’s Kigali Amendment, to lower consumption and production of HFCs with high global warming potential (GWP) and curtailing national HFC emissions by 85 per cent by 2047, an immediate shift to naturally viable substitutes in refrigerants is a necessity.
Prioritising natural refrigerants will result in direct emissions savings of 50 million tonnes of CO2e per year by 2030 in India. This accounts for more than 50 percent of the current emissions from HFC use.
Lastly, the need for a cold-chain development-specific policy focusing on research and development (R&D) and promoting the use of alternate technology is well realised. For a country like India playing a powerful role in development cooperation in healthcare, it is essential to link the R&D sector with the refrigeration sector to lead through the best innovations. While private sector players like BMS have just started their R&D infrastructure and capabilities to drive independent research, the government should support such initiatives as part of sustainability initiatives and provide them with additional incentives.
Transitions to cleaner, greener alternatives are expensive. But the government’s intervention in developing a much more robust vision for clean refrigerants, while supporting and identifying the actions and innovations required to make technologies financeable and implementable will go a long way in their adoption and aid a successful transition away from conventional means.
In its leadership in medical innovation and manufacturing, India must set a template for the world on how to make medical distribution and supplies more sustainable. As the world's largest vaccine manufacturer, India has a significant role to play in ensuring that vaccines are accessible to all while also mitigating the carbon emissions associated with vaccine production and distribution. By implementing sustainable practices in the cold chain and adopting green supply-chain management strategies, India can lead the way in promoting a more environmentally responsible approach to global healthcare.
Aparna Roy is a Fellow and Lead, Climate Change and Energy, with the Centre for New Economic Diplomacy (CNED) at the Observer Research Foundation.
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