WHO-UNICEF Joint briefing

YEMEN COVID19 Vaccine Deployment Plan

08 April 2021

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Background information• First COVID19 case reported on 10 April 2020

• Activated Yemen Covid19 Response Plan(YCRP): Incident management system with 9 pillars

• Gavi-UNICEF-WHO advocacy and recommendation to prepare one national COVID19 vaccination plan

• COVAX application submitted for the whole country• Signed Form A confirming:

• Target population, • Existence of expedited regulatory pathway,

and• Preference to only receive vaccines requiring

storage temperature (+2 to +8) • Signed Form B: general indemnification and

liability agreement with COVAX facility• Signed (as COVAX member) indemnification

agreement with Serum Institute of India (SII).

Current epidemiologic situation

Second wave: increasing rates of cases and deaths (reports are mainly from Governorates in the South)

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National Vaccine Deployment Plan• Developed national vaccine deployment plan as per

WHO guideline

• Target population prioritized as per WHO SAGE roadmap for use of COVID19 vaccine in context of supply constraint

Country specific prioritization

Objective: reduce deaths and disease burden from the COVID-19 pandemic

• Phase 1: up to 10% of target population• Health care workers (all workers in public and

private sectors)• Elderly people 55 years and above• People with comorbidities• Social groups unable to physical distance

(IDPs/refugees)

• Phase 2: 11-20%• Other essential workers including humanitarian

actors• Older adults at high risk of disease (cut-off age to

be determined based on epidemiologic data)

• Phase 3: 21-70%• Older adults not included in the previous categories• No commitment yet secured

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NDVP Coordination Structure

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Vaccine Support

• COVAX will support vaccine for up to 20% of the population in Yemen

• To date COVAX confirmed to support 1,968,000 doses of AstraZeneca vaccine/SII

• UNICEF supply division is coordinating shipment. Confirmed shipment plan of vaccines is as follows:• 360,000 doses arrived on 31 March 2021• 612,000 doses planned to arrive in April (no specific date): postponed• 996,000 doses planned to arrive in April (no specific date): postponed• Postponed shipments to be resumed in May

• AstraZeneca vaccine is a liquid ready to use vaccine

• Can be stored in the existing routine EPI cold chain storage within +2 to +8

• Two doses required for effectiveness

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Photo of WHO and UNICEF Representatives supporting Minister of Health and his team to receive the first shipment on 31 March 2021

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Implementation plan and vaccination strategy

• Phased implementation based on vaccine availability

• The first 360,000 doses will be used to vaccinate all HCW and elderly people 60 years and above (MoPHP endorsed)• HCWs refers to all personnel working in health facility, either on

payroll or contract basis, in public and private public sector.• HCWs include doctors, nurses, admin staffs, cleaners, guards

and community health workers• Most professionals working in the private sector also work in

the public sector.

• Two doses to be administered 12 weeks apart

• Time: first 360,000 doses in April and second 360,000 doses in July

• Scope: 14 Governorates under IRG control

• Team composition: • Four members including 2 vaccinators, 1 AEFI monitor and

screener, 1 recorder• In addition, 1 team supervisor per four teams and 1-2 social

mobilizers per district

Vaccination strategy

14 Governorates under IRG

133 Districts

219 Fixed site vaccination teams

Daily vaccination for 15+ days

207 outreach site vaccination teams

Daily vaccination (alternate sites)

for 12 days

Daily report: coverage, vaccine utilization, AEFIs

Pre-registration

and vaccination

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Progress status as at 4 April 2021

• Most activities are on track (completed or maturity stage)

• Target population prioritized as per WHO SAGE FW

• Microplan finalized and approved by MoPHP

• MoPHP designated focal persons

• Operational fund near final approval stage

• Regulatory requirements in place for emergency registration and import

• Central level ToT conducted and cascaded training to be completed

• Recording and monitoring tools developed and under printing

• Adequate cold chain and waste management capacity

• Distribution plan prepared for vaccines and supplies. Distribution pending printing

• Communication plan developed and messages prepared endorsed by MoPHP

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Yemen readiness for COVID-19 vaccine introduction by program area, 04 April 2021 (VIRAF output)

completed In progress-maturity stage In progress-early stage Not started

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Regulatory framework and vaccine safety surveillance

• National regulatory authority approved emergency use authorization of AstraZeneca vaccine based on:• Scientific data submitted by manufacturer• Reliance on WHO Emergency Use Listing (EUL)

In addition, NRA is monitoring statements released by WHO and EMA regarding safety of AZZ vaccine

Trained central AEFI committee on vaccine safety and monitoring of AEFI

List of AEFI committee members to be updated to include specialists such as hematologists if available

AEFI committee members will conduct field visit to each district to strengthen AEFI surveillance

AEFI training incorporated in the health workers training guideline

AEFI monitoring tools are updated and under printing

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Financial support

• A total of US$ 40,032,803.06 is required to vaccinate 20% of target population.

• The above budget is assuming $ 2.96 cost per dose

• US$ 7,761,600.00 secured from WB out of which $ 5,812,229.72 is allocated for vaccination of 998,000 (3%) of population.

• The gap (for 20%) is estimated to be $ 40,032,803.06 including $ 37,050 for central team support per round.

• Vaccination beyond 20% of the population involves securing budget for vaccine procurement ($3 per dose) in addition to cost of deployment ($2.96 per dose)

• Actual budget for each phase may vary depending on factors such as number of beneficiaries targeted, characteristics of beneficiaries

• Gavi approved and supported $ 847,466 for technical assistance to support preparatory activities.

Budget breakdown by phase of implementation

Phase

Target population

Budget estimate

Amount secured Gap

Phase 1a998,000

(3%) 5,960,429.72 5,812,229.72 148,200

Phase 1b2,328,667

(7%) 14,082,106.67 0 14,082,106.67

Phase 23,326,667

(10%) 19,990,266.67 0 19,990,266.67

Phase 39,980,000

(30%) 121,955,600.00 0 121,955,600.00

Total 16,633,333 161,988,403.06 5,812,229.72 156,176,173

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Financial support (2)

• The total cost of deployment of first dose of the vaccine is estimated to be $ 1,052,940.

• Funding sources: WB: $927,025, Gavi: 88,865 and TBC donor: 37,050

• Budget for central level team support ($ 37,050) being mobilized for the first round from other donors.

• Partner mapping ongoing to identify potential area of support (some INGOs have already communicated their plan)

• Budget breakdown for subsequent rounds to be revised based on experience from implementation of 360,000 doses

Unit Cost Breakdown

Category Total Cost Cost per dose% of cost per

dose

Variable

IPC (consumables) $ 11,451.25 $ 0.03 1%

PPE (consumables) $ 95,125.00 $ 0.22 7%

Field teams $ 502,698.62 $ 1.16 39%

Transportation for committees $ 124,696.55 $ 0.29 10%

Vaccine transport $ 75,000.00 $ 0.17 6%

Waste management $ 25,000.00 $ 0.06 2%

AEFI surveillance and management $ 17,500.00 $ 0.04 1%

Fixed

IPC (fixed) $ 9,214.00 $ 0.004 0.1%

PPE (fixed) $ 116,500.00 $ 0.05 2%

Monitoring and supervision $ 1,126,609.34 $ 0.52 18%

Printing $ 47,201.61 $ 0.02 1%

Social mobilization $ 300,000.00 $ 0.14 5%

Syringes and safety boxes $ 88,200.00 $ 0.04 1%

Training $ 463,177.66 $ 0.21 7%

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Efforts to ensure right targets are reached with the vaccine

Pre-registration

• Effort being coordinated by GoH and DoH with support of central team and partners

• Pre-registration website released by MoH and registration templates given to GoH and DoH

• Registration of eligible populations ongoing at community level

• To date list of HCWs is received from 6 Governorates

• No data received on list of elderly people

Monitoring vaccine movement

• Vaccine distribution plan is developed based on approved micro plan of the priority groups as per the NDVP and approved by the MoPHP authority

• Vaccine transaction will be documented at all supply chain levels using stock monitoring tools

• Daily report will be compiled from field level on number of people vaccinated, doses used and balance at hand

Supervision and field monitoring

• Partners will deploy supervisors in addition to those deployed by MoH to ensure accountability for delivered vaccines at each level.

• Independent monitoring will be conducted during and after the campaign

• COVID19 hotline will be used to listen to concerns

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Vaccination plan in the North• Current plans are developed based on active discussion with authorities in

Aden• Recently authorities in the North requested support for vaccination of

10,000 HCWs• Authorities in Aden are willing to provide the requested vaccine quantity• Establishing accountability mechanism on use of the vaccine under

discussion• Discussion ongoing regarding registering beneficiaries• Vaccination team and vaccination sites to be identified by MoPHP in Sana’a

in consultation with WHO and UNICEF• WHO and UNICEF will assist in registration of beneficiaries, training of

vaccination team, compilation of reports and sharing with MoPHP in South• Vaccine to be sent to Sana’a upon confirmation of implementation plan

including date and site of delivery.

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Challenges

Lack of data on elderly population despite efforts for pre-registration

Delay in finalizing budget which resulted in delay in channeling operational fund to MoH. In addition, proposal is to be approved by WB.

Lack of fund for central team support for coming rounds of vaccination.

Staffing issue at central and lower levels: understaffed and need for refresher

Low understanding and misinformation about COVID19 vaccine and anticipated vaccine hesitancy.

Postponement of vaccine shipments

No confirmation yet regarding vaccination plan in the north

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Next steps: implementation of first dose

• Finalize registration of HCWs and elderly population

• Complete cascaded training at Governorate and district levels

• Finalize printing of monitoring tools and IEC materials

• Community engagement activities commencing with 1,500 community volunteers, 800 religious leaders, media campaign with 23 community radios and 6 TV channels in the South

• Engaging with 2 popular GMS mobile phone to disseminate key messages

• Establish a network of Medical experts and public figures to activate rumor feedback mechanism

• Distribute vaccine and supplies as per the micro plan

• Channel funding to MoPHP and lower levels

• Conduct pre-campaign assessment (deploy supervisors from MoPHP and partners to high priority districts)

• Finalize partners mapping for potential support to vaccine implementation

• Finalize third party monitoring activities

• Continue coordination meetings shifting to daily meeting during implementation

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Planning for subsequent rounds

• Follow up with COVAX and UNICEF supply division on vaccine shipment dates (quantity)

• Prioritize target population based on vaccine supply: include additional cohorts with dose2 implementation

• Secure funding and finalize budget proposal using standard budgeting tool

• Implement third party monitoring

• Review performance of phase1 implementation using various observations and assessment findings

• Synchronize implementation in whole Yemen if possible, by advocating approval of vaccine use in the North

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THANK YOU VERY MUCH

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