1 of 26

COVAX Geospatial Health Community of Practice

September 29th, 2022

COVAX GIS

Working Group

2 of 26

Housekeeping

please

…keep your mic muted unless speaking

…indicate your affiliation in the zoom display name

3 of 26

Agenda

Speaker Presentation: Integrating COVID-19 vaccination into immunization programs, primary health care, and wider PHC strengthening
Audience Q&A on the programmatic guidance
Interactive Session: The role of geospatial tools in integration of COVID-19 into routine Immunization and wider PHC strengthening
Announcements: Geo-enabled microplanning handbook update

4 of 26

UNICEF & WHO

Operational Guidance

Considerations for integrating COVID-19 vaccination into immunization programmes

and Primary Health Care (PHC)

5 of 26

Speakers

Ibrahim Dadari

Immunization Specialist on the Coverage & Equity team with UNICEF Health-Immunization

UNICEF

Dr. Alba Vilajeliu

Technical Officer, Essential Programme on Immunization (EPI)

Department of Immunization, Vaccines & Biologicals (IVB)

Universal Health Coverage/Lifecourse Division

WHO

6 of 26

Purpose of this presentation

6

Content

Why integration of COVID-19 vaccination?
What are country experiences to date on integration of COVID-19 vaccination?
What are the steps and available tools to operationalize integration of COVID-19 vaccination?
Key messages

Objective

To lay out key programmatic considerations for moving from mass campaigns for COVID-19 vaccination to integrating COVID-19 vaccination into immunization programmes, PHC and other relevant health services for 2022 and beyond.

7 of 26

Where is the WHO-UNICEF operational guidance on integration of COVID-19 vaccination available?

Provides key steps & tools on how to operationalize integration

Technet21:

7

Now also in French

Considerations for integrating COVID-19 vaccination into immunization programmes and primary health care for 2022 and beyond (technet-21.org)

Éléments à prendre en considération pour intégrer la vaccination contre la COVID-19 dans les programmes de vaccination et les soins de santé primaires pour 2022 et au-delà (technet-21.org)

8 of 26

Why integration of COVID-19 vaccination into immunization programmes, PHC, and other relevant services?�

8

Epidemiological

The most likely future COVID-19 pandemic scenario will require periodic booster doses for high-risk groups

01

Sustainability

Achieving higher and sustained COVID-19 vaccination coverage will require moving from mass vaccination campaigns alone to including regular immunization services mainstreamed in PHC

Leveraging resources

Leverage existing investments and innovations towards strengthening immunization, PHC, and pandemic preparedness (and vice versa)

Life-course approach

Optimize delivery platforms across the life–course for COVID-19 vaccination and for integrated package of health services in alignment with IA2030

03

04

02

Source: WHO – UNICEF. Considerations for integrating COVID-19 vaccination into immunization programmes and primary health care for 2022 and beyond (technet-21.org). Version 1 27 July 2022.

9 of 26

What do we mean by integrating COVID-19 vaccination?

“Integration” has different meanings and is approached in varying ways. Proposed definition of integration of COVID-19 vaccination:

9

The partial or full adoption of COVID-19 vaccination into national immunization programme services, PHC and any other relevant health services with the overall aim of

improving programme efficiency and sustainability,
enhancing demand and improving user satisfaction,
achieving and maintaining satisfactory coverage,
and addressing inequities.

Source: WHO – UNICEF. Considerations for integrating COVID-19 vaccination into immunization programmes and primary health care for 2022 and beyond (technet-21.org). Version 1 27 July 2022.

10 of 26

Some form of integration is already happening in countries

10

Source: Survey conducted by WHO and UNICEF to explore current status, perceived challenges and opportunities of integration of COVID-19 vaccination and routine immunization. WHO: as of February 2022, 48 responses (5 regional offices and 41 country offices). UNICEF: as of December 2021, 54 responses (6 regional offices and 34 country offices).

11 of 26

What are country experiences on integration of COVID-19 vaccination?

11

Panama¹ – co-delivery of C-19 & influenza vaccines

Specific regions adopted the “whole family” approach which combines C-19 vaccination with healthcare services like childhood vaccination, malnutrition, and screening for NCDs

Sri Lanka²– combined delivery strategies

Routine immunization sessions provided opportunity to screen parents for C-19 booster doses and provide/motivate for vaccination
Targeted questions facilitated to identify high risk unvaccinated household individuals and get them to mobile clinics

Cambodia³ – integrating non-communicable disease (NCD) screening

A pilot provided adults over 40 with diabetes and hypertension screening while they received their C-19 vaccine

Nigeria – “whole family approach”

1. Panama. 2022 Vaccination Week of the Americas Report. June 2022.

2. WHO SEARO Regional Working Group meeting March 2022. Sri Lanka country experience on combining routine immunization sessions and COVID-19 vaccination.

3. CHAI. December 2021. https://www.clintonhealthaccess.org/integrating-early-non-communicable-disease-screening-and-counseling-with-covid-19-vaccinations-in-cambodia/

During 2022 Vaccination Week of the Americas, co-administration of C-19 & influenza vaccines for high-risk groups at health facilities and house to house

12 of 26

Digital Innovations Introduced for COVID-19 Have Broader Benefit to Routine Immunization

12

12 \| COVID-19 Integration Webinar

Jamaica: a digital health platform to manage the national COVID-19 vaccine deployment

A COVID-19 vaccine registration system (CommCare) was launched in May 2021
More than 765,260 individuals have been recorded.
Approximately 160,000 paper forms had to be entered in the digital platform and more than 1,000 healthcare workers trained in 314 vaccination sites across the island.
CommCare became a superset dashboard for visualization, with digital COVID-19 vaccine certifications rolling out in December 2021.
Thinking underway on how to maximize investments made and use of platform for routine immunization.

COVID-19 vaccine matchmaking in DRC – Using SMS to match people with vaccines

Equipping Health Workers on the Front Lines With Adaptable COVID-19 Digital Resources - Liberia, Chad, DRC, Togo + >10 more countries

13 of 26

How to operationalize integration of COVID-19 vaccination?

Proposed steps for countries to take

13

STEP 1. Initiating/building on integration

STEP 2. Planning and developing country integration plan

STEP 3. Implementation and monitoring

STEP 4. Post-integration follow-up actions

Checklist for the COVID-19 vaccine integration readiness assessment

Source: WHO – UNICEF. Considerations for integrating COVID-19 vaccination into immunization programmes and primary health care for 2022 and beyond (technet-21.org). Version 1 27 July 2022.

14 of 26

How to operationalize integration of COVID-19 vaccination?

Proposed steps for countries to take

14

STEP 1. Initiating/building on integration

STEP 2. Planning and developing country integration plan

STEP 3. Implementation and monitoring

STEP 4. Post-integration follow-up actions

Define national policy for COVID-19 vaccine booster doses with focus on high-risk groups

Identify other interventions that can be provided at the same time of COVID-19 vaccination

Establish combination of service delivery strategies

Identify key actions/short term investments (6-12 m)

Source: WHO – UNICEF. Considerations for integrating COVID-19 vaccination into immunization programmes and primary health care for 2022 and beyond (technet-21.org). Version 1 27 July 2022.

A

B

C

D

15 of 26

Define national policy: What are the latest WHO SAGE recommendations on first booster doses and additional boosters?

WHO SAGE WHO-2019-nCoV-Vaccines-SAGE-Boosters-2022.1-eng.pdf 18 August 2022.

15

Booster doses should be prioritized for higher priority-use groups before lower priority-use groups:

health workers;
older persons;
immunocompromised;
adults with comorbidities; and
pregnant women.

4–6 months since completion of the primary series

To consider a second booster dose for the following population groups:

health workers.
older persons (age specific cut-off should be defined by countries based on local COVID-19 epidemiology);
persons with moderately and severely immunocompromising conditions;
adults with comorbidities; and
pregnant women

4-6 months after the first booster dose

AGE: There is currently no recommendation for either first or second booster doses in children under the age of 12, except for children with immunocompromising conditions.
VACCINE PRODUCTS: Homologous (same vaccine platform) and heterologous (different vaccine platform) vaccines can be used for such booster doses.

For first booster doses

For second booster doses

It is likely that additional doses may be needed within 4–12 months after the second booster, especially in persons most vulnerable to severe disease and death.

Future additional doses

A

16 of 26

What other interventions can be provided at the same time as COVID-19 vaccination?�

Some ideas/examples of what could be considered

16

Covid- 19 vax and other vaccines and interventions for adults

Other vaccines:

Seasonal influenza

Other health interventions:

Medical consultation
Non-communicable disease (NCD) screening
Nutrition counseling
Malaria: bed net distribution
Neglected tropical diseases: deworming
HIV services: counseling
WASH: hygiene kit distribution
Health promotion: counseling

Routine childhood vaccination as an opportunity to provide COVID-19 vaccine to care takers

Whole-family immunization sessions

B

Source: WHO – UNICEF. Considerations for integrating COVID-19 vaccination into immunization programmes and primary health care for 2022 and beyond (technet-21.org). Version 1 27 July 2022.

17 of 26

WHO SAGE recommendations on co-administration of COVID-19 vaccines with other vaccines

17

Source: WHO SAGE Interim recommendations

Adults and adolescents

Children

COVID-19 vaccines may be given concomitantly, or any time before or after, other adult vaccines including live-attenuated, inactivated, adjuvanted, or non-adjuvanted vaccines.

WHO recommends that countries consider co-administration of COVID-19 vaccines with seasonal influenza vaccines.

Evidence from co-administration studies is currently insufficient to make a recommendation for concomitant administration with COVID-19 vaccines

A minimum interval of 14 days between administration of COVID-19 vaccines and other vaccines is recommended

18 of 26

Establish combination of service delivery strategies�

Tool: Matrix of service delivery strategies for COVID-19 vaccination – a menu for countries to apply based on context:

18

Routine mode

Fixed site 🡪family practitioner /health centre/ pharmacy/ NCD clinics/ HIV & TB clinics/ ANC clinics
Outreach 🡪 MCH outreach / long-term facilities/nursing homes/home visits

Campaign mode

Temporary fixed site 🡪dedicated C-19 vax centre or post
Mobile teams 🡪 parks-markets-workplaces/refugee camps-transit points-border checks/home visits
Mass vaccination

Implications represented by a scale (0=no implication; +=lower; +++=higher)

Source: WHO – UNICEF. Considerations for integrating COVID-19 vaccination into immunization programmes and primary health care for 2022 and beyond (technet-21.org). Version 1 27 July 2022.

C

19 of 26

What are areas for key actions/short terms investments (6-12 months)?��

19

Source: WHO – UNICEF. Considerations for integrating COVID-19 vaccination into immunization programmes and primary health care for 2022 and beyond (technet-21.org). Version 1 27 July 2022.

D

20 of 26

Key messages

20

Now, it is time to plan for sustainable COVID-19 vaccination. Importance to:

Involve relevant programmes beyond NIP (NCDs, PHC, MNCH, etc)
Leverage COVID-19 vaccine innovations, including geospatial solutions, to strengthen immunization and health system.

As countries begin or build-on integration, colleagues in WHO & UNICEF Regional and Country Offices will be available to provide support and guidance.
This is an opportunity to turn “life course immunization”, one of the IA2030 strategic priorities, into reality in many countries that to date had sub-optimal adult vaccination programmes.

21 of 26

Thank you

21

22 of 26

Q&A

please

…keep your mic muted unless speaking

…state your name and organization when intervening

23 of 26

Interactive session

The role of geospatial tools in the integration of COVID-19 into routine immunization and wider PHC strengthening

24 of 26

Announcements

Geo-enabled Microplanning Handbook

25 of 26

Geo-enabled Microplanning Handbook

The Geo-enabled Microplanning Handbook is a practical, step-by-step guide to integrating geospatial data and technologies into a microplan

Collaboratively written by 113 experts over the course of the past year
In addition to new material, the handbook pulls from key source documentation, such as that from WHO IVB, UNICEF, Gavi, Health Enabled and the Health GeoLab Collaborative.
Funded by the Bill and Melinda Gates Foundation and the World Health Organization and coordinated by the COVAX Core Partners
Publishing forthcoming 2022, along with an accompanying e-Learning course.

Many of you may already know or have been involved in the writing and reviewing of the Geo-enabled Microplanning Handbook. For a little background for those who aren’t aware:

Microplanning is a set of decision-making steps and tools to ensure that health services reach every community. They are used to identify priority communities, address barriers to access and utilization, and to develop workplans with innovative, sustainable solutions. Microplans are characterized by the use of data locally (district and health facility level) and are minutely detailed, in contrast to traditional national health plans (macroplans).
Geo-enablement of a microplan is the process of integrating geospatial data and technologies into the microplanning process. This process is not always simple and straightforward; The appropriate supporting environment, data and information, technology, capacity and financial resources must be available across different levels to be successful.

The Geo-enabled Microplanning Handbook was initiated by the COVAX GIS WG a little over a year ago with the objective to document and fill those knowledge gaps by using a crowd-sourced, step-by-step approach and documenting use cases and lessons learned from geo-enabled microplans in recent years. The Handbook is a practical guide to integrating geospatial data and technologies into a microplan. It is a crowd-sourced effort, written by 113 individuals over the course of the past year, facilitated by the COVAX Core Partners, and funded by BMGF and WHO and coordinated by the COVAX Core Partners.

In addition to new material, the handbook pulls from key source documentation, such as that from WHO IVB, UNICEF, Gavi, Health Enabled and the Health GeoLab Collaborative.

We will be publishing the handbook and releasing an accompanying eLearning course in the coming months via a public launch. Please stay tuned and be sure to reach out if you have any questions.

26 of 26

Thank you!

One column slide