COVID-19 Vaccine: Safety and Immunization Monitoring

Global demand for COVID-19 vaccines will initially outstrip the supply. But once vaccines do become available, there will be a massive global effort to get them to all countries and territories. As experts continue to work at great speed to develop and eventually manufacture vaccines, countries must also strengthen their capacity to distribute and administer them as quickly and efficiently as possible. 

Given the expected constrained vaccine supply, countries will need to prioritize target population groups. Countries must also track every dose that has been administered, especially for vaccines that follow a two-dose regime whereby individuals who receive the first shot then receive a follow up for the second shot in the interval of around 21 to 30 days. Rigorous pharmacovigilance, or safety monitoring for any adverse effects of the vaccine will be required. These tracking and monitoring procedures will require bolstering information systems, reporting documents, and training of health workers and logisticians.  

Clear expectations should also be communicated to the public about who has been prioritized and why, as well as guidance when the vaccine will be made available to the general population and where and how they can receive it. Widespread campaigns will be necessary to educate the public about the benefits of COVID-19 vaccination and increase public confidence, therefore it is also critical to develop communication strategies to improve vaccine uptake. 

Developing an overall vaccine strategy and updating information and technology systems can position DMCs to achieve optimal health outcomes and faster recovery from COVID-19 impacts. 

In this regard, there are several actions that countries can take now to make sure they are prepared to prioritize, introduce, and deliver COVID-19 vaccines:  

• Adopt a whole-of-government approach to improve vaccine delivery planning. Countries should engage key stakeholders to plan scenarios, develop a national vaccine strategy, and organize operational aspects of vaccine introduction. 

• Identify context-specific vaccine delivery resource requirements. Numerous challenges that low- and middle-income countries already face related to health systems, settings, facilities, and human resources will be amplified by the introduction of the COVID-19 vaccine. For example, at least one COVID-19 vaccine candidate will require storage at temperatures as low as minus 80 Celsius. Yet temperature-controlled logistics and point-of-care cold chain infrastructure are unreliable in many rural settings in developing countries, where electricity supply is not guaranteed. 

• Agree on the vaccine priority line. The question of who should receive the first doses of the vaccine is complex. For example, frontline workers are often at the top of the proposed priority lists. Countries should assess how to identify prioritized groups based on their country context and specific epidemiology (e.g., people at a higher risk of severe disease or people living in areas where the disease is spreading rapidly may be prioritized). 

• Strengthen vaccination infrastructure. Most vaccination infrastructure is geared towards delivery to children, and not adults. Key issues to consider include strengthening vaccine storage, quality assurance, and distribution systems, along with the information systems required to track every dose that has been administered, especially in the case of multi-dose vaccines. 

• Develop a vaccine delivery/execution plan. Implementation plans should identify how health departments will administer and track vaccines to hard-to-reach populations, such as those that are mobile, are in conflict, lack formal identities, and/or are otherwise unidentifiable. 

• Develop communication strategies to improve vaccine uptake. Widespread campaigns will be necessary to educate the public about the benefits of COVID-19 vaccination and increase public confidence. Clear expectations should also be communicated to the public about who has been prioritized and why, as well as when the vaccine will be made available to the general population and how they can receive it. 

• Ensure appropriate vaccine reporting, monitoring, and evaluation. Countries should begin now to prepare and improve their vaccine management, reporting, monitoring, and evaluation systems to reduce incidences of stock outs and wastage—and to ensure proper re-allocation and accountability. This also includes strengthening existing vaccine safety monitoring systems to identify adverse events.  

 

REFERENCES: 

Rebooting the economy: Preparing to deliver a COVID-19 vaccine 

Rebooting the economy: The global race to develop and deliver a COVID-19 vaccine 

Enhancing Readiness for Large-Scale Distribution of the COVID-19 Vaccine