17–19 September 2019Manila, Philippines

Meeting Report

WORKSHOP ON NATIONAL PANDEMIC INFLUENZA VACCINE DEPLOYMENT AND

VACCINATION PLANNING TO STRENGTHEN PANDEMIC PREPAREDNESS

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WORLD HEALTH ORGANIZATION

REGIONAL OFFICE FOR THE WESTERN PACIFIC

REPORT SERIES NUMBER: RS/2019/GE/52(PHL) English only

MEETING REPORT

WORKSHOP ON NATIONAL PANDEMIC INFLUENZA

VACCINE DEPLOYMENT AND VACCINATION PLANNING

TO STRENGTHEN PANDEMIC PREPAREDNESS

Convened by:

WORLD HEALTH ORGANIZATION

REGIONAL OFFICE FOR THE WESTERN PACIFIC

Manila, Philippines

17–19 September 2019

Not for sale

Printed and distributed by:

World Health Organization

Regional Office for the Western Pacific

Manila, Philippines

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NOTE

The views expressed in this report are those of the participants of the workshop on national

pandemic influenza vaccine deployment and vaccination planning to strengthen pandemic

preparedness and do not necessarily reflect the policies of the conveners.

This report has been prepared by the World Health Organization Regional Office for the

Western Pacific for Member States in the Region and for those who participated in the

workshop on national pandemic influenza vaccine deployment and vaccination planning to

strengthen pandemic preparedness in Manila, Philippines, 17–19 September 2019.

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Table of Contents

SUMMARY ...................................................................................................................................... 5

1. INTRODUCTION ........................................................................................................................ 7

1.1 Meeting organization ............................................................................................................ 7

1.2 Objectives ............................................................................................................................. 7

2. PROCEEDINGS........................................................................................................................... 7

2.1 Opening session .................................................................................................................... 7

2.1.1 Opening remarks .......................................................................................................... 7 2.1.2 Managing health security threats through APSED III .................................................... 8

2.1.3 Proposed Regional Strategy for the Expanded Programme for Immunization

2021–2030 .................................................................................................................... 8

2.2 Plenary 1. Are we ready for the next pandemic ................................................................... 8

2.2.1 Advancing pandemic preparedness for health security: Are we ready? .......................... 8

2.2.2 Overview of the situation of seasonal influenza vaccination in the Western Pacific Region .......................................................................................................................... 9

2.2.3 Lessons learnt from global deployment of pandemic influenza vaccines during the

Pandemic (H1N1) 2009 .............................................................................................. 10

2.2.4 Lessons learnt from pandemic influenza vaccine deployment and vaccination during the Pandemic A(H1N1) 2009 in the Western Pacific ......................................................... 11

2.3 Plenary 2. Country updates on national deployment and vaccination planning .............. 13

2.3.1 Cambodia – NDVP planning update ............................................................................... 13 2.3.2 China – NDVP planning update ...................................................................................... 14

2.3.3 Lao People’s Democratic Republic – NDVP planning update ......................................... 14

2.3.4 Mongolia – NDVP planning update ................................................................................ 14

2.3.5 Philippines – NDVP planning update .............................................................................. 15 2.3.6 Viet Nam – NDVP planning update ................................................................................ 15

2.4 Pandemic Influenza Preparedness (PIP) Deploy Game Mission 1. National Deployment

and Vaccination Plan ................................................................................................................ 15 2.4.1 Overview of the global guidance on national deployment and vaccination planning ........ 15

2.4.2 Mission 1: NDVP structure, management and organization for deployment and vaccination

operations, vaccine strategy definition and human resources aspects ............................... 16

2.5 PIP Deploy Game Mission 2: Legal and regulatory planning ............................................ 17

2.5.1 National regulatory systems readiness for pandemic influenza vaccines in the

Western Pacific Region .................................................................................................. 17

2.5.2. PIP Deploy Game Mission 2: Legal and regulatory planning .......................................... 18

2.6 PIPDeploy Game Mission 3: Public communication .......................................................... 18

2.6.1 Role of risk communication for pandemic influenza vaccine deployment and vaccination 18

2.6.2 PIPDeploy Game Mission 3: Public communication ....................................................... 19

2.7 PIPDeploy Game Mission 4: PIP Deploy Game Mission 4: Supply chain and waste

management .............................................................................................................................. 19

2.7.1 Introduction to supply chain and waste management ....................................................... 19 2.7.5 PIPDeploy Game Mission 4: Supply chain and waste management ................................. 20

2.8 PIP Deploy Game Mission 5: Post-deployment surveillance system and management ..... 20

2.8.1 Introduction to post-deployment surveillance system and management ........................... 20

2.8.2 PIPDeploy Game Mission 5: Post-deployment surveillance system and management ...... 21

2.9 PIP Deploy game hotwash ................................................................................................... 21

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2.10 Self-assessment of NVDP plans and defining next steps and priority actions.................. 21

2.11 Potential options for costing the NDVP ............................................................................ 22

3. CONCLUSIONS AND RECOMMENDATIONS........................................................................ 22

3.1 Conclusions .......................................................................................................................... 22

3.2 Recommendations................................................................................................................ 22 3.2.1 Recommendations for Member States ............................................................................. 23

3.2.3 Recommendations for the WHO Secretariat .................................................................... 23

ANNEXES ...................................................................................................................................... 24

Annex 1. Country self-assessment, next steps and priority actions for the NDVP .................. 24

Annex 2. List of participants ..................................................................................................... 26

Annex 3. Programme of activities ............................................................................................. 29

Keywords: Immunization / Influenza vaccines / Pandemics – prevention and control /

Vaccination

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SUMMARY

The World Health Organization (WHO) Regional Office for the Western Pacific convened the

Workshop on National Pandemic Influenza Vaccine Deployment and Vaccination Planning to

Strengthen Pandemic Preparedness, from 17 to 19 September 2019, at the Regional Office in

Manila, Philippines. Participants included delegates from Cambodia, China, the Lao People’s

Democratic Republic, Mongolia, the Philippines and Viet Nam, as well as technical officers

from the Regional Office for the Western Pacific and WHO headquarters.

The objectives of the meeting were:

(1) to review the strategic importance of pandemic influenza vaccine as an integral part of

a renewed approach to pandemic preparedness; and

(2) to identify critical issues and priority actions to develop and update national deployment

and vaccination plans (NDVPs) for pandemic influenza vaccines.

Critical presentations given by subject-matter experts together with participation in a

game/simulation/tabletop exercise, called PIPDeploy, provided participants an engaging and

interactive environment for a better understanding of critical components of an NDVP, as

recommended by WHO in the technical guidance for the development and implementation of

an NDVP.1 Throughout the three-day workshop, delegates were invited: (a) to learn about the

10 areas of an NDVP; and (b) based on countries’ existing NDVPs, which were mostly

developed during the Pandemic (H1N1) 2009, to perform a situational analysis of their plans,

outlining major strengths, gaps and priority next steps.

Participants learned about the global and regional efforts to strengthen countries’ pandemic

influenza preparedness capacities, including approaches promoted by the Asia Pacific

Strategy for Emerging Diseases and Public Health Emergencies (APSED III) as framework

to advance the implementation of the International Health Regulations, known as IHR 2005,

for health security in the Region.

Participants were also invited to review the knowledge acquired throughout the meeting by

participating in a question-and-answer session using the Mentimeter interactive presentation

software. Additionally, delegates completed the draft WHO Influenza Vaccine Request Form

and shared the challenges around collecting the information requested in the document.

The meeting participants recognized the threat posed by a pandemic influenza and the need to

further plan for deployment and vaccination operations. Few countries have updated their

NDVPs since the 2009–2010 pandemic influenza, and despite the progress observed in

several domains, challenges remain. Throughout the meeting countries highlighted key

NDVP areas that would need stronger development and support. Among these the following

came through chiefly: choosing vaccination strategies and identifying high-risk groups,

ensuring legal and regulatory planning, putting in place surveillance and management

systems for adverse events following immunization (AEFI), and planning for public

communication.

Member States were encouraged to advance national pandemic preparedness, including

deployment and vaccination planning, by engaging relevant ministries and stakeholders.

1 Development and Implementation of a National Deployment and Vaccination Plans

https://www.who.int/influenza_vaccines_plan/en/

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Additionally, WHO was requested to continue supporting Member States in advancing their

NDVPs.

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1. INTRODUCTION

1.1 Meeting organization

The Workshop on National Pandemic Influenza Vaccine Deployment and Vaccine

Deployment and Vaccination Planning to Strengthen Pandemic Preparedness was organized

by the World Health Organization (WHO) Regional Office for the Western Pacific at its office

in Manila, Philippines, from 17 to 19 September 2019. Participants included delegates from

Cambodia, China, the Lao People’s Democratic Republic, Mongolia, the Philippines and Viet

Nam, as well as technical officers from the Regional Office and WHO headquarters.

The aim of the workshop was to review and strengthen countries’ pandemic influenza

vaccine deployment and vaccination planning as the critical element of national pandemic

preparedness efforts. Delegates from Cambodia, China, the Lao People’s Democratic

Republic, Mongolia, Philippines, and Viet Nam attended the workshop. Participants included

focal points responsible for coordinating pandemic preparedness and response, managers (or

deputies) of the national Expanded Programme on Immunization, officers responsible for

registration and marketing authorization at national regulatory authorities, and logistics

officers from the National Immunization Programme. WHO experts from the WHO Health

Emergencies Programme at the Regional Office for the Western Pacific and from WHO

headquarters in Geneva jointly coordinated all aspects of the workshop.

1.2 Objectives

The objectives of the meeting were:

(1) to review the strategic importance of pandemic influenza vaccine as an integral part of

a renewed approach to pandemic preparedness; and

(2) to identify critical issues and priority actions to develop and update national deployment

and vaccination plans (NDVPs) for pandemic influenza vaccines.

2. PROCEEDINGS

2.1 Opening session

2.1.1 Opening remarks

The opening remarks encouraged participants to strengthen countries’ preparedness capacities

to tackle the next pandemic influenza and other health emergencies.

The key messages presented by Dr Liu Yunguo, Director of Programme Management

at the Regional Office for the Western Pacific, highlighted the progress made by

Member States in strengthening health security systems, and the role of the Asia Pacific

Strategy for Emerging Diseases and Public Health Emergencies (APSED III) in

providing a strategic framework for action to advance the implementation of the

International Health Regulations, known as IHR(2005). Moreover, he reinforced the

importance of advancing emergency planning and system readiness, including on

pandemic influenza vaccine deployment and vaccination operations as a way to

mitigate negative consequences of a future pandemic.

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2.1.2 Managing health security threats through APSED III

– Dr Chin-Kei Lee, WHO Health Emergencies Programme, WHO Regional Office for the

Western Pacific

The presentation on "Managing Health Security threats though the Asia Pacific Strategy for

Emerging Diseases and Public Health Emergencies (APSED III)" highlighted the ongoing

health security threats being faced by the WHO Western Pacific Region, which are increasingly

complex due to various factors, such as the growing movement of people and goods, and rapid

urbanization. Two influenza pandemics in the 20th century originated from this Region, and

an increased number of human infections of avian influenza are also reported in the Region,

partially due to improved surveillance systems.

The importance of APSED III as the strategic action framework to advance implementation of

core capacities required under IHR(2005) was also underlined. Since its inception, countries

have made considerable progress in improving their health security systems, such as the

development, application and strengthening of rapid response teams, event-based surveillance,

field epidemiology training programmes, emergency operations centres and incident

management systems. However, the next pandemic could strike at any time, with potentially

devastating human, social and economic consequences. Therefore, Dr Lee called on

participants to strengthen pandemic preparedness as a driving force to advance health security

systems and countries’ capacities to respond to future infectious hazard outbreaks and health

emergencies.

2.1.3 Proposed Regional Strategy for the Expanded Programme for Immunization

2021–2030

The presentation "Proposed Regional Strategy for Expanded Programme for Immunization

(EPI) 2021–2030" explained the scope and strategic direction of the draft Regional Strategy.

The Strategy proposes three strategic objectives, one of which is related to the health

emergencies. The draft strategy also proposes to strengthen synergy with the emergency

preparedness and response operations, and highlighted the importance of this activity in the

overall vaccine-preventable disease (VPD) immunization programme. Strategic Objective 3 is

on preparing for and responding to public health emergencies, and it assumes five scenarios:

1) outbreaks or resurgences of VPDs; 2) vaccine and immunization safety events; 3) outbreaks

requiring immunization responses (for example a cholera outbreak); 4) an emergency affecting

immunization systems and programmes; and 5) an event due to an emerging infectious disease

that requires immunization response (for example pandemic influenza).

2.2 Plenary 1. Are we ready for the next pandemic

2.2.1 Advancing pandemic preparedness for health security: Are we ready?

– Dr Masaya Kato, WHO Health Emergencies Programme, WHO Western Pacific Region

This session emphasized that pandemic influenza continues to pose a global threat, requiring

preparedness efforts to mitigate not only the health-related aspects, but also economic and

social disruptions. The presentation introduced series of WHO guidance documents on

pandemic influenza preparedness that were recently released, as well as the global influenza

strategy 2019–2030 with two main aims by the year 2030: i) better global tools through

coordination of research and innovation; and ii) stronger country capacities through

ownership.

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The presenter then discussed the two-tier approach for public health emergency preparedness,

including for pandemic preparedness, which has been promoted by Asia Pacific Strategy for

Emerging Diseases (APSED). The two-tier approach is composed of the two components: i)

response planning; and ii) system readiness. Response planning should be strengthened

through reviewing and updating the plan through real events and exercises, engaging relevant

stakeholders. Systems (for example people, resources, mechanisms, procedures and

equipment) have to be ready for response plans to be effectively implemented.

Pandemic influenza vaccination also requires system readiness. Based on the 2009

experience, it was highlighted that countries with a seasonal influenza programme are more

likely to receive vaccines earlier, and that countries with regulatory barriers were less likely

to have vaccine deployed in a timely manner.

To conclude, the presenter reiterated the importance of preparedness and encouraged

countries to identify systems gaps through pandemic response planning and prioritizing

actions to address those gaps.

Following the presentation, participants worked in groups and presented the main progress

and challenges regarding pandemic preparedness in their countries. Common strengths

included stronger immunization and surveillance systems, and enhanced partner and

multisectoral coordination. Viet Nam also highlighted its vaccine manufacturing capacity,

which was not available during the 2009 pandemic. The Lao People’s Democratic Republic

and Viet Nam stressed the establishment of emergency operations centres (EOC). In terms of

gaps, the delegation from Cambodia, the Lao People’s Democratic Republic and Mongolia

mentioned the difficulties around resource mobilization for health emergencies. Lao

representatives also stressed the need to strengthen risk communications, Viet Nam

highlighted gaps in human resources, and the Philippines mentioned that its deployment plan

requires testing through simulation exercises and greater clarity on roles and responsibilities

across the stakeholders involved in the pandemic response. Countries also suggested that

progress made in capacity-building through implementing their National Action Plan for

Health Security, or APSED workplans, will provide a foundation in pandemic response,

including for the pandemic influenza deployment and vaccination operations.

2.2.2 Overview of the situation of seasonal influenza vaccination in the Western

Pacific Region

– Dr Md. Shafiqul Hossain, WHO Cambodia

The presentation on seasonal influenza vaccination offered participants an overview of the

current situation of seasonal influenza vaccination in the Western Pacific Region. The number

of countries offering influenza vaccine increased from 17 in 2009 to 20 in 2018.2 A survey

conducted by the Regional Office for the Western Pacific in 2012 showed that the national

policy of all the 18 countries had prioritized health-care workers (100%) and older people

(100%) for vaccination under national seasonal influenza vaccine policies, with fewer countries

also recommending vaccination for pregnant women (72%) and those with underlying medical

conditions (72%). Fifty per cent of the respondent countries also mentioned offering the

vaccine for children from 6 to 59 months. The presenter stressed that the selection of priority

groups for seasonal influenza vaccine facilitates the development of vaccination strategies for

pandemic influenza.

2 According to a Global Survey, 17 countries in the Region offered influenza vaccines in 2009. In 2018, through

the Joint Reporting Form, 20 countries reported offering influenza vaccine.

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2.2.3 Lessons learnt from global deployment of pandemic influenza vaccines during

the Pandemic (H1N1) 2009

– Ms Ioana Ghiga, WHO Health Emergencies Programme, WHO headquarters

This presentation provided an overview of the WHO pandemic influenza vaccine deployment

processes and related challenges over the 2009–2010 pandemic, as well WHO’s current efforts

to secure access to pandemic influenza vaccine. Through the WHO Deployment Initiative,

WHO, in collaboration with donors and partners, delivered over 78 million doses of pandemic

(H1N1) vaccine to 77 countries globally between June 2009 and October 2010.3 To access

vaccine donated through WHO, countries had to submit three mandatory documents: a letter

of intent; a letter of agreement; and an NDVP.

Some of the milestones of the pandemic (H1N1) 2009 included: 1) declaration of the pandemic

by the WHO Director-General in June 2009; (2) the submission of the first letter of intent in

September 2009; 3) the submission of the first NDVP in December 2009; 4) the first vaccine

pre-qualification in November 2009; 5) start of vaccine deployment to recipient countries in

December 2009; and 6) the first vaccine delivery in January 2010. This demonstrates that

countries spent a long time developing their NDVPS, which required significant assistance and

financial resources to be finalized, generating delays in the delivery process. This shows the

importance of developing or updating these plans in the inter-pandemic phase.

Lessons learnt from the WHO deployment process at the global level include: 1) the need to

communicate more effectively among partners and with countries; 2) the hurdles presented by

inadequate transport capacity due to the significant amount of vaccine to be delivered and high

transit time, posing additional challenges in cold chain operations to maintain the vaccine

integrity; 3) the difficulties caused by complex donation processes; and 4) problems created by

a lack of preparedness in many countries.

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) the 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) national deployment planning, or

development of an NDVP, which required a significant amount of time and resources.

The presenter also highlighted the increased global production capacity of pandemic influenza

vaccines – from approximately 4 billion doses in 2011 to 6 billion doses in 2015. Additionally,

the presenter highlighted the importance of the Pandemic Influenza Preparedness (PIP)

Framework in establishing an equitable system to access pandemic products. Through the PIP,

approximately 420 million doses of pandemic vaccines, 10 million treatment courses of

antivirals and 250 000 diagnostic kits are expected to be available to countries in need.

To increase deployment preparedness and learning from the challenges observed in the 2009

pandemic, the following considerations were presented as the conclusions :

1. tailor national plans to serve context specific needs

3 World Health Organization. Main operational lessons learnt from the WHO Pandemic Influenza A(H1N1)

Vaccine Deployment Initiative. Geneva: World Health Organization; 2011.

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2. build and maintain global and national operational readiness

3. ensure effective global and country communication channels

4. sustain capacity to engage in executing legal agreements

5. ensure appropriate regulatory pathways suitable for pandemic response

6. map and continuously update cold chain capacity at both global and country level.

2.2.4 Lessons learnt from pandemic influenza vaccine deployment and vaccination

during the Pandemic A(H1N1) 2009 in the Western Pacific

– Dr Md. Shafiqul Hossain, WHO Cambodia

During the 2009–2010 pandemic influenza, 17 out of the 27 Member States in the Western

Pacific solicited access to WHO-donated vaccines and sent the documents required to receive

them.4 Among those countries, only Viet Nam did not receive the vaccines, due to national

legal and regulatory issues. A general challenge among the eligible countries was NDVP

development, which required a long time, training and technical support for completion. In

total, 8.7 million doses of vaccines were deployed to 16 countries in 29 shipments.

The presentation highlighted the main lessons learnt from the latest pandemic influenza in the

following areas of work: a) vaccination strategies and management and organization; b) human

resources and security; c) supply chain and cold chain capacity;(d) public communication; e)

communication and information; and f) post-deployment and adverse events following

immunization (AEFI) surveillance:

Regarding vaccination strategies, management and organization, the lessons learnt

included:

1. managing deployment and vaccination operations efficiently requires that managers

review critical components for making rapid decisions;

2. supporting pandemic deployment and vaccination operations requires planning of surge

capacity;

3. careful planning is required to determine what groups should be prioritized for

vaccination and how to quantify the population part of these groups;

4. the use of informed consent forms should be critically reviewed, as the pandemic

experience demonstrated it had undermined vaccine uptake;

5. establishing partnerships and/or collaborating with other sectors of society, inter-

ministerial departments and involving business enterprises and private medical

professionals is critical for the success of the pandemic response; and

6. planning committees, at all levels, should be established to ensure support and for good

implementation of the pandemic influenza vaccination activities.

In regard to human resources and security, the lessons learnt included:

4 The countries were: Cambodia, Cook Islands, Fiji, Kiribati, the Lao People’s Democratic Republic, Mongolia,

Nauru, Niue, Papua New Guinea, the Philippines, Samoa, Solomon Island, Tokelau, Tonga, Tuvalu, Vanuatu

and Viet Nam.

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1. the use of medical students, dental staff, veterinary staff, retired health professionals

and the military should be considered to attain human resources surge capacity;

2. the shortage of supervisors could be addressed by strengthening interdepartmental

(within the ministry of health) collaboration;

3. providing for the welfare and security of health-care workers responding to a pandemic

is important in order to ensure their health and ability to perform their duties; and

4. the availability of good injection practices and of a waste management programme

ensures that health staff can use their established procedures to reduce accidental

needle-stick injuries and properly dispose of used injection waste.

For Supply chain and cold chain capacity, the lessons learnt included:

1. outsourcing certain deployment operations can avoid the disruption of other critical

medical services;

2. drivers and delivery staff should be vaccinated with other front-line workers to ensure

their effectiveness and security;

3. personnel involved in vaccination and handling medical waste should be vaccinated

against hepatitis B;

4. when planning for future cold chain storage capacity for the routine immunization

programme, additional space should be considered for allowing the temporary storage

of pandemic vaccines;

5. outsourcing the additional storage capacity that is required for storing and distributing

vaccines and ancillary items is an effective strategy to create additional surge capacity;

and

6. failure to maintain cold chain equipment in proper working conditions endangers the

ability to ensure a rapid deployment and vaccination process.

With regard to public communication, main lessons learnt included:

1. involving and mobilizing community-based groups or associations is key to ensure

informed-based decision in regards to vaccination at the community level;

2. simplified and aligned messages that address multiple target groups are key to avoiding

confusion and reducing fear;

3. planning effective communication strategies requires changing messages as the

pandemic evolves and coordinate sharing of messages across agencies;

4. assuring that communications professionals are involved in the pandemic response will

support the framing of appropriate, honest messages in order to gain the trust of the

public;

5. conducting simulations is important in view of training staff in managing media

relations;

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6. using social media platforms (Facebook, Twitter, etc.) enhances communication

capabilities;

7. clear information needs to be provided to both health-care workers and the public when

using a novel pandemic influenza vaccine with a new formulation (for example one

containing adjuvants); and

8. continuous communication with the public and the media regarding the surveillance

and investigation of reported AEFI is required to maintain the trust of the public.

In regard to communication and information, it was highlighted that effective support for

deployment operations in a pandemic may require modification of the existing management

information systems.

Regarding post-deployment and AEFI surveillance, the lessons learnt included:

1. using current AEFI systems for supporting the national immunization programme

provides the platform for enhancing or creating surge capacity when using a strain-

specific pandemic influenza vaccine; and

2. adequate funds must be budgeted within the NVDP for putting in place a more resilient

and sensitive post-marketing surveillance for AEFI when using strain-specific

pandemic influenza vaccine.

2.3 Plenary 2. Country updates on national deployment and vaccination planning

In this session, country delegates provided an overview of their national deployment and

vaccination planning, including the existing policy framework and plans on health security,

pandemic preparedness and an NDVP. They presented their experiences in influenza vaccine

deployment in the 2009–2010 pandemic, gaps in the deployment preparedness, and their

expectations for the workshop. In general, countries identified that pandemic deployment and

vaccination plans require revision to ensure a timely and effective deployment of pandemic

influenza vaccines and subsequent implementation of vaccination campaigns. Detailed

information from each country is as follows:

2.3.1 Cambodia – NDVP planning update

The Cambodian delegation highlighted that their NDVP was updated in 2011 and that despite

the fact that the country does not have a national seasonal influenza vaccination policy,

seasonal influenza vaccine is available in the private market. Regarding pandemic influenza

vaccines, national laws and regulations authorize the emergency use of vaccines if they are

prequalified by WHO. To accelerate the registration, a fast-track process is in place for delivery

through the public sector only. From the 2009–2010 pandemic, the delegates identified several

strengths, including: 1) high-level political support; 2) involvement of senior national

Government officials in ensuring deployment and vaccination as a priority activity and

providing sufficient support at all levels; 3) external financial and technical support; 4) previous

experiences in implementing polio and measles supplementary immunization activities (SIAs)

and the capacities that these activities has built at the district and health centre level; and (5)

wide media coverage about the new virus that increased knowledge on the pandemic, and led

to greater vaccine uptake.

Gaps in the pandemic response were also underlined, including: 1) the challenges to identify

and quantify high-risk groups, especially people with chronic diseases; 2) strong demand for

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A(H1N1) vaccination by people not specifically in risk groups;(3) limited flexibility to change

the funding allocation for the response; and 4) limited time for planning and training.

2.3.2 China – NDVP planning update

Representatives from China stressed that the country was the first to produce the pandemic

vaccine in 2009 and that it is strengthening research and development of vaccines and new

antiviral drugs. During the 2009–2010 pandemic, the Chinese vaccines was not prequalified,

and therefore, these were not donated through the WHO deployment process. Since then, the

country has established a well-functioning National Regulatory Authority (NRA), which can

assess and ensure the quality, safety and efficacy of pandemic products, which is a key

requirement for the prequalification process.

2.3.3 Lao People’s Democratic Republic – NDVP planning update

The Lao delegation mentioned that their NDVP was updated in 2009 and that no specific law

or regulation exists to authorize the emergency use of pandemic influenza vaccines. The main

challenge has been the lack of political buy-in and resources to create and enforce such

regulations. The presenter also shared the progress in the country’s seasonal influenza

vaccination programme, which targets pregnant women, health-care workers, older people, and

patients with chronic conditions. As for the 2009–2010 pandemic influenza vaccination

operations, the following strengths were noted: strong Government commitment; hard-to-reach

areas included in microplanning; all health personnel prioritized for vaccination; high

community demand and acceptance as people genuinely wanted vaccination and active

involvement of volunteers; and contributions by village leaders and Lao Women’s Union by

mobilizing the children in their villages.

The challenges included: insufficient lead time for adequate planning; lack of a target number

for those with chronic diseases; uncertainty about vaccine availability, arrival and non-standard

presentations (for example, no vaccine viral monitor (VVM)); and addressing fears of AEFI

caused by experience of neighbouring countries.

The presenter highlighted the following lessons from the 2009–2010 pandemic influenza

vaccination:

1. the need to build consensus within the Ministry of Health and partner agencies to have

successful implementation;

2. unfamiliarity on the Letter of Agreement 5 for the vaccine, which caused concerns

among stakeholders and delays in signing;

3. the most important social mobilization agent was the local government rather than

media;

4. the A(H1N1) vaccination could be used as a platform for other mass immunization

campaigns; and

5. people appreciated receiving the A(H1N1) vaccination card, as it made the activity

seem more professional to the public.

2.3.4 Mongolia – NDVP planning update

5 The Letter of Agreement of Country Recipient Agreement (CRA) is a legal accord between WHO and a

country requesting pandemic flu vaccine supply from WHO.

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Mongolia was the first country to receive vaccines donated by WHO during the 2009–2010

pandemic. Mongolia successfully deployed the vaccines within seven days after the vaccine

arrived, and vaccination was carried out within seven days after vaccines were distributed to

primary units. Representatives emphasized that Mongolia has a national policy on seasonal

influenza vaccination and that the existing NDVP was last updated in 2009. Particular

strengths of the latest pandemic influenza vaccine response were highlighted, including: 1) an

immunization system was in place; 2) high-level political commitment; 3) multisectoral

collaboration; and(4) high public awareness. On the other hand, the following gaps were

identified: 1) health facility preparedness was not adequate; 2) communication infrastructure

was suboptimal; 3) lack of operational budget for immunization; and(4) lack of cold chain

capacity in family health centres.

2.3.5 Philippines – NDVP planning update

Representatives from the Philippines said their national pandemic preparedness and response

plan was developed in 2010, which had specified action to improve preparedness for

pandemic influenza vaccination. The presentation also highlighted the creation of an inter-

agency task force for the management of emerging infectious diseases in 2014. From the

2009–2010 pandemic experience, the following gaps were observed: 1) limited budget for

vaccine procurement; 2) challenging procurement processes; and 3) limited cold chain

storage capacity.

2.3.6 Viet Nam – NDVP planning update

Viet Nam has a seasonal influenza vaccination policy, targeting the high-risk populations.

The vision towards 2030 is to integrate seasonal influenza vaccines into the national EPI

programme, using both domestic and imported vaccines. In fact, the first domestically

produced seasonal influenza vaccines was licensed in 2019. Viet Nam implemented an

influenza vaccination campaign, targeting more than 30 000 health-care workers in 2017 and

in 2019–2020 season. During the 2009 influenza pandemic, Viet Nam was unable to receive

pandemic influenza vaccines due to the issues of registration and importation procedures.

Viet Nam’s regulatory pathways were suited for a normal review requiring clinical trials in

the country, but not for an emergency situation when fast-track review and market

authorization are required.

Viet Nam is currently developing a new National Deployment and Vaccination Plan for

Pandemic Influenza Vaccines, paying particular attention to identifying target populations;

the criteria for selecting vaccines, such as being licensed or manufactured in Viet Nam, or

supported by WHO and/or being used in developed countries; and meeting the safety criteria.

The vaccination campaign could be administered through current EPI programme. Viet Nam

also said it planned to conduct a tabletop exercise to test their its NDVP in November 2019.

2.4 Pandemic Influenza Preparedness (PIP) Deploy Game Mission 1. National

Deployment and Vaccination Plan

2.4.1 Overview of the global guidance on national deployment and vaccination planning

– Ms Ioana Ghiga, WHO headquarters

In this session, participants were introduced to two WHO documents designed to support the

Member States to develop and update their NDVP’s: (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.

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Participants learned about the 10 chapters of the NDVP: 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 AEFI; and (10) termination of deployment and vaccination

operations. These were later explored through the simulation exercise PIPDeploy.

Learning through play – PIPDeploy exercise

In addition to workshop presentations and group work, another main activity of the event was

to engage participants through active participation in a simulation exercise – PIPDeploy, which

is the first-ever tabletop exercise to strengthen countries’ capacities on pandemic influenza

deployment activities. Its learning objectives include: 1) to provoke discussions on key gaps in

preparing for or updating the NDVP for pandemic influenza vaccines; 2) to enable

conversations on best practices on in-country pandemic influenza vaccine deployment

governance and operations; and 3) to better understand country training needs and barriers in

effective roll-out of the NDVP.

The game is designed around Timoa, a fictitious country, which needs to strengthen its

preparedness and response capacity to deal with an influenza pandemic. To support the learning

process five scenarios and missions were presented to confront the players with fictitious

dynamics of pandemic vaccine deployment that could also happen in a real-life setting. For

each mission participants are given a situation – a challenge – and asked to develop a potential

solution. After a brainstorming and discussion, every group shares a proposed solution with

other groups and game facilitators, moves to the board game to collect resources for the

implementation of the proposed solution, and moves to the next challenge. Each step of the

game is followed by a facilitated discussion and technical input from WHO experts.

Throughout the game, participants discuss critical aspects of the 10 recommended chapters of

an NDVP. Delegates were split into four groups as follows: Group A: Cambodia delegation;

Group B: Lao delegation; Group C: Viet Nam delegation; Group D: Delegations from China,

Mongolia and the Philippines. The latter was grouped with multiple countries because these

delegations had fewer participants than the others.

Presentations on critical areas of the pandemic influenza deployment and vaccination

operations were given prior to the start of Missions 2 to 5.

2.4.2 Mission 1: NDVP structure, management and organization for deployment and

vaccination operations, vaccine strategy definition and human resources aspects

During the first mission, participants were invited to reflect about Timoa’s NDVP and propose

changes to it according to the WHO NDVP template.6 Additionally, they were asked to think

about management and organization, human resources, and vaccination strategy components

of an NDVP.

6 Guidance on Development and Implementation of a National Deployment and Vaccination Plan for Pandemic

Influenza Vaccines, p. 67. WHO. Available at

https://apps.who.int/iris/bitstream/handle/10665/75246/9789241503990_eng.pdf?sequence=1&isAllowed=y

17

Key discussion points

• Participants highlighted the importance of national advisory committees on

immunization and technical working groups on the selection of the vaccination

strategies. It was also stressed that these groups should have a multidisciplinary

composition, including profiles such as epidemiologists and ethical specialists.

• The involvement of the private sector in the pandemic preparedness and response

activities was mentioned as an important aspect of the operation.

• Health-care workers targeted in the pandemic vaccination campaign should be briefed

on the importance of the administration of pandemic vaccine and on their role in

engaging the community.

• Groups mentioned that each country has a particular command-and-control structure,

with different committees leading the response at national and subnational levels, and

thus coordination among those different actors are essential.

2.5 PIP Deploy Game Mission 2: Legal and regulatory planning

2.5.1 National regulatory systems readiness for pandemic influenza vaccines in the

Western Pacific Region

– Dr Jinho Shin, WHO Regional Office for the Western Pacific

In this session, participants learned about the regulatory functions and processes to expedite

the approval of medical products, including vaccines, in a pandemic. The presenter provided

an overview of the national regulatory authorities (NRAs) in the Western Pacific and

highlighted the various regulatory function requirements for importing, producing and

exporting countries.

The presentation also summarized potential registration pathways for NRAs dependent on

NRA capacities, such as recognition, reliance, work-sharing, joint activities, and full

assessment, as well as the options that countries can choose for market authorization of the

pandemic influenza vaccines. Dr Shin also provided overview of the emergency use pathway

for pandemic influenza vaccines, and the WHO Emergency Use Assessment and Listing

(EUAL) procedure, the special procedure for vaccines in the case of a public health

emergency. The presentation also summarized the situation and progress in official

independent lot releases and pharmacovigilance to monitor and ensure efficacy and safety of

vaccines.

In the Western Pacific, regulatory systems vary widely in terms of the range of regulatory

functions performed and the level of capacity. The type of regulatory functions and the level

of sophistication depend on the socioeconomic status of the country and the pharmaceutical

systems. Marketing authorization and good manufacturing practice (GMP) regulations are

relatively stronger, while pharmacovigilance and market surveillance are relatively weaker in

many middle-income economies. In such context, key regional regulatory challenges included:

(1) all countries are facing challenges in terms of capacity and resources to implement the full

range of regulatory functions; (2) a number of countries have insufficient legal frameworks and

low levels of technical competence to implement regulatory functions; and (3) the lack of a

harmonized approach for centralized marketing authorization.

Dr Shin discussed ongoing efforts to strengthen the regulatory systems in the Region, guided

by Western Pacific Regional Action Agenda on Regulatory Strengthening, Convergence and

18

Cooperation for Medicines and the Health Workforce. The Regional Office for the Western

Pacific also fosters cooperation among NRAs through fostering the Western Pacific Regional

Alliance for National Regulatory Authorities.

2.5.2. PIP Deploy Game Mission 2: Legal and regulatory planning

On Mission 2, participants were asked to discuss the existing international and national legal

and regulatory requirements to import or receive vaccines from a vaccine supplier.

Key discussion points and feedback

• It is recommended that countries define clear procedures and strategies to approve and

license vaccines during a pandemic. However, these procedures need to be in place in

the inter-pandemic phases as they require a legal foundation. Legislation should be in

place to support appropriate regulatory pathways.

• Several countries in the Region require further support to strengthen their legal and

regulatory capacities.

• NRAs should have clear procedures to receive vaccines donated by WHO or other

entities. This includes clarifying procedures on whether the WHO prequalification (PQ)

certificate is enough to approve the vaccines for use in a respective country or if further

NRA review is needed in addition to WHO PQ certificate.

• Key personnel involved in the pandemic preparedness should have a clear

understanding on the set of documents that should be required to ensure timely market

authorization and importation of pandemic vaccines.

• Strengthening legal and regulatory capacities ahead of the pandemic is key to identify

possible bottlenecks on the vaccine approval and importation process.

• Countries stressed that a major concern during the 2009–2010 pandemic was the

liability provisions that were part of the donation processes. It would be beneficial to

understand beforehand the terms and conditions of these agreements.

2.6 PIPDeploy Game Mission 3: Public communication

2.6.1 Role of risk communication for pandemic influenza vaccine deployment and

vaccination

– Dr Ljubica Latinovic, WHO Regional Office for the Western Pacific

This presentation highlighted the importance of risk communications activities before, during

and after a pandemic, and it stressed how building trust among stakeholders and communities

can support the acceptance of public health interventions such as immunization campaigns.

Participants learned about the main communication challenges of new pandemic influenza

vaccines, including:

1. perceptions of the risk may vary greatly – from outright panic to scepticism and

resistance;

2. the introduction of a new vaccine will raise questions about its safety and officials need

to provide these details in messages that are tailored for specific audiences to ensure

they contain appropriate language;

19

3. there will be limited vaccines available and communication should inform who will be

prioritized and why;

4. vaccine hesitancy or high demand may occur or even both;

5. some health workers may not be supportive of vaccination;

6. rumours may spread; and

7. the need to communicate around AEFI.

To conclude, the presenter emphasized that countries should: 1) develop an effective

communication strategy to ensure public acceptance for vaccination campaigns and uptake of

the vaccine by the priority groups; and 2) use an integrated communication approach that

should consider real-time feedback from all stakeholders involved, with a focus on the priority

vaccination groups and general population

2.6.2 PIPDeploy Game Mission 3: Public communication

On Mission 3, participants were asked to reflect about risk communications systems and

activities to address some communication challenges during an influenza pandemic.

Key discussion points and feedback

• Countries emphasized that hotlines for external communication and social networks

(for example telegrams) for communication with internal audiences are critical

channels to provide fast communication and build trust.

• Stronger coordination among stakeholders and ministries with regard to

communication is needed so that different agencies and responders can speak with the

media with “one voice”, avoiding different messages and misunderstanding.

• Health-care workers and medical societies should be considered as part of the

communication strategy, as they are both target groups and influencers for other

targeted groups such as pregnant women.

• Spokespeople should be trained at different levels and should be prepared to talk about

uncertainties. The development of standard operating procedures (SOPs) may help

define when, how and what should be communicated to the public.

• Communication to the public should aim to build trust and should be clear, easy-to-

understand, and delivered in local language.

2.7 PIPDeploy Game Mission 4: PIP Deploy Game Mission 4: Supply chain and waste

management

2.7.1 Introduction to supply chain and waste management

– Dr Ananda Amarasinghe, WHO Regional Office for the Western Pacific

This presentation highlighted the challenges in supply chain and waste management during a

pandemic, comparing to those encountered in the routine immunization system:

- Forecasting and procurement: During a pandemic, the global availability of a vaccine

may be limited, and high demand will occur globally. Careful planning should be

undertaken to ensure access to vaccines and associated ancillary products.

20

- Vaccine management: The large number of vaccines will need to be properly stored

and will require appropriate cold chain capacity and transport.

- Injection supply and waste management: Adequate supply of safe injection supplies

and proper disposal, according to WHO recommended norms and standards.

- Human resources and health systems functioning: During a pandemic, health service

will likely be overloaded, with competing priorities and limited human resources.

Dr Amarasinghe stressed advance planning is critical to address these challenges and to ensure

effective supply chain management to support vaccination during the next pandemic.

2.7.5 PIPDeploy Game Mission 4: Supply chain and waste management

The objective of this mission was to encourage participants to identify the supply chain

management processes for vaccine deployment within seven days, discuss steps to ensure safe

disposal of hazardous medical waste, and the communication systems and mechanisms to

ensure efficient operations.

Key discussion points and feedback

• Temperature monitoring should consider for all vaccines, either inactivated or live

attenuated. In the case of the latter, the exposure to high temperatures is a bigger

concern, and stability data should inform whether the vaccine can still be used in the

event of exposure to temperatures outside the recommended range.

• Regarding waste management, countries should consider the number of safety boxes

needed for the safe disposal of needles and syringes. Additionally, when developing

the waste management chapter of the NDVP, considerations on disposal of used and

expired vaccine vials should be included.

• The involvement of the military and police may be required for the safe transport of

the vaccines.

• As the countries may face challenges with the storage capacity during a pandemic, it is

advisable to assess available storage facilities where vaccines can store ensuring the

cold chain and consider alternative (external) providers of storage services.

2.8 PIP Deploy Game Mission 5: Post-deployment surveillance system and management

2.8.1 Introduction to post-deployment surveillance system and management

– Dr Ananda Amarasinghe, WHO Regional Office for the Western Pacific

This presentation provided an overview of the post-deployment surveillance systems and

management and presented several WHO global and regional resources to support countries

strengthening their capacities in this area.7

Dr Amarasinghe explained that post-deployment surveillance is very important to monitor how

safe the vaccine is (safety) and what extent of protection is being generated by the vaccines

(effectiveness). The presenter stressed the importance of a comprehensive monitoring system,

which encompass AEFI detection, notification, reporting, investigation, analysis, causality

7 https://www.who.int/vaccine_safety/publications/aefi_surveillance/en/

21

assessment and feedback. He explained that early detection of AEFI cases helps the emergency

response to minimize serious medical consequences, and take corrective actions through either

regulatory or/and programmatic measures. Dr Amarasinghe particularly emphasized that post-

deployment surveillance is a critical activity to maintain public trust on vaccines and

immunization and overall pandemic responses.

2.8.2 PIPDeploy Game Mission 5: Post-deployment surveillance system and

management

In Mission 5, participants were asked to discuss the post-deployment surveillance (PDS)

mechanisms to ensure the monitoring of the safety of the pandemic vaccine and the detection

of AEFI.

Key discussion points and feedback

• Participants stressed the use of hotlines as a well-functioning channel for

communication with the public about AEFI.

• Countries need to ensure that both active and passive surveillance systems are

considered. Active surveillance implies proactive and timely identification of serious

AEFI, which requires trained and skilled staff to detect and respond to such cases;

passive surveillance is based on being notified about AEFI cases through existing

routine systems; and vaccine recipients shall be informed about signs of potential AEFI

and encouraged to report any symptoms that may indicate an AEFI.

• Medical personnel should adequately be trained in detecting and managing potential

AEFI.

• The documentation of lessons learnt can potentially contribute to future advocacy

purposes both in terms of budget pledges and increasing human resources for

emergency response.

2.9 PIP Deploy game hotwash

Overall, participants found the game an innovative and interactive tool to expand their

knowledge on the deployment and vaccination planning. It was also stressed that through the

game, players were able to identify gaps in their national systems and think about how to

tackle those gaps. Participants said PIPDeploy was a fun way to learn and discuss pandemic

vaccine deployment and noted that the game would be a useful tool to strengthen knowledge

on pandemic deployment and vaccination with national stakeholders and partners.

2.10 Self-assessment of NVDP plans and defining next steps and priority actions

In this session, delegates were asked to assess their existing NDVPs and to identify strengths

and gaps, as well as timelines for developing or updating their NDVPs. In addition, the

participants were also asked to provide feedback on the draft WHO Vaccine Request Form.

Countries discussed the strengths as well as potential areas of improvement in their NDVPs,

and proposed the following steps to update their plans, with the key points summarized in the

Annex 1. In general, the countries proposed that they aim to update their existing NDVPs,

building on the strengths and lessons learnt from the 2009/–2010 pandemic. Delegates

emphasized that simulation exercises will likely be implemented to test their plans, once their

draft is developed.

When developing the NDVPs it was considered beneficial:

22

▪ to articulate a time frame needed to implement each activity required to develop or

update the plan, and to address any identified gaps and priority actions to strengthen

preparedness;

▪ to enclose a decision-making diagram, which can support the decision-making process

during a pandemic; and

▪ to ensure that the provisions of the NDVP, including roles and responsibilities, are in

line with legislation or have legal standing.

Regarding the WHO Vaccine Request Form, delegates mentioned that the document requires

comprehensive information and input from various departments in their country. This activity

will require further collaboration among sectors and stakeholders.

2.11 Potential options for costing the NDVP

This presentation highlighted the importance of costing for all the NDVP components that

may require surge capacity. It presented the domains of a draft NDVP costing tool, which is

currently being developed to support countries to cost essential aspects and activities of their

deployment and vaccination efforts.

3. CONCLUSIONS AND RECOMMENDATIONS

3.1 Conclusions

1. Member States have made considerable progress in strengthening health security

systems, as well as national immunization and regulatory systems. The Asia Pacific

Strategy for Emerging Diseases and Public Health Emergencies (APSED III) and its

earlier iterations and the Regional Framework for Implementing Global Vaccination

Action Plan in the Western Pacific and other regional policy and strategic guidance have

served as important action frameworks.

2. The context of managing health security threats in the Asia Pacific region is increasingly

complex due to various factors, such as increasing movement of people and goods,

growing urbanization, ageing populations and antimicrobial resistance.

3. In such an evolving context, participants renewed their recognition of the major public

health threats posed by an influenza pandemic, and agreed to further advance national

pandemic preparedness by identifying strengths and gaps in system readiness through

response planning, and prioritizing actions to address the gaps.

4. Participants agreed that pandemic influenza vaccination plays a critical role in the public

health response to an influenza pandemic, and that the national pandemic influenza

vaccine deployment and vaccination planning is an essential component of pandemic

preparedness.

5. Through the tabletop exercise Pandemic Influenza Preparedness Deploy Game, the

participants reviewed the chapters of the National Deployment and Vaccination Plan

(NDVP) in line with WHO guidance, and discussed key issues in each chapter.

6. Participants identified strengths as well as potential areas for improvement of the NDVP

of respective countries, and proposed priority actions to revise and update the NDVP.

7. Participants supported the values of simulation exercises in validating the NDVP and

broader pandemic response plan.

3.2 Recommendations

23

3.2.1 Recommendations for Member States

Member States are encouraged:

1. to use pandemic preparedness to drive further strengthening of systems to address

influenza pandemics and other health security threats;

2. to engage relevant stakeholders to review identified strengths and gaps of the NDVP and

facilitate coordinated process to update the NDVP;

3. to consider designing and conducting simulation exercises to test and validate the NDVP

working with relevant stakeholders;

4. to review and address identified issues of regulatory systems to cope with public health

emergencies, including for rapid introduction of pandemic influenza vaccines, by

developing clear requirements, timeline and processes;

5. to review and address identified issues of immunization safety surveillance and response

to cope with public health emergencies, including for rapid introduction of pandemic

influenza vaccines; and

6. to ensure that a national plan and agreed procedures to conduct risk communications for

pandemics are in place as part of a broader multi-hazard risk communications framework,

and covers public communication plans for vaccine deployment and vaccination.

3.2.3 Recommendations for the WHO Secretariat

The WHO Secretariat should continue to support Member States to implement the above

recommendations, particularly on the following:

a. reviewing and updating the NDVP;

b. designing a simulation exercise to test and validate the NDVP and broader

pandemic response plan;

c. strengthening immunization safety surveillance and response to cope with public

health emergencies; and

d. reviewing and updating risk communications plan for pandemic response.

24

ANNEXES

Annex 1. Country self-assessment, next steps and priority actions for the NDVP

Country Strengths Gaps Challenges Next steps and

priority actions

Timeline

Cambodia ▪ Political support

▪ Management and

organization

▪ Multisectoral

engagement

▪ Legal and regulatory aspects

▪ Public communications

▪ Termination of deployment is

missing

▪ Waste management activities

should be better detailed in the plan

▪ Budget and flexibility

of fund

▪ Organize a workshop to

review NDVP

▪ Finalize and approve

NDVP

▪ Disseminate NDVP to

relevant stakeholders

Quarter 1, 2020

China ▪ Strengthen data

gathering

▪ Multisectoral

coordination

▪

To be determined

Lao People’s

Democratic

Republic

▪ National advisory

committees on

immunization;

communication and

advocacy committee;

National AEFI

committee

▪ Immunization law and

influenza strategy

▪ Cold chain capacity

▪ Support from PIVI8

▪ Difficulties in forecasting of people

with chronic medical conditions

▪ AEFI case investigation

▪ Insufficient coordination among

departments

▪ Limited public communication and

information, education and

communications materials

▪ Need to improve

coordination among

the existing

committees

▪ Preparedness planning

for pandemic and

outbreak response

▪ Budget allocation for

investigation

▪ Training of relevant

human resources

▪ Strengthening

communication in

health centres and

private clinics

To be determined

8 Partnership for influenza vaccine introduction

25

Country Strengths Gaps Challenges Next steps and

priority actions

Timeline

▪ Regular EOC meetings

during emergencies

Mongolia ▪ Multisectoral

collaboration

▪ Vaccine management

system

▪ Limited budget

▪ Issues with cold chain capacity at

the time of the pandemic

▪ Lack of cold chain capacity in

primary health-care centres

▪ Stakeholders

commitment

Budget

▪ Establish the inter-

institutional working

group to revise the

national plan

Assessment of the draft

NDVP by WHO

experts

▪ By December

2019, update

NDVP

By 2020, endorse

NDVP

Philippines ▪ AEFI surveillance

▪ Existing command and

control structure

▪ NRA not involved in the onset of

the pandemic

▪ Need to clarify roles and

responsibilities among stakeholders

and partners involved in the

pandemic response

▪ Need for clear guidelines for staff

involved in communication

activities

▪ Concurrent

outbreaks and

priorities

▪ Inter-agency tabletop

exercise planned in

October 2019

December 2019

Viet Nam ▪ Established regulatory

systems, and influenza

surveillance systems

▪ Domestic vaccine

production capacity

▪ Limited human resource capacities

for pandemic response

▪ Limited waste management

capacity

▪ Limited cold chain capacity

▪ Need to develop/update

communication plan

▪ Lack of budget for

deployment

▪ Organize PIPDeploy

workshop at national

level in Viet Nam

▪ Update NDVP

▪ Mobilize budget for

deployment activities

▪ Strengthen cold chain

capacity

Late 2019

26

Annex 2. List of participants

1. PARTICIPANTS

CAMBODIA Dr Teng Srey, Deputy Director, Department of CDC, Ministry of Health

Sangkat Boeungkak 2, Toul Kork District, Phnom Penh, Tel No.: (855) 89717133, Fax No.: (855) 8971 7133, email: tengsrey72@gmail.com

Mr Ork Vichit, Deputy Director, National Maternal and Child Health Center

Manager, National Immunization Program, Ministry of Health, National Road No 6,

Kien Khlang, Prek Leap, Chrov, Changva, Phnom Penh, Tel. No.: (855) 12830 548, Fax No.: (855) 23426 257, email: orkvichit@yahoo.com

Mr Sea Thol, Chief, Essential Drug Bureau, Department of Drug and Food, Ministry of Health, Phnom Penh, Cambodia, Tel. No.: (855) 1235 5161,

email:tholsea@gmail.com

Mr Kong Heang Kry, Vaccine and Cold Chain Officer, National Immunization

Program, Ministry of Health, Phnom Penh, Cambodia, Tel. No.: (855) 1296 4889,

email: kongheangkry@gmail.com

CHINA Dr Xu Keming, Director, National Health Commission of the People's

Republic of China, No. 1 Xizhimenwainanlu, Beijing 100044, Tel. No.: (8610) 687

9235, Fax No.: (8610) 687 2514, email:13901155885@163.com

Mr Wei Lijun, Government Officer, Health Emergency Response Office

National Health Commission of the People's Republic of China, No. 1 Xizhimenwainanlu, Beijing 100191, Tel. No.: (8610) 6879 1235,

Fax No.: (8610) 6879 2590, email: wljbuaa@163.com

LAO PEOPLE'S

DEMOCRATIC

REPUBLIC

Dr Somphone Soulaphy, Director, Prevention Division, Department of

Communicable Disease Control, Ministry of Health, Simeuang Road, Sisattanak

District, Vientiane, Tel. No.: (8560) 2122 6052, Fax No.: (8560) 21 241003,

email: sphone59@yahoo.com

Dr Chanthavong Savatchirang, Deputy Chief of VPD Division, EPI, Ministry of

Health, Mother and Child Health Center, National Immunization Program, Km 3 Thadeua Road, Sisattanak District, Vientiane, Tel. No.: (856) 2131 2352,

Fax No.: (856) 2131 2120, email: janwonvientiane@hotmail.com

Dr Chansay Pathammavong, Deputy, Vaccine-Preventable Diseases Division

Mother and Child Health Center, National Immunization Program , Ministry of

Health, Km 3 Thadeua Road, Sisatanak District, Vientiane,

Tel. No.: (856) 21 312 352/ (856) 20 5560 6480, Fax No.: (856) 21 312 120, email: chansay_epi@yahoo.com

Dr Khammany Phommachanh, Planning Officer, Administration, Planning Division Maternal and Child Health Center, Ministry of Health, Simeuang Road, Sisattanak

District, Vientiane, Tel. No.: (856) 021 452519, Fax No.: (856) 021 452519,

email: khammanypmc@gmail.com

27

MONGOLIA

Dr Munkhdavaa Oyun, Epidemiologist, Department of Immunization, National Center for Communicable Diseases, Ministry of Health, Nam Yan Ju Street

Ulaanbaatar, Tel. No.: (976) 9191 6642, Fax No.: (976) 1145 1798,

email: oyun@nccd.gov.mn

Ms Tsolmonbaatar Bolortuya, Officer-in-Charge, Medicine Registration, Health

Development Center, Ministry of Health, Sukhbaatar District, Ulaanbaatar,

Tel. No.: (976) 9900 8182, Fax No.: (976) 1132 0633, email: bolortuya@hdc.gov.mn

Ms Tumurbaatar Oyun-Erdene, Epidemiologist, National Influenza Center , NCCD

Nam Yan Ju Street, Ulaanbaatar, Tel. No.: (976) 9900 3287, Fax No.: (976) 1145 1798 , email: oyunerdene.nccd@gmail.com

PHILIPPINES Ms Pia Angelique Priagola , Food and Drug Regulation Officer III, Center for Drugs,

Regulation and Research, Food and Drug Administration, Muntinlupa City, Tel. No. (632) 857 1900, email: padpriagola@fda.gov.ph

VIET NAM

Dr Ha Thi Cam Van, Deputy Head, Division of Vaccine and Biosafety

Management, Department of Preventive Medicine, Ministry of Health,

Ha Noi, Tel. No.: (8443) 846 2364, Fax No.: (8443) 736 7379,

email: hacamvan210@gmail.com

Dr Bui Huy Hoang, Officer, Division of Communicable Disease Control, General Department of Preventive Medicine, Ministry of Health, 135 Nui Truc, Ba Dinh, Ha

Noi, Tel. No.: (849) 4428 1988, Fax No.: (8443) 736 7379,

email: dr.hoang88@gmail.com

Dr Nguyen Dac Trung, Researcher, National Institute of Hygiene and Epidemiology

Ha Noi, Tel. No.: (8443) 972 1334, Fax No.: (8443) 8213782,

email: dactrungn@gmail.com

Dr Le Thi Tuyet Lan, Officer, Drug Registration Division, Drug Administration of

Viet Nam, Hanoi, Tel. No.: (849) 1250 5290, Fax No.: (843) 823 0794,

email: lttlan2212@yahoo.com.vn

2. SECRETARIAT

WHO REGIONAL

OFFICE FOR THE

WESTERN

PACIFIC

Dr Chin-kei Lee, Acting Regional Emergencies Director, WHO Health

Emergencies Programme, WHO, Regional Office for the Western Pacific, P.O.

Box 2932, 1000 Manila, Philippines, Tel. No.: (632) 528 8001,

Fax No.: (632) 521 1036, email: leec@who.int

Dr Masaya Kato, Programme Area Manager, Country Health Emergency

Preparedness and International Health Regulations, WHO Health Emergencies

Programme, WHO for the Regional Office for the Western Pacific,

P.O. Box 2932, 1000 Manila, Philippines, Tel. No.: (632) 528 8001,

Fax No.: (632) 521 1036, email: katom@who.int

Dr Socorro Escalante, Coordinator, Essential Medicines and Health

Technologies, Division of Health Systems and Services, WHO Regional Office

for the Western Pacific, P.O. Box 2932, 1000 Manila, Philippines,

Tel. No.: (632) 528 9846, Fax No.: (632) 521 1036, email: escalantes@who.int

Dr Yoshihiro Takashima, Coordinator, Expanded Programme on Immunization

WHO Regional Office for the Western Pacific, P.O. Box 2932, 1000 Manila,

28

Philippines, Tel. No.: (632) 528 9746, Fax No.: (632) 521 1036,

email: takashimay@who.int

Dr Ananda Amarasinghe, Technical Officer, Expanded Programme on

Immunization, WHO Regional Office for the Western Pacific,

P.O. Box 2932, 1000 Manila, Philippines , Tel. No.: (632) 528 9032, Fax No.:

(632) 521 1036, email: amarasinghea@who.int

Dr Shin Jinho, Technical Officer, Essential Medicines and Health Technologies

Unit, WHO Regional Office for the Western Pacific, P.O. Box 2932,

1000 Manila, Philippines, Tel. No.: (632) 528 8001, Fax No.: (632) 521 1036 /

528 0279, email: shinj@who.int

Mr Jan Erik Larsen, Technical Officer, Operations Support and Logistics

WHO Health Emergencies Programme, WHO Regional Office for the Western

Pacific, P.O. Box 2932, 1000 Manila, Philippines, Tel. No.: (632) 528 8001, Fax

No.: (632) 521 1036 / 528 0279, email: larsenj@who.int

Ms Cheryl Valerie Legaspi, Consultant, Essential Medicines and Health

Technologies Unit, WHO Regional Office for the Western Pacific, P.O. Box

2932, 1000 Manila, Philippines, Tel. No.: (632) 528 8001, Fax No.: (632) 521

1036 / 526 0279, email: legaspic@who.int

Ms Ljubica Latinovic, Consultant, Risk Communications, Division of

Programme for Disease Control, WHO Regional Office for the Western Pacific,

P.O. Box 2932, 1000 Manila, Philippines, Tel. No.: (632) 528 8001,

Fax No.: (632) 521 1036 / 526 0279, email: latinovicl@who.int

WHO

CAMBODIA

Dr Md. Shafiqul Hossain, Technical Officer, Expanded Programme on

Immunization, Office of the WHO Representative in Cambodia

Phnom Penh, Cambodia, Tel. No.: (855) 23216610, Fax No.: (855) 12917755,

email: hossains@who.int WHO

PHILIPPINES

Ms Rowena Capistrano, Technical Coordinator (SSA), Emerging and Re-emerging

Infectious Disease Programme (EREID), WHO Health Emergencies (WHE), Office

of the WHO Representative in the Philippines

Manila, Philippines, Tel. No.: (632) 528 9762, email: capistranor@who.int WHO

HEADQUARTERS

Ms Ioana Ghiga, Technical Officer, IHM, Infectious Hazard Management

World Health Organization, Avenue Appia 20, 1211 Geneva 27, Switzerland

Tel. No.: (4122) 791 21 11, Fax No.: (4122) 791 0746, email: @who.int

Ms Viviane Melo Bianco, Consultant, Infectious Hazard Management

World Health Organization, Avenue Appia 20, 1211 Geneva 27, Switzerland

Tel. No.: (4122) 791 4282, Fax No.: (4122) 791 0746, email: biancov@who.int

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Annex 3. Programme of activities

Day 1 – Tuesday, 17 September 2019

08:30 – 09:00 Registration

09:00 – 09:30 Opening session

Message from Dr Yunguo Liu, Director of Programme Management, WHO

Regional Office for the Western Pacific

Opening remarks

Objectives and programme of the meeting

Introduction of participants

Administrative announcements

Group photo

09:30 – 09:45 Managing health security threats through Asia Pacific Strategy for Emerging Diseases and Public Health Emergencies (APSED III)

– Dr Chin-kei Lee, Acting Health Emergencies Director, WHO Health

Emergencies Programme, WHO Regional Office for the Western Pacific

9:45 – 10:00 Proposed Regional Strategy for Expanded Programme for Immunization 2021–

2030

Dr Ananda Amarasinghe, Expanded Programme for Immunization, WHO Regional Office for the Western Pacific

10:00 – 10:30 Coffee break

10:30 – 12:00 Plenary 1: Are we ready for the next pandemic?

10:30 – 10:50 Advancing pandemic preparedness for health security: Are we ready?

– Dr Masaya Kato, WHO Health Emergencies Programme, WHO Regional Office for the Western Pacific

10:50 – 11:30 Discussion: Pandemic preparedness in our countries – Progress and challenges

11:30 – 11:40 Overview of the situation of seasonal influenza vaccination in the Western Pacific

Region

– D. Md. Shafiqul Hossain, WHO Cambodia

11:40 – 11:55 Lessons learnt from global deployment of pandemic influenza vaccines during

the Pandemic (H1N1) 2009

– Ms Ioana Ghiga, WHO Health Emergencies Programme, WHO headquarters

11:55 – 12:10 Lessons learnt from pandemic influenza vaccine deployment and vaccination

during the Pandemic (H1N1) 2009 in the Western Pacific

– Dr. Md. Shafiqul Hossain, WHO Cambodia

12:10 – 12:30 Plenary discussion

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12:30 – 13:30 Lunch break

13:30 – 15:00 Plenary 2: Country updates on National deployment and vaccination planning

Country presentations

- Cambodia

- China

- Lao People’s Democratic Republic Mongolia

- Philippines

- Viet Nam

15:00 – 15:30 Coffee break/mobility break

15:30 – 17:45 Pandemic Influenza Preparedness (PIP) Deploy Game

Mission 1: National Deployment and Vaccination Plan

15:30 – 15:45 Overview of the global guidance on national deployment and vaccination

planning

– Ms Ioana Ghiga, WHO Health Emergencies Programme, WHO headquarters

15:45 – 17:15 PIP Deploy Game Mission 1: National Deployment and Vaccination Plan

End of Day 1

17:30 – 19:00 Reception

Day 2 – Wednesday, 18 September 2019

08:30 – 08:35 Recap of day 1

– Ms Viviane Bianco

08:35 – 10:15 PIP Deploy Game Mission 2: Legal and regulatory planning

08:35 – 08:55 National regulatory systems readiness for pandemic influenza vaccines in the

Western Pacific Region

– Dr Jinho Shin, Medical Officer, Division of Health System, WHO Regional Office for the Western Pacific

08:55 – 10:15 PIP Deploy Game Mission 2: Legal and regulatory planning

10:15 – 10:45 Coffee break

10:45 – 12:00 PIP Deploy Game Mission 3: Public Communication

10:45 – 11:00 Roles of risk communication for pandemic influenza vaccine deployment and

vaccination

– Dr Ljubica Latinovic, Division of Disease Control, WHO Regional Office for

the Western Pacific

11:00 – 12:00 PIP Deploy Game Mission 3: Public Communication

12:00 – 13:00 Lunch break

13:00 – 14:00 PIP Deploy Game Mission 4: Supply chain and waste management

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13:00 – 13:05 Introduction to supply chain and waste management

– Dr Ananda Amarasinghe, Expanded Programme for Immunization,

WHO Regional Office for the Western Pacific

13:05 – 14:05 PIP Deploy Game Mission 4: Supply chain and waste management

14:05 – 15:10 PIP Deploy Game Mission 5: Post-deployment surveillance system

and management

14:05 – 14:10 Introduction to post-deployment surveillance system and management

– Dr Ananda Amarasinghe, Expanded Programme for Immunization,

WHO Regional Office for the Western Pacific

14:10 – 15:10 PIP Deploy Game Mission 5: Post-deployment surveillance system and

management

15:10- 15:40 Coffee break/mobility break

15:40 - 17:00 PIP Deploy Game Hot-wash

15:40 – 16:20 Quiz (Mentimeter)

16:20 – 17:00 Hotwash

End of Day 2

Day 3 Thursday, 19 September 2019

08:30 – 08:35 Recap of day 2 – Ms Viviane Bianco

08:35 – 08:45 Costing the NDVP – Potential options

– Ms Ioana Ghiga, WHO Health Emergencies Programme, WHO headquarters

08:45 – 10:00 Self-assessment of NVDP plans and defining next steps and priority actions

10:00 – 10:30 Coffee Break

10:30 – 11:40 Country presentations of the next steps and priority actions

11:40 – 12:00 Quiz (Mentimeter)

12:00 – 13:00 Lunch break

13:00 – 13:30 Summary and conclusions

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