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��Leveraging the learnings from Covid-19 vaccination for Routine Immunization

  • Dr Pradeep Haldar
  • Strategic Advisor - JSI

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    • Covid-19 vaccination coverage
    • Early action and response
    • Governance and coordination mechanism
    • Prioritization for vaccine administration
    • Operational Guidelines and capacity building
    • Streamlining supply chain
    • CoWIN and its attributes
    • Demand generation and community engagement
    • Covid-19 vaccination assets

Outline

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COVID-19 VACCINATION COVERAGE

More than 219.95 crore total doses administered by Nov 22

Eligible Population

12-14 years

Doses Administered

1st dose

41.3 million

(88%)

2nd dose

32.5 million

(69%)

Eligible Population

15-18 years

1st dose

62.0 million

(84%)

2nd dose

53.4 million

(72%)

Eligible Population

18 years and above

1st dose

922.1 million

(98%)

2nd dose

864.7 million

(92%)

COVID-19 vaccine is made available free of cost for all citizens of the country aged 12 years and above, irrespective of their socio-economic status, at all Government COVID-19 Vaccination Centres (CVCs). In addition this vaccine is also available in the private market in order to address to access to entire country.

Data Source – Co-WIN as of Nov 2022

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Early action and response

30 Jan20 India's first Case reported

19 April 2020 GOI sets up a high level task force for COVID-19 vaccine development

5 May 2020 PM Chairs a meeting of task force

30 June 2020 Covaxin approved for Phase I & II human clinical trials

Oxford University-Astra Zeneca COVID-19 vaccine (Covishield) approved for phase II + III clinical trials in India

29 November 2020 GOI announces third stimulus package of Rs. 900 crores for the Mission COVID Suraksha- The Indian COVID-19 Vaccine Development Mission

1 January 2021 Covishield approved for restricted use in emergency situations

2 January 2021 Covaxin approved for restricted use in emergency situations

Initiated the preparedness of Health System to respond to all aspect of COVID-19 Management

National Expert Group on Vaccine Administration for COVID-19 (NEGVAC), constituted in August 2020, to formulate comprehensive action plan for vaccine administration

Trail runs for conducting Vaccination as per guidelines and use of CoWIN carried out

Operational guideline of Covid-19 vaccination was issued in December 2020.

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5

Block

Control Room (BCR)

State Control Room (SCR)

District / Municipal

Control Room (DCR)

State Level

District Level

Block Level

NEGVAC

National Expert Group on Vaccine Administration for COVID-19

Urban Task Force (UTF)

Chair: Municipal Commissioner

State Steering Committee (SSC)

(Chair: Chief Secretary)

District Task Force (DTF)

(Chair: District Collectors)

Block Task Force (BTF)

(Chair: SDM/ Tehsildar/ BDO)

State Task Force (STF)

(Chair: Principal Secretary Health)

Role of government departments, partners, professional organizations and other stake holders defined

Governance and Coordination Mechanism

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Prioritization for Vaccine Administration by NEGVAC – based on Scientific Evidence & Global Best Practices

Vaccination for lactating mothers approved on 19th May, 2021 and of pregnant women on 2nd July, 2021

16th Jan 2021

1st Mar 2021

1st May 2021

2nd Feb 2021

21st June 2021

10th Jan 2022

3rd Jan 2022

Health Care

Workers

Aged ≥60 years & �45 – 59 years with identified 20 co-morbidities

Persons aged 18 years & above (In Pvt sector/ State’s prioritization)

Adolescents aged 15-18

Phase 1

Phase 4

Phase 2

Phase 3

Phase 5

Front Line

Workers

All persons aged ≥ 45 years

1st Apr 2021

Free vaccination to all persons aged 18 years & above

Precaution doses for HCW, FLW and 60yrs+ population with Co-morbidities

16th Mar 2022

Phase 6

Children aged 12 to 14 years

&

Precaution dose for all persons aged ≥60 years

Phase 7

10th Apr 2022

Free Precaution dose for all persons aged ≥18 years at Govt. CVCs

Free Precaution dose for all persons aged ≥ 60 years

(paid for 18-59yrs in Pvt CVCs)

15th Jul 2022

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Operational Guidelines shared with States/UTs

Capacity building for Covid-19 vaccination

  • National ToT for states/UTs held virtually
  • All State trainings - - 7,600 programme
  • District trainings conducted- - 62,000 participants
  • 2,60,000 vaccinators, vaccination team members and mobilizers trained
  • Continuous Refresher trainings conducted
  • Orientation of the other ministries like Urban affairs, Defense etc
  • CoWIN Training

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Streamlining supply chain

Equitable distribution

Initially on demand, later on rate of vaccination and target population

Daily review with vaccine manufacturer

Reducing dead stock at every level including manufacturer

Batch wise Supply Schedule with advance visibility for one month

Supplies made to states almost every day.

From December 2021 supplies made only on demand by State/UTs

Principles of Covid-19 vaccine Supply Chain

WHERE ARE MY VACCINES ?

ARE THEY STORED IN ADEQUATE QUANTITIES ?

ARE THEY STORED AT

RECOMMENDED TEMPERATURES ?

Smartphone App

Online Dashboard

Temperature Logger

Easy-to-use mobile app

for recording vaccine data

Web interface for

real-time visibility

Temperature loggers for accurate remote

temperature monitoring in real time

3 Critical Questions for Vaccine Supply Chain

Pre-empting the need, eVIN expanded from 24 to 36 States/UTs

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Phases of Covid Vaccine supply

Supplies to State/UTs on demand

  • Demand > availability
  • Supplies to States/UTs on target population & coverage (to prevent stock piling)
  • One month advance batchwise supply schedule visibility to States/UTs
  • Short self life

Demand > production per month

Demand < production per month

Stock piling by States/UTs as supplies > utilisation

Production per month

Covishield 25-30 crore

Covaxine 5-6 crore

Production per month

Covishield 1 crore

Covaxine 0.25 crore

Production increase over period. Also more covid vaccine type added to pool

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Consistent Efforts Achieving Major Milestones

9 months

9 months

> 2.5 crore doses administered in a day on 17th Sept’21

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Learnings from Covid-19 vaccination to RI

To capitalize on COVID-19 vaccination investments, innovations, and new tools to strengthen and re-imagine routine immunization

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I. CoWIN : THE DIGITAL BACKBONE FOR THE COVID-19 VACCINATION PROGRAM

Leveraging CoWIN for RI strengthening

Equitable and Inclusive

Single Source of Truth

Evolvability and Scalability

Feedback and Analysis

Citizen centric

Open and interoperable

KEY ATTRIBUTES OF CoWIN

  • An open-source, multilingual application ecosystem that allows administrators to manage and update vaccine status along with inventory databases, while enabling recipients to book vaccine appointments.
    • Citizen-centric model
    • Minimal data needed from registration
    • Optimizes resource utilization
    • Captures each step of the vaccination process
    • Maximizes efficiency
    • Ensures each person has access to COVID-19 vaccines

The platform is currently in the progress of being leveraged for routine immunization

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Key take away from CoWIN

Existing database

Age and sex-wise database: Esp. useful for new vaccine introduction like for HPV (9-14y girls)

Co-WIN already has a database of 12-14y girls, only 9-11y database needs to be updated

Healthcare professionals and health facilities

Citizen centric model

Blended Registration and Convenience in Slot Booking

Track Vaccination Schedule

Instant Digital Certificate

Advisories for a People-Centric Vaccination Programme

  • Vaccination of Pregnant & Lactating Women
  • Work-place CVCs
  • Near to Home CVCs for Elderly & Differently-abled
  • Priority vaccination of School Teachers & Staff
  • Vaccination of Vulnerable Groups: Persons w/o Identity cards, Prisoners, Transgender, Differently-abled, destitutes, Vagabonds
  • Reduction in the minimum period for 2nd dose vaccination (Covishield) and precaution dose administration for International Travel, Education, Employment, Sports
  • Vaccination of Foreign Nationals

Digitally Signed

Single Source of Truth

Offline-Verifiable

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Key take away from CoWIN

Tackling digital divide and low internet connectivity

-Self registration and Toll-free helpline no. to book appointment

-Linkages with different platforms

-HWs can upload in real time as well as with flexibility in low network areas

Uniform access across private and public, fixed or mobile

-Vaccine Stock Management and equitable consumption

-Realtime Dashboards

Coverage, maps etc

-Robust System

handles a

billion+ visits daily

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CoWIN dashboard and data visualization

Features provided by Dashboard

  • Live Vaccinations Centres
  • # of Citizens Registered
  • # of Vaccine doses Administered
  • Split b/w 1st & 2nd Dose
  • AEFI reports
  • Distribution by States & District
  • Split by Age and Gender
  • Split by Vaccines brands

Accessible by all

Policy Makers

State & District Administrators

All Citizens and foreign entities

Hospitals

Vaccinators

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II. Demand generation and community engagement

Strengthening partnerships and engagement of trusted community representatives and community-based networks for demand generation and uptake

Helpline number 181,Chhattisgarh

AIIMS Bhatinda,

Punjab

Border Security Force, Punjab

Camel cart –

Rajasthan

Tea Gardens,

Assam

Boat for

awareness

Mobile Vaccination Units – Vaccine Express

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Influencer Engagement

Vaccination of Madrasa students in Asia’s biggest Masjid, compound, Bhopal

Facilitating vaccination of “person with disability” by volunteer of Pingalwada Ashram, Punjab

Partnership with Missionaries of charity for vaccination, Madurai, Tamil Nadu

Faith-Based Leader engaged for vaccination, Assam

Engagement of faith-based organizations, religious groups and community influencers for mobilization to address vaccines hesitancy and build community trust in COVID-19 Vaccination

II. Demand generation and community engagement

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Collaboration with a religious organization in Madhya Pradesh

Transgender vaccination in Tamil Nadu with help of local community group

Vaccination of Salt Pan workers in Tamil Nadu

Senior Citizens – Self Help Groups

Children engagement

Community-driven engagement

Active engagement with members from within communities for generating awareness about COVID-19 Vaccination

II. Demand generation and community engagement

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III. Opportunity to leverage various assets for RI

Just prior to Covid-19 vaccination introduction, Pan India scale up of e-VIN from 24 to all 36 States/UTs

Strengthening cold chain space to handle volume of Covid-19 vaccines over and above RI vaccines

Connectivity of remotest areas and hard-to-reach areas to health infrastructure

Augmented workforce e.g.: staff nurses from medical colleges was used and can may be leveraged for future exigency also

Implementation of SoPs for supply chain

-Demand-based or consumption-based supplies

Integration of SAFE-VAC with CoWIN for AEFI reporting

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III. Opportunity to leverage various assets for RI

Strengthened governance model for citizen centric policies

Quick and continuous updation of guidelines based on emerging evidence

Intersectoral convergence with ‘other’ 19 Ministries

Capacitated Health workers for blended modality of training (offline + online) of learning

Alternate vaccine delivery in hard-to-reach and inaccessible terrain

(e.g. drones tested in 2 states)

Better informed community on importance of vaccination

Partnerships beyond traditional partners

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Thank you