Brazzaville, 28 January 2021 – As African countries gear up for the rollout of COVID-19 vaccines, it is crucial to lay a strong groundwork for what will be the continent’s largest-ever immunization campaign. The World Health Organization (WHO), UNICEF and Gavi, the Vaccine Alliance, are working with countries to shore up readiness using a 10-point assessment tool that include the following aspects:
Planning and coordination
WHO recommends that all countries set up a National Immunization Technical Advisory Group to provide the Ministry of Health with scientific guidance and recommendations for the vaccine introduction. WHO also recommends the establishment of coordination structures to develop and monitor vaccine delivery timelines, identify priority groups to be targeted first with the limited number of doses initially available based on contextualised epidemiological data. Countries must also develop national vaccination plans to guide implementation and the basis upon which vaccines are allocated.
Resources and funding
Countries need to estimate the human and financial resources required to roll out the COVID-19 vaccine. While the COVAX Facility will provide most African countries with 20% of the doses they need for the initial priority populations, this does not include the cost of deploying the vaccine. Additional resources are needed for transportation, cold chain, training of health staff/vaccinators and creating demand for the vaccine. Costs vary for every country depending on many factors, including geography, distances to cover, the number of health workers and type of vaccine used.
Countries need to ensure that they have the regulatory pathways in place to quickly assess and authorize emergency use or issue licenses for a vaccine, while securing the necessary approvals and emergency waivers for quick importation. There should be senior authorizing staff to ensure that all paperwork is in order two weeks before vaccines are shipped to avoid delays at ports of entry and potentially losing their potency if they leave the cold chain.
Using the guidelines set by a country’s technical advisory group, the category of people to be given priority vaccination are identified to establish how many vaccine doses the country will require. The Strategic Advisory Group of Experts on Immunization recommended the prioritization of frontline health workers, older people and adults with comorbidities. However, countries make their final decisions depending on their epidemiological evidence.
Once the target groups have been identified, the country decides on the vaccine delivery strategies to reach them wherever they are. Traditional strategies use health facilities or outreach sites to vaccinate people, other methods see vaccinators carry out house-to-house visits. Planning on how to deliver the vaccine helps vaccinators find people and ensure they receive the necessary dose. Due to COVID-19, all vaccinators should have personal protective equipment, carry hand sanitizers and organize vaccination sessions that avoid crowding to limit transmission of the virus.
Training and supervision
Training a health workforce to safely deliver vaccines means identifying training needs, developing training materials and finding the right platforms to train staff. Due to COVID-19, most trainings now need to be delivered virtually. WHO has developed several COVID-19 vaccination training materials for health workers. The training covers the basics of vaccines, handling, looking out for any adverse events following immunization, waste management and disposal, communicating with communities, among others. Once vaccination starts, health ministry staff and partners provide supportive supervision to vaccinators, identifying and demonstrating best practices.
Monitoring & evaluation
To monitor vaccine uptake, countries need to develop monitoring and data collection tools. Monitoring tools include personal health cards, vaccine forms and registers which helps to track doses, estimate coverage and manage stocks. Data collection help to inform evaluation of the vaccination programme, whether all the doses were delivered and the impact of the vaccine.
Vaccine cold chain and logistics
All vaccines must be kept refrigerated, and some COVID-19 vaccines will require ultra-cold chain refrigeration. Countries need to assess and plan along the full cold chain distribution at all levels from the moment the vaccine arrives at the port of entry, transport to national storage facilities, to district level, health facilities and eventually to the service delivery point into the recipient’s arm. Maintaining a cold chain means planning down to the last detail.
Safety and surveillance
No matter which vaccine is delivered, countries must have systems in place to detect any adverse reactions or events following vaccination. The system must allow for any side effects to be quickly identified, properly logged and managed in the community or health facility and reported directly to the manufacturer to determine if the event is related to the vaccine. The system must also be prepared to treat any potential side effect that may be reported from the vaccine.
Demand generation and communication
Countries need to prepare and implement demand generation strategies that provide clear and accessible information on vaccines to help build confidence and trust in the vaccine, paving the way for demand and desire to receive it. No vaccine is mandatory, yet people should know it is available and where to find it so that no vaccine is wasted. At the same time, high levels of misinformation and disinformation circulating around COVID-19 vaccines mean countries should also prepare risk communications approaches that counter false information. Risk communication also prepares teams to communicate immediately to the highest level in the event of a potential adverse event to keep people’s confidence in the vaccine.