Vaccines shall be delivered by the federal government to the provincial governments, who in turn will distribute these among district health administrations
COVAX facility is not the name of a Covid-19 vaccine, as might be perceived from the word. It is, in fact, the abbreviated form of Covid-19 Global Vaccines Access facility (COVAX facility). This facility focuses on provision of innovative and equitable access to Covid-19 vaccination across the globe. COVAX is coordinated by the GAVI, the CEPI (Coalition for Epidemic Preparedness Innovations) and the WHO (World Health Organisation). GAVI, leading the COVAX facility, is the Global Alliance for Vaccines and Immunisations, founded by the Bill & Melinda Gates Foundation, the UNICEF, the WHO and the World Bank Group.
Initially, the COVAX is aiming to secure 2 billion doses of the Covid-19 vaccines and make those available by the end of 2021 for countries that are part of the COVAX facility. The government of Pakistan took part in the COVAX application process and Pakistan is expected to receive sizeable support from this facility. The government plans to immunise at least 30 percent of the population (approximately 62.3 million individuals) at highest risk for Covid-19. The COVAX facility is expected to cover approximately 45.5 million individuals (20 percent of the population). The remaining 15 million individuals amongst the prioritised 30 percent population shall be covered by government’s own funding and through other donors. Recently, the Chinese government has donated half a million Sinopharm vaccine doses to Pakistan. The first batch of 17 million doses of the vaccine from GAVI is expected in a few weeks. This will be the vaccine manufactured by Astra-Zeneca.
The first priority group, which has started receiving the vaccine at the time of this writing, is the Frontline Healthcare Worker. This includes the staff working at hospitals dealing directly with Covid-19 patients. The second priority group is other healthcare staff. This includes, non-Covid hospital staff, public health staff, laboratory staff, and the vaccinators involved. The third priority group is the general population, except children under the age of 18 years and pregnant women. A question commonly asked, about the third group, is that why the elderly (in case of some vaccines, 60 plus and in other cases 65 plus) and children (under 18 years of age) are being excluded. The reason for this exclusion is that some of the vaccine trials have not covered these age groups and hence, the vaccine safety and efficacy is not well-known for these age groups. However, the elderly shall be vaccinated on priority once the vaccines that have been tested on the elderly are available to Pakistan. All three priority groups shall receive free of cost vaccination irrespective of the source of vaccine supply.
Three vaccines that have currently received emergency approval from the Drug Regulatory Authority of Pakistan (DRAP) include the vaccines manufactured by Sinopharm, Astra-Zeneca and Gamalye (Sputnik V). The vaccines shall be delivered by the federal government to the provincial governments, who in turn will distribute those among district health administrations. Adult Vaccination Centers (AVCs) have been established at public sector hospitals (tertiary and secondary level) and shall be expanded to the level of primary healthcare facilities if the need arises.
The routine immunisation programme of the government of Pakistan, the EPI, has a well-developed and strong cold-chain system deployed across the country, with extensive support from the GAVI and the UNICEF. The same system shall be used for transport and storage of Covid-19 vaccine. To further strengthen the supply chain system, additional support is also being provided by the GAVI. This shall include expansion of warehousing capacity for storage of vaccine through installation of ultra-cold chain freezers. Eighteen such storage spaces are being established; one each in 15 mega cities across the country and three at the federal level.
The quality of vaccine service delivery will be ensured through tracking of the cold chain and by maintaining a robust data collection system. Temperature monitoring devices which are generally installed at the vaccine storage facilities as well as transport vehicles will also be used for monitoring the temperature of Covid-19 vaccines. Additional temperature monitoring devices are being installed for this purpose.
Vaccine security is another issue. It is being addressed by installation of surveillance cameras at the storage sites at all levels. Adverse effects following immunisation (AEFI) is another area of concern for all vaccines, and hence for Covid-19 vaccine as well. These are generally known adverse effects that may occur in rare cases, just as with any other medicines that we take. A comprehensive AEFI management plan has been prepared by the government and Rapid Response Teams have been established for immediate redress of such events.
Appropriate communication is a major challenge in this era of misinformation. As, misinformation as well as rumors and conspiracy theories spread at a pace that is much faster than most factual news and information. The government is using both traditional media channels and digital media to spread factual news and information and to counteract fake and false information. Media teams have been trained for risk communication.
The writer is a Technical Focal Person (RI) at EPI Punjab