17–19 September 2019Manila, Philippines
Meeting Report
WORKSHOP ON NATIONAL PANDEMIC INFLUENZA VACCINE DEPLOYMENT AND
VACCINATION PLANNING TO STRENGTHEN PANDEMIC PREPAREDNESS
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WORLD HEALTH ORGANIZATION
REGIONAL OFFICE FOR THE WESTERN PACIFIC
REPORT SERIES NUMBER: RS/2019/GE/52(PHL) English only
MEETING REPORT
WORKSHOP ON NATIONAL PANDEMIC INFLUENZA
VACCINE DEPLOYMENT AND VACCINATION PLANNING
TO STRENGTHEN PANDEMIC PREPAREDNESS
Convened by:
WORLD HEALTH ORGANIZATION
REGIONAL OFFICE FOR THE WESTERN PACIFIC
Manila, Philippines
17–19 September 2019
Not for sale
Printed and distributed by:
World Health Organization
Regional Office for the Western Pacific
Manila, Philippines
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NOTE
The views expressed in this report are those of the participants of the workshop on national
pandemic influenza vaccine deployment and vaccination planning to strengthen pandemic
preparedness and do not necessarily reflect the policies of the conveners.
This report has been prepared by the World Health Organization Regional Office for the
Western Pacific for Member States in the Region and for those who participated in the
workshop on national pandemic influenza vaccine deployment and vaccination planning to
strengthen pandemic preparedness in Manila, Philippines, 17–19 September 2019.
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Table of Contents
SUMMARY ...................................................................................................................................... 5
1. INTRODUCTION ........................................................................................................................ 7
1.1 Meeting organization ............................................................................................................ 7
1.2 Objectives ............................................................................................................................. 7
2. PROCEEDINGS........................................................................................................................... 7
2.1 Opening session .................................................................................................................... 7
2.1.1 Opening remarks .......................................................................................................... 7 2.1.2 Managing health security threats through APSED III .................................................... 8
2.1.3 Proposed Regional Strategy for the Expanded Programme for Immunization
2021–2030 .................................................................................................................... 8
2.2 Plenary 1. Are we ready for the next pandemic ................................................................... 8
2.2.1 Advancing pandemic preparedness for health security: Are we ready? .......................... 8
2.2.2 Overview of the situation of seasonal influenza vaccination in the Western Pacific Region .......................................................................................................................... 9
2.2.3 Lessons learnt from global deployment of pandemic influenza vaccines during the
Pandemic (H1N1) 2009 .............................................................................................. 10
2.2.4 Lessons learnt from pandemic influenza vaccine deployment and vaccination during the Pandemic A(H1N1) 2009 in the Western Pacific ......................................................... 11
2.3 Plenary 2. Country updates on national deployment and vaccination planning .............. 13
2.3.1 Cambodia – NDVP planning update ............................................................................... 13 2.3.2 China – NDVP planning update ...................................................................................... 14
2.3.3 Lao People’s Democratic Republic – NDVP planning update ......................................... 14
2.3.4 Mongolia – NDVP planning update ................................................................................ 14
2.3.5 Philippines – NDVP planning update .............................................................................. 15 2.3.6 Viet Nam – NDVP planning update ................................................................................ 15
2.4 Pandemic Influenza Preparedness (PIP) Deploy Game Mission 1. National Deployment
and Vaccination Plan ................................................................................................................ 15 2.4.1 Overview of the global guidance on national deployment and vaccination planning ........ 15
2.4.2 Mission 1: NDVP structure, management and organization for deployment and vaccination
operations, vaccine strategy definition and human resources aspects ............................... 16
2.5 PIP Deploy Game Mission 2: Legal and regulatory planning ............................................ 17
2.5.1 National regulatory systems readiness for pandemic influenza vaccines in the
Western Pacific Region .................................................................................................. 17
2.5.2. PIP Deploy Game Mission 2: Legal and regulatory planning .......................................... 18
2.6 PIPDeploy Game Mission 3: Public communication .......................................................... 18
2.6.1 Role of risk communication for pandemic influenza vaccine deployment and vaccination 18
2.6.2 PIPDeploy Game Mission 3: Public communication ....................................................... 19
2.7 PIPDeploy Game Mission 4: PIP Deploy Game Mission 4: Supply chain and waste
management .............................................................................................................................. 19
2.7.1 Introduction to supply chain and waste management ....................................................... 19 2.7.5 PIPDeploy Game Mission 4: Supply chain and waste management ................................. 20
2.8 PIP Deploy Game Mission 5: Post-deployment surveillance system and management ..... 20
2.8.1 Introduction to post-deployment surveillance system and management ........................... 20
2.8.2 PIPDeploy Game Mission 5: Post-deployment surveillance system and management ...... 21
2.9 PIP Deploy game hotwash ................................................................................................... 21
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2.10 Self-assessment of NVDP plans and defining next steps and priority actions.................. 21
2.11 Potential options for costing the NDVP ............................................................................ 22
3. CONCLUSIONS AND RECOMMENDATIONS........................................................................ 22
3.1 Conclusions .......................................................................................................................... 22
3.2 Recommendations................................................................................................................ 22 3.2.1 Recommendations for Member States ............................................................................. 23
3.2.3 Recommendations for the WHO Secretariat .................................................................... 23
ANNEXES ...................................................................................................................................... 24
Annex 1. Country self-assessment, next steps and priority actions for the NDVP .................. 24
Annex 2. List of participants ..................................................................................................... 26
Annex 3. Programme of activities ............................................................................................. 29
Keywords: Immunization / Influenza vaccines / Pandemics – prevention and control /
Vaccination
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SUMMARY
The World Health Organization (WHO) Regional Office for the Western Pacific convened the
Workshop on National Pandemic Influenza Vaccine Deployment and Vaccination Planning to
Strengthen Pandemic Preparedness, from 17 to 19 September 2019, at the Regional Office in
Manila, Philippines. Participants included delegates from Cambodia, China, the Lao People’s
Democratic Republic, Mongolia, the Philippines and Viet Nam, as well as technical officers
from the Regional Office for the Western Pacific and WHO headquarters.
The objectives of the meeting were:
(1) to review the strategic importance of pandemic influenza vaccine as an integral part of
a renewed approach to pandemic preparedness; and
(2) to identify critical issues and priority actions to develop and update national deployment
and vaccination plans (NDVPs) for pandemic influenza vaccines.
Critical presentations given by subject-matter experts together with participation in a
game/simulation/tabletop exercise, called PIPDeploy, provided participants an engaging and
interactive environment for a better understanding of critical components of an NDVP, as
recommended by WHO in the technical guidance for the development and implementation of
an NDVP.1 Throughout the three-day workshop, delegates were invited: (a) to learn about the
10 areas of an NDVP; and (b) based on countries’ existing NDVPs, which were mostly
developed during the Pandemic (H1N1) 2009, to perform a situational analysis of their plans,
outlining major strengths, gaps and priority next steps.
Participants learned about the global and regional efforts to strengthen countries’ pandemic
influenza preparedness capacities, including approaches promoted by the Asia Pacific
Strategy for Emerging Diseases and Public Health Emergencies (APSED III) as framework
to advance the implementation of the International Health Regulations, known as IHR 2005,
for health security in the Region.
Participants were also invited to review the knowledge acquired throughout the meeting by
participating in a question-and-answer session using the Mentimeter interactive presentation
software. Additionally, delegates completed the draft WHO Influenza Vaccine Request Form
and shared the challenges around collecting the information requested in the document.
The meeting participants recognized the threat posed by a pandemic influenza and the need to
further plan for deployment and vaccination operations. Few countries have updated their
NDVPs since the 2009–2010 pandemic influenza, and despite the progress observed in
several domains, challenges remain. Throughout the meeting countries highlighted key
NDVP areas that would need stronger development and support. Among these the following
came through chiefly: choosing vaccination strategies and identifying high-risk groups,
ensuring legal and regulatory planning, putting in place surveillance and management
systems for adverse events following immunization (AEFI), and planning for public
communication.
Member States were encouraged to advance national pandemic preparedness, including
deployment and vaccination planning, by engaging relevant ministries and stakeholders.
1 Development and Implementation of a National Deployment and Vaccination Plans
https://www.who.int/influenza_vaccines_plan/en/
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Additionally, WHO was requested to continue supporting Member States in advancing their
NDVPs.
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1. INTRODUCTION
1.1 Meeting organization
The Workshop on National Pandemic Influenza Vaccine Deployment and Vaccine
Deployment and Vaccination Planning to Strengthen Pandemic Preparedness was organized
by the World Health Organization (WHO) Regional Office for the Western Pacific at its office
in Manila, Philippines, from 17 to 19 September 2019. Participants included delegates from
Cambodia, China, the Lao People’s Democratic Republic, Mongolia, the Philippines and Viet
Nam, as well as technical officers from the Regional Office and WHO headquarters.
The aim of the workshop was to review and strengthen countries’ pandemic influenza
vaccine deployment and vaccination planning as the critical element of national pandemic
preparedness efforts. Delegates from Cambodia, China, the Lao People’s Democratic
Republic, Mongolia, Philippines, and Viet Nam attended the workshop. Participants included
focal points responsible for coordinating pandemic preparedness and response, managers (or
deputies) of the national Expanded Programme on Immunization, officers responsible for
registration and marketing authorization at national regulatory authorities, and logistics
officers from the National Immunization Programme. WHO experts from the WHO Health
Emergencies Programme at the Regional Office for the Western Pacific and from WHO
headquarters in Geneva jointly coordinated all aspects of the workshop.
1.2 Objectives
The objectives of the meeting were:
(1) to review the strategic importance of pandemic influenza vaccine as an integral part of
a renewed approach to pandemic preparedness; and
(2) to identify critical issues and priority actions to develop and update national deployment
and vaccination plans (NDVPs) for pandemic influenza vaccines.
2. PROCEEDINGS
2.1 Opening session
2.1.1 Opening remarks
The opening remarks encouraged participants to strengthen countries’ preparedness capacities
to tackle the next pandemic influenza and other health emergencies.
The key messages presented by Dr Liu Yunguo, Director of Programme Management
at the Regional Office for the Western Pacific, highlighted the progress made by
Member States in strengthening health security systems, and the role of the Asia Pacific
Strategy for Emerging Diseases and Public Health Emergencies (APSED III) in
providing a strategic framework for action to advance the implementation of the
International Health Regulations, known as IHR(2005). Moreover, he reinforced the
importance of advancing emergency planning and system readiness, including on
pandemic influenza vaccine deployment and vaccination operations as a way to
mitigate negative consequences of a future pandemic.
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2.1.2 Managing health security threats through APSED III
– Dr Chin-Kei Lee, WHO Health Emergencies Programme, WHO Regional Office for the
Western Pacific
The presentation on "Managing Health Security threats though the Asia Pacific Strategy for
Emerging Diseases and Public Health Emergencies (APSED III)" highlighted the ongoing
health security threats being faced by the WHO Western Pacific Region, which are increasingly
complex due to various factors, such as the growing movement of people and goods, and rapid
urbanization. Two influenza pandemics in the 20th century originated from this Region, and
an increased number of human infections of avian influenza are also reported in the Region,
partially due to improved surveillance systems.
The importance of APSED III as the strategic action framework to advance implementation of
core capacities required under IHR(2005) was also underlined. Since its inception, countries
have made considerable progress in improving their health security systems, such as the
development, application and strengthening of rapid response teams, event-based surveillance,
field epidemiology training programmes, emergency operations centres and incident
management systems. However, the next pandemic could strike at any time, with potentially
devastating human, social and economic consequences. Therefore, Dr Lee called on
participants to strengthen pandemic preparedness as a driving force to advance health security
systems and countries’ capacities to respond to future infectious hazard outbreaks and health
emergencies.
2.1.3 Proposed Regional Strategy for the Expanded Programme for Immunization
2021–2030
The presentation "Proposed Regional Strategy for Expanded Programme for Immunization
(EPI) 2021–2030" explained the scope and strategic direction of the draft Regional Strategy.
The Strategy proposes three strategic objectives, one of which is related to the health
emergencies. The draft strategy also proposes to strengthen synergy with the emergency
preparedness and response operations, and highlighted the importance of this activity in the
overall vaccine-preventable disease (VPD) immunization programme. Strategic Objective 3 is
on preparing for and responding to public health emergencies, and it assumes five scenarios:
1) outbreaks or resurgences of VPDs; 2) vaccine and immunization safety events; 3) outbreaks
requiring immunization responses (for example a cholera outbreak); 4) an emergency affecting
immunization systems and programmes; and 5) an event due to an emerging infectious disease
that requires immunization response (for example pandemic influenza).
2.2 Plenary 1. Are we ready for the next pandemic
2.2.1 Advancing pandemic preparedness for health security: Are we ready?
– Dr Masaya Kato, WHO Health Emergencies Programme, WHO Western Pacific Region
This session emphasized that pandemic influenza continues to pose a global threat, requiring
preparedness efforts to mitigate not only the health-related aspects, but also economic and
social disruptions. The presentation introduced series of WHO guidance documents on
pandemic influenza preparedness that were recently released, as well as the global influenza
strategy 2019–2030 with two main aims by the year 2030: i) better global tools through
coordination of research and innovation; and ii) stronger country capacities through
ownership.
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The presenter then discussed the two-tier approach for public health emergency preparedness,
including for pandemic preparedness, which has been promoted by Asia Pacific Strategy for
Emerging Diseases (APSED). The two-tier approach is composed of the two components: i)
response planning; and ii) system readiness. Response planning should be strengthened
through reviewing and updating the plan through real events and exercises, engaging relevant
stakeholders. Systems (for example people, resources, mechanisms, procedures and
equipment) have to be ready for response plans to be effectively implemented.
Pandemic influenza vaccination also requires system readiness. Based on the 2009
experience, it was highlighted that countries with a seasonal influenza programme are more
likely to receive vaccines earlier, and that countries with regulatory barriers were less likely
to have vaccine deployed in a timely manner.
To conclude, the presenter reiterated the importance of preparedness and encouraged
countries to identify systems gaps through pandemic response planning and prioritizing
actions to address those gaps.
Following the presentation, participants worked in groups and presented the main progress
and challenges regarding pandemic preparedness in their countries. Common strengths
included stronger immunization and surveillance systems, and enhanced partner and
multisectoral coordination. Viet Nam also highlighted its vaccine manufacturing capacity,
which was not available during the 2009 pandemic. The Lao People’s Democratic Republic
and Viet Nam stressed the establishment of emergency operations centres (EOC). In terms of
gaps, the delegation from Cambodia, the Lao People’s Democratic Republic and Mongolia
mentioned the difficulties around resource mobilization for health emergencies. Lao
representatives also stressed the need to strengthen risk communications, Viet Nam
highlighted gaps in human resources, and the Philippines mentioned that its deployment plan
requires testing through simulation exercises and greater clarity on roles and responsibilities
across the stakeholders involved in the pandemic response. Countries also suggested that
progress made in capacity-building through implementing their National Action Plan for
Health Security, or APSED workplans, will provide a foundation in pandemic response,
including for the pandemic influenza deployment and vaccination operations.
2.2.2 Overview of the situation of seasonal influenza vaccination in the Western
Pacific Region
– Dr Md. Shafiqul Hossain, WHO Cambodia
The presentation on seasonal influenza vaccination offered participants an overview of the
current situation of seasonal influenza vaccination in the Western Pacific Region. The number
of countries offering influenza vaccine increased from 17 in 2009 to 20 in 2018.2 A survey
conducted by the Regional Office for the Western Pacific in 2012 showed that the national
policy of all the 18 countries had prioritized health-care workers (100%) and older people
(100%) for vaccination under national seasonal influenza vaccine policies, with fewer countries
also recommending vaccination for pregnant women (72%) and those with underlying medical
conditions (72%). Fifty per cent of the respondent countries also mentioned offering the
vaccine for children from 6 to 59 months. The presenter stressed that the selection of priority
groups for seasonal influenza vaccine facilitates the development of vaccination strategies for
pandemic influenza.
2 According to a Global Survey, 17 countries in the Region offered influenza vaccines in 2009. In 2018, through
the Joint Reporting Form, 20 countries reported offering influenza vaccine.
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2.2.3 Lessons learnt from global deployment of pandemic influenza vaccines during
the Pandemic (H1N1) 2009
– Ms Ioana Ghiga, WHO Health Emergencies Programme, WHO headquarters
This presentation provided an overview of the WHO pandemic influenza vaccine deployment
processes and related challenges over the 2009–2010 pandemic, as well WHO’s current efforts
to secure access to pandemic influenza vaccine. Through the WHO Deployment Initiative,
WHO, in collaboration with donors and partners, delivered over 78 million doses of pandemic
(H1N1) vaccine to 77 countries globally between June 2009 and October 2010.3 To access
vaccine donated through WHO, countries had to submit three mandatory documents: a letter
of intent; a letter of agreement; and an NDVP.
Some of the milestones of the pandemic (H1N1) 2009 included: 1) declaration of the pandemic
by the WHO Director-General in June 2009; (2) the submission of the first letter of intent in
September 2009; 3) the submission of the first NDVP in December 2009; 4) the first vaccine
pre-qualification in November 2009; 5) start of vaccine deployment to recipient countries in
December 2009; and 6) the first vaccine delivery in January 2010. This demonstrates that
countries spent a long time developing their NDVPS, which required significant assistance and
financial resources to be finalized, generating delays in the delivery process. This shows the
importance of developing or updating these plans in the inter-pandemic phase.
Lessons learnt from the WHO deployment process at the global level include: 1) the need to
communicate more effectively among partners and with countries; 2) the hurdles presented by
inadequate transport capacity due to the significant amount of vaccine to be delivered and high
transit time, posing additional challenges in cold chain operations to maintain the vaccine
integrity; 3) the difficulties caused by complex donation processes; and 4) problems created by
a lack of preparedness in many countries.
Main challenges identified at country level during the 2009 WHO pandemic vaccine
deployment process included: 1) national regulatory issues associated with unique regulatory
processes for legal importation and distribution of vaccines; 2) the lack of legal agreements
with donors and beneficiary countries and the challenges associated with establishing a single
framework that was acceptable to all parties; and 3) national deployment planning, or
development of an NDVP, which required a significant amount of time and resources.
The presenter also highlighted the increased global production capacity of pandemic influenza
vaccines – from approximately 4 billion doses in 2011 to 6 billion doses in 2015. Additionally,
the presenter highlighted the importance of the Pandemic Influenza Preparedness (PIP)
Framework in establishing an equitable system to access pandemic products. Through the PIP,
approximately 420 million doses of pandemic vaccines, 10 million treatment courses of
antivirals and 250 000 diagnostic kits are expected to be available to countries in need.
To increase deployment preparedness and learning from the challenges observed in the 2009
pandemic, the following considerations were presented as the conclusions :
1. tailor national plans to serve context specific needs
3 World Health Organization. Main operational lessons learnt from the WHO Pandemic Influenza A(H1N1)
Vaccine Deployment Initiative. Geneva: World Health Organization; 2011.
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2. build and maintain global and national operational readiness
3. ensure effective global and country communication channels
4. sustain capacity to engage in executing legal agreements
5. ensure appropriate regulatory pathways suitable for pandemic response
6. map and continuously update cold chain capacity at both global and country level.
2.2.4 Lessons learnt from pandemic influenza vaccine deployment and vaccination
during the Pandemic A(H1N1) 2009 in the Western Pacific
– Dr Md. Shafiqul Hossain, WHO Cambodia
During the 2009–2010 pandemic influenza, 17 out of the 27 Member States in the Western
Pacific solicited access to WHO-donated vaccines and sent the documents required to receive
them.4 Among those countries, only Viet Nam did not receive the vaccines, due to national
legal and regulatory issues. A general challenge among the eligible countries was NDVP
development, which required a long time, training and technical support for completion. In
total, 8.7 million doses of vaccines were deployed to 16 countries in 29 shipments.
The presentation highlighted the main lessons learnt from the latest pandemic influenza in the
following areas of work: a) vaccination strategies and management and organization; b) human
resources and security; c) supply chain and cold chain capacity;(d) public communication; e)
communication and information; and f) post-deployment and adverse events following
immunization (AEFI) surveillance:
Regarding vaccination strategies, management and organization, the lessons learnt
included:
1. managing deployment and vaccination operations efficiently requires that managers
review critical components for making rapid decisions;
2. supporting pandemic deployment and vaccination operations requires planning of surge
capacity;
3. careful planning is required to determine what groups should be prioritized for
vaccination and how to quantify the population part of these groups;
4. the use of informed consent forms should be critically reviewed, as the pandemic
experience demonstrated it had undermined vaccine uptake;
5. establishing partnerships and/or collaborating with other sectors of society, inter-
ministerial departments and involving business enterprises and private medical
professionals is critical for the success of the pandemic response; and
6. planning committees, at all levels, should be established to ensure support and for good
implementation of the pandemic influenza vaccination activities.
In regard to human resources and security, the lessons learnt included:
4 The countries were: Cambodia, Cook Islands, Fiji, Kiribati, the Lao People’s Democratic Republic, Mongolia,
Nauru, Niue, Papua New Guinea, the Philippines, Samoa, Solomon Island, Tokelau, Tonga, Tuvalu, Vanuatu
and Viet Nam.
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1. the use of medical students, dental staff, veterinary staff, retired health professionals
and the military should be considered to attain human resources surge capacity;
2. the shortage of supervisors could be addressed by strengthening interdepartmental
(within the ministry of health) collaboration;
3. providing for the welfare and security of health-care workers responding to a pandemic
is important in order to ensure their health and ability to perform their duties; and
4. the availability of good injection practices and of a waste management programme
ensures that health staff can use their established procedures to reduce accidental
needle-stick injuries and properly dispose of used injection waste.
For Supply chain and cold chain capacity, the lessons learnt included:
1. outsourcing certain deployment operations can avoid the disruption of other critical
medical services;
2. drivers and delivery staff should be vaccinated with other front-line workers to ensure
their effectiveness and security;
3. personnel involved in vaccination and handling medical waste should be vaccinated
against hepatitis B;
4. when planning for future cold chain storage capacity for the routine immunization
programme, additional space should be considered for allowing the temporary storage
of pandemic vaccines;
5. outsourcing the additional storage capacity that is required for storing and distributing
vaccines and ancillary items is an effective strategy to create additional surge capacity;
and
6. failure to maintain cold chain equipment in proper working conditions endangers the
ability to ensure a rapid deployment and vaccination process.
With regard to public communication, main lessons learnt included:
1. involving and mobilizing community-based groups or associations is key to ensure
informed-based decision in regards to vaccination at the community level;
2. simplified and aligned messages that address multiple target groups are key to avoiding
confusion and reducing fear;
3. planning effective communication strategies requires changing messages as the
pandemic evolves and coordinate sharing of messages across agencies;
4. assuring that communications professionals are involved in the pandemic response will
support the framing of appropriate, honest messages in order to gain the trust of the
public;
5. conducting simulations is important in view of training staff in managing media
relations;
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6. using social media platforms (Facebook, Twitter, etc.) enhances communication
capabilities;
7. clear information needs to be provided to both health-care workers and the public when
using a novel pandemic influenza vaccine with a new formulation (for example one
containing adjuvants); and
8. continuous communication with the public and the media regarding the surveillance
and investigation of reported AEFI is required to maintain the trust of the public.
In regard to communication and information, it was highlighted that effective support for
deployment operations in a pandemic may require modification of the existing management
information systems.
Regarding post-deployment and AEFI surveillance, the lessons learnt included:
1. using current AEFI systems for supporting the national immunization programme
provides the platform for enhancing or creating surge capacity when using a strain-
specific pandemic influenza vaccine; and
2. adequate funds must be budgeted within the NVDP for putting in place a more resilient
and sensitive post-marketing surveillance for AEFI when using strain-specific
pandemic influenza vaccine.
2.3 Plenary 2. Country updates on national deployment and vaccination planning
In this session, country delegates provided an overview of their national deployment and
vaccination planning, including the existing policy framework and plans on health security,
pandemic preparedness and an NDVP. They presented their experiences in influenza vaccine
deployment in the 2009–2010 pandemic, gaps in the deployment preparedness, and their
expectations for the workshop. In general, countries identified that pandemic deployment and
vaccination plans require revision to ensure a timely and effective deployment of pandemic
influenza vaccines and subsequent implementation of vaccination campaigns. Detailed
information from each country is as follows:
2.3.1 Cambodia – NDVP planning update
The Cambodian delegation highlighted that their NDVP was updated in 2011 and that despite
the fact that the country does not have a national seasonal influenza vaccination policy,
seasonal influenza vaccine is available in the private market. Regarding pandemic influenza
vaccines, national laws and regulations authorize the emergency use of vaccines if they are
prequalified by WHO. To accelerate the registration, a fast-track process is in place for delivery
through the public sector only. From the 2009–2010 pandemic, the delegates identified several
strengths, including: 1) high-level political support; 2) involvement of senior national
Government officials in ensuring deployment and vaccination as a priority activity and
providing sufficient support at all levels; 3) external financial and technical support; 4) previous
experiences in implementing polio and measles supplementary immunization activities (SIAs)
and the capacities that these activities has built at the district and health centre level; and (5)
wide media coverage about the new virus that increased knowledge on the pandemic, and led
to greater vaccine uptake.
Gaps in the pandemic response were also underlined, including: 1) the challenges to identify
and quantify high-risk groups, especially people with chronic diseases; 2) strong demand for
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A(H1N1) vaccination by people not specifically in risk groups;(3) limited flexibility to change
the funding allocation for the response; and 4) limited time for planning and training.
2.3.2 China – NDVP planning update
Representatives from China stressed that the country was the first to produce the pandemic
vaccine in 2009 and that it is strengthening research and development of vaccines and new
antiviral drugs. During the 2009–2010 pandemic, the Chinese vaccines was not prequalified,
and therefore, these were not donated through the WHO deployment process. Since then, the
country has established a well-functioning National Regulatory Authority (NRA), which can
assess and ensure the quality, safety and efficacy of pandemic products, which is a key
requirement for the prequalification process.
2.3.3 Lao People’s Democratic Republic – NDVP planning update
The Lao delegation mentioned that their NDVP was updated in 2009 and that no specific law
or regulation exists to authorize the emergency use of pandemic influenza vaccines. The main
challenge has been the lack of political buy-in and resources to create and enforce such
regulations. The presenter also shared the progress in the country’s seasonal influenza
vaccination programme, which targets pregnant women, health-care workers, older people, and
patients with chronic conditions. As for the 2009–2010 pandemic influenza vaccination
operations, the following strengths were noted: strong Government commitment; hard-to-reach
areas included in microplanning; all health personnel prioritized for vaccination; high
community demand and acceptance as people genuinely wanted vaccination and active
involvement of volunteers; and contributions by village leaders and Lao Women’s Union by
mobilizing the children in their villages.
The challenges included: insufficient lead time for adequate planning; lack of a target number
for those with chronic diseases; uncertainty about vaccine availability, arrival and non-standard
presentations (for example, no vaccine viral monitor (VVM)); and addressing fears of AEFI
caused by experience of neighbouring countries.
The presenter highlighted the following lessons from the 2009–2010 pandemic influenza
vaccination:
1. the need to build consensus within the Ministry of Health and partner agencies to have
successful implementation;
2. unfamiliarity on the Letter of Agreement 5 for the vaccine, which caused concerns
among stakeholders and delays in signing;
3. the most important social mobilization agent was the local government rather than
media;
4. the A(H1N1) vaccination could be used as a platform for other mass immunization
campaigns; and
5. people appreciated receiving the A(H1N1) vaccination card, as it made the activity
seem more professional to the public.
2.3.4 Mongolia – NDVP planning update
5 The Letter of Agreement of Country Recipient Agreement (CRA) is a legal accord between WHO and a
country requesting pandemic flu vaccine supply from WHO.
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Mongolia was the first country to receive vaccines donated by WHO during the 2009–2010
pandemic. Mongolia successfully deployed the vaccines within seven days after the vaccine
arrived, and vaccination was carried out within seven days after vaccines were distributed to
primary units. Representatives emphasized that Mongolia has a national policy on seasonal
influenza vaccination and that the existing NDVP was last updated in 2009. Particular
strengths of the latest pandemic influenza vaccine response were highlighted, including: 1) an
immunization system was in place; 2) high-level political commitment; 3) multisectoral
collaboration; and(4) high public awareness. On the other hand, the following gaps were
identified: 1) health facility preparedness was not adequate; 2) communication infrastructure
was suboptimal; 3) lack of operational budget for immunization; and(4) lack of cold chain
capacity in family health centres.
2.3.5 Philippines – NDVP planning update
Representatives from the Philippines said their national pandemic preparedness and response
plan was developed in 2010, which had specified action to improve preparedness for
pandemic influenza vaccination. The presentation also highlighted the creation of an inter-
agency task force for the management of emerging infectious diseases in 2014. From the
2009–2010 pandemic experience, the following gaps were observed: 1) limited budget for
vaccine procurement; 2) challenging procurement processes; and 3) limited cold chain
storage capacity.
2.3.6 Viet Nam – NDVP planning update
Viet Nam has a seasonal influenza vaccination policy, targeting the high-risk populations.
The vision towards 2030 is to integrate seasonal influenza vaccines into the national EPI
programme, using both domestic and imported vaccines. In fact, the first domestically
produced seasonal influenza vaccines was licensed in 2019. Viet Nam implemented an
influenza vaccination campaign, targeting more than 30 000 health-care workers in 2017 and
in 2019–2020 season. During the 2009 influenza pandemic, Viet Nam was unable to receive
pandemic influenza vaccines due to the issues of registration and importation procedures.
Viet Nam’s regulatory pathways were suited for a normal review requiring clinical trials in
the country, but not for an emergency situation when fast-track review and market
authorization are required.
Viet Nam is currently developing a new National Deployment and Vaccination Plan for
Pandemic Influenza Vaccines, paying particular attention to identifying target populations;
the criteria for selecting vaccines, such as being licensed or manufactured in Viet Nam, or
supported by WHO and/or being used in developed countries; and meeting the safety criteria.
The vaccination campaign could be administered through current EPI programme. Viet Nam
also said it planned to conduct a tabletop exercise to test their its NDVP in November 2019.
2.4 Pandemic Influenza Preparedness (PIP) Deploy Game Mission 1. National
Deployment and Vaccination Plan
2.4.1 Overview of the global guidance on national deployment and vaccination planning
– Ms Ioana Ghiga, WHO headquarters
In this session, participants were introduced to two WHO documents designed to support the
Member States to develop and update their NDVP’s: (1) Guidance on Development and
Implementation of a National Deployment and Vaccination Plan for Pandemic Influenza
Vaccines; and (2) Checklist for Development and Implementation of a National Deployment
and Vaccination Plan for Pandemic Influenza Vaccines.
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Participants learned about the 10 chapters of the NDVP: 1) vaccination strategies; 2)
management and organization; 3) legal and regulatory planning for vaccine deployment; 4)
communication and information management; 5) human resources and security; 6) public
communication; 7) supply chain management; 8) waste management; 9) post-deployment
surveillance and management of AEFI; and (10) termination of deployment and vaccination
operations. These were later explored through the simulation exercise PIPDeploy.
Learning through play – PIPDeploy exercise
In addition to workshop presentations and group work, another main activity of the event was
to engage participants through active participation in a simulation exercise – PIPDeploy, which
is the first-ever tabletop exercise to strengthen countries’ capacities on pandemic influenza
deployment activities. Its learning objectives include: 1) to provoke discussions on key gaps in
preparing for or updating the NDVP for pandemic influenza vaccines; 2) to enable
conversations on best practices on in-country pandemic influenza vaccine deployment
governance and operations; and 3) to better understand country training needs and barriers in
effective roll-out of the NDVP.
The game is designed around Timoa, a fictitious country, which needs to strengthen its
preparedness and response capacity to deal with an influenza pandemic. To support the learning
process five scenarios and missions were presented to confront the players with fictitious
dynamics of pandemic vaccine deployment that could also happen in a real-life setting. For
each mission participants are given a situation – a challenge – and asked to develop a potential
solution. After a brainstorming and discussion, every group shares a proposed solution with
other groups and game facilitators, moves to the board game to collect resources for the
implementation of the proposed solution, and moves to the next challenge. Each step of the
game is followed by a facilitated discussion and technical input from WHO experts.
Throughout the game, participants discuss critical aspects of the 10 recommended chapters of
an NDVP. Delegates were split into four groups as follows: Group A: Cambodia delegation;
Group B: Lao delegation; Group C: Viet Nam delegation; Group D: Delegations from China,
Mongolia and the Philippines. The latter was grouped with multiple countries because these
delegations had fewer participants than the others.
Presentations on critical areas of the pandemic influenza deployment and vaccination
operations were given prior to the start of Missions 2 to 5.
2.4.2 Mission 1: NDVP structure, management and organization for deployment and
vaccination operations, vaccine strategy definition and human resources aspects
During the first mission, participants were invited to reflect about Timoa’s NDVP and propose
changes to it according to the WHO NDVP template.6 Additionally, they were asked to think
about management and organization, human resources, and vaccination strategy components
of an NDVP.
6 Guidance on Development and Implementation of a National Deployment and Vaccination Plan for Pandemic
Influenza Vaccines, p. 67. WHO. Available at
https://apps.who.int/iris/bitstream/handle/10665/75246/9789241503990_eng.pdf?sequence=1&isAllowed=y
17
Key discussion points
• Participants highlighted the importance of national advisory committees on
immunization and technical working groups on the selection of the vaccination
strategies. It was also stressed that these groups should have a multidisciplinary
composition, including profiles such as epidemiologists and ethical specialists.
• The involvement of the private sector in the pandemic preparedness and response
activities was mentioned as an important aspect of the operation.
• Health-care workers targeted in the pandemic vaccination campaign should be briefed
on the importance of the administration of pandemic vaccine and on their role in
engaging the community.
• Groups mentioned that each country has a particular command-and-control structure,
with different committees leading the response at national and subnational levels, and
thus coordination among those different actors are essential.
2.5 PIP Deploy Game Mission 2: Legal and regulatory planning
2.5.1 National regulatory systems readiness for pandemic influenza vaccines in the
Western Pacific Region
– Dr Jinho Shin, WHO Regional Office for the Western Pacific
In this session, participants learned about the regulatory functions and processes to expedite
the approval of medical products, including vaccines, in a pandemic. The presenter provided
an overview of the national regulatory authorities (NRAs) in the Western Pacific and
highlighted the various regulatory function requirements for importing, producing and
exporting countries.
The presentation also summarized potential registration pathways for NRAs dependent on
NRA capacities, such as recognition, reliance, work-sharing, joint activities, and full
assessment, as well as the options that countries can choose for market authorization of the
pandemic influenza vaccines. Dr Shin also provided overview of the emergency use pathway
for pandemic influenza vaccines, and the WHO Emergency Use Assessment and Listing
(EUAL) procedure, the special procedure for vaccines in the case of a public health
emergency. The presentation also summarized the situation and progress in official
independent lot releases and pharmacovigilance to monitor and ensure efficacy and safety of
vaccines.
In the Western Pacific, regulatory systems vary widely in terms of the range of regulatory
functions performed and the level of capacity. The type of regulatory functions and the level
of sophistication depend on the socioeconomic status of the country and the pharmaceutical
systems. Marketing authorization and good manufacturing practice (GMP) regulations are
relatively stronger, while pharmacovigilance and market surveillance are relatively weaker in
many middle-income economies. In such context, key regional regulatory challenges included:
(1) all countries are facing challenges in terms of capacity and resources to implement the full
range of regulatory functions; (2) a number of countries have insufficient legal frameworks and
low levels of technical competence to implement regulatory functions; and (3) the lack of a
harmonized approach for centralized marketing authorization.
Dr Shin discussed ongoing efforts to strengthen the regulatory systems in the Region, guided
by Western Pacific Regional Action Agenda on Regulatory Strengthening, Convergence and
18
Cooperation for Medicines and the Health Workforce. The Regional Office for the Western
Pacific also fosters cooperation among NRAs through fostering the Western Pacific Regional
Alliance for National Regulatory Authorities.
2.5.2. PIP Deploy Game Mission 2: Legal and regulatory planning
On Mission 2, participants were asked to discuss the existing international and national legal
and regulatory requirements to import or receive vaccines from a vaccine supplier.
Key discussion points and feedback
• It is recommended that countries define clear procedures and strategies to approve and
license vaccines during a pandemic. However, these procedures need to be in place in
the inter-pandemic phases as they require a legal foundation. Legislation should be in
place to support appropriate regulatory pathways.
• Several countries in the Region require further support to strengthen their legal and
regulatory capacities.
• NRAs should have clear procedures to receive vaccines donated by WHO or other
entities. This includes clarifying procedures on whether the WHO prequalification (PQ)
certificate is enough to approve the vaccines for use in a respective country or if further
NRA review is needed in addition to WHO PQ certificate.
• Key personnel involved in the pandemic preparedness should have a clear
understanding on the set of documents that should be required to ensure timely market
authorization and importation of pandemic vaccines.
• Strengthening legal and regulatory capacities ahead of the pandemic is key to identify
possible bottlenecks on the vaccine approval and importation process.
• Countries stressed that a major concern during the 2009–2010 pandemic was the
liability provisions that were part of the donation processes. It would be beneficial to
understand beforehand the terms and conditions of these agreements.
2.6 PIPDeploy Game Mission 3: Public communication
2.6.1 Role of risk communication for pandemic influenza vaccine deployment and
vaccination
– Dr Ljubica Latinovic, WHO Regional Office for the Western Pacific
This presentation highlighted the importance of risk communications activities before, during
and after a pandemic, and it stressed how building trust among stakeholders and communities
can support the acceptance of public health interventions such as immunization campaigns.
Participants learned about the main communication challenges of new pandemic influenza
vaccines, including:
1. perceptions of the risk may vary greatly – from outright panic to scepticism and
resistance;
2. the introduction of a new vaccine will raise questions about its safety and officials need
to provide these details in messages that are tailored for specific audiences to ensure
they contain appropriate language;
19
3. there will be limited vaccines available and communication should inform who will be
prioritized and why;
4. vaccine hesitancy or high demand may occur or even both;
5. some health workers may not be supportive of vaccination;
6. rumours may spread; and
7. the need to communicate around AEFI.
To conclude, the presenter emphasized that countries should: 1) develop an effective
communication strategy to ensure public acceptance for vaccination campaigns and uptake of
the vaccine by the priority groups; and 2) use an integrated communication approach that
should consider real-time feedback from all stakeholders involved, with a focus on the priority
vaccination groups and general population
2.6.2 PIPDeploy Game Mission 3: Public communication
On Mission 3, participants were asked to reflect about risk communications systems and
activities to address some communication challenges during an influenza pandemic.
Key discussion points and feedback
• Countries emphasized that hotlines for external communication and social networks
(for example telegrams) for communication with internal audiences are critical
channels to provide fast communication and build trust.
• Stronger coordination among stakeholders and ministries with regard to
communication is needed so that different agencies and responders can speak with the
media with “one voice”, avoiding different messages and misunderstanding.
• Health-care workers and medical societies should be considered as part of the
communication strategy, as they are both target groups and influencers for other
targeted groups such as pregnant women.
• Spokespeople should be trained at different levels and should be prepared to talk about
uncertainties. The development of standard operating procedures (SOPs) may help
define when, how and what should be communicated to the public.
• Communication to the public should aim to build trust and should be clear, easy-to-
understand, and delivered in local language.
2.7 PIPDeploy Game Mission 4: PIP Deploy Game Mission 4: Supply chain and waste
management
2.7.1 Introduction to supply chain and waste management
– Dr Ananda Amarasinghe, WHO Regional Office for the Western Pacific
This presentation highlighted the challenges in supply chain and waste management during a
pandemic, comparing to those encountered in the routine immunization system:
- Forecasting and procurement: During a pandemic, the global availability of a vaccine
may be limited, and high demand will occur globally. Careful planning should be
undertaken to ensure access to vaccines and associated ancillary products.
20
- Vaccine management: The large number of vaccines will need to be properly stored
and will require appropriate cold chain capacity and transport.
- Injection supply and waste management: Adequate supply of safe injection supplies
and proper disposal, according to WHO recommended norms and standards.
- Human resources and health systems functioning: During a pandemic, health service
will likely be overloaded, with competing priorities and limited human resources.
Dr Amarasinghe stressed advance planning is critical to address these challenges and to ensure
effective supply chain management to support vaccination during the next pandemic.
2.7.5 PIPDeploy Game Mission 4: Supply chain and waste management
The objective of this mission was to encourage participants to identify the supply chain
management processes for vaccine deployment within seven days, discuss steps to ensure safe
disposal of hazardous medical waste, and the communication systems and mechanisms to
ensure efficient operations.
Key discussion points and feedback
• Temperature monitoring should consider for all vaccines, either inactivated or live
attenuated. In the case of the latter, the exposure to high temperatures is a bigger
concern, and stability data should inform whether the vaccine can still be used in the
event of exposure to temperatures outside the recommended range.
• Regarding waste management, countries should consider the number of safety boxes
needed for the safe disposal of needles and syringes. Additionally, when developing
the waste management chapter of the NDVP, considerations on disposal of used and
expired vaccine vials should be included.
• The involvement of the military and police may be required for the safe transport of
the vaccines.
• As the countries may face challenges with the storage capacity during a pandemic, it is
advisable to assess available storage facilities where vaccines can store ensuring the
cold chain and consider alternative (external) providers of storage services.
2.8 PIP Deploy Game Mission 5: Post-deployment surveillance system and management
2.8.1 Introduction to post-deployment surveillance system and management
– Dr Ananda Amarasinghe, WHO Regional Office for the Western Pacific
This presentation provided an overview of the post-deployment surveillance systems and
management and presented several WHO global and regional resources to support countries
strengthening their capacities in this area.7
Dr Amarasinghe explained that post-deployment surveillance is very important to monitor how
safe the vaccine is (safety) and what extent of protection is being generated by the vaccines
(effectiveness). The presenter stressed the importance of a comprehensive monitoring system,
which encompass AEFI detection, notification, reporting, investigation, analysis, causality
7 https://www.who.int/vaccine_safety/publications/aefi_surveillance/en/
21
assessment and feedback. He explained that early detection of AEFI cases helps the emergency
response to minimize serious medical consequences, and take corrective actions through either
regulatory or/and programmatic measures. Dr Amarasinghe particularly emphasized that post-
deployment surveillance is a critical activity to maintain public trust on vaccines and
immunization and overall pandemic responses.
2.8.2 PIPDeploy Game Mission 5: Post-deployment surveillance system and
management
In Mission 5, participants were asked to discuss the post-deployment surveillance (PDS)
mechanisms to ensure the monitoring of the safety of the pandemic vaccine and the detection
of AEFI.
Key discussion points and feedback
• Participants stressed the use of hotlines as a well-functioning channel for
communication with the public about AEFI.
• Countries need to ensure that both active and passive surveillance systems are
considered. Active surveillance implies proactive and timely identification of serious
AEFI, which requires trained and skilled staff to detect and respond to such cases;
passive surveillance is based on being notified about AEFI cases through existing
routine systems; and vaccine recipients shall be informed about signs of potential AEFI
and encouraged to report any symptoms that may indicate an AEFI.
• Medical personnel should adequately be trained in detecting and managing potential
AEFI.
• The documentation of lessons learnt can potentially contribute to future advocacy
purposes both in terms of budget pledges and increasing human resources for
emergency response.
2.9 PIP Deploy game hotwash
Overall, participants found the game an innovative and interactive tool to expand their
knowledge on the deployment and vaccination planning. It was also stressed that through the
game, players were able to identify gaps in their national systems and think about how to
tackle those gaps. Participants said PIPDeploy was a fun way to learn and discuss pandemic
vaccine deployment and noted that the game would be a useful tool to strengthen knowledge
on pandemic deployment and vaccination with national stakeholders and partners.
2.10 Self-assessment of NVDP plans and defining next steps and priority actions
In this session, delegates were asked to assess their existing NDVPs and to identify strengths
and gaps, as well as timelines for developing or updating their NDVPs. In addition, the
participants were also asked to provide feedback on the draft WHO Vaccine Request Form.
Countries discussed the strengths as well as potential areas of improvement in their NDVPs,
and proposed the following steps to update their plans, with the key points summarized in the
Annex 1. In general, the countries proposed that they aim to update their existing NDVPs,
building on the strengths and lessons learnt from the 2009/–2010 pandemic. Delegates
emphasized that simulation exercises will likely be implemented to test their plans, once their
draft is developed.
When developing the NDVPs it was considered beneficial:
22
▪ to articulate a time frame needed to implement each activity required to develop or
update the plan, and to address any identified gaps and priority actions to strengthen
preparedness;
▪ to enclose a decision-making diagram, which can support the decision-making process
during a pandemic; and
▪ to ensure that the provisions of the NDVP, including roles and responsibilities, are in
line with legislation or have legal standing.
Regarding the WHO Vaccine Request Form, delegates mentioned that the document requires
comprehensive information and input from various departments in their country. This activity
will require further collaboration among sectors and stakeholders.
2.11 Potential options for costing the NDVP
This presentation highlighted the importance of costing for all the NDVP components that
may require surge capacity. It presented the domains of a draft NDVP costing tool, which is
currently being developed to support countries to cost essential aspects and activities of their
deployment and vaccination efforts.
3. CONCLUSIONS AND RECOMMENDATIONS
3.1 Conclusions
1. Member States have made considerable progress in strengthening health security
systems, as well as national immunization and regulatory systems. The Asia Pacific
Strategy for Emerging Diseases and Public Health Emergencies (APSED III) and its
earlier iterations and the Regional Framework for Implementing Global Vaccination
Action Plan in the Western Pacific and other regional policy and strategic guidance have
served as important action frameworks.
2. The context of managing health security threats in the Asia Pacific region is increasingly
complex due to various factors, such as increasing movement of people and goods,
growing urbanization, ageing populations and antimicrobial resistance.
3. In such an evolving context, participants renewed their recognition of the major public
health threats posed by an influenza pandemic, and agreed to further advance national
pandemic preparedness by identifying strengths and gaps in system readiness through
response planning, and prioritizing actions to address the gaps.
4. Participants agreed that pandemic influenza vaccination plays a critical role in the public
health response to an influenza pandemic, and that the national pandemic influenza
vaccine deployment and vaccination planning is an essential component of pandemic
preparedness.
5. Through the tabletop exercise Pandemic Influenza Preparedness Deploy Game, the
participants reviewed the chapters of the National Deployment and Vaccination Plan
(NDVP) in line with WHO guidance, and discussed key issues in each chapter.
6. Participants identified strengths as well as potential areas for improvement of the NDVP
of respective countries, and proposed priority actions to revise and update the NDVP.
7. Participants supported the values of simulation exercises in validating the NDVP and
broader pandemic response plan.
3.2 Recommendations
23
3.2.1 Recommendations for Member States
Member States are encouraged:
1. to use pandemic preparedness to drive further strengthening of systems to address
influenza pandemics and other health security threats;
2. to engage relevant stakeholders to review identified strengths and gaps of the NDVP and
facilitate coordinated process to update the NDVP;
3. to consider designing and conducting simulation exercises to test and validate the NDVP
working with relevant stakeholders;
4. to review and address identified issues of regulatory systems to cope with public health
emergencies, including for rapid introduction of pandemic influenza vaccines, by
developing clear requirements, timeline and processes;
5. to review and address identified issues of immunization safety surveillance and response
to cope with public health emergencies, including for rapid introduction of pandemic
influenza vaccines; and
6. to ensure that a national plan and agreed procedures to conduct risk communications for
pandemics are in place as part of a broader multi-hazard risk communications framework,
and covers public communication plans for vaccine deployment and vaccination.
3.2.3 Recommendations for the WHO Secretariat
The WHO Secretariat should continue to support Member States to implement the above
recommendations, particularly on the following:
a. reviewing and updating the NDVP;
b. designing a simulation exercise to test and validate the NDVP and broader
pandemic response plan;
c. strengthening immunization safety surveillance and response to cope with public
health emergencies; and
d. reviewing and updating risk communications plan for pandemic response.
24
ANNEXES
Annex 1. Country self-assessment, next steps and priority actions for the NDVP
Country Strengths Gaps Challenges Next steps and
priority actions
Timeline
Cambodia ▪ Political support
▪ Management and
organization
▪ Multisectoral
engagement
▪ Legal and regulatory aspects
▪ Public communications
▪ Termination of deployment is
missing
▪ Waste management activities
should be better detailed in the plan
▪ Budget and flexibility
of fund
▪ Organize a workshop to
review NDVP
▪ Finalize and approve
NDVP
▪ Disseminate NDVP to
relevant stakeholders
Quarter 1, 2020
China ▪ Strengthen data
gathering
▪ Multisectoral
coordination
▪
To be determined
Lao People’s
Democratic
Republic
▪ National advisory
committees on
immunization;
communication and
advocacy committee;
National AEFI
committee
▪ Immunization law and
influenza strategy
▪ Cold chain capacity
▪ Support from PIVI8
▪ Difficulties in forecasting of people
with chronic medical conditions
▪ AEFI case investigation
▪ Insufficient coordination among
departments
▪ Limited public communication and
information, education and
communications materials
▪ Need to improve
coordination among
the existing
committees
▪ Preparedness planning
for pandemic and
outbreak response
▪ Budget allocation for
investigation
▪ Training of relevant
human resources
▪ Strengthening
communication in
health centres and
private clinics
To be determined
8 Partnership for influenza vaccine introduction
25
Country Strengths Gaps Challenges Next steps and
priority actions
Timeline
▪ Regular EOC meetings
during emergencies
Mongolia ▪ Multisectoral
collaboration
▪ Vaccine management
system
▪ Limited budget
▪ Issues with cold chain capacity at
the time of the pandemic
▪ Lack of cold chain capacity in
primary health-care centres
▪ Stakeholders
commitment
Budget
▪ Establish the inter-
institutional working
group to revise the
national plan
Assessment of the draft
NDVP by WHO
experts
▪ By December
2019, update
NDVP
By 2020, endorse
NDVP
Philippines ▪ AEFI surveillance
▪ Existing command and
control structure
▪ NRA not involved in the onset of
the pandemic
▪ Need to clarify roles and
responsibilities among stakeholders
and partners involved in the
pandemic response
▪ Need for clear guidelines for staff
involved in communication
activities
▪ Concurrent
outbreaks and
priorities
▪ Inter-agency tabletop
exercise planned in
October 2019
December 2019
Viet Nam ▪ Established regulatory
systems, and influenza
surveillance systems
▪ Domestic vaccine
production capacity
▪ Limited human resource capacities
for pandemic response
▪ Limited waste management
capacity
▪ Limited cold chain capacity
▪ Need to develop/update
communication plan
▪ Lack of budget for
deployment
▪ Organize PIPDeploy
workshop at national
level in Viet Nam
▪ Update NDVP
▪ Mobilize budget for
deployment activities
▪ Strengthen cold chain
capacity
Late 2019
26
Annex 2. List of participants
1. PARTICIPANTS
CAMBODIA Dr Teng Srey, Deputy Director, Department of CDC, Ministry of Health
Sangkat Boeungkak 2, Toul Kork District, Phnom Penh, Tel No.: (855) 89717133, Fax No.: (855) 8971 7133, email: [email protected]
Mr Ork Vichit, Deputy Director, National Maternal and Child Health Center
Manager, National Immunization Program, Ministry of Health, National Road No 6,
Kien Khlang, Prek Leap, Chrov, Changva, Phnom Penh, Tel. No.: (855) 12830 548, Fax No.: (855) 23426 257, email: [email protected]
Mr Sea Thol, Chief, Essential Drug Bureau, Department of Drug and Food, Ministry of Health, Phnom Penh, Cambodia, Tel. No.: (855) 1235 5161,
email:[email protected]
Mr Kong Heang Kry, Vaccine and Cold Chain Officer, National Immunization
Program, Ministry of Health, Phnom Penh, Cambodia, Tel. No.: (855) 1296 4889,
email: [email protected]
CHINA Dr Xu Keming, Director, National Health Commission of the People's
Republic of China, No. 1 Xizhimenwainanlu, Beijing 100044, Tel. No.: (8610) 687
9235, Fax No.: (8610) 687 2514, email:[email protected]
Mr Wei Lijun, Government Officer, Health Emergency Response Office
National Health Commission of the People's Republic of China, No. 1 Xizhimenwainanlu, Beijing 100191, Tel. No.: (8610) 6879 1235,
Fax No.: (8610) 6879 2590, email: [email protected]
LAO PEOPLE'S
DEMOCRATIC
REPUBLIC
Dr Somphone Soulaphy, Director, Prevention Division, Department of
Communicable Disease Control, Ministry of Health, Simeuang Road, Sisattanak
District, Vientiane, Tel. No.: (8560) 2122 6052, Fax No.: (8560) 21 241003,
email: [email protected]
Dr Chanthavong Savatchirang, Deputy Chief of VPD Division, EPI, Ministry of
Health, Mother and Child Health Center, National Immunization Program, Km 3 Thadeua Road, Sisattanak District, Vientiane, Tel. No.: (856) 2131 2352,
Fax No.: (856) 2131 2120, email: [email protected]
Dr Chansay Pathammavong, Deputy, Vaccine-Preventable Diseases Division
Mother and Child Health Center, National Immunization Program , Ministry of
Health, Km 3 Thadeua Road, Sisatanak District, Vientiane,
Tel. No.: (856) 21 312 352/ (856) 20 5560 6480, Fax No.: (856) 21 312 120, email: [email protected]
Dr Khammany Phommachanh, Planning Officer, Administration, Planning Division Maternal and Child Health Center, Ministry of Health, Simeuang Road, Sisattanak
District, Vientiane, Tel. No.: (856) 021 452519, Fax No.: (856) 021 452519,
email: [email protected]
27
MONGOLIA
Dr Munkhdavaa Oyun, Epidemiologist, Department of Immunization, National Center for Communicable Diseases, Ministry of Health, Nam Yan Ju Street
Ulaanbaatar, Tel. No.: (976) 9191 6642, Fax No.: (976) 1145 1798,
email: [email protected]
Ms Tsolmonbaatar Bolortuya, Officer-in-Charge, Medicine Registration, Health
Development Center, Ministry of Health, Sukhbaatar District, Ulaanbaatar,
Tel. No.: (976) 9900 8182, Fax No.: (976) 1132 0633, email: [email protected]
Ms Tumurbaatar Oyun-Erdene, Epidemiologist, National Influenza Center , NCCD
Nam Yan Ju Street, Ulaanbaatar, Tel. No.: (976) 9900 3287, Fax No.: (976) 1145 1798 , email: [email protected]
PHILIPPINES Ms Pia Angelique Priagola , Food and Drug Regulation Officer III, Center for Drugs,
Regulation and Research, Food and Drug Administration, Muntinlupa City, Tel. No. (632) 857 1900, email: [email protected]
VIET NAM
Dr Ha Thi Cam Van, Deputy Head, Division of Vaccine and Biosafety
Management, Department of Preventive Medicine, Ministry of Health,
Ha Noi, Tel. No.: (8443) 846 2364, Fax No.: (8443) 736 7379,
email: [email protected]
Dr Bui Huy Hoang, Officer, Division of Communicable Disease Control, General Department of Preventive Medicine, Ministry of Health, 135 Nui Truc, Ba Dinh, Ha
Noi, Tel. No.: (849) 4428 1988, Fax No.: (8443) 736 7379,
email: [email protected]
Dr Nguyen Dac Trung, Researcher, National Institute of Hygiene and Epidemiology
Ha Noi, Tel. No.: (8443) 972 1334, Fax No.: (8443) 8213782,
email: [email protected]
Dr Le Thi Tuyet Lan, Officer, Drug Registration Division, Drug Administration of
Viet Nam, Hanoi, Tel. No.: (849) 1250 5290, Fax No.: (843) 823 0794,
email: [email protected]
2. SECRETARIAT
WHO REGIONAL
OFFICE FOR THE
WESTERN
PACIFIC
Dr Chin-kei Lee, Acting Regional Emergencies Director, WHO Health
Emergencies Programme, WHO, Regional Office for the Western Pacific, P.O.
Box 2932, 1000 Manila, Philippines, Tel. No.: (632) 528 8001,
Fax No.: (632) 521 1036, email: [email protected]
Dr Masaya Kato, Programme Area Manager, Country Health Emergency
Preparedness and International Health Regulations, WHO Health Emergencies
Programme, WHO for the Regional Office for the Western Pacific,
P.O. Box 2932, 1000 Manila, Philippines, Tel. No.: (632) 528 8001,
Fax No.: (632) 521 1036, email: [email protected]
Dr Socorro Escalante, Coordinator, Essential Medicines and Health
Technologies, Division of Health Systems and Services, WHO Regional Office
for the Western Pacific, P.O. Box 2932, 1000 Manila, Philippines,
Tel. No.: (632) 528 9846, Fax No.: (632) 521 1036, email: [email protected]
Dr Yoshihiro Takashima, Coordinator, Expanded Programme on Immunization
WHO Regional Office for the Western Pacific, P.O. Box 2932, 1000 Manila,
28
Philippines, Tel. No.: (632) 528 9746, Fax No.: (632) 521 1036,
email: [email protected]
Dr Ananda Amarasinghe, Technical Officer, Expanded Programme on
Immunization, WHO Regional Office for the Western Pacific,
P.O. Box 2932, 1000 Manila, Philippines , Tel. No.: (632) 528 9032, Fax No.:
(632) 521 1036, email: [email protected]
Dr Shin Jinho, Technical Officer, Essential Medicines and Health Technologies
Unit, WHO Regional Office for the Western Pacific, P.O. Box 2932,
1000 Manila, Philippines, Tel. No.: (632) 528 8001, Fax No.: (632) 521 1036 /
528 0279, email: [email protected]
Mr Jan Erik Larsen, Technical Officer, Operations Support and Logistics
WHO Health Emergencies Programme, WHO Regional Office for the Western
Pacific, P.O. Box 2932, 1000 Manila, Philippines, Tel. No.: (632) 528 8001, Fax
No.: (632) 521 1036 / 528 0279, email: [email protected]
Ms Cheryl Valerie Legaspi, Consultant, Essential Medicines and Health
Technologies Unit, WHO Regional Office for the Western Pacific, P.O. Box
2932, 1000 Manila, Philippines, Tel. No.: (632) 528 8001, Fax No.: (632) 521
1036 / 526 0279, email: [email protected]
Ms Ljubica Latinovic, Consultant, Risk Communications, Division of
Programme for Disease Control, WHO Regional Office for the Western Pacific,
P.O. Box 2932, 1000 Manila, Philippines, Tel. No.: (632) 528 8001,
Fax No.: (632) 521 1036 / 526 0279, email: [email protected]
WHO
CAMBODIA
Dr Md. Shafiqul Hossain, Technical Officer, Expanded Programme on
Immunization, Office of the WHO Representative in Cambodia
Phnom Penh, Cambodia, Tel. No.: (855) 23216610, Fax No.: (855) 12917755,
email: [email protected] WHO
PHILIPPINES
Ms Rowena Capistrano, Technical Coordinator (SSA), Emerging and Re-emerging
Infectious Disease Programme (EREID), WHO Health Emergencies (WHE), Office
of the WHO Representative in the Philippines
Manila, Philippines, Tel. No.: (632) 528 9762, email: [email protected] WHO
HEADQUARTERS
Ms Ioana Ghiga, Technical Officer, IHM, Infectious Hazard Management
World Health Organization, Avenue Appia 20, 1211 Geneva 27, Switzerland
Tel. No.: (4122) 791 21 11, Fax No.: (4122) 791 0746, email: @who.int
Ms Viviane Melo Bianco, Consultant, Infectious Hazard Management
World Health Organization, Avenue Appia 20, 1211 Geneva 27, Switzerland
Tel. No.: (4122) 791 4282, Fax No.: (4122) 791 0746, email: [email protected]
29
Annex 3. Programme of activities
Day 1 – Tuesday, 17 September 2019
08:30 – 09:00 Registration
09:00 – 09:30 Opening session
Message from Dr Yunguo Liu, Director of Programme Management, WHO
Regional Office for the Western Pacific
Opening remarks
Objectives and programme of the meeting
Introduction of participants
Administrative announcements
Group photo
09:30 – 09:45 Managing health security threats through Asia Pacific Strategy for Emerging Diseases and Public Health Emergencies (APSED III)
– Dr Chin-kei Lee, Acting Health Emergencies Director, WHO Health
Emergencies Programme, WHO Regional Office for the Western Pacific
9:45 – 10:00 Proposed Regional Strategy for Expanded Programme for Immunization 2021–
2030
Dr Ananda Amarasinghe, Expanded Programme for Immunization, WHO Regional Office for the Western Pacific
10:00 – 10:30 Coffee break
10:30 – 12:00 Plenary 1: Are we ready for the next pandemic?
10:30 – 10:50 Advancing pandemic preparedness for health security: Are we ready?
– Dr Masaya Kato, WHO Health Emergencies Programme, WHO Regional Office for the Western Pacific
10:50 – 11:30 Discussion: Pandemic preparedness in our countries – Progress and challenges
11:30 – 11:40 Overview of the situation of seasonal influenza vaccination in the Western Pacific
Region
– D. Md. Shafiqul Hossain, WHO Cambodia
11:40 – 11:55 Lessons learnt from global deployment of pandemic influenza vaccines during
the Pandemic (H1N1) 2009
– Ms Ioana Ghiga, WHO Health Emergencies Programme, WHO headquarters
11:55 – 12:10 Lessons learnt from pandemic influenza vaccine deployment and vaccination
during the Pandemic (H1N1) 2009 in the Western Pacific
– Dr. Md. Shafiqul Hossain, WHO Cambodia
12:10 – 12:30 Plenary discussion
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12:30 – 13:30 Lunch break
13:30 – 15:00 Plenary 2: Country updates on National deployment and vaccination planning
Country presentations
- Cambodia
- China
- Lao People’s Democratic Republic Mongolia
- Philippines
- Viet Nam
15:00 – 15:30 Coffee break/mobility break
15:30 – 17:45 Pandemic Influenza Preparedness (PIP) Deploy Game
Mission 1: National Deployment and Vaccination Plan
15:30 – 15:45 Overview of the global guidance on national deployment and vaccination
planning
– Ms Ioana Ghiga, WHO Health Emergencies Programme, WHO headquarters
15:45 – 17:15 PIP Deploy Game Mission 1: National Deployment and Vaccination Plan
End of Day 1
17:30 – 19:00 Reception
Day 2 – Wednesday, 18 September 2019
08:30 – 08:35 Recap of day 1
– Ms Viviane Bianco
08:35 – 10:15 PIP Deploy Game Mission 2: Legal and regulatory planning
08:35 – 08:55 National regulatory systems readiness for pandemic influenza vaccines in the
Western Pacific Region
– Dr Jinho Shin, Medical Officer, Division of Health System, WHO Regional Office for the Western Pacific
08:55 – 10:15 PIP Deploy Game Mission 2: Legal and regulatory planning
10:15 – 10:45 Coffee break
10:45 – 12:00 PIP Deploy Game Mission 3: Public Communication
10:45 – 11:00 Roles of risk communication for pandemic influenza vaccine deployment and
vaccination
– Dr Ljubica Latinovic, Division of Disease Control, WHO Regional Office for
the Western Pacific
11:00 – 12:00 PIP Deploy Game Mission 3: Public Communication
12:00 – 13:00 Lunch break
13:00 – 14:00 PIP Deploy Game Mission 4: Supply chain and waste management
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13:00 – 13:05 Introduction to supply chain and waste management
– Dr Ananda Amarasinghe, Expanded Programme for Immunization,
WHO Regional Office for the Western Pacific
13:05 – 14:05 PIP Deploy Game Mission 4: Supply chain and waste management
14:05 – 15:10 PIP Deploy Game Mission 5: Post-deployment surveillance system
and management
14:05 – 14:10 Introduction to post-deployment surveillance system and management
– Dr Ananda Amarasinghe, Expanded Programme for Immunization,
WHO Regional Office for the Western Pacific
14:10 – 15:10 PIP Deploy Game Mission 5: Post-deployment surveillance system and
management
15:10- 15:40 Coffee break/mobility break
15:40 - 17:00 PIP Deploy Game Hot-wash
15:40 – 16:20 Quiz (Mentimeter)
16:20 – 17:00 Hotwash
End of Day 2
Day 3 Thursday, 19 September 2019
08:30 – 08:35 Recap of day 2 – Ms Viviane Bianco
08:35 – 08:45 Costing the NDVP – Potential options
– Ms Ioana Ghiga, WHO Health Emergencies Programme, WHO headquarters
08:45 – 10:00 Self-assessment of NVDP plans and defining next steps and priority actions
10:00 – 10:30 Coffee Break
10:30 – 11:40 Country presentations of the next steps and priority actions
11:40 – 12:00 Quiz (Mentimeter)
12:00 – 13:00 Lunch break
13:00 – 13:30 Summary and conclusions
www.wpro.who.int