WHO2024东南亚区域免疫工作组报告

SEA-Immun-157

ReportonSouth-EastAsiaRegionalWorkingGrouponImmunization

22March2022

worldHealthorganization

REGioNAOFFicEFORSouth-EastAsia

ReportonSouth-EastAsiaRegionalWorkingGrouponImmunizationintheSouth-EastAsiaRegion.SEA-Immun-157

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iii

Contents

PageNo.

1.Introduction 1

2.Openingsession 1

2.1Regionalstatusofimmunizationandvaccinepreventable

disease(VPD)controlandRegionalVaccine

ImplementationPlan2022-2026 2

3.Session:Improvingcoverageandequityofroutineimmunization

amidrespondingtotheCOVID-19pandemic 4

3.1Revitalizingroutineimmunizationservices 4

3.2Catch-upimmunizationactivitiesforchildrenand

womenwhomissedvaccination 9

3.3Synergizingroutineimmunizationservicesand

COVID-19vaccinations 13

4.Synergizingpartnersupportforimmunization 15

4.1OperationalizingGavi5.0intheSouth-EastAsiaRegion 15

4.2Partnerupdates 17

5.Conclusionsandfollow-upactions 18

Annexes

1.

Agenda 20

2.

Listofparticipants 21

1

1.Introduction

TheRegionalWorkingGroup(RWG)onimmunizationsystemsstrengthening(ISS),whichalsocoversintroductionofnewandunderutilizedvaccines(NUV)andtheimpactonhealthsystemstrengthening(HSS),isaninteragencybodythatwassetupintheWHOSouth-EastAsiaRegionin2007–2008.Itliaiseswithglobalandotherregionalimmunizationinitiativesandactsastheprimaryregionalforumforpartnerandprogrammecoordination,consensus-buildingandmonitoringoftheimplementationofresources,includingthatofGavi,theVaccineAlliance,andalsoprovidescountrysupport.

ThemembershipoftheRWGmeetingcomprisesBillandMelindaGatesFoundation(BMGF),USCentersforDiseaseControlandPrevention(USCDC),Gavi,theVaccineAlliance,UnitedStatesAgencyforInternationalDevelopment(USAID),UnitedNationsChildren’sFund(UNICEF),theWorldBankandtheWorldHealthOrganization(WHO).

ThevirtualRWGmeetingwasconductedon22March2022withthegeneralobjectivetoharmonizeandcoordinatepartnersupporttocountriesintheRegioninordertorevitalizeroutineimmunizationcoverage,followingtheCOVID-19pandemic,andoperationalizethestrategicframeworkfortheSouth-EastAsiaRegionalVaccineActionPlan2022–2030,whichisalignedwiththeImmunizationAgenda2030.Thespecificobjectiveswereto:

supportcountriestoplanactionsforimprovingtheroutineimmunizationcoveragetothepre-pandemiclevelandconductcatch-upimmunizationactivitiesforchildren,whomissedroutinevaccines;

supportcountriesinintegratingCOVID-19vaccinationandroutineimmunizationactivitiestothegreatestextentpossible;

discussandfacilitateintroductionofnewvaccinesthatareplannedinthecurrentbienniumorwereplannedin2020and2021buthadtobedeferredduetotheCOVID-19pandemic;

discusstheRegionalVaccineImplementationPlan2022-2026;and

discussoperationalizingGavi5.0strategyintheRegion.

TheagendaofthemeetingisattachedherewithasAnnex1andthelistofparticipantsisaddedasAnnex2.1.

2.Openingsession

DrSunilBahl,Coordinator(COVAX,IVD),WHOSEARO,welcomedtheparticipantsandpresentedtheobjectivesofthemeeting.HeappreciatedtherobustcollaborationamongRWGpartnerstosupportcountriesformaintainingandrevitalizingtheroutineimmunizationandvaccinepreventablediseasesurveillance,followingtheCOVID-19pandemic,androllingoutCOVID-19vaccination.

MrBasilRodriques,RegionalHealthAdviserwiththeEastAsiaandPacificRegionalOfficeofUNICEF,mentionedthattheRWGmeetingwastimelybecausethereisaneedtorefocusagainonroutineimmunizationandgetcountriesbackontrack.Hestressedthemeetingwouldbeagoodplatformtodiscussthechallengesobservedandthewaysinwhichthosechallengescouldbeaddressedtogether.Harmonizationandcoordinationofpartnersupporttocountriesareimportantsinceateamisstrongerthanindividuals.

ReportonSouth-EastAsiaRegionalWorkingGrouponImmunization

DrGünterBoussery,SeniorHealthSpecialistwiththeReginalOfficeforSouthAsiaofUNICEF,highlightedthatmultiplewavesofCOVID-19circulationseverelyaffectedimmunizationservicesincountriesintheWHOSouth-EastAsiaRegion.TheslowingdownofCOVID-19transmissionhasprovidedanopportunitytodiscussthecountryexperiencesandhowtheexperiencesfromCOVID-19canbeusedtoleverageRIservicestoincreasecoverageofbothCOVID-19androutineimmunization.

MsColetteSelman,RegionalHead,Asia-PacificRegion,Gavi,theVaccineAlliance,appreciatedtheeffortsofWHOandUNICEFcountryofficesinsupportingthecountriesoverthepasttwoyearsinacomplexandchallengingpandemicenvironment.TheGavi5.0StrategywaslaunchedayearagoandalignedwiththeUNICEFandWHOstrategiesforreachingzero-dosechildrenandleavingnoonebehind,thusidentifyingcommunitiesthathadbeensystematicallymissingroutinevaccinations.TherearenewapplicationsforGavisupport,anewplatformforreachingzero-dosechildrenandfundingopportunitiesforcountries.TheRWGmeetingprovideslearningopportunitiesbetweencountriesandhelpaddressissuestherebycreatingthemomentumtomoveforward.

2.1Regionalstatusofimmunizationandvaccinepreventabledisease

(VPD)controlandRegionalVaccineImplementationPlan

2022-2026

DrSunilBahlpresentedanupdateonthestatusofimmunizationandVPDelimination/controlintheSouth-EastAsiaRegionandtheSouth-EastAsiaRegionalVaccineImplementationPlan2022–2026.

Thekeypointsfromthepresentationwere:

Routineimmunizationcoverage(3dosesofdiphtheria-tetanus-pertussisvaccine/DTP3)intheSouth-EastAsiaRegionincreasedsteadilytoreach91%in2019,butdroppedfrom91%to85%in2020.

Thenumberofunvaccinatedorunder-vaccinatedchildrenincreasedfrom

3millionto4.9million.

Sixcountriesmaintainedimmunizationcoverage(DTP3)above90%in2020,althoughsubnationalvariabilitywasseenin2019and2020.

Despitedelays,newvaccineintroductionandsurveillancewereprogressingwellintheRegionwithanumberofcountriesintroducingnewvaccinesduring2020–2021.

However,surveillanceactivitiesencounteredmultiplechallengesduetotheCOVID-19pandemic.

ThemainachievementsoftheRegionincludemaintainingthepolio-freestatus(certifiedin2014),maintainingthematernalandneonataltetanuseliminationstatusoftheRegion(achievedin2016),makingprogresstowardstheReginalFlagshipProgrammeon–“measlesandrubellaeliminationby2023”,eliminationofmeaslesinfivecountries(achievedbetween2017and2019)andeliminationofrubellaintwocountries(achievedin2020).HepatitisBwascontrolledthroughimmunizationinfourcountries(achievedin2019).Theseachievementsareatariskbecauseofthereductionintheroutineimmunizationcoverage.

ReportonSouth-EastAsiaRegionalWorkingGrouponImmunization

3

14.0

12.0

10.0

8.0

6.0

4.0

2.0

Immunizationcoverage(DTP3)intheSEAsiaRegiondroppedfrom91%(2019)to85%in2020Numberofun-orunder-vaccinatedchildrenincreasedfrom3millionto4.9million

100

95

90

Coverage(%)

85

80

75

70

65

60

55

2020

2019

50

Un-andundervaccinated(millions)

-

91

85

200020012002200320042005200620072008200920102011201220132014201520162017201820192020

ZerodoseDrop-OutDTPcoverage

Zerodo

se,2.0

Zerod

ose,4.1

Drop-O

ut,1.0

Drop-O

ut,0.8

-0.51.01.52.02.53.03.54.04.55.0

Source:WHO/UNICEFEstimatesofNationalImmunizationCoverage(July2021)Note:Dropoutisdifferencebetweennumberofchildrenvaccinatedwith1stdoseofDTPand3rddoseDTP3

TheRegionhasprogressedwellinCOVID-19vaccinationand10outof11countriesareofferingvaccines–allhavereachedthefirsttargetof40%fullyvaccinatedcoverage.Twocountries(BhutanandThailand)havereachedthenexttargetof70%fullvaccination.Thefirst-dosecoverageintheRegionis68%andtheprimaryseriescoverageis56%.

TheStrategicFrameworkforRegionalVaccineActionPlan2022–2030hasbeendeveloped;itwasendorsedbytheRegionalCommitteeinSeptember2021.WorkontheRegionalVaccineImplementationPlan2022–2026isbeingcarriedout,forwhichregionalpartnersaredevelopingthemonitoringframeworkwithidentificationofbaselinetargets,nationaltargetsandscorecards.

ThemainchallengesnowarerenewingpoliticalandorganizationalcommitmentforimmunizationdespitetheCOVID-19pandemic,identifyingnewwaysofworking,supportingsubnationallevels,ensuringconsensusofallstakeholders,demandgenerationandaddressingvaccinehesitancy,supportingsomecountriesfordataqualityimprovement,andconductingfrequentanalysestotakecorrectiveactions.

Thenextstepsarethefollowing:

ReachconsensusonmodalitiesofRWGsupporttocountriestoimproveimmunizationcoverageandequity.

Takeallopportunitiestovaccinatechildrenandwomen,whomissedroutineimmunization.

IdentifyopportunitiesforcombiningCOVID-19vaccinationwithroutineimmunization.

TheregionalofficewillconsolidatefeedbackanddeveloparevisedRegionalVaccineImplementationPlan2022–2026.

Synergizepartnersupporttothecountries.

Enhancefocusonthesubnationallevelforcontinuousqualityimprovement.

ReportonSouth-EastAsiaRegionalWorkingGrouponImmunization

3.Session:Improvingcoverageandequityofroutineimmunizationamidrespondingtothe

COVID-19pandemic

3.1Revitalizingroutineimmunizationservices

3.1.1Bangladesh’sexperienceofrevitalizationofroutineimmunizationafterthe

initiallockdownperiodin2020

OnbehalfofthecountryofficesofWHOandUNICEFinBangladesh,DrBalwinderSingh,MedicalOfficer,WHOCountryOfficeofBangladeshpresentedtheimpactoftheCOVID-19outbreakonroutineimmunizationfrom2020to2021.

FollowingtheCOVID-19outbreakin2020,routineimmunizationsessionswereaffectedfromMarchtoMay2020,leadingtoacoveragedecline(3dosespentavalentvaccine/Penta3coverageby22%inMarch,68%inApriland53%inMay).Theprogrammeundertookinfectionpreventionandcontrol(IPC)trainingofhealthworkersinsmallbatchestobuildtheircapacityonIPCduringimmunizationsessionsandboosttheirconfidenceforcontinuingvaccinationdespitetheCOVID-19pandemic,followingwhichtheroutineimmunizationcoveragepickeduprapidly.However,anationwideprotestofhealthworkersinNovember2020againledtoadeclineincoverage.

Aftertheprotestwasresolved,anationwidemeasles-rubellacampaignwasundertakeninJanuary2021duringwhich35.3millionchildrenwerevaccinated.Bangladeshundertookroutineimmunizationcatch-upduringtheWorldImmunizationWeekinApril2021andvaccinated60000zero-dosechildren.ThesecondwaveofCOVID-19inJune2021alsoledtosomereductioninroutineimmunizationcoverage.Nevertheless,thethirdwaveofCOVID-19inJanuary2022didnotaffectroutineimmunizationcoverage.

Acomparativeanalysisofcoveragebetween2019and2020showedthatalldivisionshadsimilartrendsinroutineimmunizationthroughouttheCOVID-19pandemic.Itwasfoundthat20%(24400)routineimmunizationsessionswerenotheldinApril2020and28%(36600)inMay2020.Hence,in2020,comparedwith2019,Penta3coveragedeclinedby22%inMarch,68%inApriland53%inMay.Theurbanareasweremoreaffectedthantheruralonesduetolockdowns.Forexample,thePenta3coverageinurbanareaswas27%ascomparedwith50%inruralareasinApril2020.

ThefollowingfactorscontributedtotherevitalizationofroutineimmunizationinBangladesh:

TherewasahighlevelofpoliticalcommitmentwithregularmessagesfromthePrimeMinistertorevitalizeroutineimmunization.

TheperiodicassessmentofCOVID-19impactonroutineimmunizationwascarriedoutthroughdevelopmentoftoolstoidentifyfunctionalityofhealthfacilitiesandtheirstaffaffectedbythepandemicandtheeffectonroutineimmunizationcoverageandVPDsurveillance,includingoutbreakdetection,storageandshipmentofVPDsamples.

RoutineimmunizationandVPDreviewwereundertakeninprioritydistrictsandcitycorporationsjointlybythepartnersandthegovernment.Thisdeepdivewasconductedtoassessthequalityofthegenerateddataatalllevelsandthefindingsweresharedatalloperationallevelsforcorrectiveactions.

ReportonSouth-EastAsiaRegionalWorkingGrouponImmunization

5

Reviewedandstrategizedmicroplanningforroutineimmunizationwascarriedoutinallareas,includingCox'sBazar.

Healthmanagementinformationsystem(HMIS)datawasmonitoredonamonthlybasis,usingDHIS2,andvirtualmeetingswereconductedbyEPIwithunderperformingdistricts.

Routineimmunizationserviceswereresumedfollowingin-personIPCtrainingfor26000vaccinatorsanddevelopmentofguidelinesforvaccination.Thetrainingboostedtheconfidenceofthevaccinatorsanddispelledtheirfears.

Communityengagementremainsinstrumentalandthehealthworkers,includingvaccinators,aretrustedandacceptedasmostofthemresideinthesamecommunity.

AccesstovaccinationsessionsiteswasfacilitatedevenduringlockdownsandaccesstooutreachvaccinationsessionswasfacilitatedbythegovernmentthroughpresentationofEPIcardsatthesecuritychecks.Messagesinmediainformedparentsaboutthisarrangement.

Trackingofsupplies:Despitelockdowns,vaccinesupplywasensured,basedonvaccinealerts,andnomajorvaccineandlogisticstock-outreported.UNICEFsupportedvaccinedistributionthroughspecialshipmentanddistributionfromnationaltosubnationallevels.TheWHOSurveillanceandImmunizationMedicalOfficer(SIMO)networkalsosupportedtransportationsfromdistricttoupazilalevels.

TheSIMOnetworkandUNICEFfieldstaffmemberswereavailableforlocal-leveladvocacy,planningandon-the-spotsupport.

InstitutionssuchastheIslamicFoundationplayedabigroleinreachingouttocommunitiesforacceptanceofvaccines.Theengagementofreligiousleadersplayedanimportantrolesincetheydisseminatedmessagesoncontinuingvaccinationofchildrentoparentsthroughpublicserviceannouncement(PSA),mediainterviews,postersandleaflets.Announcementsfrommosquesduringthetimeofprayersplayedakeyroleincommunitymobilizationatthelocalandgrassrootslevel.Mediaplatforms,includingsocialmedia(inlocallanguage),wereengaged.UNICEFplayedakeyroleincommunicationwithdevelopmentanddisseminationofsocialmediapacksforallsocialmediaplatforms.OpportunitiesofmediabriefingsforCOVID-19werealsousedtoreinforcemessagesforcontinuationofroutineimmunization.

Real-time,concurrenthouse-to-housemonitoringwasinitiatedinhigh-riskareastoidentifygapsinroutineimmunization.Thiswascombinedwithsessionsitemonitoringofimmunization,coupledwithreal-timecorrectiveactions

Regularreviewmeetingswereheldthroughvirtualplatforms.

ReportonSouth-EastAsiaRegionalWorkingGrouponImmunization

Thewayforwardisto

EnsurethatnooneisleftbehindbecauseoftheCOVID-19pandemicandundertaketriangulationofdatatocarryoutfocusedactions.

Continuecapacity-buildingofhealthworkforcethroughface-to-faceandvirtualplatforms.

Re-establishandstrengthenreviewandfeedbackmechanisms,includingface-to-facemeetings.

Ensureorientationofmiddle-levelmanagers.

Sustainandstrengthencivilsocietyandnon-governmentalorganization(NGO)networks.

EnsurecontinuationoftheWHOSIMOnetworkandUNICEFfieldstaffmembersthatplayedaveryimportantroleinrevitalizationofRIandCOVID-19vaccination.

3.1.2RevitalizingroutineimmunizationservicesintheSouth-EastAsiaRegion

DrJayanthaLiyanage,RegionalAdviser,ISS,IVD,WHOSEARO,summarizedtheactionstakenbythecountriesforrevitalizationofRIservicesduringthepandemicinapresentation.

AvirtualmeetingofRWGwasconductedinApril2020toidentifysupportrequiredbycountriesforimmunizationandVPDsurveillance.Subsequently,theWHOSouth-EastAsiaRegionalImmunizationTechnicalAdvisoryGroup(ITAG)meetingsinJuly2020andAugust2021reviewedthestatusofroutineimmunization,togetherwiththenationalimmunizationprogrammesandpartners.

TheannualreportssubmittedtoITAGbythenationalimmunizationprogrammeshaveanalysedrevitalizationofRIatnationalandsubnationallevels.TherecommendationsfromITAGhavebeenfollowedthroughcountry-focusedvirtualmeetingshostedbyGavi,UNICEFandWHO.TheactivitiesareinaccordancewiththeRegionalVaccineActionPlan2022–2026,whichemphasizestheneedtofocusonrevitalizationofroutineimmunizationwhilesupportingCOVID-19vaccination.

TheimpactoftheCOVID-19pandemiconroutineimmunizationineachoftheSouth-EastAsiaRegioncountrieswashighlighted.RoutineimmunizationwasimpactedsignificantlyinBangladeshandBhutanin2020.However,programmeshaverecoveredandsustainedvaccinationcoveragein2021despitetheCOVID-19Delta

ReportonSouth-EastAsiaRegionalWorkingGrouponImmunization

7

andOmicronwaves,whencomparedwiththe2019coverage.India,Maldives,SriLankaandThailandexperiencedaimmunizationcoveragedeclinein2020withrecoveryandalsohadsomereductionin2021.Indonesiahadasignificantreductioninroutineimmunizationcoverage,whichcontinuedin2021,despitemakingarecoveryinthelatterhalfof2020.SignificantlylowcoverageintheDemocraticPeople’sRepublic(DPR)ofKorea,MyanmarandTimor-LestewasalsoaffectedbyreasonsbeyondtheCOVID-19pandemic.

Keyelements:

•Alternativestrategies/innovationsfor

Nationalguidelinesonimmunization/VPDsurveillanceduringtheCOVID-19pandemicdevelopedin2020bymostcountries;updatedin2021,basedonlearningsfrom2020

SriLanka

conductingfixedandoutreachsessionsduringhightransmissionofCOVID-19

•Catch-upvaccinationformissedchildren

(infants,schoolgoingchildren,adolescents)andpregnantwomen

•InfectionpreventionandcontrolduringEPIsessions

•HighcoverageofCOVID19vaccinationinhealth-careworkers

•Communicationstrategiesandtools

Bangladesh

India

•Real-timemonitoringofRIcoverage

nationallyandsubnationallyinmostcountries

Nepal

Indonesia

•Upperagelimittoprovidevaccinesthroughroutineimmunizationwasincreasedinsomecountries

NationalguidelinesonconductingimmunizationsessionsandVPDsurveillanceduringtheCOVID-19pandemicweredevelopedin2020bymostcountriesandupdatedin2021,basedonlearningsfrom2020.Keyelementsinclude:

alternativestrategiesandinnovationsforconductingfixedandoutreachsessionsduringtheCOVID-19pandemic;

catch-upvaccinationformissedchildren(infants,schoolattendingchildren,adolescents)andpregnantwomen;

infectionpreventionandcontrolduringEPIsessions;

highcoverageofCOVID-19vaccinationamonghealth-careworkers;

communicationstrategiesandtools;

real-timemonitoringofroutineimmunizationcoveragenationallyandsubnationallyinmostcountries;and

theupperagelimitofroutineimmunizationraisedabovetwoyearsincountriesforcatch-upvaccinationofmissedchildren.

Followingarethekeyhighlightsfromcountriesonrevitalizationofroutineimmunization:

Bangladesh:Routineimmunizationprogrammeperformancewasregainedby2021,andthecountryismovingtodevelopingtheNationalImmunizationStrategy.

Bhutan:Routineimmunizationprogrammeperformancewasregainedbyearly2021.ThefocusisonCOVID-19boosterdosesandvaccinating>5-year-oldchildrenwithCOVID-19vaccine.

DPRKorea:Routineimmunizationhasbeenhaltedsince2021duetonon-availabilityofvaccinesfollowingcompleteborderclosure.

ReportonSouth-EastAsiaRegionalWorkingGrouponImmunization

India:ThecountryadoptedatailoredapproachforstrengtheningroutineimmunizationthroughMissionIndradhanush(MI)in2021and2022.ImplementationofMissionIndradhanush4.0wascarriedout(FebruarytoApril)in416selecteddistricts.

Indonesia:ThecountryanalysedimmunizationcoveragebyprovincesandtriangulatedwiththeVPDsurveillancedatatoidentifyareasathighrisk.Ahigh-levelnationalmeetingwasheldwithprovincialpolicymakers,pledgingforrevitalizationofroutineimmunization,andastudyonbehaviouralandsocialdriversofvaccinationandvaccineacceptancewasconducted.Thefindingsfromtheanalysisofroutineimmunizationcoverage,VPDsurveillancedataandthestudieswereextensivelydiscussedinarecentmeetingtodevelopaproposalforGavimiddle-incomecountrysupport.IndonesiaisplanningforaNationalChildrenImmunizationMonth(BIAN)intwophases(May–JuneandJuly–August2022).

Myanmar:Routineimmunizationcoveragehassignificantlyreduced.Theroutineimmunizationrevitalizationplanwasdevelopedin2020byallstakeholdersanddiscussionswereinitiatedtooperationalizetheactionplan,whichwassubsequentlyupdatedin2021.

Nepal:Routineimmunizationcoveragehassignificantlyreduced.Plansareinplaceforidentificationandvaccinatingthechildren,whomissedanyvaccination,duringtheupcomingtyphoidconjugatevaccineTCVimmunizationcampaign.

SriLanka:Therehasbeensomereductioninroutineimmunizationcoverageanddelaysinreportingcoveragetothenationallevelwerealsoafactorforthecoveragedip.FollowingcontroloftheCOVID-19situation,district-levelimmunizationprogrammereviewsandotherinterventionshavebeenrestarted.

Thailand:Routineimmunizationcoveragehassignificantlyreduced.FollowingsuccessfulCOVID-19vaccination,thegovernmentisfocusingonimprovingroutineimmunizationinprovinceswithlowperformanceandimprovingdemandgeneration.

Timor-Leste:Routineimmunizationcoveragehasreducedverysignificantly.Thelimitedoperati