Dear Technet community,
Hope you’re well.
I’d like to share a short article I wrote (published on May 15) making the case to immediately start planning for COVID-19 immunization delivery and suggesting activities to focus on now. The article focuses on India, but the core points and suggestions for what we could do now to start planning should apply across countries.
I’d love your thoughts and feedback on the article: https://www.hindustantimes.com/analysis/a-covid-19-vaccine-will-be-found-plan-for-its-delivery/story-guxbzBcIvG02mypZOKNV5K.html
I would love it if you engaged in a discussion with me about the points in the article or shared your feedback and comments. You can do so
- on LinkedIn here: https://www.linkedin.com/posts/sidharth-rupani-54b5a71_covid-vaccineswork-immunization-activity-6667321726751293440-zmQn
- or on Twitter here: https://twitter.com/sidrup/status/1261505385917079553?s=20
Importantly, I’d also love to explore your feedback to a common reaction I received. I paraphrase the reaction below.
"It is too early to plan for vaccine scale-up and delivery. We have not yet managed to control the spread of the virus and urgently need to focus on improving test-trace-isolate. Alongside that we have other urgent economic recovery matters (surge of unemployment, breakdown of several sectors of the economy…). Making future plans for vaccine delivery would dilute attention from things needing attention urgently."
What are your thoughts?
LinkedIn Polls:
- Do you think it is too early to plan for COVID-19 vaccine delivery?
- Do you think focusing on vaccine delivery now would prevent us making progress on the other urgent matters that need attention?
Thanks very much!
Best,
Sidharth Rupani
Director - Global Impact Team, LLamasoft, Inc.
[email protected]
Dear Sidharth,
Because my comment on TechNet dated around 25 April was placed under a different category ("Immunization in the context of COVID-19 pandemic: frequently asked questions (FAQ) (Reply)”, I am adding my comment verbatim below so it "lives" within this current chain, as I think it is pertinent to the issues you have raised so well. I agree entirely with you that the time to start planning, even in the midst of so many unknowns, is now. Otherwise, we will be caught flat-footed when a vaccine finally is available. I would only add that I think participation in a Vaccination Task Force needs to include perspectives beyond those of logisticians alone, although I do not think you were suggesting that.
"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)
Sid,
So great to see your article in the Hindustantimes and all the comments circulating on LinkedIn. Thank you for sharing here and starting the conversation with the community. I wholeheartedly agree with you that the time to start planning is now - for a COVID vaccine introduction, for COVID therapeutics introduction, and for the surge in routine vaccines needed for catching up on the services being missed in the interim. We're starting to see this planning take place in a number of countries where we work, which is great.
I've also seen a lot of wonderful commentary on plans for equitable access to COVID vaccines, largely centered around ensuring that all countries will have access regardingless of their income status. My concern is that populations within countries who were already being left behind will continue to be left behind if we do not include an equity lens in the downstream distribution plans as well. As we advocate for - and in many cases participate in - supply chain planning now, let's make sure those plans include strategies for reaching populations who are currently left behind. From remote rural settings, to migrant populations, conflict settings and urban poor environments. For exmaple, in the very likely scenario that vaccination strategies will first prioritize health workers, supply chain plans need to include reaching the health workers serving the underserved populations. This may sound obvious but given that many community health workers were not included in official workforce counts, they were not consistently included in forecasts and quantifications for PPE.
From a supply chain perspective, the effort to ensure equitable access will take tremendous collaboration and coordination. And it really starts with all of us working together. We can start globally to ensure that last mile delivery needs are part of the advance market commitments on selection and production and we can carry our collaboration through to the distribution plans and strategies at the country level and to the last mile.
Jessica M Crawford | [email protected]
Director, Global Technical Team
VillageReach Starting at the Last Mile
Thank you so much for sharing this valuable perspective, Robert.
I’m very pleased you’ve responded with a detailed comment, because I’ve been telling people your line (with attribution) “Vaccines don’t deliver themselves!”.
You’ve raised many good detailed examples of aspects governments can start preparing for now.
Thanks for the contribution to the discussion!
Jessica,
Thank you so much for your valuable comments.
I agree with you on the importance of an equity lens in planning access. Your example of planning vaccine access for Community Health Workers in early tranches of the vaccine is an excellent one.
Thanks so much!
Best,
Sid
Dear Sidharth,
I am very concerned about all aspect of commentaries led. I can also say that I agree all aspect shown by Robert. I would like to integrate one aspect of things: the communication aspect.
As you know, resistance to the vaccination activities is increasing, moreover with the COVID-19 reality, and we can see protests all around the continent. So a communication strategy must be held in order to reduce resistance against COVID-19 vaccines. I can remember lastly, the head of the COVID-19 riposte in the country when he spoke about the disposition of country to be part of the COVID-19 experiment process. There were protests in the entire country.
I suggest to find out how to communicate goodly in the country or at the sub-national or operational level. What mechanism to integrate in the system in order to reduce immunization barriers at all levels and prioritize strategies to avoid misleading.
Richard Tongo N.
MPH-Epidemiology
Independent Consultant / DRC
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