Embed Size (px)
Citation preview
OFFICE OF THE ASSISTANT REGIONAL DIRECTOR
IMMUNIZATIONS AND VACCINE DEVELOPMENT PROGRAMME (IVD)
PANDEMIC INFLUENZA A (H1N1) 2009
VACCINE DEPLOYMENT ACTIVITY IN AFRICAN REGION
Richard Mihigo, Zenaw Adam and Amos Chweya
31 October 2010, Brazzaville, Republic of Congo
P a g e | 2
ACKNOWLEDGEMENT
The H1N1 team at the Regional Office would like to thank WHO and USAID for the
joint but unique opportunity we were provided during the past year.
We are particularly indebted to IVD Programme and the very supportive staff which
ensured this particular task come to a successful end.
The support from USAID through MCHIP and DELIVER, its energetic teams of public
health and logistics specialists, the overall support of JSI staff in Washington was
vitally required for the success of H1N1 vaccine deployment activity in African Region.
We thank all colleagues, IVD focal persons at ISTs, WCOs and at WHO –HQ for the
harmonious team approach to deal with the challenge of Pandemic H1N1.
31 October, 2010
Brazzaville, Republic of Congo
P a g e | 3
1 CONTENTS 1 Contents......................................................................................................................................................... 3
2 LIST OF TABLES AND FIGURES ......................................................................................................................... 4
3 ACCRONYMS .................................................................................................................................................. 5
1. H1N1 IN AFRICAN REGION.............................................................................................................................. 7
A. EPIDEMIOLOGICAL SITUATION ANALYSIS 7
B. PANDEMIC PREPAREDNESS AND RESPONSE 11
2. THE VACCINE DONATION INITIATIVE ............................................................................................................ 12
A. STRATEGIC ADVISORY GROUP (SAGE) RECOMMENDATION 12
B. ELIGIBILITY OF COUNTRIES AND CRITERIA FOR VACCINE DONATION 14
a) Letter of Intent (LOI) ............................................................................................................................. 14
b) Letter of Agreement (LOA) .................................................................................................................... 14
c) national deployment plan (ndp) ............................................................................................................ 14
3. THE ABUJA WORKSHOP................................................................................................................................ 16
A. WORKSHOP GOAL 16
B. SPECIFIC OBJECTIVES 16
4. TECHNICAL SUPPORT ................................................................................................................................... 17
A. DEPLOYMENT OF CONSULTANTS 17
5. VACCINE DEPLOYMENT PLAN: process and components .............................................................................. 18
A. DEPLOYMENT PLAN (NDP) COMPONENTS 19
a) Vaccination strategies ........................................................................................................................... 19
b) management and organization .............................................................................................................. 20
c) vaccine registration and licensing .......................................................................................................... 20
d) information and communication ........................................................................................................... 21
e) human resource and security ................................................................................................................ 21
f) public information ................................................................................................................................. 21
g) supply and cold chain processes ............................................................................................................ 21
h) post marketing surveillance ................................................................................................................... 22
i) waste management ............................................................................................................................... 22
j) evaluation ............................................................................................................................................. 22
6. VACCINE DEPLOYMENT ACTIVITIES: vaccines and implementation .............................................................. 23
A) DEPLOYMENT PLANS (NDPS): THE APPROVAL PROCESS 23
B) VACCINES AND ANCILLARY SUPPLIES: SHIPMENT AND DISTRIBUTION 26
i. Vaccines ................................................................................................................................................ 26
ii. Ancillary supplies .................................................................................................................................. 27
C) FUNDING 28
D) VACCINATION IMPLEMENTATION ACTIVITIES 29
10. REPORTING AND DATA................................................................................................................................. 35
11. AEFI .............................................................................................................................................................. 35
12. LESSONS LEARNT ......................................................................................................................................... 36
14. POST PANDEMIC PERIOD AND THE WAY FORWARD .................................................................................... 37
P a g e | 4
2 LIST OF TABLES AND FIGURES
LIST OF TABLES
Table 1: WHO Regions and countries eligible for H1N1 vaccine donation
Table 2: AFR countries eligible for vaccine donation i
Table 3: Prioritization of AFR countries for H1N1 vaccine deployment
Table 4: Participants of Abuja workshop on H1N1 vaccine deployment in AFR
Table 5: H1N1 consultant activities and country visits
Table 6: Vaccine deployment plan (NDP) approval by month
Table 7: Vaccine deployment plan (NDP) approval by IST
Table 8: H1N1 vaccine deployment activity by month
Table 9: H1N1 vaccines distributed in AFR- manufacturer and recipient country
Table 10: H1N1 vaccines in AFR- donors and recipient countries
Table 11: H1N1 vaccine products and recipient countries
Table 12: Ancillary supplies by donors and recipient country
Table 13: H1N1 vaccine deployment – financial support in AFR
Table 14: Distribution of target populations
Table 15: Time lapse to complete H1n1 vaccine deployment activities in AFR
Table 16: H1N1 vaccination coverage
Table 17: H1N1 vaccine utilization in AFR
Table 18: H1N1 vaccine allocation by target populations
Table 19: H1N1 Vaccine deployment plan- budgeting pattern
LIST OF FIGURES
Figure 1: Pandemic Influenza H1N1 in AFR (map)
Figure 2: Number of AFR countries reporting H1N1 cases by month
Figure 3: Number of new H1N1 cases by month
Figure 4: Number and distribution of H1N1 cases in South Africa and rest of AFR
Figure 5: Cumulative number of H1N1 cases in AFR
Figure 6: Number of new H1N1 cases in eligible and non-eligible AFR countries
Figure 7: Distribution curve of new H1N1 cases by IST
Figure 8: Reported H1N1 cases by IST
Figure 9: Implementation status of H1N1 vaccine deployment in AFR (map)
Figure 10: H1N1 vaccine deployment plan (NDP) approval by month
Figure 11: H1N1 vaccine deployment in AFR- funding sources
Figure 12: Distribution of target populations for H1N1 vaccination in AFR
Figure 13: Time lapse from submitting LOI to H1N1 vaccination implementation
Figure 14: H1N1 vaccine utilization by IST
Figure 15: Status of H1N1 vaccine deployment status by 31 October 2010
Figure 16: AFR member countries by sub region (IST) - map
P a g e | 5
3 ACCRONYMS
AEFI Adverse Events Following Immunization
AFR African Region of World Health Organization
AFRO African Regional Office of the World Health Organization
AED Academy for Educational Development
ARDO Office of the Assistant Regional Director of AFRO
CAF Central Africa Republic
CDC Centers for Disease Control and Prevention (Atlanta)
CMT Crisis Management Team
DDC Division of Prevention and Control of Communicable Diseases (now DPC)
DG Director General , of WHO
DPC Disease Prevention Cluster of AFRO (formerly DDC)
EPI Expanded Program of Immunization
GSK GlaxoSmithKline
HIC High Income Countries
IDSR Integrated Disease Surveillance and Response Programme in AFRO
IST/CA Inter-country Support Team Central Africa
IVD Immunization Vaccine Development Programme in AFRO
JSI John Snow Inc.
LIC Low Income Countries
LMIC Low- to-Middle Income Countries
LOA Letter of Agreement in H1N1 Vaccine Deployment Initiative
LOI Letter of Intent in H1N1 Vaccine Deployment Initiative
NDP National H1N1 Vaccine Deployment Plan
PAHO Pan American Health Organization
RO Regional Office (AFRO)
SAGE Strategic Advisory Group of Experts
SARS Severe Acute Respiratory Syndrome
UNICEF United Nations Children's Fund
UNSG United nations Secretary general
USA United States of America
USAID United States Agency for International Development
USG United States Government
WHO World Health Organization
P a g e | 6
EXECUTIVE SUMMARY
The Regional Office for Africa, in its preparedness and response effort to address Pandemic Influenza A
(H1N1), gave due priority to vaccine donation initiative where IVD/ARDO was mandated to take the lead to
coordinate and facilitate vaccine deployment and implementation activity.
The IVD/AFRO effort to strengthen the Regional preparedness and response capacity, garnered the
acquisition of teams of public health and logistics experts1 from USAID, who were seconded to provide
technical support to countries from within existing WHO system at Regional and Sub-regional levels.
In November 2009, a two-part workshop, each in French and English, was conducted to help eligible
countries to develop national vaccine deployment plans (NDP) as per the WHO guideline designed to cater
Pandemic (H1N1). At this stage, the newly appointed H1N1 technical teams joined the training workshop
and helped facilitation of the workshop..
Member countries, except Algeria and South Africa were all eligible for the H1N1 vaccine donation, which
all confirmed their participation by submitting letter of intent (LOI) to WHO. Enrolled countries, among
which 39/44 members entered an agreement with WHO by signing letter of agreement (LOA) where 37 of
them have their national vaccine deployment plan (NDP) approved at all levels.
In spite of challenges and priorities that each country has had, with the technical assistance from ISTs and
RO, eligible countries progressed to executed the H1N1 vaccine deployment activities very well.
Accordingly, 34 (78%) AFR countries have finally reached the goal to access to H1N1 vaccines and receive
more than 32 million doses enough to vaccinate up to 10% of their prioritized target populations.
By the time of compiling this report, 30 (88%) countries have implemented by administering H1N1 vaccines
to their prioritized target populations. Preliminary data indicates a Regional average of vaccine uptake of
78%, with rates as high as 100% in some countries. In line with the recommended strategy, countries
prioritized target populations, particularly health care workers to receive H1N1 vaccines. Few which
received vaccines but yet to implement are to complete vaccination by November and December 2010.
In view of the overall goal of vaccine donation initiative, which envisaged to assist countries to have access to H1N1 vaccines, the whole exercise was a success: countries had access to H1N1 vaccines. All countries that requested vaccines have all received. All countries that received vaccines and ancillary supplies were assisted financially to cover operational cost.
In view of the specific objectives of protecting the integrity of the health-care system and critical infrastructure, reduction in morbidity/mortality and viral transmission, the AFR H1N1 vaccine deployment exercise is once again a big success. The SAGE recommended strategies and prioritization were fully implemented. Health care workers were vaccinated first, pregnant women and children were also targeted for vaccination. Vaccine was also available to other prioritized populations.
In general the WHO Regional Office, ISTs and WCOs as well as countries have demonstrated their preparedness and response capacity very well.
The outcome of the initiative in the African Region reflected the most needed collaborative effort of
countries, WHO and partners in all levels. The catalytic role played by the technical teams comprising
public health experts and logisticians at IST and RO levels is viewed as a testimony to yet another
successful story of AFRO-USAID partnership
1 USAID (MCHIP/DELIVER) seconded 8 consultants (4public health experts and 4 logisticians) based at RO and three ISTs from Nov. 2009 to end of October 2010..
P a g e | 7
1. H1N1 IN AFRICAN REGION
a. EPIDEMIOLOGICAL SITUATION ANALYSIS
The first laboratory confirmed case of Pandemic Influenza A (H1N1) 2009 was reported from South
Africa on 18 June, 2009. The pandemic and disease occurrence was fast increasing as number of cases
and number of reporting countries grow each week.
More than 18,500 laboratory confirmed cases and 180 deaths were reported from 35 countries from the
African Region. Only eleven member countries2 reported no case during this period.
Although the pandemic reached 35 countries, magnitude and seasonality of H1N1 cases vary greatly
from country to country and even from sub-region to sub-region.
Figure 1. Pandemic H1N1 in African Region, June 2009-May 2010
Of the 46 countries in the African Region, lab confirmed cases of pandemic influenza (H1N1) were
reported from 35 (76%) countries signifying the wide spread of the H1N1 virus (Fig. 1), of which 29 (83%)
have already reported cases until December, 2009. Only 6 countries (14%) were infected in 2010, at
least until May, up to which data on case reports is available. Figure 2, illustrates that the pandemic
overwhelmed the Region in the 3rd and 4th quarter of 2009 and slowed down in 2010 to the level of zero
cases in the 2nd and 3rd quarter.
2Benin, Burkina Faso, Central African Republic, Comoros, Equatorial Guinea, Eritrea, Gambia, Guinea-Bissau, Liberia, Sierra Leone, and Togo.
P a g e | 8
During the course of nearly15 months of the pandemic, 11 countries3 from the Region never reported
H1N1 cases and remained free from H1N1 virus to date. In view of inadequacy of surveillance systems
in some countries of the Region, and problems of completeness, regularity and quality of reporting
systems, the disease free status of these countries is in question and perhaps misleading.
Figure 2:: AFR Countries which reported cases of H1N1 from July 2009 to June 2010.
In the H1N1 infected countries, a total of 18,596 H1N1 cases were reported from 37 AFR countries
including Algeria and South Africa. Reviewing the weekly and monthly distribution of cases suggest that
much (90%) of H1N1 was reported in the year 2009, reaching its peak during August and September.
Only 1964 (10%) of lab confirmed cases occurred in 2010 (Figure 3).
Figure 3: No. of lab confirmed H1N1 cases in AFR by month, (July 2009-June 2010)
Most affected populations were those between 5-45 years of age with a relatively higher
hospitalization and fatality rate among young adults. While epidemiologic and serologic data
suggested that older adults are less susceptible, pregnant women, people with chronic illnesses,
immunocompromised and people with underlying health conditions, and young children were
identified as groups most at risk.
3 Benin, Burkina Faso, Central African Republic, Comoros, Eq. Guinea, Eritrea, Gambia, Guinea-Bissau, Liberia and Togo.
13
8
35
01
31 1 1
0 00
2
4
6
8
10
12
14
July Aug Sept Oct Nov Dec Jan Feb Mar Apr May Jun
2009 2010
Nu
mb
er
of
Co
un
trie
sNo. of AFR countries which reported H1N1 cases
0
1
2
3
4
5
6
7
8
9
July Aug Sept Oct Nov Dec Jan Feb Mar Apr May Jun
2009 2010
No
. cas
es ('
000)
No. reported H1N1 cases in AFR, 2009-2010
29 (84%) 6 (16%)
16,634 (90%) 1964 (10%)
P a g e | 9
The early build up of the pandemic appears to be more from countries in the Southern and Eastern sub-
region (IST/ESA) where majority of the cases were reported from. were mostly affected. Analyzing data
from the weekly case report updates, it is clearly shown that most cases of H1N1 were reported from
the Southern Africa, especially from South Africa which by is the most affected country in the Region. As
shown in Figure 4 below, the epidemic curve in South Africa is much higher than number of cases
reported from other member countries put together. It can also be seen that, after the number of
reported cases from South Africa dropped at around October 2009, the magnitude of H1N1 in general
remained low throughout the year 2010.
Figure 4: Distribution of H1N1 case in South Africa vs Rest of AFR, June 2009-May 2010
Figure 5: Cumulative number of lab confirmed cases of H1N1 in AFR by month, (Jul. 2009-Jun. 2010)
0
20
40
60
80
100
July Aug Sept Oct Nov Dec Jan Feb Mar Apr May Jun
Cas
es
in '0
0
Distribution of new cases of H1N1 by month, (July 2009-June 2010)
Other AFR Countries S Africa
0.0
2.0
4.0
6.0
8.0
10.0
12.0
14.0
16.0
18.0
20.0
1 3 5 7 9 111315171921232527293133353739414345474951
Re
po
rte
d c
ase
s ('
00
0)
Weeks
Cumulative cases of Pandemic H1N1 in AFR (Jul. 2009-Jun. 2010)
20102009
P a g e | 10
This was further illustrated in Figure 5, which the cumulative reported cases started to level around
week 21 (October-November 2009) onwards. This coincides with time when reported cases from South
Africa reached Zero in November 2009.
When data from South Africa is taken off and analyzing data from all other countries suggests that, even
though the pandemic was still active in many of the countries, the pandemic was declining as the
number of cases being reported were scant.
Figure 6:Distribution of cases in South Africa and Algeria compared to the rest of AFR, June 2009-May 2010
As seen from Figure 6, cases from countries other than South Africa and Algeria, were being reported
until the end of the year 2009. By December 2009, there were literally no cases being reported until 1 st
quarter of 2010, when a slight increase in the number of reported cases was noted, around March 2010.
It was also apparent that in 2010, the pandemic was active in countries, Senegal and Niger from
the Western sub-region (IST/WEST) and Chad from IST Central while there was no indication of
activity in the Southern or much of Central sub-regions.
Figure 7: Distribution curve of H1N1 cases by IST, June 2009-May 2010
0.02.04.06.08.0
10.012.0
July
Au
g
Sep
t
Oct
No
v
Dec Jan
Feb
Mar
Ap
r
May Jun
2009 2010
No
. cas
es (
'000
)
No. new H1N1 cases reported, Algeria & South Africa
0.0
0.5
1.0
1.5
July
Au
g
Sep
t
Oct
No
v
Dec Jan
Feb
Mar
Ap
r
May Jun
2009 2010
Cas
es ('
000
)
No. of new H1N1 cases in AFR(without Algeria & South Africa)
-0.2
0.0
0.2
0.4
0.6
0.8
1.0
1.2
1.4
July Aug Sept Oct Nov Dec Jan Feb Mar Apr MayJune
2009 2010
Cas
es (
'000
)
Distribution of H1N1cases by IST(without South Africa & Algeria)
Central
WEST
ESA
P a g e | 11
Figure 6 illustrates that in IST West, there was spikes of pandemic activity and increase in the number of
cases being reported around January and march 2010.
Although the pandemic Influenza H1N1 occurred in most of the member countries, the magnitude of
the problem was higher in some countries than others. Similarly, there was also a difference between
ISTs, as IST ESA was most affected than the other two ISTs.
As shown in Figure 7, Some countries in the respective ISTs reported more cases, such as Madagascar,
Tanzania and Rwanda in IST ESA. Or Ghana and Senegal in the IST West and Democratic republic of
Congo in IST Central.
Figure 8: Reported number of cases by country and IST, June 2009-May 2010
PANDEMIC PREPAREDNESS AND RESPONSE
Following reports received by WHO on sustained person to person transmission of a new
influenza virus during April 12-23, 2009, the Regional Office took early steps in preparation to
respond to this new threat. The Regional 'Crisis management committee (CMT) was established
before even the pandemic alert level was raised to phase 6
Likewise, ISTs and countries established National CMTs and revised Regional Integrated
Pandemic preparedness and Response plans to accommodate H1N1. The Regional conference
on H1N1 held in South Africa, in August, 2009 was also part of this effort.
The Regional Office support to countries included distribution of tools and guidelines to
enhancing national surveillance systems to enable the system to report cases of H1N1 including
zero reporting. Pandemic monitoring was launched using a software tool known as 'Event
management System (EMS)' which is still on use in 37 countries.
0 200 400
CAR
Eq. …
Chad
Gabon
Burundi
Congo
Angola
Cm'rn
STP
DRC
Number of cases
H1N1 cases in IST CENTRAL
(Jul. 09-Jun. 2010)
0 200 400 600 800
Benin
B. Faso
Gambia
G-Bissau
Liberia
Sr Leone
Togo
Guinea
Nigeria
Mr'tania
Côt dvr
Mali
Niger
Cp Vrde
Senegal
Ghana
Number of cases
H1N1 cases in IST WEST(Jul. 09-Jun. 2010)
0 200 400 600 800 1000
Comoros
Eritrea
Sw'zland
Malawi
Ethiopia
Botswana
Seychelles
Zimbabwe
Mz'mbque
Lesotho
Mauritius
Namibia
Zambia
Uganda
Kenya
Rwanda
Tanzania
Md'gscar
Number of cases
H1N1 cases in IST South/East
(Jul. 09-Jun.2010)
P a g e | 12
Along with the surveillance enhancement, the influenza laboratory capacity was strengthened by
mapping the network for fast sample referrals. Effort was made to strengthen 19 of the 25
influenza lab facilities by providing with real-time PCR and other essential materials for all
member countries.
Antiviral courses and personal protection equipment (PPE) were distributed to member countries
with additional supplies prepositioned at country, ISTs and Regional levels. Construction of a
modern strategic health operations centre (SHOC room) was also a related development that is
viewed to greatly improve the management of health crisis and pandemics in the region. '
2. THE VACCINE DONATION INITIATIVE
The WHO Director-General (DG) and the UN Secretary General (UNSG) called for international solidarity
to provide fair and equitable access to pandemic influenza vaccines for all countries. This initiative was
to assist low income (LIC) and low-middle income countries (LMIC) to have access to vaccines through
donations to vaccinate at least 10% of their population. Several high-income (HIC) governments and
manufacturers responded positively to support the initiative. WHO has thus been directing and
coordinating the deployment of donations and continued to provide technical/operational support in
collaboration with governments, donors and other stakeholders.
Table 1:WHO Regions and number of countries eligible for Vaccine Donation Initiative.
Around 95 low to middle-income countries, which would not otherwise have access to pandemic
vaccines, will be eligible (based on need) to receive support through the initiative. WHO's goal was to
provide each of these countries with vaccines enough to immunize at least 10% of its population.
With 444 of the 95 countries, AFRO started to coordinate the initiative since second half of 2009,
to help these countries get access to vaccines which otherwise was difficult or impossible to get
by their own.
A. STRATEGIC ADVISORY GROUP (SAGE) RECOMMENDATION
The Strategic Advisory Group of Experts5 (SAGE) on Immunization in its meeting of July 7, 2009,
reviewed the pandemic situation, status, and potential of vaccine production to make the following
4 All but Algeria and South Africa are eligible for the WHO H1N1 vaccine donation initiative
5 WER, 24 JULY 2009, No. 30, 2009, 84, 301–308, http://www.who.int/wer
Region Eligible countries
Millions to vaccinate
Africa 44 75.02
Americas 10 7.59
Europe 8 11.55
Eastern Mediterranean 7 26.29
South-east Asia 9 55.66
Western Pacific 17 23.76
Totals 95 199.87
P a g e | 13
recommendations. The recommendations stems on three different objectives that countries could
adopt as part of their pandemic vaccination strategy:
i. protect the integrity of the health-care system and the country's critical infrastructure;
ii. reduce morbidity and mortality; and
iii. reduce transmission of the pandemic virus within communities.
To reach these objectives, countries were encouraged to adapt strategies that reflect epidemiological
situation, availability of resources for access and administration of vaccines to prioritized targeted
groups. As per the recommendations, certain population groups were identified as a priority in
reflection to the stated objectives above. The following groups were thus recommended and endorsed
by WHO to be the first to be vaccinated.
Target Populations (groups)
a. Health care workers
b. Pregnant women
c. Individuals aged >6 months with chronic medical conditions
d. Healthy young adults ( 15-49 yrs)
e. Healthy children
f. Healthy adults aged >49 years and <65 years
g. Healthy adults aged >65 years
All countries should first immunize their front-line health care workers (HCW) estimated to be 1-2% of
population in order to protect the health care system. the recommendations, further specified to
prioritizing specific groups who are at increased risk of morbidity and mortality such as:
To protect those at greatest risk and to minimize disruption to health-care services, each selected
developing country will receive sufficient doses of pandemic vaccine (at 2% of its population) to
immunize at least its health-care workers, as recommended by SAGE in July 2009. The WHO secretariat
presented to SAGE a summary of ongoing activities aimed at ensuring that developing countries will
effectively use the vaccines soon to be provided to them. This includes technical assistance to
governments to evaluate adverse events following immunization.
The Strategic Advisory Group of Experts (SAGE) made a further review6 of the pandemic situation and
made the following recommendations. H1N1 cases continue to occur mostly in teenagers and young
adults, and pregnant women, especially in their 2nd-3rd trimester, have had a higher likelihood of
hospitalization compared to the general population. Severe outcomes occur more often when
underlying medical conditions are present, such as chronic lung diseases (including asthma).SAGE
considered that its previous recommendations7 on target populations for prioritizing pandemic
vaccination remained appropriate.
6 Weekly Epidemiological Record on 11 December 2009 7 SAGE Recommendations Wkly epp?
P a g e | 14
The recommendation pointed out that children prioritized for vaccination, then those aged >6 months
and <10 years should receive 2 doses of vaccine, but later replaced with a single dose, which may be
sufficient in healthy adults.. In the interests of public health, vaccine supplies should be used to give first
doses to as many children as possible, with second doses following as further supplies become available.
Inactivated and live attenuated vaccines are not known to have direct or indirect harmful effects with
respect to fertility or pregnancy. In this context, and given the elevated risk for severe outcomes of
infection with H1N1 virus in pregnant women, SAGE recommended 8that, in the absence of a specific
contraindication by the regulatory authority or from the WHO prequalification review, any licensed
pandemic vaccine can be used to protect pregnant women.
B. ELIGIBILITY OF COUNTRIES AND CRITERIA FOR VACCINE DONATION
Before a country can receive vaccines some key requirements must be met, including submitting letter
of intent (LOI) sent to WHO, entering a signed formal agreement with WHO including acceptance of
liability for any rare adverse events/side effects (LOA) and submission national vaccine deployment plan
(NDP).
a) LETTER OF INTENT (LOI)
One of the requirements by member countries to get the donated vaccines was to officially respond to
the Director General of WHO, who on 22 September, 2009, sent out a signed invitation for H1N1 vaccine
donation. Countries were required to confirm the country’s intent to have access to vaccines to protect
the most vulnerable populations. All n eligible member countries accepted the WHO offer by submitting
a signed letter known as 'Letter of Intent' (LOI). All (44/44)member countries have met the first
requirement of the vaccine donation program by submitting LOI.
b) LETTER OF AGREEMENT (LOA)
One of the three conditions that eligible countries need to meet to qualify for vaccine donation is
submitting the letter of agreement (LOA). The letter is a more formal document that envisages the
commitment and obligations of the beneficiary country. LOA was one of the prerequisites to receive
vaccines, financial and material support . The document spells all the procedures and legal issues in case
of liability and related matters. The LOA is signed by the DG of WHO for countersigning by the highest
health authority, often the Minister of Health.
c) NATIONAL DEPLOYMENT PLAN (NDP)
At the end of the Abuja workshop, draft deployment plans of varying stages of completion was available
from almost all participating countries. Most national plans by then were of high quality but were not
quite at the level to warranty vaccine donations. Countries were thus given a two-weeks deadline to
improve the plan and re-submit the final version by 15 December, 2009.
Although countries did not meet the deadline, most countries sent their draft plans for review at IST and
RO levels, during which most plans are returned with comments back to the country for improvement
During the review process, most country plans were consistently deficient in few important areas
including, errors in calculating target populations, over and/or under budgeting of the whole operation
or over/under funding of a particular component, lack or shortage of funding sources.
8 Weekly Epidemiological Record on 11 December 2009
P a g e | 15
As shown from Table 1, all eligible countries submitted LOI, while 39 of them signed LOA to receive
vaccines. When it comes to NDPs, Togo and Kenya were the first two in the Region to have their plan
approved on 14 and 17 January, 2010, and countries followed to submit afterwards.
Furthermore, eligible countries were required to ensure smooth registration and regulatory processes to
importing and authorization of using the donated vaccines in the country.
Table 2: Eligible countries by vaccine deployment status
AFRO Eligible Countries Number %
Total 44 100.0
Submitted LOI9 44 100.0
Submitted LOA10
39 88.6
Submitted NDP11
37 84.1
At the beginning of the initiative, when availability of H1N1 vaccines were pretty uncertain, a plan was
drawn to sequence vaccine distribution, by prioritizing countries as groups using vulnerability and
programmatic criteria. Furthermore, disease burden and commitment, readiness to implement and the
fulfillment of legal and regulatory issues were all used as criteria to prioritize countries.
As shown in Table 3, three countries12, were identified as the first priority group to receive and deploy
vaccines in November, 2009, while two13 more were picked as group two priority countries where it was
envisaged to receive supplies in December, 2009 and deploy vaccines in seven days afterwards.
The rest of 39 eligible countries14 were prioritized as a third category, which again were hoped to deploy
the H1N1 vaccine by February, 2010.
Table 3, Prioritization of AFR countries for H1N1 vaccine deployment
Priority Group AFRO IST West IST Central IST East&
South
Member countries 46 17 10 19
Member States eligible for H1N1 vaccine donation 44 16 10 18
Group A priority countries 3 1 0 1
Group B priority countries 2 1 1 -
Group C countries (the rest ) 39 14 9 17
9 LOI: Letter of Intent
10 LOA: Letter of Agreement
11 NDP; National Vaccine Deployment Plan
12 Kenya, Sao Tome and Principe, and Togo
13 Democratic Republic of Congo and Nigeria
14 Angola , Benin, Botswana, Burkina, Burundi, Cameroon, Cape Verde, CAR, Chad, Comoros, Congo, Cote d'Ivoire, Equatorial Guinea, Eritrea,
Ethiopia, Gabon, Gambia, Ghana, Guinea-C, Guinea-B, Lesotho, Liberia, Madagascar, Malawi, Mali, Mauritania, Mauritius, Mozambique, Namibia, Niger, Rwanda, Sao Tome and Principe, Senegal, Seychelles, Sierra Leone, Swaziland, Uganda, U R of Tanzania, Zambia, Zimbabwe
P a g e | 16
3. THE ABUJA WORKSHOP
While AFRO-USAID consultative meeting in October bolstered IVD's technical capacity, it was the
workshop that created the platform for representatives of MoH and WCO from 45 countries that
begun the planning process.
In view of the WHO vaccine donation initiative and SAGE recommendations, a training workshop
was held in Abuja, Nigeria from 15-26 November 2009 with the following objectives:
A. WORKSHOP GOAL
Prepare a good DRAFT Deployment and vaccination plan for using a H1N1 influenza pandemic vaccine,
that can be rapidly approved by the participants national authorities upon return from this workshop.
B. SPECIFIC OBJECTIVES
1. Provide a framework for developing/assessing preparedness of a deployment plan for
delivery of pandemic influenza vaccine and other ancillary products in seven days.
2. Understand the core concepts/activities discussed in the Guidelines related to:
a. pre-event planning
b. planning for a required surge capacity
c. conducting exercises to test a country's deployment capacity
d. core-management activities to achieve a 7 day deployment
e. command and control
Two workshops organized for francophone and Anglophone speaking countries, was a capacity building
exercise where representatives were expected to prepare national vaccines deployment plans.
Those in attendance included National immunization programme managers, Pandemic influenza focal
points and one from WHO (EPI focal point) .
Over 160 participants came to attend from all 46 member countries (78 from French/Portuguese
speaking and 82 English speaking countries). USAID (MCHIP/JSI/DELIVER) consultants seconded to AFRO
participated in the second workshop after which they were deployed to ISTs and Regional office.
Equipped with the tools and hands-on experience, participants were to return to their respective
countries to finalize the draft national deployment plans for submission by mid-December 2009.
The workshop contributed in building the capacity of participants on Influenza A H1N1 issues in general
and vaccines deployment in particular. In addition to draft national deployment plans, participants also
returned home equipped with tools developed by WHO/AED that enabled the countries to have adequate training
and communication materials to be used during the implementation.
The materials and methods used during the workshop were generally at the level of participants’
expectations and found the useful. The logistic planning tool was a a bit complex to many participants.
At the end of the workshop, most of the countries submitted draft deployment plans, which however
needed more enrichment for finalization and be resubmitted about 2-weeks after their return home.
P a g e | 17
The final plan was expected to be detailed taking many components into consideration, with special
attention of the following:
a) prioritization, b). vaccine deployment plans,
c) operational plans for vaccination, d).advocacy and communication plans
e) Determine the required PMS activities f) Prepare a Plan of Action with costed activities
Table 4: Participants of Abuja Training Workshop, November 2009
PARTRCIPANT/ORGANIZATION FRANCOPHONE ANGLOPHONE TOTAL
NO.OF COUNTRIES 25 20 45
MOH 47 41 88
WHO CONUTRY OFFICE 26 18 48
WHO/AFRO 2 11 13
WHO/HQ 1 5 6
UNICEF 1 0 1
USAID 1 7 8
TOTAL PARTICIPANTS 78 82 160
4. TECHNICAL SUPPORT
IVD/AFRO has been overseeing the overall H1N1 vaccine deployment activity through the
existing WHO human resources and by collaborating with USAID15 to provide countries with
technical support and expertise. Technical support was instrumental in accomplishing activities
such as planning, training, supervision and facilitated logistical and financial assistance to
countries.
A. DEPLOYMENT OF CONSULTANTS
As part of the USAID-WHO partnership in the response to pandemic H1N1 influenza, USAID
(MCHIP/DELIVER) committed to post technical officers to complement existing staff within AFRO
regional and sub-regional offices with roles primarily to support countries to develop vaccine
deployment plans as per the WHO policy and guidelines.
Consultant teams were positioned in three of inter-country support teams (IST), in Harare (Zimbabwe),
Libreville (Gabon) and Ouagadougou (Burkina Faso) with a coordination supported by one other team of
two experts based in the IVD Programme of WHO Regional Office in Brazzaville, Congo.
The contributions of consultants at ISTs was to assist and guide country planning teams in the planning
process and provide technical support through regular communications by all available means including
e-mails, phone, and sometimes formal written letters.
15 USAID (MCHIP/DELIVER) seconded 8 consultant logisticians and public health specialists since Nov. 2009.
P a g e | 18
The most direct and hands on assistance were made by travelling to each country to work with planning
teams from MoH of the respective countries. Travelling is normally initiated by a request from the
country, but sometimes by the IST coordinators or by consultants themselves. Once on the ground,
consultants were involved in a wide range of activities with emphasis on trainings, micro planning,
resource mobilization and other key technical inputs embodied in the national deployment plan (NDP).
Although the teams assume somewhat permanent station, consultants were engaged in a more flexible
work arrangement that suits that allows more mobility and capacity to respond to short travel
announcements. This model of work was made possible by the efficiency of the managerial support
from both MCHIP/DELIVER headquarters and the respective WHO offices.
Table 5: Consultant’s activities and country visits, Dec. 2009- April 2010.
IST Country Activity no.
visits
No.
Consultants
IST Country Activity No
visits
No.
Consultants
CEN
DRC P 1 1
ESA
South Afr. PTI 2 2
Burundi P 1 1 Lesotho PTI 1 1
Cameroon P 1 1 Swaziland PTI 2 1
Gabon P 3 Botswana PTI 1 2
CAR PI 1 1
WEST
Togo PTI 3 3
Congo PI 1 1 Mali P 1 2
ESA
Kenya PTI 2 2 Senegal P 1 1
Rwanda P 1 1 Ghana I 1 2
Zimbabwe PTI 2 S. Leone I 1 1
Malawi PTI 2 2 B. Faso P 1 2
Namibia PTI 1 1 P=Planning; T=training; I=Implementation
5. VACCINE DEPLOYMENT PLAN: process and components
The H1N1 vaccine donation scheme is intended to support countries to have access to pandemic
influenza H1N1 vaccine. The initiative coordinated by WHO with the collaboration with donor
governments and partners is to allow countries to vaccinate up to 10% of their populations.
A total of 44 countries from AFRO, were listed as eligible and all have consented to be enrolled in the
donation program. On the basis of disease burden and other epidemiological and logistical criteria by
then, eligible countries were grouped into three priority blocks of A, B and C, in which Kenya, Sao Tome
& Principe and Togo are in Group A, Nigeria and D R Congo in Group B and the remaining 39 countries in
group C.
Although countries that were eligible for the vaccine donation were already selected, proceeding with
vaccine deployment activities do require countries meet key criteria. Deployment and technical teams
of all levels ensure that the following criteria are met .
P a g e | 19
A. DEPLOYMENT PLAN (NDP) COMPONENTS
The vaccine deployment plan is the most technical document which involve technical
collaborative work between the MoH, WCO, IST and Regional Office.
The first draft plan that reach IST will be reviewed by the technical team and decision is made
either to approve and forward the plan to the Regional office, or return to the country team with
comments and recommendations for re-submission.
Plans arriving at RO will also be reviewed and once again a decision is made to either approve
and forward it WHO-HQ or liaise with ISTs for explanations or comments. In most, if not all,
instances, a plan that was approved at the Regional level is likely to be approved at the HQ level,
which is final to move forward. The approval at the HQ level will lead to granting vaccines and
supplies, as well as securing financial support to cover operational cost. . A general framework
of planning and plan approval process is illustrated in Figure 8. Below.
An approved plan is expected to clearly outline the storage and cold chain capacity, availability of
resources, and the ability to mobilize resources from government and/or donors' support. In general,
the plan should illustrate how the donation is effectively and efficiently be handled from the point of
import to the point of delivery in not more than seven days.
As availability of donated vaccine is only enough to cover up to 10% of the population, prioritization of
various populations as target is mandatory. The deployment plan is structured by major components
which frames the country's commitment and clearly spell strategies to deliver high quality vaccination
services.
a) VACCINATION STRATEGIES
WHO targeted to provide pandemic influenza vaccine to vaccinate approximately 10% of the
populations in all eligible member states. It was planned that this was to be carried out in 2 phases. The
first Phase to cover 2% of the population followed by 8%.
P a g e | 20
Apart from Kenya, Togo, Gambia and Liberia who received 2% and later followed by 8%, all other sates
received all their supplies of 10% in one shipment.
Vaccinations were made available to health care workers in both public and private sectors at all
existing immunizing facilities. Pregnant women were vaccinated via routine antenatal clinics at all levels
of health care delivery while others were reached through a combination of existing service delivery
points and outreach services. Patients with chronic illnesses received vaccines at their regular clinics.
Some member states targeted special populations/critical workers who were reached through mobile
vaccination teams in their camps and places of work.
Most member states planned to reach more than 80% of vaccination sites and targeted population
within 7 days after receiving vaccine and ancillary items .This however did not happen as most countries
started late. This was mainly due to late release of operational funds from WHO, competing priorities,
reduction of the pandemic severity etc.
b) MANAGEMENT AND ORGANIZATION
The response to H1N1 pandemic was coordinated by the Departments of Disease Control and
Prevention in most member states. They worked closely with EPI. National Task forces were constituted
to coordinate the country response to the pandemic. The task forces were chaired by Senior
Government officials from the ministries of health and members drawn from various governmental and
non-governmental agencies. The National Taskforces coordinated, decided, implemented and evaluated
the vaccination planning and implementation as well as resource mobilization.
c) VACCINE REGISTRATION AND LICENSING
The vaccines were new medical products and needed the authorisation by National regulatory
authorities. In most countries, the authorisation process was initiated much before the arrival of the
vaccines. Efforts were made to fast-track the necessary legal and regulatory steps. The rules and
regulations governing importation, warehousing, packaging, bundling, transportation and use of
vaccines and medical devices was adhered to as stipulated by respective National Regulatory
Authorities.
The letters of agreement signed between the countries and WHO described the waiving of some of this
control. A prequalification letter from the WHO was issued for each vaccine shipment to all recipient
countries. These two documents were instrumental in facilitating regulatory authorities to waive certain
requirements during vaccine importation.
The governments of member states undertook to be responsible for registration, handling the
importation and customs clearance of the pandemic influenza vaccine in to the countries
WHO/HQ undertook to and availed documents (airway bill, certificate of origin, package list, and
customs value of donation) from suppliers that were mandatory when importing vaccines and other
materials into the country.
Some countries had been granted by the Ministry of Health for the waiver of the importation and
registration of the vaccine while others indicated that the H1N1 pandemic influenza vaccine can be used
in the countries without any restrictions.
P a g e | 21
d) INFORMATION AND COMMUNICATION
Member states have systems of data collection, collation, analysis and transmission. No specific H1N1
influenza pandemic-specific system was set up. The data on the specific target groups was updated.
Brochures, fliers, posters, radio spots, information sheets and bulletins detailing specific messages were
developed and distributed to most health facilities.
Mobile phones were the main mode of communication between the national, provincial levels/Regional
and district levels. Email, circulars and other modes of communication were also utilized.
e) HUMAN RESOURCE AND SECURITY
Majority of the countries were reported to have adequate human resource for the immunisation
exercise. The vaccination campaign was conducted by the existing health workforce both in public and
private vaccinating health facilities.
Trainings were carried out for personnel on all practical aspects of the campaign and supervisory roles
that were to be carried out. The training workshops started from National levels and were cascaded
down to facility levels. It targeted health care workers at the national and Regional level, who then
cascades the training down to the health facility level staff. The national and regional heath workers
acted as supervisors during the actual vaccination exercise.
Consultants from AFRO and ISTs participated physically and remotely in supporting these trainings..
Training tools proposed by WHO and AED were generally adopted and used during training sessions. In
addition to other materials and documents, AFRO and IST consultants prepared and delivered
presentations during training sessions in a number of countries focusing on general updates on Influenza
H1N1, logistics management and social mobilization. The consultants also supported the country teams
to organize a special training session for media professionals in some countries.
The in country existing security system for routine vaccines and logistics management were used for
deploying the pandemic vaccine.
f) PUBLIC INFORMATION
Countries focused on advocacy and targeted communication strategies which drew inspiration from the
general communications document on H1N1 produced by WHO/AED. Social mobilization strategies
were not sufficiently developed in the plans. In addition, most country offices and EPI units do not have
communication and social mobilization specialists.
Public awareness campaigns were organized during the vaccination through advocacy meetings, folk
announcers, utilizing television, radio and print materials. The aim of the awareness campaign was to
ensure all community members received the messages and the target population presented themselves
for the vaccine. In addition, press conferences were conducted with representatives from all media
outlets with the aim to provide clear and correct information to the press and public.
g) SUPPLY AND COLD CHAIN PROCESSES
Country logistics and supply chain plans were mainly based on existing systems used in routine
immunization and other mass campaign activities. Even though some countries indicated the need for
additional surge capacity, no country stated that it will not be able to receive and deploy vaccines if this
gap in cold chain capacity was not closed. The key issue which was raised in the plans and subsequently
seen in the field was transportation especially to hard-to-reach areas
P a g e | 22
Most countries reported that the existing cold chain capacity in the countries were adequate for the
deployment and storage of this Influenza A H1N1 2009 vaccine. Injection materials such as AD syringes
and mixing syringes had been estimated including wastage and their volumes estimated for logistic
planning purposes .Vaccine refrigerators, vaccine carriers, cold boxes, thermometers and freeze tags
were estimated and found to be sufficient for conducting the activity.
Vaccine stock management systems were well developed for the routine childhood immunization
program and the Influenza A H1N1 2009 vaccine was to utilize these existing services. Distribution of
vaccine stocks were to be tracked via a vaccine stock registers that easily identified the location and
batches of vaccines.
In majority of the countries, it was expected that the vaccine was to be deployed to all vaccination sites
within 7 days. The distribution of vaccine was planned to follow the routine EPI vaccination distribution
system.
h) POST MARKETING SURVEILLANCE
There is a functional adverse events following immunisation (AEFI) monitoring system that is used for
the childhood immunisation programme in all member states. The existing systems were sufficient to
detect any AEFI from the Influenza A H1N1 2009 vaccine.
All countries used the AEFI surveillance tools used during immunization campaigns to document AEFI
cases detected during the campaign. Country plans equally laid out data collection and case
management strategies. Any AEFI suspected by a doctor or a nurse were notified to the higher
authorities. Minor cases of AEFI were reported from all implementing countries.
i) WASTE MANAGEMENT
Waste generated was segregated into the sharps, infectious wastes (swabs) and general wastes. The
sharps were collected in provided safety containers, the infectious wastes were collected in infectious
colour coded bins/liners and general wastes in appropriate containers. Sharps and infectious wastes
were disposed by incineration where incinerators were available and while burning and burying on site
or offsite was most common for the rest. Waste was transported generation to final disposal sites where
they incinerated/ treated and disposed. Most of the plans were not well detailed in this area of waste
management.
j) EVALUATION
Evaluation of the Influenza A H1N1 2009 vaccine was planned to take place after completion of the
campaign with a written report submitted within 60 days to the Ministries of Health, donors and
regional agencies. The final report was to include financial returns, coverage rates, reported AEFI,
challenges, lessons learnt, recommendations and details of the major activities.
Some countries planned for a final evaluation meeting. No external evaluation was planned by any of
the countries. By the time this report was being compiled, 11 countries had submitted termination
reports..
P a g e | 23
6. VACCINE DEPLOYMENT ACTIVITIES: vaccines and implementation
Deployment activities in the African Region has been operational in all participating countries. As shown
in Figure 9 below where 28 countries, shaded with green, which received vaccine and supplies and fully
implemented or in some cases are ready to implement in few weeks time.
Figure 9: Implementation of H1N1 Vaccine Deployment Activity in AFR
Furthermore, five other member countries16, yellow shaded countries, did continue to participate by
completing most of the requirements, but fall short to receive vaccines and other supplies due to one or
more incomplete criteria or voluntary decision to withdraw from the whole scheme.
It is only 6 countries17, shaded red, which did not pursue to submit either letter of agreement or failure to develop deployment plans or both.
a) DEPLOYMENT PLANS (NDPS): THE APPROVAL PROCESS
One of the primary requirements for a country to receive the donation is to submit a deployment plan that provides a detailed account of operations using a universally adapted planning tool. It is a highly technical document which covers various components on which decisions whether a country should
16 Benin, Gabon, Mali, Mozambique, and Burundi 17 Chad, Eritrea, Cape Verde, DR Congo, Tanzania and Uganda
P a g e | 24
receive vaccines is made. Deployment plan approval was one of the most complex exercise that is put to test at all levels: at country and IST levels, at Regional and Headquarter levels.
Although it was anticipated that countries will submit an improved version plans by mid December, 2009, it was not until mid January, 2010 that plans started to be approved. Delays in plan approval process is mainly during communications between the country and ISTs which was often difficult to facilitate. Once draft plans from countries are submitted to ISTs, communications and feedbacks were not always fast and productive.
Figure 10 NDP approval in AFR by month
24 (67%)
Country planning teams, many of whom were trained at the Abuja workshop, were expected to take the lead to put the country's deployment plans together and submit to IST. In practice, however, most of them find it difficult to do the job due to practical and unforeseen challenges. There were delays and sometimes complete blackout of communications between the planning teams and consultants at ISTs. Most countries did not respond quickly as possible due to either they become busy of other things or even think that they finished their part.
Plan approval process at both the Regional and Headquarter levels, in most instance, took relatively shorter period
As shown in Figure 10 and Table 6, plans started coming in more numbers during March and afterwards reaching its peak in April. By may, 24 (67%) of national plans were approved at the regional Office, and subsequently at HQ level.
Table 6 H1N1 vaccine deployment plan approval in AFR by month, 2010
Monthly NDP Approval at Regional Office - 2010
Jan Feb Mar Apr May Jun Jul
3 1 6 10 8 3 5
Togo Mozambique Namibia Lesotho Mauritania Madagascar Rwanda
Kenya Liberia Nigeria Mauritius Guinea Comoros
Guinea-B Ethiopia Ghana Burundi C Afr Rep Zimbabwe
Sao Tome Malawi Angola Eq Guinea
Seychelles Swaziland Cote d'Ivoire Zambia
Sr. Leone Cameroon Congo
Mali Burkina F
Senegal Botswana
Gambia
Nigeria
P a g e | 25
The technical teams at RO and IST levels held series of conference calls, and adapted a strategy to
update each other on developments, including zero developments, on daily basis. IST teams would
make a daily follow up call to countries for any new developments during the day and share findings,
including 'no findings', with the team at the Regional Office every day at 4:00 pm. The Regional team
would then compile all reports from ISTs and disseminate the summary electronically to colleagues and
partners at all levels. The strategy worked very well and more NDPs were approved at all levels.
Table 7: Status of NDP approval by IST
IST No. of
Countries
NDP
Approved
WEST 1618 15 (93.7%)
CENTRAL 10 7 (70.0%)
SOUTH & EAST 1819 15 (83.3%)
AFR 44 37 (84%)
The approval process analyzes among many other variables, the technical and financial feasibility of the
whole undertaking and whether prioritization of target populations is in line with the SAGE20
recommendations.
Table 8: Distribution of H1N1 vaccine deployment activities in AFR by month
MONTH
LOI
submitted to
WHO-HQ
LOA
Sent to
country
LOA signed
& submitted
to WHO HQ
NDP final
approved at
WHO HQ
Vaccine
arrival in
countries
Actual
vaccination
started
September, 2009 3
October 8
November 11 2
December 12 3 2
January, 2010 5 33 4 1
February 4 5 11 1 1
March 2 2 20 7 1
April
2 6 2 2
May
1 8 7 3
June
8 10 8
July
6 4 4
August
7 3
September
2 2
October
7
November
5*
45 45 40 37 34 34
a) By the time this report was compiled, implementation in 4 countries21
was not confirmed.
By July 2010, a total of 37 (84%) countries have had their plan approved for vaccine donation.
Deployment plans from IST West were approved for all member countries except Cape Verde, which
started but did not finish the process, making the approval rate at nearly 94%. Approval rate for IST
18
One country in IST West, Algeria is not included. 19
One country in IST S&E, South Africa, not included. 20
WHO weekly epidemiological report, 2009: 84 (30) 301-308. 21 Angola, Burkina Faso, Nigeria and Rwanda
P a g e | 26
Central with approval rate of 70% was lower than both IST West and South & East which respectively
had a 93.7% and 83.3% plan approval rate. (table 6).
As shown in Table 7, H1N1 vaccine deployment activities were ongoing through a period of a little over a
year. Starting from end of September (22 Sept. 2009), all eligible countries received a signed letter from
the Director general of WHO, asking countries to participate in the vaccine donation initiative. Some
countries responded by signing the letter of intent (LOI) and returning it WHO immediately but many
others took a varying length of time to complete. There was a difference of more than 6 months
between the first and the last countries to submit LOI, the first being in September 2009 and thae last
on march 2010.
Similarly, all other main deployment activities had a similar pattern spreading over period of time longer
than desired in pandemic situations nor first anticipated in planning the donation programme. It is
clearly shown from Table 5, that no component of vaccine deployment activity was complete in under 6
months.
b) VACCINES AND ANCILLARY SUPPLIES: SHIPMENT AND DISTRIBUTION
1. Vaccines
Once an eligible country meets all the requirements, shipment of vaccines and ancillary will follow.
Although it appears that countries are expected to complete LOI first, LOA next and do other activities
one after the other, it was possible to do activities in parallel without any particular order. Countries
could go ahead in developing NDP before submission of counter-signed letter of agreement (LOA).
However, shipment of vaccines and ancillary supplies is one activity that does not move forward
without ensuring the completeness of all other activities such as submission of all documents LOI, LOA,
Order Planning Form, confirmation on approval of NDP and availability of funding and fulfillment of
regulatory and legal requirements.
Shipment of vaccines and supplies is also an activity that is almost entirely executed at the headquarter
level both at WHO and USAID or by a coordination from both.
Shipment of vaccines and ancillary supplies normally takes about 10-15 days after a country is confirmed
to have met requirements to import and use the donated vaccines. Decisions on type and quantity of
vaccines are determined by the deployment team at WHO-HQ. In some occasions, countries directly
negotiate on quantity and/or shipment arrangements.
The process of vaccine allocation, shipment coordination and distribution is more complex than it
presents itself. It is a process by which a particular product from a given manufacturer is made available
on time in quantity that matches a specific request from a country. It also takes into account on the
complex transport needs of the product from origin to destination.
As of September 2010, a total of 32.1 million doses of H1N1 vaccines were distributed to 34 countries
over a period of 8 months, from February to September 2010. Six types of vaccine products from four 4
manufacturers were distributed in the Region. About 40% of the vaccines distributed were Sanofi US
followed by Pandemrix from GSK (28.5%) and Panenza from Sanofi France comprising 25.2%. In
P a g e | 27
contrast, Fluvarin and Focetria both from Novartis are two products least distributed comprising a
combined 3.1% going to two countries Kenya and Zambia. Pandemrix of GSK is the most widely
distributed product going to 9 countries, followed by Panvax from CSL and Sanofi US each going to 8
countries (Table XX).
Table 9: Distribution of H1N1 Vaccines in AFR: products, quantity, manufacturer, and recipient countries
No Brand Manufacturer
No.
Countries
Doses
(000) % Countries
1 Fluvarin Novartis 1 730.0 2.3 Kenya
2 Focetria Novartis 1 256.8 0.8 Zambia
3 Pandemrix GSK 9 9,134.5 28.5
Burkina Faso, Ethiopia, Ghana, Guinea,
Namibia, Rwanda, Sao Tome, Senegal, Togo
4 Panenza Sanofi, Fr. 7 8,074.7 25.2
Botswana, Cameroon, Central African Republic,
Congo, Cote d'Ivoire, Guinea-B, Mauritius
5 Panvax CSL 8 957.7 3.0
Comoros, EQ Guinea, Gambia, Lesotho, Liberia,
Mauritania, Seychelles, Swaziland
6 Sanofi US Sanofi, US. 8 12,947.3 40.3
Angola, Madagascar, Malawi, Niger, Nigeria,
Sierra Leone, South Africa, Zimbabwe
Total 34 32,101.0 100.0
Once vaccines arrive in a country, the country is expected to confirm receiving vaccines and ancillary
supplies by sending a completed and signed vaccine arrival report form.
Storage and proper handling of vaccines and supplies and in-country distribution to o various
vaccination sites is the responsibility of each recipient country.
The WHO-DG initiative of vaccine deployment was supported by donor governments and vaccine
manufacturers. As shown in Table10, African Member States benefited from donations of seven high
income governments and three vaccine manufacturers of which support from US Government was the
largest contribution of more than 5.6 million doses (17.6%) going to Nigeria, Kenya and Angola.
Similarly, three vaccine manufacturers (GSK, Sanofi and CSL) donated a total of 19 million doses or
nearly two-thirds (59%) of all vaccines distributed to the Region. Donation from Sanofi comprises the
largest contribution of more than 13 million doses or 42.5% of the vaccines while CSL contributed about
2% of the vaccines. Although CSL is the least contributor (2%), it is one of the vaccines which reached as
many as eight countries, mainly to those with smaller populations. .
1. Ancillary supplies
Shipment of ancillary supplies to a given country takes effect almost automatically following the
approval of a deployment plan. As shipment of ancillary supplies are handled differently from that of
vaccines, it is less complex and delivered slightly ahead of vaccines. Unlike vaccines which is donated by
several donors, ancillary supplies are donations only from USAID and WHO and handled by both.
Ancillary supplies donated from USAID reached 11 countries while 20 others received donations from
WHO. Three more countries received their ancillary supplies from both WHO and USAID (Table XXX).
P a g e | 28
Table 10: Donors of H1N1 vaccines and beneficiary countries in the African Region
DONORS Donated Countries Doses %
Australia Comoros, Eq. Guinea, Gambia, Liberia, Seychelles 349,300 1.1
France Botswana, CAR, Congo 2,460,800 7.7
Italy Zambia 256,800 0.8
Norway Namibia 216,000 0.7
Switzerland Ethiopia 3,000,000 9.3
UK Guinea, Rwanda 1,249,000 3.9
USG Angola, Kenya, Nigeria 5,640,000 17.6
CSL Lesotho, Mauritania, Swaziland, 608,400 1.9
GSK Burkina F., Ghana, STP, Senegal, Togo 4,669,500 14.5
Sanofi Cameroon, Cote d'Ivoire, Guinea-B, Madagascar, Malawi,
Mauritius, Niger, Sierra Leone, South Africa, Zimbabwe 13,651,190 42.5
Total doses donated 32,100,990 100.00
Table 11: H1N1 vaccine products and recipient country in African Region
PRODUCT RECIPIENT COUNTRIES Doses (000) %
CSL Comoros, Eq. Guinea, Gambia, Lesotho, Liberia, Mauritius,
Seychelles, Swaziland 957.7 3.0
GSK Burkina F., Ethiopia, Ghana, Guinea, Namibia, Rwanda, Sao
Tome, Senegal, Togo 9,134.5 28.5
Novartis, adj. Zambia 256.8 0.8
Novartis ,unadj. Kenya 730.0 2.3
Sanofi, Fr. Botswana, Cameroon, CAR, Congo, Cote d'Ivoire, Guinea-
B, Mauritius 6,969.8 21.7
Sanofi, US. Angola, Madagascar, Malawi, Niger, Nigeria, Sierra Leone,
South Africa, Zimbabwe 14,052.2 43.8
32,101.0 100.0
Table 12: Ancillary supplies by donors and recipient countries
Ancillary Supplies by Donor
USAID (11) B. Faso, Cameroon, Cote d'Ivoire, Ethiopia, Kenya, Liberia, Malawi,
Namibia, Rwanda, Senegal, Togo
WHO (20)
Angola, Botswana, Burundi, CAR, Comoros, Congo, Eq. Guinea, Gambia,
Guinea-C, Guinea-B, Madagascar, Mauritania, Mauritius, Niger, Nigeria, Sao
Tome, Seychelles, Sierra Leone, Zambia, Zimbabwe
USAID/WHO (3) Ghana, Lesotho, Swaziland
c) FUNDING
Apart from the cost for vaccines and ancillary supplies, operational cost for H1N1 vaccine deployment activities in the African Region was shared by governments and partners. More than $USD 22 million was mobilized between WHO, USAID and Governments. As shown in Figure XXX,
P a g e | 29
the funding by and large was a joint contribution by WHO (67.3%), Governments (26.2%) and USAID (5.7%). Four countries, Algeria, Botswana, Mauritius and South Africa, fully funded the deployment operation, with only technical support..
The cost of ancillary supplies and in-country handling and distribution of vaccines and related supplies was largely covered by USAID
Figure 11: Operational cost contribution for H1N1 vaccine deployment in African Region
Thirty one countries were granted financial support, of which 20 countries obtained $250,000 or more. Only four countries22 received under $ 100,000 USD. Although data on funding from other sources is not completely reported, some implementing countries reported financial and technical support from agencies other than WHO and USAID. Four member countries23 have conducted the campaign by covering the entire cost from own resources.
Table 13: Financial support to Member States
Amount awarded (USD) No. of
Countries
$ ≥ 1 million 3
$ 500,000-999,999 7
$ 250,000-499,999 6
$ 100,000-249,999 11
% <100,000 4
d) VACCINATION IMPLEMENTATION ACTIVITIES
The ultimate goal of the vaccine deployment activities was to administer H1N1 vaccines to the
target population groups (Table 14). After going through all the planning, distribution of vaccines
and ancillary supply activities, training and other resource mobilization was to reach that goal.
Countries in the African region have thus passed these steps and vaccinated to protect prioritized
population groups.
22 Comoros, Eq. Guinea, Sao Tome & Principe and Seychelles 23 Algeria, Botswana, Mauritius and South Africa
0
5,000
10,000
15,000
WHO Govt. USAIDUNICEF UNDP
14,941
5,812
1,272
14320
USD
('0
00)
Funding H1N1 vaccine deployment in AFR )
P a g e | 30
Table 14: H1N1 vaccine deployment in AFR; Target Populations
% Total Number Target Pop. group
6 2,893,557 Health care workers
31 14,338,704 Pregnant women
15 6,628,515 Chronic conditions
34 15,370,416 Children 6mths-5yrs
8 3,518,139 Critical worker
6 2,810,745 Healthy adults
100 45,560,076 Total
Figure 12: Distribution of populations targeted for H1n1 vaccines in AFR
1. Coverage of vaccine deployment activities
Of the 44 eligible countries in the African region, all (100%) requested WHO (submitted LOI) to be enrolled in the H1N1 vaccine donation and deployment scheme.
Thirty nine (88.6%) eligible countries went further and entered a signed agreement with WHO confirming the commitment to administer the donated vaccines to the prioritized target population.
Of the 39 countries which submitted LOA, 37 (95%) went further to develop a national deployment plan (NDP) which was approved at all levels guaranteeing the donation of vaccines and ancillary supplies.
Of the 37 countries that qualified for the donation, 34 (92%) have successfully met all the requirements and received not only vaccines and ancillary supplies, but also financial support to cover operational cost.
Although five (11%) other eligible countries developed NDP which gained approval at all levels and secured adequate funding to cover operational cost, the vaccine donation
0
5
10
15
20
25
30
35
40
children 6mths-5yrs
Pregnant women
Chronic conditions
critical workers
Health care workers
Healthy adults
per
cen
tage
Distribution of Target Population (%)
P a g e | 31
was withheld due to either withdrawal by request or failure to provide one or more documents.
Six countries (13%) including DR Congo, as group two priority country, did not go far beyond submitting LOI.
2.Time lapse and duration of completing deployment activities
The effectiveness of any preparedness and response to a pandemic situation can be measured by how fast the intervention including vaccination activities are deployed to limit the consequences. Time and its effective utilization is therefore a crucial component of vaccine deployment activity. It was with this spirit and high anticipation to acting quickly that H1N1 vaccine deployment activities were organized in African Region, to deploy vaccines and resources within a period as short as seven days.
Analysis of time taken to complete each deployment activity in the Region in general and in some ISTs and countries in particular was clearly in contravention to the desire to act quickly and vaccinate all targeted population in the whole region within three to four months in 2009 and early 2010. But, vaccination was not even started in any country during this period. Precious time was lost at every step of completing invariably all activities.
The general consensus to submit the first revised deployment plan in mid-December 2009, was not met by a single member country. This was consistently true for all countries..
Table 15: Summary of time lapse to complete vaccine deployment activities
ACTIVITIES IST
CENT
IST
ESA
IST
WEST
Regional
Average
LOI signed and returned to HQ 59.8 69.4 71.3 68.4
LOA signed and returned to HQ 31.0 25.5 48.6 38.2
LOI – LOA signed & returned to HQ 88.2 104.2 74.7 93.4
LOA Signed – Vaccine arrival 56.0 32.0 62.8 47.1
NDP approval: RO-HQ 8.2 15.2 26.0 13.0
NDP (RO)-Implementation 106.2 75.3 103.8 92.6
NDP (HQ)-Implementation 101.3 65.1 69.3 75.5
LOI signed-Implementation 291.2 236.4 256.1 261.4
Key: signed and returned refers to the days taken to have signed LOI/LOA be submitted to WHO-HQ; LOA signed-vaccine arrival refers to the time lapse between submitting LOA and arrival of vaccine in a country NDP approval RO-HQ refers to the time lapse for HQ to approve NDP after Regional approval; NDP-Implementation is time taken to start implementation after NDP was approved at Regional/Headquarter level LOI-implementation refers to the period of time taken between submitting LOI and vaccination implementation
The H1N1 vaccine deployment and administering vaccines was initially planned to be completed in few weeks in the group A and B countries and cover the rest of the Region in few months thereafter. As shown in Table 15, it took an average 261 days (38 weeks) to reach implementation (vaccination) in the whole Region and in some countries as long as 290 days, ranging from 114 days in Mauritius and 386 days in Guinea.
Ten countries took more than 300 days while another 15 needed 200-299 days to start implementation from the day they submitted the LOI to WHO. The countries with the relatively short duration have all required more than 100 days to start implementation.
P a g e | 32
Figure 13: Time lapse from submitting LOI and vaccination implementation by IST
The three group A priority countries, Kenya, Sao Tome and Togo, which originally thought would complete the entire activity within 2-4 weeks required 211 225 and 134 days respectively. This had a serious implication on either the criteria used to prioritize countries and on the spread of the pandemic and on related morbidity and mortality. In analyzing time as parameter, two important indicators are worth mentioning:
Time lapse between plan approval and vaccine arrival
Once a country plan is approved by HQ, the policy was to deliver vaccines in 10-15 days after
that. If a given country is declared to have complied to all the criteria including approval of its
plan, the time lapse and delays after that could only be contributed by either IST, RO and WHO-
HQ, or sometimes by external sources such as vaccine manufacturer or transport company.
The time lapse from the plan approval to the arrival of vaccine, for example, has no relation with
activities in the country. Rather, it is a delay emanating from vaccine allocation, shipment and
related logistical issues which all are done from the HQ level. There was a Regional average
delay of 44 days from the day the plan approved at HQ to the day vaccines arrive in a country.
In summary, the WHO policy of delivering vaccines in 10-15 days after plan approval has been
grossly exceeded.
Time lapse between vaccine arrival to implementation
The other key and sensitive parameter is the time elapsed from the day vaccines arrived in a country and the day vaccination started which signify how fast the country responded. The generally agreed policy of WHO was to deploy vaccines and supplies within 7 days after the arrival of vaccines. Available data on this suggests that the regional average duration to start vaccination was 47 days with the range from 3 days in Botswana and South Africa to 134 days in Guinea Bissau.
In view of the '7days' deployment policy, only three countries (8.8%) were able to comply and another 10 countries (30%) managed to implement in a relatively short period of 4 weeks after they receive vaccines. Ten of the countries implemented in less
0 10 20 30 40 50
CENT
WEST
ESA
AFR
Weeks
ISTS
LOI to Implementation: time elapsed in weeks
P a g e | 33
than 60 days while 4 countries24 kept the vaccine for more than 100 days before they implemented vaccination.
If the H1N1 pandemic progressed in the way it advanced early in June –July 2009, consequences would have been far more disastrous.
3, Vaccination coverage
By the end of October, 2010, there were 34/44 (78%) countries that received vaccines
and ancillary supplies. During the same period, vaccination implementation has either
been completed or still ongoing in 26 (76%) of the countries. The other four are set to
implement during November and December 2010.
Data on number of populations groups covered and on vaccine utilization has not been
fully made available. Data from countries for which complete data is available, indicate
that a total of 3.8 million people were given H1N1 vaccine with an average coverage of
about 88% (ranging from 43% for Seychelles and over 100% for Togo.).
Table 16: H1N1 vaccination preliminary coverage in AFR countries*
Population
Target Population vaccinated
Coverage (%)
Central African Republic 448.0 448.0 100.0
Congo 276.0 253.9 92.0
Ethiopia 389.6 159.0 40.8
Gambia 164.5 152.5 92.7
Guinea 1,048.7 972.6 92.7
Kenya 730.7 609.3 83.4
Lesotho 123.0 92.3 75.0
Liberia 78.0 76.4 97.9
Mauritania 296.4 12.4 4.2
Madagascar 469.6 189.7 40.4
Mauritius 124.0 5.5 4.4
Namibia 164.0 136.6 83.3
Niger 1,375.0 1,180.9 85.9
Seychelles 5.1 2.2 42.7
Sierra Leone 59.4 54.3 91.4
STP 15.2 12.2 80.4
Swazi 104.7 22.1 21.1
Togo 616.3 676.9 109.8
Zimbabwe 1,250.0 1,031.8 82.5
7,743.3 6,090.6 78.7
The over 100% coverage for Togo (Table XX) was reportedly due to splitting doses of
0.5ml H1N1 vaccine to two-0.25 ml doses to give to children under 2 years of age as the
appropriate size syringes were unavailable.
The breakdown data by category of target population is not yet available. However,
coverage reports for health care workers was consistently high in all countries compared
to other population groups. Member countries have implemented recommendations
regarding prioritizing target populations. Health care workers were the first group to be
vaccinated in all countries. Pregnant women were the second priority group in many
24 Cameroon, Guinea-Bissau, Malawi, and Niger,
P a g e | 34
countries but some countries such as Kenya, opted to withhold the vaccine from being
given to pregnant women. The Kenyan decision was mainly due to vaccine safety
concerns rather than the criteria to prioritization. As long as countries targeted health
care workers as the first to be vaccinated, it was more up to the country to decide on
which group to include or exclude. Although pregnant women were the 2nd priority
group, preliminary reports indicate that the turnout of pregnant women in general was
relatively lower than expected.
Figure 14: H1N1 Vaccine utilization in the African sub regions
As can be seen from Figure14 vaccine utilization in countries and sub regions, has had a
similar pattern. Not all vaccines shipped to a country were distributed down to
vaccination posts (health facilities) and not all vaccines distributed are administered.
Reviewing reports from 18 countries (Table17) from the total of 10.7 million doses of
H1N1 vaccine received, 10.3 million (96%) doses were dispatched to health facilities in
the countries. From vaccines that was distributed, only 7.9 million doses, 74% was
administered. The vaccine uptake of 81.9% in IST West was comparatively higher than
the Regional average and rate for ISTs. This summary for IST central was lower than the
other two sister sub-regions.
Table 17: H1N1 vaccine utilization in AFR*
IST
VACCINE UTILIZATION
Doses Received
Doses Distributed
Doses Administered
CENTRAL (3) 864.0 710.5 587.2 (68%)
WEST (8) 6,483.3 6,235.3 5309.9 (81.9%)
SOUTH & EAST (7) 3,391.1 3,391.8 2048.2 (60,4%)
REGION (18) 10,738.4 10,337.6 7945.3 (74%)
* Preliminary data from 18 countries
0.0
2,000.0
4,000.0
6,000.0
8,000.0
10,000.0
12,000.0
REGION (18) IST WEST (8) IST ESA (7) IST CENT (3)
No
. do
ses
('00
0)
H1N1 vaccine utilization
Received Distributed Admimistered
P a g e | 35
Implementation of vaccine deployment was not seen to be related with reports of cases or deaths from
Influenza A (H1N1). Previous history of the pandemic (H1N1) in a country did not seem to have
influenced the country's decision to go through the vaccine deployment and implementation activity.
Of the eleven countries which did not report any H1N1 case, nine (82%) have met all the three25 key
criteria of vaccine deployment activities. Togo is among the group of countries which never reported a
case, but was the first in the Region to implement H1N1 vaccination. In contrast, of the 33 member
countries which reported one or more cases of H1N1, 25 (75.6%) implemented H1N1 vaccination.
10. REPORTING AND DATA
Reporting and flow of information on the overall implementation, uptake of vaccines
and coverage has generally been slow to be ready for preparation of this report.
In almost all implementing countries, vaccination campaigns were extended longer
to unspecified length of time or until vaccines last and/or expire. This implied that
data collection is still ongoing t provide final reports.
Information provided in this report should thus be viewed as partial which will be
updated at a later time.
WHO HQ has embarked on a small survey, raising the hope for more complete
information which at the end will be made available for sharing.
11. AEFI
Further to the incompleteness in reporting and data flow, including AEFI, there were no
comprehensive data on adverse events following the administration of H1N1 vaccines.
From what was made available, however, there was no major events that was related to any
of H1N1 vaccine products on use in the African Region. All cases of AEFI events brought to
attention were all mild, localized reactions to and around injection sites which subsided by
itself or with some analgesics.
The HQ survey may shed some light on AEFI as well.
25 LOI, LOA, and NDP
P a g e | 36
12. LESSONS LEARNT
LESSONS LEARNT AND MAJOR CHALLENGES
In view of the overall goal of vaccine donation initiative, which envisaged to assist countries to have access to H1N1 vaccines, the whole exercise was a success: countries had access to H1N1 vaccines. All countries that requested vaccines have all received. All countries that received vaccines and ancillary supplies were assisted financially to cover operational cost.
In view of the specific objectives of protecting the integrity of the health-care system and critical infrastructure, reduction in morbidity/mortality and viral transmission, the AFR H1N1 vaccine deployment exercise is once again a big success. The SAGE recommended strategies and prioritization were fully implemented. Health care workers were vaccinated first, pregnant women and children were vaccinated. Vaccine was also available to other prioritized populations.
In general the WHO Regional Office, ISTs and WCOs as well as countries have demonstrated their preparedness and response capacity very well.
The outcome of the initiative in the African Region reflected the most needed collaborative effort of countries, WHO and partners in all levels. Among others, however, the catalytic role played by the technical teams comprising public health experts and logisticians at IST and RO levels is viewed as a testimony to yet another successful story of AFRO-USAID partnership.
In reaching such a level of achievement was not without challenges and barriers which some of them are worth documenting:
a. Ensuring preparedness and response to a pandemic situation demands a speedy process an deployment of resources. Time elapsed in accomplishing activities, such as signing documents, getting response and feedbacks from countries, timely delivery of vaccines and supplies were all slow with significant delays.
b. The new WHO guideline, though instrumental in getting things done, it was less flexible in some areas to allow quick plan approval specially for some countries which were ready to do activities in their terms than the criteria on the guideline.
c. The complex nature of the letter of agreement (LOA) may have contributed to delays or even cancellation on some cases. Although a version in languages other than English was available by request, the English version is suspected to have contributed to delays in the non-English speaking countries.
d. The effort on communications and public information, advocacy and social mobilization was realized to be inadequate, weak and inconsistent compared to all other efforts. H1N1 vaccine deployment in general and implementation in particular was vulnerable to allegations on a wide area of issues. Negative information on safety of vaccines, legitimacy of the pandemic as a health threat, uncertainty on targeting pregnant women and health care workers were all contributors to delays, dilemmas and negative campaigns.
e. As countries moved to meet requirements and readiness to implement, delayed arrival of vaccines was a frustrating experience for some countries that did so much to develop plans and worked hard to meet the criteria but only to wait for vaccines to arrive. Although the problem may have eased towards the last quarter of the
P a g e | 37
deployment activities, it was a reason for delays with a negative impact on implementation.
f. As H1N1 vaccines were all new, the need to have these products registered and meet all legal and regulatory requirements was a test case in many countries for fast deployment . The experience was both smooth and relatively easy as it was slow and frustrating in some countries.
14. POST PANDEMIC PERIOD AND THE WAY FORWARD
With the world now in the post-pandemic period26 and reduction in reported cases and
deaths, much of the ongoing effort and attention is likely to shift to other areas and
priorities.
Lessons from past pandemics suggests, however, that the virus will continue to circulate and
population groups at risk during the pandemic continue to be vulnerable.
In such circumstances, vaccination is still one of the recommended strategies in post-
pandemic period27. Member countries should thus continue their effort to watch for H1N1
virus and need to administer vaccines whenever feasible.
AFRO and ISTs should also continue to strengthen the support countries maintain existing
level of preparedness in the event of health threats and pandemics in the future.
26 DG statement www.who.int/entity/mediacentre/news/statements/2010/h1n1_vpc_20100810/en/index.html 27 DG statement www.who.int/entity/mediacentre/news/statements/2010/h1n1_vpc_20100810/en/index.html
P a g e | 38
Figure 15 Status of H1N1 Vaccine Deployment Activity in AFRO as of 31 October 2010.
No Member Countries
L
O
I
L
O
A
N
D
P
Current status: supplies, funding and implementation
1 Angola Y Y Y Received vaccines/supplies; funding made available; yet to announce date of implementation.
2 Botswana Y Y Y Vaccination completed.
3 Burkina Faso Y Y Y Received vaccines/supplies; funding made available; yet to announce date of implementation.
4 Cameroon Y Y Y Vaccination campaign completed.
5 Cent. Afr. Rep. Y Y Y Vaccination campaign completed.
6 Comoros Y Y Y .Vaccination campaign completed
7 Congo Republic Y Y Y Vaccination campaign completed.
8 Cote d’Ivoire Y Y Y Vaccination campaign completed.
9 Equatorial Guinea Y Y Y Received vaccines/supplies; funding made available; yet to announce date of implementation.
10 Ethiopia Y Y Y Vaccination campaign ongoing.
11 Gambia Y Y Y Vaccination campaign completed.
12 Ghana Y Y Y Vaccination campaign completed.
13 Guinea-Bissau Y Y Y Vaccination Campaign completed
14 Guinea Y Y Y Vaccination campaign completed.
15 Kenya Y Y Y Vaccination campaign completed.
16 Lesotho Y Y Y Vaccination campaign completed.
17 Liberia Y Y Y Vaccination campaign completed.
18 Madagascar Y Y Y Vaccination campaign ongoing.
19 Malawi Y Y Y Vaccination campaign completed
20 Mauritania Y Y Y Vaccination campaign launched but suspended soon after
21 Mauritius Y Y Y Vaccination campaign completed.
22 Namibia Y Y Y Vaccination campaign completed.
23 Niger Y Y Y Vaccination campaign completed.
24 Nigeria Y Y Y Vaccination campaign planned for end of November, 2010.
25 Rwanda Y Y Y Funding made available; vaccines and supplies received; implementation date to be announced.
26 Sao Tome & Pr. Y Y Y Vaccination campaign completed.
27 Senegal Y Y Y Vaccination campaign ongoing.
28 Seychelles Y Y Y Vaccination campaign completed.
29 Sierra Leone Y Y Y Vaccination campaign completed.
30 Swaziland Y Y Y Vaccination campaign completed.
31 Togo Y Y Y Vaccination campaign completed.
32 Zambia Y Y Y Vaccination campaign completed.
33 Zimbabwe Y Y Y Vaccination campaign completed.
34 South Africa* Vaccination campaign completed.
1 Benin Y N Y NDP approved; funding available; LOA not submitted; gave notice on withdrawal from the scheme.
2 Burundi Y Y Y NDP approved; funding available; country withdrew by request.
3 Eritrea Y Y N Submitted both LOI and LOA; submitted NDP to IST; withdrew from donation scheme by request.
4 Mali Y N Y NDP approved; funding available; country did not submit Letter of Agreement (LOA).
5 Mozambique Y N Y NDP approved; funding available; country did not submit letter of Agreement (LOA).
6 Cape Verde Y Y N
Despite the effort made during the past months, progress was not made in having these countries submit
either LOA or NDP or both..
7 Chad Y Y N
8 D. R. Congo Y N N
9 Gabon Y Y N
10 Tanzania Y Y N
11 Uganda Y N N
*South Africa was not among the countries originally identified as eligible for donation.
P a g e | 39
Table 18: H1N1 Vaccine Deployment in AFR: target population and vaccine allocation
no Country Total Pop
vaccine
allocated
Target Population
Health care
Workers Pregnant women
others number % Number % number %
1 Angola 16,557,000 2,030,000 2,029,957 12.3 85,000 0.51 256,000 1.55 1,643,274
3 Botswana 1,858,000 1,612,800 1,832,397 86.8 21,615 1.16 51,040 2.75 1,799,542
4 Burkina Faso 14,359,000 1,450,000 1,573,097 10.1 24,404 0.17 629,239 4.38 919,454
6 Cameroon 18,175,000 1,825,000 1,967,267 10.0 98,364 0.54 393,453 2.16 744,450
7 CAR 4,650,000 448,000 448,000 9.6 5,000 0.11 197,087 4.24 245,840
8 Comoros 818,000 65,000 64,600 7.9 1,500 0.18 0 0.00 63,100
9 Congo 3,689,000 400,000 400,000 10.8 12,000 0.33 80,000 2.17 308,000
10 Cote d'Ivoire 18,914,000 2,197,000 2,196,258 11.6 25,000 0.13 1,098,129 5.81 1,073,129
11 EQ Guinea 496,000 33,500 101,500 6.8 2,500 0.50 25,380 5.12 73,620
12 Ethiopia 81,021,000 3,000,000 5,000,000 3.7 300,000 0.37 1,100,000 1.36 4,400,000
13 Gambia 1,663,000 163,800 170,000 9.8 10,000 0.60 32,000 1.92 128,000
14 Ghana 23,008,000 2,300,000 2,111,056 10.0 67,600 0.29 727,537 3.16 1,315,919
15 Guinea 9,181,000 1,049,000 1,048,674 11.4 50,000 0.54 313,674 3.42 685,000
16 Guinea-Bissau 1,646,000 160,000 94,625 9.7 2,500 0.15 31,934 1.94 60,191
17 Kenya 36,553,000 730,000 731,286 2.0 109,949 0.30 621,337 1.70 0
18 Lesotho 1,995,000 195,000 215,050 9.8 25,000 1.25 50,000 2.51 140,050
19 Liberia 3,579,000 78,000 78,000 2.2 10,000 0.28 68,000 1.90 0
20 Madagascar 19,159,000 1,056,090 2,042,447 5.5 15,367 0.08 584,156 3.05 1,442,924
21 Malawi 13,571,000 1,300,000 1,340,000 9.6 33,752 0.25 234,948 1.73 976,300
23 Mauritania 3,044,000 296,400 303,370 9.7 8,000 0.26 153,370 5.04 142,000
24 Mauritius 1,252,000 327,000 822,700 26.1 17,000 1.36 36,000 2.88 769,700
26 Namibia 2,047,000 216,000 220,358 10.6 8,836 0.43 46,621 2.28 164,901
27 Niger 13,737,000 1,374,900 1,482,507 10.0 20,000 0.15 711,603 5.18 750,904
28 Nigeria 144,720,000 2,880,000 8,617,520 2.0 1,538,972 1.06 4,616,194 3.19 2,462,354
29 Rwanda 9,464,000 200,000 195,900 2.1 100,900 1.07 0 0.00 95,000
33 Sao T & P 155,000 16,000 16,000 10.3 1,047 0.68 4,011 2.59 10,144
30 Senegal 12,072,000 240,000 1,137,175 2.0 30,536 0.25 0 0.00 1,106,639
31 Seychelles 86,000 9,000 9,280 10.5 1,995 2.32 1,200 1.40 6,085
32 Sierra Leone 5,743,000 577,000 560,793 10.0 7,000 0.12 218,709 3.81 335,084
33 Swaziland 1,134,000 117,000 422,462 10.3 15,500 1.37 19,036 1.68 387,926
34 Togo 6,410,000 663,500 589,500 10.4 22,500 0.35 180,000 2.81 387,000
35 Zambia 11,696,000 256,800 245,000 2.2 70,000 0.60 175,000 1.50 0
36 Zimbabwe 13,228,000 1,250,000 1,025,000 9.4 55,000 0.42 150,080 1.13 819,920
495,680,000 28,516,790 39,091,779 5.8 2,796,837 0.56 36,294,942
P a g e | 40
Table 19: H1N1 Vaccine Deployment Activity in AFR: budget allocation and distribution plan
Country
Budget
Total
Cost/
dose
Vaccine
Strtgey
Mgmt
Orgnz
Comm
Info
HR
Secc
Public
Info
Supply
CChain
Wast
mgmt
Post
Market
Evalu
ate
Angola 612,905 0.30 35.5 6.2 17.2 26.6 1.3 11.2 0.0 0.0 2.0
Botswana 2,279,624 1.24 75.8 0.4 0.5 3.6 9.6 5.1 0.1 0.0 4.9
Burkina Faso 855,790 0.54 10.0 26.9 11.2 28.3 3.6 13.7 2.4 3.8 0.0
Camaeroon 839,528 0.43 49.9 1.0 0.7 17.7 4.8 22.3 0.0 1.2 2.2
CAR 525,993 1.17 48.1 20.2 0.1 0.1 4.4 22.5 1.6 0.6 2.3
Comoros 64,664 1.00 34.9 23.3 0.0 3.1 38.8 0.0 0.0 0.0 0.0
Congo 155,727 0.39 65.9 15.7 1.4 3.4 6.4 3.5 0.1 0.7 2.8
Cote d'Ivoire 975,241 0.44 16.1 2.0 5.5 43.6 12.5 16.2 0.0 1.3 2.8
EQ Guinea 55,514 0.55 28.7 14.8 17.2 2.2 25.6 1.1 0.0 10.4 0.0
Ethiopia 6,477,920 1.30 64.4 3.4 0.0 7.7 4.9 16.4 0.3 2.9 0.0
Gambia 168,561 0.99 20.6 41.2 3.5 14.4 8.7 4.7 1.5 3.3 2.2
Ghana 1,125,460 0.53 18.7 29.5 1.5 12.9 19.6 7.6 6.2 4.1 0.0
Guinea 425,986 0.41 15.5 36.0 0.9 13.7 7.4 7.1 7.4 11.9 0.0
Guinea-Bissau 172,261 1.82 41.0 26.4 13.1 8.1 4.8 5.1 0.8 0.7 0.0
Kenya 452,778 0.62 0.7 4.2 5.7 33.3 25.9 11.1 0.2 6.6 12.3
Lesotho 128,090 0.60 22.7 36.9 12.4 17.5 10.0 0.0 0.5 0.0 0.0
Liberia 109,200 1.40 12.3 6.1 0.1 27.8 16.3 20.1 5.8 11.5 0.0
Madagascar 903,574 0.44 13.6 2.8 0.4 58.8 0.5 8.8 6.8 4.2 4.0
Malawi 821,397 0.61 32.0 15.8 10.7 0.0 10.4 15.7 0.6 0.0 14.9
Mauritania 229,801 0.76 45.5 22.1 1.2 15.2 9.8 0.1 0.0 5.2 0.0
Mauritius 51,830 0.06 27.1 16.1 1.1 8.0 38.6 0.1 8.1 1.0 0.0
Namibia 418,800 1.90 34.7 9.3 13.2 41.1 1.4 0.3 0.0 0.0 0.0
Niger 587,837 0.40 58.4 5.3 3.4 13.7 3.7 14.0 0.0 1.4 0.0
Nigeria 7,168,395 0.83 28.1 28.3 15.1 11.9 4.0 2.2 7.1 0.4 3.0
Rwanda 163,405 0.83 33.1 20.8 0.0 46.0 0.0 0.0 0.0 0.0 0.0
Sao T & P 25,589 1.60 46.6 5.7 0.9 12.9 25.1 0.1 0.0 3.9 3.9
Senegal 822,603 0.72 18.2 11.9 0.0 31.7 11.4 14.4 0.0 12.4 0.0
Seychelles 23,764 2.56 0.0 16.6 0.0 12.7 30.3 7.4 14.7 7.3 11.0
Sierra Leone 431,159 0.77 26.4 17.5 5.3 17.7 1.6 9.3 8.1 13.9 0.0
Swaziland 442,356 1.05 23.0 13.6 10.0 30.0 12.2 2.0 8.8 0.4 0.0
Togo 493,902 0.84 27.5 5.5 7.8 4.0 31.4 13.7 0.0 10.1 0.0
Zambia 206,964 0.84 44.4 0.0 0.0 20.9 27.7 6.9 0.0 0.0 0.0
Zimbabwe 804,080 0.78 24.9 12.2 12.4 19.2 7.5 19.4 1.9 2.5 0.0
P a g e | 41
Figure 16: WHO INTER-COUNTRY SUPPORT TEAM (IST) OF AFRICAN REGION
IST WEST: Algeria Benin Burkina F Cape Verde Cote d’Ivoire Gambia Ghana Guinea Gn-Bissau Liberia Mali Mauritania Niger Nigeria Senegal Sierra Leone Togo
IST EAST & SOUTH:
Botswana Comoros Eritrea Ethiopia Kenya Lesotho Madagascar Malawi Mauritius Mozambique Namibia Rwanda Seychelles South Africa Swaziland Tanzania Uganda Zambia Zimbabwe
IST CENTRAL: Angola Burundi Cameroon CAR Chad. Congo bzv\ DR Congo Eq. Guinea Gabon Sao Tome & P
![A DNA vaccine against an H1N1 avian influenza virus induced … · 2016. 10. 7. · Journal of Biotech Research [ISSN: 1944-3285] 2011; 3:27-36 27 A DNA vaccine against an H1N1 avian](https://img.dokumen.tips/doc/110x75/60ab1d115ecc3527e24938f2/a-dna-vaccine-against-an-h1n1-avian-influenza-virus-induced-2016-10-7-journal.jpg)
