Report of the WHO Pandemic Vaccine Deployment Workshop
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Report of the WHO Pandemic Vaccine Deployment Workshop Lagos, Nigeria, 4−6 November 2019
Transcript of Report of the WHO Pandemic Vaccine Deployment Workshop
Report of the
WHO Pandemic Vaccine Deployment
Workshop Lagos, Nigeria, 4−6 November 2019
Report of the WHO Pandemic Vaccine Deployment Workshop, Lagos, Nigeria, 4-6 November 2019
ISBN 978-92-4-001285-1 (electronic version)
ISBN 978-92-4-001286-8 (print version)
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Contents
Acronyms ............................................................................................................................................... iv
Executive summary ................................................................................................................................ v
Introduction ........................................................................................................................................... 1
1. Global mechanisms for effective deployment and vaccination operations during an influenza
pandemic ................................................................................................................................................ 2
The Pandemic Influenza Preparedness (PIP) Framework and the importance of vaccination............... 2
Lessons learned from the 2009 H1N1 pandemic vaccine deployment initiative ....................................... 2
National Deployment and Vaccination Plan guidance, checklist and game introduction ........................ 3
2. Enhancing pandemic influenza deployment and vaccination capacities in Nigeria ...................... 4
Nigeria update: pandemic preparedness and the NDVP ............................................................................ 4
Pandemic influenza risk communication ...................................................................................................... 6
Medical countermeasures (MCM) supply chain plan ................................................................................. 7
Regulatory pathways for pandemic influenza vaccine deployment: overview of the Nigerian system ... 7
3. Learning in action − the PIP Deploy exercise .................................................................................. 9
Mission 1: National Deployment and Vaccination Plan (NDVP) ............................................................... 9
Mission 2: Legal and regulatory planning .................................................................................................. 10
Mission 3: Public communication in a pandemic situation ....................................................................... 11
Mission 4: Communication, supply chain and waste management .......................................................... 11
Mission 5: Post-deployment surveillance system and management of adverse effects following
immunization ................................................................................................................................................. 12
Participants’ feedback on the PIP Deploy game ........................................................................................ 12
4. Group work and next steps ........................................................................................................... 12
Annex 1: Agenda ................................................................................................................................. 13
Annex 2: Recommended activities to facilitate development and implementation of Nigeria’s
NDVP ................................................................................................................................................... 16
Annex 3. PIP Deploy game evaluation ............................................................................................... 20
iv
Acronyms
AEFI
EOC
FMoH
FMoARD
IHR
MCM
NAFDAC
NCDC
Adverse Events Following Immunization
Emergency Operations Centre
Federal Ministry of Health
Federal Minister of Agriculture and Rural Development
International Health Regulations
Medical countermeasures
National Agency for Food and Drug Administration and Control
Nigeria Centre for Disease Control
NDVP National Deployment and Vaccination Plan for Pandemic Influenza
Vaccines
NEMA
NOA
National Emergency Management Agency
National Orientation Agency
NPHCDA
NSCDC
National Primary Health Care Development Agency
National Security and Civil Defence Corps
PIP
Pandemic Influenza Preparedness
RCTWG Risk Communication Technical Working Group
RI
Routine Immunization
WHO World Health Organization
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Executive summary
Pandemic influenza vaccines play a major role in mitigating the spread of an influenza pandemic and
protecting vulnerable populations. During the 2009−2010 pandemic, Nigeria received 2 880 000
doses of pandemic influenza vaccine which were donated through the WHO Deployment Initiative.
Experience during the 2009 H1N1 pandemic demonstrated the importance of planning for
deployment operations – which span the entire deployment and vaccination process from importing
of vaccines and other supplies, transporting and distributing these products throughout the supply
chain, organizing vaccination campaigns (taking into account all elements that may impact these
activities), and monitoring the safety, quality and efficacy of the medical products administered, up to
the termination of vaccination operations.
The Pandemic Vaccine Deployment Workshop held from 4 to 6 November 2019 in Lagos, Nigeria,
brought together participants from several sectors that play a key role in deployment and vaccination
operations. The aim of the workshop was to initiate the development of Nigeria’s National
Deployment and Vaccination Plan for Pandemic Influenza Vaccines (NDVP). The interactive format
of the workshop included a combination of presentations with the use of PIP Deploy.
Participants emphasized that the workshop allowed them to gain knowledge on key areas that an
NDVP should contain, to identify gaps in current response capacities, and to identify and discuss
roles and responsibilities of different national agencies during an influenza pandemic.
To capitalize on these discussions, further work is envisaged, namely: 1) to clarify coordination
approaches among the different agencies and partnering organizations in the country, so duplication
of work can be avoided; 2) to identify leading agencies on specific components of the deployment
and vaccination operations in view of further development of these operational approaches; and 3) to
develop the NDVP and address the gaps identified throughout the workshop to ensure timely and
efficient response operations.
1
Introduction
This report summarizes the results and recommendations of the Pandemic Vaccine Deployment
Workshop held from 4 to 6 November 2019 in Lagos, Nigeria.
Thirty-one representatives from different national agencies and institutions,1 the WHO country office
and WHO headquarters attended the workshop. Participants included experts in immunization, risk
communications, logistics, immunization, surveillance and influenza.
The overall objective of the workshop was to support the country in drafting an updated National
Deployment and Vaccination Plan for Pandemic Influenza Vaccines (NDVP) and to discuss key
issues that should be addressed before, during and after a future influenza pandemic. Other workshop
objectives included:
• to reinforce the importance of pandemic vaccine deployment in the wider planning of
pandemic influenza preparedness;
• to stress the need to update Nigeria’s NDVP for pandemic influenza;
• to raise awareness of in-country planning in order to ensure capacities and capabilities for
effective and efficient deployment of pandemic vaccines;
• to run the PIP Deploy table-top/simulation game/exercise.
The workshop included critical presentations given by experts in the subject matter plus the
interactive game/table-top exercise – PIP Deploy. The game provided participants with an engaging
environment in which to better understand the main components of an NDVP.
Following this exercise, participants were divided into groups according to their areas of work in
order to reflect on the main aspects that should be addressed in Nigeria’s NDVP. A list of
recommended activities that should be implemented following the workshop was developed and can
be found in Annex 2 of this report.
1 Representatives from the following agencies and institutions attended the workshop: National Primary Health Care Development Agency (NPHCDA); National Agency for Food and Drug Administration and Control (NAFDAC); Nigeria Centre for Disease Control (NCDC); Nnamdi Azikiwe University Teaching Hospital, Nnewi; National Orientation Agency (NOA); Federal Ministry of Humanitarian Affairs, Disaster Management and Social Development (MHADMSD); Federal Ministry of Agriculture and Rural Development (FMoARD); Aminu Kano Teaching Hospital; National Agency for Quarantine Service (NAQS); National Security and Civil Defence Corps (NSCDC); Lagos State University Teaching Hospital (LASUTH); National Emergency Management Agency (NEMA); and WHO.
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1. Global mechanisms for effective deployment and vaccination
operations during an influenza pandemic
The opening session of the workshop stressed the importance of planning for deployment and
vaccination operations in order to enhance Nigeria’s response capacity in the event of an influenza
pandemic. It was highlighted that, when the latest pandemic influenza hit Nigeria in 2009, no
deployment plans were available, which added to the challenges and slowed down the
implementation of vaccination campaigns. Consequently, participants were encouraged to strengthen
collaboration and commit to update and test Nigeria’s NDVP.
The Pandemic Influenza Preparedness (PIP) Framework and the importance of
vaccination
This session presented the PIP Framework, which was adopted by the World Health Assembly in
2011. The framework is an innovative public health instrument that seeks to improve global
preparedness for, and the response to, the next pandemic. The framework’s key goals include
improving and strengthening the sharing of influenza viruses with pandemic potential, and increasing
the access of developing countries to pandemic vaccines and other supplies. Through PIP, some 420
million doses of pandemic vaccines, 10 million treatment courses of antivirals and 250 000
diagnostic kits will be available to countries in most need.
The presentation also highlighted the benefits of pandemic influenza vaccine in decreasing morbidity
and mortality. The 2009 influenza pandemic evaluations showed that vaccination rates were much
higher in high-income countries (16.8%) than in middle-income (8.5%) and low-income countries
(5.7%).2 This led to discussion of the benefits of having a seasonal influenza vaccination programme.
Evidence from the 2009 pandemic demonstrated that countries with seasonal influenza vaccination
programmes were more likely to access vaccines by attaining a state of readiness faster than other
countries and received their shipments earlier as a result of this.
Lessons learned from the 2009 H1N1 pandemic vaccine deployment initiative
This session presented the lessons learned from the WHO pandemic influenza vaccine deployment
processes during the 2009−2010 pandemic as well as WHO’s current efforts to ensure efficient
global deployment operations.
Lessons learned from the global deployment process included:
• Meeting the WHO Deployment Initiative requirements for pandemic H1N1 vaccine
donations, receiving vaccine deliveries and deploying them took longer than anticipated in
most countries.
• Existing immunization systems, infrastructure and education played an important role during
deployment.
2 Mihigo et al., 2012; Tizzoni et al., 2012; WHO, 2013b.
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• Negative media coverage and rumours had less impact on vaccine utilization in countries that
had high-profile government support for deployment.
• Limited influenza surveillance systems (and a lack of infrastructure for seasonal influenza
surveillance in particular) led to public uncertainty about the extent of the pandemic and made
it difficult to rally political support and commitment in some countries.
The main challenges identified at country level during the 2009 WHO pandemic vaccine deployment
process included: 1) national regulatory issues associated with unique regulatory processes for legal
importation and distribution of vaccines; 2) lack of legal agreements with donors and beneficiary
countries and the challenges associated with establishing a single framework that was acceptable to
all parties; and 3) lack of NDVPs in many affected countries.
In the WHO African Region, competing priorities such as measles and polio outbreaks delayed the
pandemic response. Vaccine deliveries occurred mostly during or after the peak of the 2009 H1N1
pandemic, with the utilization of donated vaccines varying widely between countries. Nigeria
received 2 880 000 doses on 24 September 2010.
To facilitate deployment operations at national level, countries were advised to develop, revise and
test NDVPs for pandemic influenza vaccines. This is mandatory for countries interested in accessing
pandemic influenza vaccines donated by WHO. Looking back at the 2009−2010 experience, the
development of NDVPs required significant assistance and financial resources, leading to delays in
the delivery process.
To increase deployment preparedness and learning from the challenges observed in the 2009
pandemic, it was recommended to: 1) tailor NDVPs to serve context-specific needs; 2) build and
maintain global and national operational readiness; 3) ensure effective global and country
communication channels; 4) sustain capacity to execute legal agreements; 5) ensure appropriate
regulatory pathways suitable for pandemic response; and 6) map and continuously update cold-chain
capacity at both global and country levels.
National Deployment and Vaccination Plan guidance, checklist and game introduction
In this session participants were introduced to two documents designed to support Member States to
develop/update their NDVPs, namely: 1) Guidance on development and implementation of a
National Deployment and Vaccination Plan for Pandemic Influenza Vaccines and (2) Checklist for
development and implementation of a National Deployment and Vaccination Plan for Pandemic
Influenza Vaccines.
According to WHO recommendations, an NDVP should contain 10 main chapters with consideration
of: 1) vaccination strategies; 2) management and organization; 3) legal and regulatory planning for
vaccine deployment; 4) communication and information management; 5) human resources and
security; 6) public communication; 7) supply chain management; 8) waste management;(9) post-
deployment surveillance and management of adverse events following immunization (AEFI); and 10)
termination of deployment and vaccination operations.
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Participants were invited to reflect on the 10 chapters of Nigeria’s NDVP during the exercise – PIP
Deploy.
2. Enhancing pandemic influenza deployment and vaccination
capacities in Nigeria
Nigeria update: pandemic preparedness and the NDVP
This presentation provided an overview of Nigeria’s investigation and response efforts in both animal
and human populations and the environment.
In the area of surveillance, Nigeria is enhancing its national influenza sentinel surveillance by: 1)
conducting influenza surveillance at four sentinel sites; 2) investigating and responding to all
outbreaks related to influenza (including avian influenza outbreaks) in collaboration with the Federal
Ministry of Agriculture and Rural Development (FMoARD); 3) conducting regular coordination and
collaboration meetings under the One Health concept with FMoARD; and 4) coordinating the
influenza technical working group at national level.
With regard to pandemic influenza preparedness, Nigeria has initiated the revision of its National
Pandemic Influenza Preparedness Plan which was developed in 2013. It is also working on the
implementation of the Pandemic Influenza Severity Assessment (PISA)3 and planning a simulation
exercise to test the updated NDVP when it becomes available.
It was highlighted that the country does not have a seasonal influenza immunization programme.
Discussion on this session highlighted the need for stronger synergies among government agencies
involved in outbreak/pandemic responses. Additionally, participants stressed that the country’s
human resources capacity should be better assessed, and that the Nigeria Centre for Disease Control
(NCDC) is currently working on a database of emergency responders.
3 See: https://www.who.int/influenza/surveillance_monitoring/pisa/en/, accessed 4 January 2020.
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Leveraging routine immunization structures to support immunization campaigns in
Nigeria
This session presented the routine immunization structure in Nigeria, encompassing coordination
mechanisms at national, state, local government and ward levels.
The following challenges and corresponding potential solutions to address them were highlighted:
Area Key challenges Current efforts to address
identified challenges
Security
Volatile and fluid nature of the
security challenge across the
country
Innovative strategies, “hit and
run”, “Reaching Every
Settlement“ and Reaching
Inaccessible Children”
Micro-planning
Obtaining accurate population
data (denominators) for
immunization
- Household-based
enumeration
- Geographic Information
System mapping
- Use of house-to-house
mobilization and line listing
teams
Cold Chain/logistics
Achieving timely last mile
vaccine distribution
- Implementation of Cold
Chain equipment
optimization platform
- Deployment of faster Cold
Chain equipment
- Construction of three hubs
and system redesign
Human resources
Human resource gaps for large
campaigns requiring skilled
health workforce
- Campaign phasing and
staggering of intra-country,
state and local government
authorities
- Ad hoc recruitment of
qualified volunteers (retirees,
etc.)
Funding at operational level Funding gaps, especially for
unexpected outbreaks - Advocacy for early budgeting
and release of funds
Vaccine hesitancy
Vaccine hesitancy in some
localities
- Revised communication plan
to address hesitancy
- Community engagement
strategy for routine
immunization extended
during campaigns
6
Additionally, the presentation stressed some of the lessons learned from previous immunization
campaigns in the country. These included:
• With a fluid security situation, especially in the north-east of Nigeria, adequate contingency
plans with innovative approaches are required to reach target cohorts.
• Although progress has been made, determining an accurate denominator still remains a
challenge in a number of locations.
• Cold Chain equipment and capacity assessment is important prior to deployment. Use of
vaccine accountability officers has been a game changer, improving vaccine security and
accountability.
• Where disease outbreaks transcend country borders, cross-border collaboration is an essential
component of responses to outbreaks.
• The new Community Engagement Strategy instituted by the National Emergency Routine
Immunization Coordination Centre has been useful in house-to-house mobilization for
immunization campaigns.
• Financial and political commitment are key to a successful immunization campaign.
To conclude, the presenter emphasized that Nigeria has the capacity to carry out immunization
campaigns using existing structures. However, the changing landscape of the country should be
considered, especially due to the security situation in some regions. In this regard, detailed
reassessments are essential for closing gaps when rapid deployment is required.
Pandemic influenza risk communication
This presentation stressed the importance of risk communication activities before, during and after a
pandemic. It emphasized how building trust among stakeholders and communities can support the
acceptance of public health interventions, including vaccination campaigns.
Participants discussed the main challenges concerning communication of the introduction of a new
pandemic vaccine and highlighted important aspects which should be considered, including: 1) the
high speed of information and multiple communication channels; 2) the analysis of risk perception of
targeted and non-targeted groups and their attitudes towards vaccination; and 3) the importance of
health-care workers as both recipients and advocates of the pandemic influenza vaccine.
A successful risk communication strategy should consider a mix of communication and engagement
strategies, such as media and social media communications, mass awareness campaigns, health
promotion, social mobilization, stakeholder engagement and community engagement. The strategy
should consider enhancing five key areas, as recommended by the WHO Joint External Evaluation
tool,4 namely: 1) risk communication systems for unusual/unexpected events and emergencies; 2)
internal and partner coordination; 3) public communication for emergencies; 4) communication
engagement with affected communities; and 5) addressing perceptions, risky behaviours and
misinformation.
4 WHO Joint External Evaluation tool, p. 88. See: https://extranet.who.int/sph/joint-external-evaluation-tool-2nd-edition, accessed 4
January 2020.
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Participants discussed some of the lessons learned from the Ebola outbreak which demonstrated that
greater understanding of beliefs and practices and engagement with the community is needed. They
highlighted the importance of local governments in this regard and emphasized that interventions to
tackle stigmatization should be strengthened.
It was highlighted that risk communication activities in Nigeria are led by the Risk Communication
Technical Working Group (RCTWG) located in the NCDC. The working group consists of
communication experts from different ministries, and its terms of reference are tailored to addressing
risk communication needs regarding infectious disease in the country. The RCTWG is guided by a
set of guidelines, protocols and standard operating procedures that define activities at national and
subnational levels.
Risk communication messages are developed at national level and then adapted and translated at
subnational level. At the subnational level, a social mobilization committee performs a similar role to
that of the RCTWG, leading the risk communication and community engagement efforts.
Medical countermeasures (MCM) supply chain plan
This session presented Nigeria’s efforts to advance its medical countermeasures (MCM) supply chain
plan which is being developed by the NCDC in collaboration with national partners. The objectives
of the MCM plan are to:
• provide a framework for managing MCM supply chain operations in response to public health
emergencies in Nigeria;
• describe supply chain operational procedures such as requesting, procurement, receipt,
stockpiling and distribution of MCM assets from the NCDC, MDAs, state and local
governments and other partners in preparation for, and response to, infectious disease
outbreaks and emergencies of public health importance;
• provide a coordinated supply chain operations strategy between national, state and local
government incident management authorities and partners during public health emergencies.
The presentation highlighted the importance of inter-agency collaboration and coordination for
effective deployment of MCMs, including vaccines.
Discussion during this session emphasized the need to assess the number of functional incinerators
available in the country, as some have become a burden to states which are not able to sustain their
high maintenance costs. Other solutions, such as outsourcing this service to external
institutions/companies, may be considered.
Additionally, participants mentioned that an assessment of Cold Chain storage should be performed
to identify gaps in the current infrastructure.
Regulatory pathways for pandemic influenza vaccine deployment: overview of the
Nigerian system
This presentation provided an overview of the regulatory pathways available in the country to
support the approval for use and importation of pandemic influenza vaccines. Participants learned
about the National Agency for Food and Drug Administration and Control (NAFDAC) role in
8
regulating and controlling the manufacture, importation, exportation, distribution, advertisement, sale
and use of drugs, including vaccines.
It was highlighted that the deployment of pandemic influenza vaccines in Nigeria will require the
directorates of NAFDAC to provide input to a number of processes, namely:
Drug Evaluation and Research – Ensuring clinical trial oversight, Good Manufacturing Practice
inspection of manufacturing facilities producing vaccines that are not prequalified by WHO, and
Cold Chain monitoring of storage facilities at federal, state and local levels.
Registration and Regulatory Affairs – Granting licensure for medicinal products. Pandemic
influenza vaccines may not require licensure but authorizations/waivers can be provided to facilitate
clearance processes at ports of entry.
Vaccine Laboratory – Testing and conducting vaccine lot release.
Ports Inspection Directorate − Import document verification, inspection, sampling and other
clearance procedures while coordinating with other government agencies, including the customs
offices located at the ports of entry. The Ports Inspection Directorate also monitors transportation,
including the type of vehicle, in order to ensure that the Cold Chain is not broken during local transit.
Pharmacovigilance/Postmarketing Surveillance – Postmarketing surveillance and monitoring of
AEFI for some vaccines – especially vaccines distributed through the National Immunization
Programme – which is done in collaboration with the National Primary Health Care Development
Agency (NPHCDA).
Investigation and Enforcement − Coordination of the disposal of vaccines/empty vials, usually by
incineration and burial.
During a pandemic, the NCDC will be responsible for surveillance, data collection and reporting and
will act as the International Health Regulations (IHR) focal point. Moreover, it will be the authority
responsible for declaring the event in the country, triggering partner coordination at the Emergency
Operations Centre (EOC). Based on the outcome of the EOC meeting on the need to import
pandemic influenza vaccine, the NPHCDA is the responsible agency for raising a request to the
NAFDAC which will authorize/waive the regulatory review. The Federal Ministry of Health (FMoH)
will also be notified of this request.
For emergency use of vaccines, it is expected that the NAFDAC will waive the need for a review and
will accept the WHO prequalification certificate of the manufacturer. WHO should provide a
certificate of donation, which allows the NAFDAC to inform its officers at the ports of entry to fast-
track the clearance process. The Import Duty Exception Certificate is also submitted to the Nigeria
Customs Service to facilitate clearance.
Currently, the NAFDAC is developing regulations on new licensing regulatory pathways for
emergency situations. The agency also implements reliance approaches and recognizes approvals
granted by stringent regulatory authorities.
Vaccine labelling, patient leaflets and other documentation are required in English, in accordance
with NAFDAC regulations. Documents that need to be enclosed in the shipment of vaccines are:
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− certificate of analysis
− certificate of lot release
− certificate of WHO prequalification
− packing list
− shipment temperature
− certificate of origin
− certificate of donation/proforma invoice and other certification as may be required.
3. Learning in action − the PIP Deploy exercise
The second part of the workshop was dedicated to the PIP Deploy simulation exercise which
encouraged participants to reflect on key processes and activities that should be in place in Nigeria
for effective and timely deployment of pandemic influenza vaccines.
The learning objectives of PIP Deploy include:
1. To provoke discussion on key gaps in preparation for, or updating of, national pandemic
influenza deployment plans.
2. To enable conversations on best practices on in-country governance and operations for pandemic
influenza vaccine deployment.
3. To better understand country training needs and barriers to future participation in simulation
exercises.
The game consists of five missions which are presented with fictitious scenarios of pandemic vaccine
deployment which could also happen in a real-life setting. Throughout the missions – which involve
brainstorming, presentations and board-game sessions – players are invited to discuss and reflect
about the 10 NDVP chapters. Participants were divided into four teams.
Mission 1: National Deployment and Vaccination Plan (NDVP)
On this mission, participants were invited to reflect on the NDVP structure and chapters, according to
the WHO NDVP template.5 Additionally, they were asked to think about the management,
organization, human resources and vaccination strategies that should be considered in Nigeria in the
event of a pandemic influenza.
Key discussion points
• In addition to the 10 chapters recommended in the WHO guidance, it was recommended that
Nigeria should include consideration of security as a separate chapter, covering important
issues regarding how to reach conflict zones, especially in the north-east part of the country.
5 Guidance on development and implementation of a National Deployment and Vaccination Plan for Pandemic Influenza Vaccines
Geneva: World Health Organization, 2012:67
(https://apps.who.int/iris/bitstream/handle/10665/75246/9789241503990_eng.pdf?sequence=1&isAllowed=y, accessed 4 January
2020).
10
• Regarding vaccination strategies, participants stated that the ultimate responsibility for
determining the priority vaccination groups rests with the FMoH. Additionally, the NPHCDA
has operational responsibility and works with various partners to establish a national technical
working group on immunization to decide which groups should be prioritized in the
vaccination campaign, following recommendations provided by WHO Strategic Group of
Experts (SAGE) on Immunization.6 There was discussion on whether the composition of the
such a technical working group on immunization should be revised to better support a
response to pandemic influenza.
• Participants stressed that a comprehensive workforce strategy, ensuring continuous training of
health-care workers as well as incentivized career paths, should be developed. A package of
incentives should be established for health-care workers involved in a pandemic influenza
response. According to participants, this proposed package should consider providing
responders with: 1) 70% of the per diem in advance; 2) a communication allowance to enable
communication with their families during the response; and 3) physical, medical and
psychosocial support.
• With regard to management and organization, it was highlighted that the NCDC’s EOC will
oversee coordination of the response. The Director General of the NCDC will appoint the
Incident Manager who will then notify the NPHCDA, WHO, UNICEF, FMoH, FMoARD and
other relevant stakeholders about the event and associated needs for coordination. All key
stakeholders are expected to report in the EOC within 24 hours or not more than 48 hours of
notification. The National Influenza Technical Working Group will also be activated and will
be subsumed into the structure of the EOC.
• Participants highlighted the importance of involving security personnel in the deployment
process.
Mission 2: Legal and regulatory planning
The objective of Mission 2 was to encourage participants to discuss existing international and
national legal and regulatory requirements and procedures for importing and receiving pandemic
influenza vaccines and other supplies.
Key discussion points
• Participants mentioned that the donation agreement between WHO and the country should
include not only vaccines but also the same number of syringes, as well as safety boxes,
because Nigeria may not have the capacity to cover the cost of these products without
external support. Participants recognized the importance of well-defined procedures to
expedite the importation of vaccines and other supplies during an influenza pandemic.
• Legal and regulatory aspects were recognized as a main barrier to a successful deployment
operation.
6 The Strategic Advisory Group of Experts (SAGE) on Immunization was established by the Director-General of WHO in 1999 to
provide guidance on the work of WHO. See: https://www.who.int/immunization/policy/sage/en/, accessed 4 January 2020.
11
• National agencies involved in importation of pandemic supplies and other regulatory work
that accompanies the deployment process should have well defined roles and responsibilities.
Mission 3: Public communication in a pandemic situation
For Mission 3, participants were asked to reflect on risk communications systems and activities in
order to address communication challenges during an influenza pandemic.
Key discussion points
• Participants noted that special consideration should be given at the subnational level to
engagement with different community leaders who should be involved in the response
through the existing epidemic preparedness committee.
• Throughout the pandemic, a preliminary and dynamic risk assessment should be performed,
including a risk perception analysis. If there are rumours or misconceptions, the source will
be identified and then a community dialogue can be initiated to understand the perceptions
and to engage in educational activities on the importance and safety of the vaccine.
• Cultural and religious beliefs can be barriers to seeking medical treatments. In addition to
community leaders, it is important also to consider social or community-level mobilizers.
Mission 4: Communication, supply chain and waste management
The objective of Mission 4 was to encourage participants to identify the supply chain management
processes for vaccine deployment within 7 days, to discuss steps to ensure safe disposal of hazardous
medical waste, and to identify the communication systems and mechanisms for ensuring efficient
operations.
Key discussion points
• Participants emphasized that Nigeria needs to consider security issues when developing its
NDVP so that vaccines can be delivered to populations in hard-to-reach areas. Associated
challenges to this operation should be foreseen and addressed.
• Participants suggested that the country should conduct an estimate of the volume of waste that
is likely to be generated during a pandemic. Additionally, an assessment of the availability of
well-functioning incinerators across the country was recommended. Public−private
partnerships should be leveraged for waste management, considering that several incinerators
have become a burden to some of the states in the country due to their high maintenance
costs.
• A Cold Chain storage assessment should be performed to identify gaps in the current
infrastructure. Plans should be made to identify the shortest transportation routes and the
conditions of the transportation and storage.
12
Mission 5: Post-deployment surveillance system and management of adverse effects
following immunization
For Mission 5, participants were asked to discuss the post-deployment surveillance mechanisms to
ensure the monitoring of the safety of the pandemic vaccine and the detection of AEFI.
Key discussion points
• Two agencies − NPHCA and NAFDAC − are currently responsible for the surveillance of
AEFI in Nigeria. Participants suggested the need for a better understanding of their
interactions and the differences in their work.
• A reporting format should be developed in order to capture termination activities. Post-
campaign evaluation should be done through after-action reviews or workshops and should
involve partners and stakeholders who were part of the vaccination campaign.
• Participants mentioned the need to establish baseline data for AEFI and adverse events of
special interest in the country.
• Participants highlighted the need to advance the active surveillance system in the country.
Participants’ feedback on the PIP Deploy game
Participants highlighted that the game combined with the presentations given during the workshop
provided an interactive and engaging method to brainstorm and reflect on gaps that should be
addressed in the country. It was mentioned that the game contributed to creating a stress-free
environment in which to discuss critical elements of Nigeria’s deployment and vaccination
operations.
Feedback from the evaluation forms included:
“This was a great and intensive exercise with a lot of brainstorming.”
“The game allowed us to do a lot of work in a stressless environment.”
“The discussions during the game made us realize that stronger coordination is needed across the
different agencies involved in pandemic influenza deployment and vaccination operations.”
Participants stressed the usefulness of using games as a learning method for adults and suggested
adapting PIP Deploy’s approach and method to other workshops and training on other global health
threats such as Ebola and Lassa fever.
4. Group work and next steps
Following the PIP Deploy exercise, participants were divided according to their technical areas of
work. They were asked to reflect on the key recommendations and activities that should be
implemented according to the 10 different components of an NDVP. This list of recommendations
and activities can be found in Annex 2 of this report.
13
Annex 1: Agenda
WORLD HEALTH ORGANIZATION NIGERIA COUNTRY OFFICE
WORKSHOP ON NATIONAL PANDEMIC INFLUENZA VACCINE DEPLOYMENT AND
VACCINATION PLANNING TO STRENGTHEN PANDEMIC PREPAREDNESS
Lagos, Nigeria
4-6 November 2019
AGENDA
DAY ONE – 4 November 2019
09:00 – 09:30 Registration
09:30 – 09:45 Welcome and opening remarks
WCO and NCDC
09:45-10:15 PIP Framework and IPPP activities in the AFRO region
WCO
10:15-10:30 Why planning for pandemic influenza vaccine deployment now? Lessons learned
from the 2009 H1N1 pandemic vaccine deployment initiative and the importance
of planning for deployment in the interpandemic phase
WHO HQ
10:30-10:45 Group photo and Coffee break
10:45 – 11:00 National Deployment and Vaccination Plan guidance, checklist and game
introduction
WHO HQ
11:00 – 11:30 Nigeria update: recent outbreaks and country’s level of preparedness, status of
pandemic preparedness planning, including current vaccine deployment plan
NCDC
11:30-12:15 Pandemic Influenza Risk Communication
WHO
12:15-13-15 Lunch
14
13:15– 13:30 Immunization structures and approaches to emergency immunization campaigns
in Nigeria: “Routine immunization programme – challenges and lessons learnt”
NPHCDA
13:30 – 13:45 Regulatory pathways and capacity building for pandemic vaccine deployment
NAFDAC
13:45- 14:00 Active and passive surveillance
NPHCDA and WCO
14:00-14:30 Coffee break
14:30-16:00 PIP Deploy game
Mission 1: National Deployment and Vaccination Plan
• Video
• Challenge M1
o Brainstorming
o Team presentation
• Discussion
• Board game
DAY TWO – 5 November 2019
9:00 – 09:15 Recap of Day 1 and overview of Day 2
09:15-10:30 PIP Deploy game
Mission 2: Legal and regulatory planning
• Video
• Challenge M2
o Brainstorming
o Team presentation
• Discussion
• Board game
10:30-11:00 Coffee break
11:00-12:00 PIP Deploy game
Mission 3: Public communication
• Video
• Challenge M3
o Brainstorming
15
o Team presentation
• Discussion
• Board game
12:00-13:00 Lunch
13:00-14:00 PIP Deploy game -
Mission 4: Supply chain and waste management
• Video
• Challenge M4
o Brainstorming
o Team presentation
• Discussion
• Board game
14:00-15:00 PIP Deploy game
Mission 5: Post-deployment surveillance system and management
• Video
• Challenge M5
o Brainstorming
o Team presentation
• Discussion
• Board game
15:00-15:30 Coffee break
15:30-16:30 Hotwash
16:30-17:00 Stakeholder mapping for NDVP development and implementation
DAY THREE – 6 November 2019
9:00 - 09:05 Recap of day 2 and day 3 overview
9:05 - 10:00 Outlining Nigeria’s NDVP: Populating NVDP chapters and defining next steps
10:00-10:30 Coffee
10:30-12:00 Group presentations and next steps
12:00-12:30 Summary and conclusions
16
12:30-13:30 Lunch
Annex 2: Recommended activities to facilitate development and
implementation of Nigeria’s NDVP NDVP chapter Recommendation Suggested activities Estimated
time
frame
Lead Potential
partners
Vaccination
strategy
Constitute a technical
advisory or strategy group
to coordinate and plan for
the processes of
vaccination
Invite the relevant
stakeholders from various
agencies/partners across
various areas of expertise
December
2019
FMoH WHO,
UNICEF,
US CDC etc.
Target population:
Prioritize first respondent
to human or animal cases
of outbreaks, elderly,
under-5s, health workers,
security personnel,
persons with comorbidity,
close contacts of cases,
pregnant women and any
other group that may
appear to be at risk within
the outbreak period
Map the different registries or
sources of data such as
demographics from National
Population Commission,
federal and states MDAs,
which may enable calculating
the denominator for various
risk groups
February
2020
FMoH (PRS,
Responsible
officer)
WHO,
UNICEF,
US CDC etc.
How each target group
will be vaccinated: Fixed
and temporary/mobile
posts should be used to
vaccinate each target
group. For security
compromised areas, the
innovative vaccination
strategies existing should
be used to deliver the
vaccines
Detail microplanning to be
done at all levels, utilizing
data from the nonpolio SIAs
and vaccination coordinating
structures
March
2020
NPHCDA
(Director
Disease
Control)
WHO,
UNICEF,
US CDC etc.
Table listing target: Results of MP March
2020
NPHCDA
(Director
Disease
Control)
WHO,
UNICEF,
US CDC etc.
Cost of plans: Results of MP March
2020
NPHCDA
(Director
Disease
Control)
WHO,
UNICEF,
US CDC etc.
Management
and
organization
Development of an
organigram and table with
the roles and
responsibilities of
different actors involved
in the deployment and
vaccination response
February
2020
NCDC National TWG
17
Legal and
regulatory
planning
Review, update,
adapt/finalize suitable
regulatory pathways for
approval of medicinal
products such as pandemic
influenza vaccines during
emergency (consider
implementation of WHO’s
2017 Guidelines on
regulatory preparedness
for provision of marketing
authorization of human
pandemic influenza
vaccines in non-vaccine-
producing countries)7
1. Relevant stakeholders’
workshop for the review of
regulatory pathways
2. Modification of existing
laws and regulations
3. Evaluation of the
deployment plan
4. Budgeting
1. Two
years
2. Five
years
3. Two
years
4. One
year
1. NAFDAC
2. NAFDAC
3. NAFDAC
4. NAFDAC
1. NCDC,
NPHCDA,
FMoARD,
MoJ,
Nigeria
Customs,
WHO
5.
Communication
and information
Finalize the linking of
logistics with
epidemiological data to
identify which vaccine
vial has been administered
to which person.
June 2020 NPHCDA NCDC,
NEMA,
NERIC
Human
resources and
training
Map the current existing
capacities in the system
when it comes to human
resources.
Develop a training plan/
curriculum based on
different roles
Develop a plan for
reaching security-
compromised areas.
Develop a deployment
plan for the security
officers to security-
compromised areas
Provide training/Briefing
on Basic security tips for
Health workers.
7 Guidelines on regulatory preparedness for provision of marketing authorization of human pandemic influenza vaccines in non-
vaccine-producing countries. In: WHO Expert Committee on Biological Standardization, sixty-seventh report. Geneva: World Health
Organization; 2017: Annex 7 (WHO Technical Report Series, No. 1004;
http://apps.who.int/medicinedocs/documents/s23326en/s23326en.pdf, accessed 4 January 2020).
18
Risk
communication
and community
engagement
RCTWG to develop and
adapt all infectious disease
risk communication plans
for pandemic influenza
risk communication
Train RCTWG members
and other communicators
at subnational level on
pandemic influenza
communication.
Conduct workshop to adapt
all infectious disease risk
communication plans and
develop key messages
Carry out pre-test of IEC
materials.
Conduct training at national
and subnational levels on
pandemic influenza response
communication and
vaccination
January
2020
February
2020
April to
June 2020
NCDC NOA,
FMI,
FME,
NYSC,
FMHADMSD,
NEMA,
WHO,
UNICEF,
NSCDC,
AFENET,
FMENV,
FMoH,
FMoARD,
NPHCDA,
US CDC
Supply chain
management
Develop a comprehensive
supply chain and logistics
costed plan
Update the Cold Chain
inventory and determine
gaps. Develop detailed plans
to address the gaps (This
should be part of the MP and
be presented in a table
format)
March
2020
NPHCDA
(Director
Logistics)
WHO,
UNICEF,
CHAI
Develop a detailed vaccine
distribution plan based on the
target population
April 2020 NPHCDA
(Director
Logistics)
WHO,
UNICEF,
CHAI
Identify means of vaccine and
supply transportation and
map routes at all levels for
effective delivery within 7
days
April 2020 NPHCDA
(Director
Logistics)
WHO,
UNICEF,
CHAI
Conduct supply chain human
resource mapping and build
capacities for surge
deployment and management
April 2020 NPHCDA
(Director
Logistics)
WHO,
UNICEF,
CHAI
Review the exiting data tools,
ledgers and logistics
management information
system for adaptability
April 2020 NPHCDA
(Director
Logistics)
WHO,
UNICEF,
CHAI
Develop a comprehensive
budget based on the outlined
activities on the detailed
plans
May 2020 NPHCDA
(Director
Logistics)
WHO,
UNICEF,
CHAI
19
Managing
waste
1. Assessing existing
capabilities
2. Deciding on methods of
waste collection, transport,
treatment and disposal
3. Establish a risk
management strategy
1. List national and state
regulations for proper
collection and disposal of
medical waste
2. Identify all existing waste
disposal facilities and routes
for collecting and
transporting
3. Estimate the daily amount
of waste each immunization
site will generate
4. Devise simple indicators to
monitor the quality of waste
management standards and
practices
5. Budgeting
Post-deployment
surveillance and
management of
AEFI
Clarify different areas of
work of NAFAC and
NPHCDA around AEFI
Making provisions to
ensure active surveillance
in the event of a pandemic
Termination of
the deployment
and vaccination
operations
Develop an M&E
framework for vaccine
deployment
Develop a reporting
format for the campaign
Track milestones and
changes
Establish AEFI
surveillance
Conduct post-vaccination
review
Conduct workshop to develop
reporting format for the
campaign
Carry out inventory and
documentation of resources
utilized
Document, publish and
disseminate
Conduct monitoring of
activities and results
Conduct AEFI surveillance
Post-event NPHCDA WHO
FMoARD
FMENV
NOA
NCDC
20
Annex 3. PIP Deploy game evaluation
Total of 20 responders.
(Numbers in red indicate the number of responses in each category).
Please express your opinions
The game play met my individual objectives and was relevant to my job:
Yes: 15 No: 0 Missing response: 4 Somehow: 1
The duration of the exercise was: (please circle your answer): correct: 18 too short: 1 too long: Missing
response: 1
Rate from 1 to 4: 1 indicating strong disagreement with the statement and 4 strong agreement
Statement Do not Strongly
agree agree
The game play was well organized and structured 1 2 3: 7 4: 13
The instructions were clear and comprehensive 1 2 3: 7 4: 13
The exercise scenario was adequately designed for its use 1 2 3: 12 4: 7
Participants were encouraged to play an active role in the
game 1 2: 1 3: 5 4: 14
The videos and briefings helped me understand and become
engaged in the scenario 1 2 3: 6 4: 14
The game documents (injects, scenarios, cards) are adequately
designed for their use 1 2 3: 9 4: 10
Handouts were relevant 1 2 3: 7 4: 13
The exercise helped me to identify some of my strengths as
well as some of the gaps in my understanding of response
systems, plans and procedures
1 2 3: 10 4: 10
The level and mix of disciplines and participants included the
right people for this game play 1 2 3: 9 4: 12
The exercise improved my understanding of my role and
function during an emergency response 1 2 3: 6 4: 14
At the end of the exercise, I learned one or more things which
will allow me to increase preparedness and readiness for
deployment of pandemic influenza vaccine in my country
1 2 3: 5 4: 15
I would recommend playing this game to my colleagues 1 2 3: 4 4: 17
