Ready immunisation systems to deliver safe and effective Covid-19 vaccines

Immunisation saves lives and promotes life-long health and well-being. It is among the most powerful public health and development interventions that exist. Since the beginning of the Covid-19 response, the WHO South-East Asia region has made urgent and sustained efforts to maintain immunisation as part of a broader commitment to ensure that all people can continue to access essential health services amid the pandemic.

Member-state progress has been strong and steady. Despite initial disruptions in March through May, most routine and supplementary immunisation activities in the region have been revived and maintained. Millions of children have continued to receive life-saving protection against a range of vaccine-preventable diseases, from diphtheria, pertussis and tetanus, to rotavirus and rubella. Not a single vaccine stock-out has occurred. Amid enhanced physical distancing and infection prevention and control protocols, programme managers, health workers and volunteers from across the region have shown tremendous resolve. They deserve our highest praise.

Throughout the Covid-19 response, recovery and beyond, WHO will continue to support member states and the region to remain polio-free, to sustain maternal and neonatal tetanus elimination, and to accelerate progress towards measles and rubella elimination by 2023. To achieve this and more, it is essential that countries identify remaining immunisation gaps and rapidly implement catch-up campaigns. But as together we continue to strengthen all aspects of the response, we must not only reinforce and build the capacity of immunisation systems, but also ready them to meet our next challenge: to equitably and efficiently deploy vaccines against Covid-19.

Almost all countries in the region plan to procure a first tranche of vaccines from the WHO-supported COVAX Facility, the vaccine pillar of the Access to Covid-19 Tools Accelerator. For the allocation framework to be effective, and for at least 2 billion doses to be delivered to all participating countries globally by the end of next year, immediate and sustained increases in international and global funding are required. Rapid advances in research and development on vaccines against Covid-19 have seen more than a handful of vaccines reach phase 3 trials, and some have already gone for emergency use authorisation, or are likely to do so very soon. Anticipation is building.

As and when vaccines are found to be safe and effective, countries will need to activate detailed plans to efficiently deploy the initial tranches of Covid-19 vaccines to cover up to 20 percent of the most vulnerable of their population, and to carry out coordinated and equitable deployments thereafter. WHO will continue to provide member states its full support to help finalise such plans, with a focus on several key areas.

First, defining priority groups for vaccination. The WHO Strategic Advisory Group of Experts on immunisation has in recent months published critical guidance that considers priority groups for vaccination based on different epidemiologic settings and vaccine supply scenarios.

Informed by the guidance, countries must make evidence-based, context-specific decisions, accounting for the risk profile of different groups based on age, underlying health and comorbidities, and socio-demographic risks, among other factors. Across all settings, and whatever the supply scenario, it is imperative that frontline health personnel are provided first access.

Second, enhancing service delivery, communication and vaccine demand. Across the region, countries must identify platforms to deliver vaccines to target populations, while also strengthening infection prevention and control protocols.

But of increasingly urgent need is the development and roll-out of comprehensive plans to identify and train an adequate number of health workers and volunteers to administer the vaccine. Crucially, communities must continue to be engaged, listened to and provided with high-quality, scientifically sound information, which will in turn drive vaccine demand.

Third, strengthening vaccine cold chain and logistics. Even to reach an initial 20 percent coverage, countries may have to increase cold chain capacity, which will require additional resources. Logistics working groups will need clear terms of reference and standard operating procedures not only to coordinate the deployment of vaccines, but also to source and deliver ancillary products. To address these and other challenges, WHO will continue to work with international and global partners to mobilise the financial, material and technical resources required.

Complacency must not set in. Although vaccine manufacturing has already started, reaching sufficient availability will take time. In a crisis such as this, there are no silver bullets. Today, tomorrow, and for many more months to come, we must continue to implement the basic public health measures that we know work, and which have defined our "new normal". Wash your hands. Wear a mask. Maintain physical distance and avoid the three Cs—crowded places, close-contact settings, and confined and enclosed spaces.

Almost a year since Covid-19 emerged, we have cause for optimism. Countries in the region are to be commended for beginning immunisation planning as early as July, for carrying out vaccine readiness assessments, and for continuing to act in solidarity and with recognition that vaccines are a global public good. Now is the time to firm up and finalise such plans, for the equitable and efficient protection of vulnerable populations, and for the health and wellbeing of all.

Dr Poonam Khetrapal Singh is the WHO Regional Director for South-East Asia.