Role and Challenges of NPHIs in COVID-19 Vaccination

As part of its COVID-19 webinar series, IANPHI hosted a webinar on April 14, 2021 on the role and challenges of national public health institutes (NPHIs) in COVID-19 vaccination. The objectives of the session were to 1) understand and compare the NPHIs role and activities regarding COVID-19 vaccination, showing the diversity and regional specificities among the IANPHI network, as well as 2) identify the common challenges encountered by the NPHIs regarding COVID-19 vaccination, and 3) show how they are facing them by sharing good practices and discussing with the IANPHI membership.

Speakers included Dr. Roee Singer, head of IHR National Focal Point and deputy director of the Division of Epidemiology at Israel's Ministry of Health, Prof. (Dr.) Tahmina Shirin, director of Bangladesh's Institute of Epidemiology Disease Control and Research, and Dr. Kim Fox, tri-lead of the Vaccine Task Force for COVID-19 Response at the U.S. Centers for Disease Control and Prevention (CDC).

The webinar was moderated by Dr. Jeffrey Koplan, co-founder of IANPHI and vice president for Global Health at Emory University and offered interpretation in French, Spanish and Portuguese thanks to funding support from U.S. CDC. After thanking the speakers and the participants, Dr. Koplan praised the valuable ability of IANPHI to offer an opportunity to leaders of NPHIs to share their experiences and learn from each other. 

Israel National COVID-19 Immunization Campaign 

Presentation by Dr. Roee Singer, Deputy Director, Division of Epidemiology, Ministry of Health, Israel

The particularities of the Israeli context, i.e. the demography and the size of the national territory, are to be considered to understand the management of the national COVID-19 immunization campaign. The campaign has been based on the existing community health system and on simple criteria for prioritizing populations to be first vaccinated. This strategy has aimed to vaccinate as rapidly as possible to reduce morbidity and mortality. To guarantee transparency to the public and to encourage the population mobilization, the national authorities have used national Electronic Medical Records (EMR), which have allowed to track progress, identify risks and manage them.

The efficiency of the campaign has moreover relied on the organization of the Israeli health system, which is centralized and well documented. To face logistics challenges due to the scale of the campaign and the specific requirements for vaccines production, transport and storage, the Israeli Ministry of Health has centralized the control and the planning of the campaign, and has based the distribution on local channels while securing a second dose for each first dose distributed. The Israeli COVID-19 immunization campaign is considered a success: as of April 11, 2021 10.2 million doses have been distributed and 5.3 million citizens have been immunized, for a population of 9.3 million inhabitants.

Bangladesh Experience in COVID-19 vaccination

Presentation by Prof. Dr. Tahmina Shirin, Director, Institute of Epidemiology Disease Control and Research (IEDCR) and National Influenza Center, Bangladesh

The COVID-19 vaccination program in Bangladesh first relies on national COVID-19 surveillance, through a national COVID-19 database, contact tracing and investigations of cases and clusters. This surveillance is the basis for regular policy advice and guidance, e.g. for the identification of priority groups. The Bangladeshi COVID-19 vaccination program was launched in January 2021. As of April 11, over 5 million first doses and around 380,000 second doses were administered. Following the beginning of the vaccination campaign, IEDCR has started to develop active and passive AEFI and AESI surveillance, through a hotline, surveillance on development of specific COVID-19 antibodies, and genomic surveillance.

The main challenges faced by IEDCR are related to the global supply shortfall of COVID-19 vaccines, the evolution of variants and the recent upsurge of cases in Bangladesh. The implementation of the vaccination campaign is also confronted to resource limitation, the difficulty to coordinate the different organizations and sectors involved in the process, and vaccine hesitancy. To address these issues, the Bangladeshi government is exploring different vaccine sources and types, while initiating the second dose campaign. Vaccine effectiveness and efficacy studies as well as enhanced genomic surveillance will also be major stakes in the coming weeks.

COVID-19 Vaccine Implementation in the United States 

Presentation by Dr. Kim Fox, Tri-Lead of the Vaccine Task Force, COVID-19 Response, U.S. Centers for Disease Control and Prevention, United States

As of April 13, 2021 more than 192 million vaccine doses have been administered in the U.S., which means that around 36% of the population received at least one dose of vaccine and 22.7% have been fully vaccinated. The vaccination program uses three authorized vaccines and its implementation is organized into five steps: 1) prioritizing populations; 2) allocation; 3) distribution; 4) administration; and 5) follow-up. This process is completed by a large set of activities, including communication, guidance and data management.

To face the challenge of the limited number of vaccines, prioritizing populations has been key. There have been three priority phases depending on age and medical conditions, before opening vaccination to the general public. Distribution and administration have followed the same strategy: the vaccines have been first administered in focused areas for priority groups, before increasing the number of administration sites to reach broader populations. A COVID-19 Vaccine Safety Strategy has also been set up and new tools have been developed to ensure safety and prevent risks. Finally, U.S. CDC has worked on a national strategy to reinforce confidence in the vaccines, by providing information and resources and engaging communities.

Sharing Good Practices: Open Discussion between IANPHI Member Institutes 

After the presentations, IANPHI members were able to ask speakers questions. Here are the highlights of the discussion.

In Israel the adverse event system used in period of vaccination against COVID-19 is the same as the one in place in regular time, as it allows to efficiently collect vaccine safety reporting from either health care providers or hospitals.

In the U.S. health authorities have recommended to pause the use of the Johnson&Johnson vaccine, while the U.S. CDC safety team is working closely with the Food and Drug Administration to investigate six cases of adverse events to provide further recommendations.

With regards to antibody titers, there are several limited-scale research programs ongoing in Israel, even though it is too soon to be able to draw conclusions at this stage.

Concerning the choice of the criteria for priority population, many countries were able to expend their scope while other are limited in their policies due to the lack of vaccine doses. In Israel, persons with higher risks were prioritized (persons over 60 and healthcare workers, particularly the ones working in long term care facilities). 

Finally, while the possibility of interchanging the brands of vaccines between first and second doses is being discussed to facilitate the vaccination process, there is no clear answer yet to this question.

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