Dear TechNet members, please find below a link to a new WHO-UNICEF publication related to the ongoing COVID-19 pandemic that you may find useful.
Immunization in the context of the COVID-19 pandemic: FAQs
https://apps.who.int/iris/handle/10665/331818
The document will be translated and the links for alternative languages shared as soon as available. As the COVID-19 pandemic evolves, the FAQ will be revised as necessary.
These FAQs accompany the following WHO publication:
Guiding principles for immunization activities during the COVID-19 pandemic
https://apps.who.int/iris/handle/10665/331590
The FAQs are organised in four categories, as follows.
Immunization services
- Should newborn vaccination programmes continue as planned during the COVID-19 pandemic?
- Is adult vaccination recommended during the COVID-19 pandemic?
- Should school-based vaccination be continued as planned during the COVID-19 pandemic?
- Are there measures that countries can take to protect immunization providers from the COVID-19 virus?
- Are there ways to organize the immunization service site to minimize the risk of COVID-19 virus transmission?
- Can a person with COVID-19 (confirmed or suspected) infection be vaccinated?
- Can a person exposed to a COVID-19 case be vaccinated (a contact)?
- If immunization services are suspended or reduced, will countries need to conduct catch-up immunization activities?
- During the COVID-19 pandemic, are there activities that can be undertaken to preserve community acceptance of vaccines?
- If immunization services are suspended or reduced, what should be communicated to concerned parents who are worried about their children missing vaccine doses?
- If immunization services are suspended, when can immunization activities resume?
Vaccine-preventable disease surveillance
- Should surveillance for VPDs continue during the COVID-19 pandemic?
- What changes to VPD surveillance are recommended if the COVID-19 pandemic does not allow for existing VPD surveillance systems to continue as normal?
- How can continuity of laboratory-based surveillance for VPDs be ensured?
- How can COVID-19 surveillance be integrated with existing VPD surveillance?
- Should community-based surveillance be continued?
Cold chain and supplies
- What can be done to prevent vaccine stock out during and after the COVID-19 pandemic period?
- What actions can be taken to ensure availability of vaccines and related supplies for routine immunization programme at all levels?
- Can COVID-19 test kits, reagents and lab supplies be stored in vaccine cold chain?
- How can countries assess their cold chain system surge capacity?
- Are there ways to minimize burden on the cold chain storage during the COVID-19 pandemic?
Miscellaneous
- Should other activities such as immunization trainings and coverage surveys continue?
- Should new vaccine introductions continue?
- Should verification exercises of measles-rubella elimination continue during the COVID-19 pandemic?
- Should MNTE assessments continue during the COVID-19 pandemic (e.g., pre-validation assessments, validation surveys and post-validation assessments)?
- Are there vaccines that are recommended for health care workers in the context of COVID-19?
- Is there a vaccine against COVID-19?
Thank you for these resources from Ann. I realize that there are still so many unknowns about the characteristics of any future COVID-19 vaccine including, among many other things, the number of doses required per person, thermostability, cold chain volume per dose, uniformity of dose size irrespective of age (e.g., 0.5 ml for everyone?), liquid or lyophilized, duration of immunity, possible need for re-vaccination, whether immunity acquired from vaccination will be fast enough to protect people possibly exposed at crowded vaccination sites, etc.
However, we can already assume that everyone in the entire country will need to be vaccinated. EPI has no experience operating at that scale. So, while waiting for a COVID-19 vaccine to be developed, manufactured and distributed, I think each country should begin preparing now by identifying strategies for mass vaccination of their entire population and surge requirements likely to be needed. For example, if Egypt were to vaccinate every person in its entire population with one injection using single-use syringes, the number and volume of syringes to be distributed, used, safely collected and destroyed would be enormous. To help visualize the challenge, the syringes -- laid end to end -- would stretch from Cairo all the way to Johannesburg and half-way back again to Cairo!
Ministries of Health can already start thinking about the criteria (and how) to phase in a nationwide vaccination campaign (while possibly also implementing physical distancing), in case human resources and other systems supports are unlikely to be sufficient for vaccination everywhere at the same time. How will they prevent “leakage” to the black market? How will they keep track of individuals who get vaccinated, so that people do not try to return for extra unneeded doses on the assumption that “if one shot is good, two must be better”. How will they manage expectations, crowds, consistent and transparent communications? The list goes on. Amidst the current urgency of other preventive measures, patient care, and health worker safety, what will it take to get started with planning to be ready for nationwide mass vaccination of all age groups in each country?
Robert Steinglass
(retired, former Director, Immunization Center, JSI)
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