How to do a post-Covid reboot

COUNTRIES should start planning now to deliver Covid-19 vaccines, in order to enjoy a faster recovery from both the health and economic impacts of the pandemic.
How to do a post-Covid reboot How to do a post-Covid reboot How to do a post-Covid reboot How to do a post-Covid reboot How to do a post-Covid reboot

Dr Patrick L Osewe

Dr Patrick L Osewe

This is the view of Patrick L Osewe, who is chief of health sector group for the Asian Development Bank and these are some of his thoughts on how to go about that recovery. This is an edited version of Dr Osewe's views:
Given global demand, it is inevitable that the eventual supply of Covid-19 vaccines - currently in development in a dozen or so countries - will not be sufficient. But once they do become available, there will be a massive global effort to get the vaccines to all countries and territories.
As scientists continue to work at great speed to develop safe and effective vaccines, countries must also strengthen their capacity to distribute and administer them as quickly and efficiently as possible. There are a number of actions countries can take now to make sure they are prepared to prioritize, introduce, and deliver Covid-19 vaccines:
Adopt a whole-of-government approach to improve vaccine delivery planning 
Every aspect of the Covid-19 response - from the development of test kits to the designation of treatment facilities - has involved partnerships across society. Preparing for the delivery of a Covid-19 vaccine is no exception. Countries should engage key stakeholders to plan scenarios, develop a national vaccine strategy, and organise operational aspects of vaccine introduction. Given the enormous scale of Covid-19 vaccination - and its broader impact on travel, schooling, and economic recovery - partnerships at every level will be critical to success.
Identify context-specific vaccine delivery resource requirements
It is likely that many of the challenges that low- and middle-income countries already face related to health systems, settings, facilities, and human resources will be amplified by the introduction of the Covid-19 vaccine.  For example, it is anticipated that at least one Covid-19 vaccine candidate will require storage at temperatures as low as -80C. Yet temperature-controlled logistics and point-of-care cold chain infrastructure are unreliable in many rural settings in low- and middle-income countries, where electricity supply is not guaranteed. These varying vaccine characteristics—along with the substantial increase in volume, ranging from millions and in some cases billions of Covid-19 doses—mean that countries will have to carefully determine not only what resources they will need for effective storage, distribution, handling, and stock management of their supply (for example high-capacity freezers and refrigerators, vaccine carriers, cold boxes, IT systems, and more) but also workforce requirements to deliver and administer nationwide vaccinations at scale.
Agree on the vaccine priority line 
The question of who should receive the first doses of the vaccine is complex. For example, frontline workers are often at the top of proposed priority lists. Yet this category alone requires careful consideration - who is considered a frontline worker? Which frontline workers should be prioritized? Who will follow and in what order? These are all questions that will have to be answered and clearly communicated to the public.
Countries should assess how to identify prioritised groups based on their country context and specific epidemiology (for example, people at a higher risk of severe disease or people living in areas where the disease is spreading rapidly may be prioritized). They should also model different scenarios for vaccinating the general population and set expectations accordingly.
By preparing now to implement widespread vaccination, countries can position themselves to enjoy faster recovery from both the health and economic impacts of Covid-19.
Strengthen vaccination infrastructure
Virtually every country in the world will have to strengthen and expand their existing vaccination infrastructure in order to be able to transport, track, store, and administer Covid-19 vaccines. This is particularly important given that most vaccination infrastructure is geared towards delivery to children, and not adults. Simultaneously, Covid-19 vaccination must be introduced while avoiding disruptions to routine national immunization programs.
Key issues for countries to consider include strengthening vaccine storage, quality assurance, and - distribution systems, along with the information systems required to track every dose that has been administered, especially in the case of multi-dose vaccines. Issues of building capacity, training health workers, and expanding sites (for example, hospitals, clinics, pharmacies, schools, occupational health settings and so on) should also be considered.
Develop a vaccine delivery/execution plan
Once vaccines are secured by a country, they will need to be distributed, including to rural, hard-to-reach, and urban areas. Implementation plans should identify how health departments will administer and track vaccines to hard-to-reach populations, such as those that are mobile, are in conflict, lack formal identities, and/or are otherwise unidentifiable.
Implementation plans should also emphasise strategic delivery of the vaccine and wide geographic accessibility. This might include designating multiple distribution points across a range of community locations (for example schools, parking lots, large stadiums, pharmacies, workplaces, prisons, military, conference centres and so on) or designing innovative distribution strategies (for example drive-through sites).
Develop communication strategies to improve vaccine uptake
At the start of the pandemic, a parallel Covid-19 ‘infodemic' emerged, making it difficult for people around the world to find reliable guidance about transmission of and protection from the virus. As such, widespread campaigns will be necessary to educate the public about the benefits of COVID-19 vaccination and increase public confidence.
Clear expectations should also be communicated to the public about who has been prioritised and why, as well as when the vaccine will be made available to the general population and how they can receive it. With vaccine coverage essential to the protection of population health, developing and implementing clear advocacy and communication strategies will be critical for overall success.
Ensure appropriate vaccine reporting, monitoring, and evaluation
Given how scarce Covid-19 vaccines are likely to be at the beginning, managing and monitoring supplies will be paramount. Countries should begin now to prepare and improve their vaccine management, reporting, monitoring, and evaluation systems in order to reduce incidences of stock outs and wastage - and to ensure proper re-allocation and accountability. This also includes strengthening existing vaccine safety monitoring systems to identify adverse events.
As countries in the Asia-Pacific region, like the rest of the world, wait for one or more Covid-19 vaccines to be successfully developed and approved, there are a number of immediate actions that they can take to accelerate the national response to the pandemic. By preparing now to implement widespread vaccination, countries can position themselves to enjoy faster recovery from both the health and economic perspectives.
Dr Patrick L Osewe is chief of the Asian Development Bank's health sector group, providing leadership on all health sector group technical and operational matters. He has been at the forefront of strengthening health systems against the threat of disease outbreaks through innovative, multi-sector approaches for more than 25 years. Before his time at ADB, Dr Osewe worked as the World Bank's global lead of healthy societies. He received his medical degree from the University of Nairobi and holds a Master's of Public Health from Harvard University.