5 Lessons to Consider For COVID-19 Vaccine Introduction
April 30th, 2020 | Viewpoint
April 30th, 2020 | Viewpoint
This World Immunization Week, the world is understandably focused on preventing the spread of the novel coronavirus and hoping that vaccines are available quickly. Meanwhile, countries must simultaneously focus on ensuring routine immunization services to their population.
As we know from immunization system delivery experience, just having a vaccine available is not a silver bullet. Even as some new vaccine introductions are being paused in light of the coronavirus pandemic, vaccine development efforts are full-speed ahead to combat the virus itself. Many steps are required to introduce a new vaccine and sustain equitable coverage in any country — including for COVID-19 vaccines.
JSI has been at the forefront in helping to control and prevent infectious disease outbreaks in many countries, including as vaccines are rolled out for urgent use. Having introduced more than 72 vaccines in 25 countries (with a focus on routine health systems while also assisting with campaigns), we have gathered lessons that are important to consider for the future COVID-19 vaccine, as Bill Gates has also emphasized.
Countries that have the ability to develop vaccines domestically may be able to accelerate manufacturing and distribution. For international markets, the process requires pre-qualification by WHO and the ability—often required through larger clinical trials—to ensure that the vaccine is effective with these different populations, environments, and epidemiologic contexts. Expedited approvals for the new vaccine should be considered, as they were for the H1N1 vaccine and other vaccines, especially considering the vulnerability of the health systems under the strain of COVID-19.
Based on experiences with rolling out newer vaccines targeting non-infant groups (such as early efforts to introduce the HPV vaccine in Madagascar and other countries), we know the importance of multi-partner committees that include representatives from immunization and infectious diseases, health surveillance units, adolescent services, education, finance, and partner organizations. In preparation for introducing a COVID-19 vaccine, convening a fully participatory, multi-sector committee will ensure that populations most at risk of contracting the disease are the first to receive the vaccine.
Communities, local leaders, and civil stakeholders, collectively referred to as “non-health stakeholders,” have an important role in supporting the national roll-out of vaccines. In addition to assisting with financial and in-kind support for services (see this example from Tanzania), these stakeholders also help to mobilize community support for and involvement in vaccination campaigns.
Major barriers to full immunization coverage in developing countries include a lack of awareness and information gaps. Many remote communities still lack access to internet, television, and even radios and smartphones. This leaves already overburdened health workers with the nearly impossible task of visiting individual households to follow up on vaccinations.
In Uganda, JSI has involved non-health stakeholders in immunization and built health personnel capacity to engage with communities. These efforts have increased financial, in-kind, and social/political support for routine immunization in more than 25 districts. Similar work will be imperative for ensuring the introduction of COVID-19 vaccines and adherence to routine immunization that will prevent the spread of outbreaks among future generations.
Local innovation is also important. Communication approaches must incorporate cultural traditions and engage communities under a common goal. Listen to the drums that are helping communities adhere to vaccination schedules in this video from India.
Delivering vaccines to communities is not easy. It often requires a stable cold chain from the factory all the way to the facility and outreach sessions conducted by health workers. Some of the COVID-19 vaccine candidates in development may require specialized cold chain equipment, which means that along with the new vaccine, parallel cold chains may need to be established to ensure its potency. This is not easy to arrange in most countries around the world, with thousands of health centers dispersed in hard-to-reach areas including mountainous regions without roads, deserts with extreme heat, dispersed islands, and areas affected by floods and irregular modes of transportation. In many places, the situation is complicated by unreliable sources of power to run refrigerators and outdated cold chain equipment.
Technology to ensure that vaccines, including the future COVID-19 vaccine, are delivered to the last mile is now available. With Nexleaf Analytics, we are installing the ColdTrace 5, a remote temperature monitoring device that alerts health workers to temperature variations that might put vaccines at risk and sends data to a dashboard for ongoing monitoring of the cold chain.
Learn more about additional supply chain considerations in this blog by immunization experts Wendy Prosser and Lora Shimp.
It is critical that sufficient time is allotted to the planning process and implementation, given the multiple stakeholders and the need for coordination among institutions that may not be actively providing health services. This includes microplanning, training and capacity building, development and dissemination of communications materials, how the vaccine will be provided in vaccination sessions, and reporting and recording vaccine-use data (linked to other data, like surveillance and disease burden). As the immediate pandemic response is demanding our attention, countries must also start planning now for the eventual roll-out of the COVID-19 vaccine.