Never before has immunization received so much media attention as it is the case today. COVID-19 vaccination has become a global priority, with several safe and effective vaccines developed in record time as a result of an unparallel scientific mobilization.
WHO has been working with partners around the world to help coordinate key steps that will grant equitable access to COVID-19 vaccines for billions of people, including refugee populations.
In Bangladesh, WHO is supporting the Government through technical guidance, capacity building and operationalization coordination to ensure the safe and effective roll-out of the COVID-19 vaccine across the country, at the same time it enhances the preparations of the campaign in the world’s largest refugee camp, which is pending of the allocation of vaccines from the COVID-19 Vaccines Global Access (COVAX)* with no expected date of arrival due to the recent crisis in India.
WHO Representative to Bangladesh, Dr Bardan Jung Rana, receiving the first dose of COVID-19 vaccine. WHO Bangladesh/ Manuela Altomonte
After a tough battle against the coronavirus, the vaccine brought a glimpse of hope for 2021 all over the world. In Bangladesh, the COVID-19 national vaccination campaign started rolling out on 7th February 2021 following a set of criteria which prioritized the most vulnerable groups of the population. Within three months, as of 10 May 2021, over 5 819 000 of Bangladeshi nationals have received the first dose of Oxford/AstraZeneca vaccine and around 3 496 000 million completed the full vaccination.
However, preparations for the COVID-19 vaccination campaign started months before the roll-out. Since October 2020, WHO has been providing guidance and technical advice to the Government of Bangladesh in order to ensure an effective and safe deployment of the vaccines across the country. The Immunization and Vaccine Development (IVD) team has been working closely with senior government authorities and key partners to develop the National Deployment and Vaccination Plan (NDVP) for COVID-19, a master document that aims to guide the entire vaccine roll-out in Bangladesh.
Aligned with the NDVP, WHO and partners developed the National Operational Guidelines to provide healthcare workers and partners with a deep and comprehensive insight on technical and operational considerations to take into account before, during and after the campaign. Aspects such as planning and coordination mechanisms, human resources, cold chain and logistic requirements, best practices for vaccine administration and surveillance, among others, are covered in these guidelines to facilitate a successful campaign implementation in Bangladesh.
WHO conducted a series of trainings on operational guidelines and Adverse Events Following Immunization (AEFI) at COVID-19 Vaccination at upazila level. WHO Bangladesh/Irene Gavieiro Agud
WHO has also been strengthening the capacities of the healthcare professionals involved in the process of vaccination countrywide through multiple training programmes. Three months on the COVID-19 vaccination campaign, the IVD team continues providing monitoring supervision during vaccination sessions to ensure that infection prevention and control practices, safe injection practices and waste disposal are followed.
Additionally, a surveillance system on Adverse Events Following Immunization (AEFI) has been established in the vaccination centers to enable the timely collection, monitoring and dissemination of public health data.
“Our wide experience conducting large-scale vaccination campaigns in coordination with the Government of Bangladesh enabled to build an extensive and effective immunization networking structure in the country over the past decades. Today more than ever, WHO’s technical skills, expertise and resources are available to the Government to ensure that the vaccines reach the most remote areas and vulnerable populations are protected”, says Dr Bardan Jung Rana, WHO Country Representative.
The recent COVID-19 crisis in India has severely impacted the vaccination campaign in Bangladesh causing a shortage of the Oxford-AstraZenca vaccine. Due to the uncertainty over the arrival of the next COVID-19 vaccine shipment, health authorities have temporarily hold on the first dose administration across Bangladesh.
WHO International Consultant for COVID-19, Dr Aarti Singh, and IVD team in Cox’s Bazar conducted several visits to health facilities in the camps to assess and map those that could support the COVID-19 vaccination campaign in the refugee setting. WHO Bangladesh/Tatiana Almeida
Leave no one behind: Including Rohingya refugees in the national vaccination plan
Ensuring equitable access to safe and effective COVID-19 among the poorer countries and vulnerable populations has been part of WHO’s core mission since the onset of the pandemic. As such, the inclusion of the Rohingya refugee population in the Bangladesh national vaccination plan has been one of the Health Sector’s priorities for Cox’s Bazar.
In early February 2021, coinciding with the national campaign roll-out, the Government of Bangladesh signed a revised version of the National Deployment and Vaccination Plan (NDVP) which included the Rohingya refugee population as a target group, with a similar phased approach as used for the host community. WHO and Health Sector partners have been since supporting the Government in COVID-19 vaccination campaign preparations for the Rohingya community, which is pending the arrival of the allocation of vaccines from the COVID-19 Vaccines Global Access (COVAX)* facility for Bangladesh.
The critical situation in the neighboring country also affected the vaccination plan in the Rohingya refugee setting as vaccine supplies were redirected to meet urgent domestic needs bringing uncertainty to the refugees’ vaccination roll-out.
“Equitable distribution is particularly important in the area of vaccines, which, if used correctly and equitably, could help to stop the acute phase of the pandemic and allow the rebuilding of our societies and economies. Despite the current uncertainty, WHO and partners continue enhancing community awareness and strengthening healthcare workers’ capacities to ensure the COVID-19 vaccination campaign for the Rohingya refugees is ready to roll-out as soon as the vaccines arrive”, says Head of WHO Emergency Sub-Office in Cox’s Bazar, Dr Kai von Harbou.
WHO Immunization and Vaccine Development (IVD) team visited the health facilities to ensure the safe vaccine storage and proper cold chain requirements. WHO Bangladesh/Tatiana Almeida
Due to the complexity of Cox’s Bazar humanitarian context, the Operational Guidelines for the Rohingya community had to be adjusted and developed through a consultative process with the Civil Surgeon, the Ministry of Health and Family Welfare - Coordination Center (MoHFW-CC), the Refugee Relief and Repatriation Commissioner (RRRC) and key humanitarian partners such as WHO, UNICEF and UNHCR. Aspects such as Adverse Event Following Immunization (AEFI) management capability, transport and storage of vaccines and geographical distribution in the camps, as well as health facility-based vaccination, were addressed to ensure a realistic roll-out framework in the world’s largest refugee camp.
“The vaccination strategy in Cox’s Bazar involves a multi-sector approach that goes beyond the health sector coordination. WHO Immunization and Vaccine Development (IVD) team has been working closely with Government and humanitarian partners to adjust the national parameters to the Rohingya’s complex setting. At least one vaccination site has been identified in each camp to ease accessibility and a community awareness and engagement plan is currently ongoing to effectively prepare the Rohingya population for COVID-19 vaccination”, says Dr Aarti Singh, WHO International Consultant for COVID-19.
A total of 57 health facilities have been identified as vaccination sites in the camps and 62 vaccination teams –comprising of two vaccinators and four trained volunteers– were formed. The preparations of the COVID-19 campaign in the Rohingya refugee camps has also provided a unique opportunity to continue building capacities among healthcare workers in Cox’s Bazar. Over 450 health professionals from Government and partner-led facilities in Ukhiya and Teknaf upazilas have received training on operational guidelines and Adverse Events Following Immunization (AEFI) for COVID-19 vaccination through an interactive methodology which combined informative content, problem-solving scenarios and active trainee participation.
“WHO is supporting the Government to ensure that all health workers involved in implementation of COVID-19 vaccination have adequate knowledge and skills in order to ensure safe and efficient COVID-19 vaccine administration in Cox’s Bazar. These trainings are part of WHO’s efforts to build a national health system that can deal with public concerns and rapidly evaluate the risks when adverse events occur”, recalls Dr Md Zion, WHO Immunization Coordinator in Cox’s Bazar.
WHO Immunization Coordinator, Dr Md. Zion, and WHO Consultant for COVID-19 vaccination, Dr Tazkia Tarannum, have been providing technical support for the rolling out of the COVID-19 vaccination campaign in Cox’s Bazar. WHO Bangladesh
Additionally, the IVD team has designed a community preparedness assessment tool to measure the awareness of Rohingya refugees regarding the upcoming COVID-19 vaccination campaign in the camps. This tool will help the Government and partners better drive the risk communications strategy in the field to encourage vaccinations and ensure that no one is left behind.
An extensive communication and engagement campaign involving key community members and religious leaders is currently on going in all the camps to raise confidence and acceptance among the Rohingya refugees. Through a multi-channel strategy which includes community radio, interpersonal communication and digital media, WHO is tracking vaccine hesitancy and rumors in the field and promoting community mobilization.
Since the onset of the pandemic, routine immunization programmes were adjusted to the new scenario continue protecting vulnerable populations against vaccine-preventable diseases. WHO Bangladesh/Tatiana Almeida
Without losing sight of routine immunization
However, while preparations are ongoing to guarantee a successful deployment in the world’s largest refugee camp, the Rohingya population continues to be at risk of vaccine-preventable diseases, such as polio and measles. Upholding the routine immunization programmes continues being a priority for WHO in Cox’s Bazar as part of the essential health service delivery provided to nearly 890 000 Rohingya refugees in the camps.
The pandemic highly impacted the immunization services in the refugee settlement due to the movement restrictions and the subsequent impact on essential health services, along with raised fears from the community. In response, WHO in close coordination with the Government of Bangladesh and a group of immunization experts developed a health-based transitional strategy to resume the routine immunization services.
Currently, 59 health facilities are working as immunization fixed sites and another 66 vaccination teams are conducting outreach sessions both in community and healthcare facilities to guarantee the continuation of routine immunization programs in the Rohingya camps.
Over 250 vaccinators and supervisors and 25 Health Field Monitors have been trained on Infection Prevention and Control (IPC) and basic Routine Immunization. WHO Bangladesh/Tatiana Almeida
* COVAX is a global initiative aimed at equitable procurement and distribution of COVID-19 vaccines led by WHO, Gavi - the Vaccine Alliance, and the Coalition for Epidemic Preparedness Innovations (CEPI), together with UNICEF as key delivery partner.