What Vietnam needs immediately for large-scale Covid vaccination

By Thu Anh Nguyen   January 27, 2021 | 11:59 am GMT+7
Vietnam has been taking a number of rigorous measures to control the Covid-19 pandemic, but vaccination is the ultimate solution and the country needs big preparations to handle that.
Thu Anh Nguyen

Thu Anh Nguyen

Vietnam aims to vaccinate its entire population, gradually covering by subject priority and vaccine supply capacity aligned with World Health Organization recommendations. Its priority population numbers 15 million.

Of more than 60 Covid-19 vaccine candidates being trialed, those of Pfizer, Moderna and AstraZeneca Oxford have been authorized for use in many countries.

Pfizer-BioNTech, Russia’s Sputnik V and China’s Sinovac are also on the list for exploration and discussion for import to Vietnam.

There is an expectation that Vietnam would be able to make its own Covd-19 vaccine eventually.

The Pfizer-BioNTech vaccine requires storage at -70 degrees Celsius in an ultra-cold chain for up to six months and at 2-8 degrees Celsius for up to five days.

Once a box is opened, all doses need to be used within 30 days or discarded.

The AstraZeneca Oxford vaccine requires less extensive logistic arrangements. It can be stored at 2-8 degrees Celsius for six months though it needs to be protected from light.

Once a vial is opened, it should be used within six hours or discarded.

Transportation of vaccines will require a cold chain with refrigerated vehicles, cold storage at the delivery site, thermometers, temperature warning systems, and power generators.

Vietnam lacks a cold chain that allows storage at -70 degrees Celsius. Thus, while the Pfizer-BioNTech vaccine can be transported to Vietnam using the manufacturer’s standard packing method, it is not possible for Vietnam to store it and distribute to its 63 provinces.

However, the existing cold chains in provinces and districts mostly allow storage at 2-8 degrees Celsius, and at -20 degrees Celsius in some places.

This will be enough to transport, store and deliver the AstraZeneca Oxford vaccine. Nevertheless, infrastructure needs to be upgraded in many remote and isolated communes.

Vials of Nanocovax, a Vietnamese Covid-19 vaccine candidate, at a laborartory in HCMC, December 8, 2020. Photo by VnExpress/Quynh Tran.

Vials of Nanocovax, a Vietnamese Covid-19 vaccine candidate, at a laborartory in HCMC, December 8, 2020. Photo by VnExpress/Quynh Tran.

As for vaccinating people, lining up groups of eligible vaccine recipients, ensuring the correct interval between the two doses, and management of adverse events pose enormous challenges not just for Vietnam, but also for developed countries.

The U.S. will take almost a year to vaccinate 80 percent of its population at the current pace. By the end of 2020 it had vaccinated 14 percent of its target, or 20 million people.

Israel is expected to vaccinate its entire population in less than 51 days.

To achieve this, Israel placed orders early and paid a higher price to secure sufficient volumes of vaccines. Besides, it carefully planned vaccine operation logistics, sufficiently and safely dividing the large consignments into smaller batches to send out to remote locations, developing an orderly queue of people coming for vaccination and vaccinating people not in priority groups at the end of the day to not waste vials about to expire.

Israel has carried out a large communication campaign. It has a strong digitized healthcare system in which everyone is registered. The digital information system allows the vaccine program to track recipients and take appropriate action.

Assuming Vietnam has the capacity to carry out the vaccination at the same pace as Israel (daily average of 126,000 people), it would take four months to vaccinate 15 million priority recipients, and almost two years to cover 80 percent of the population.

Though the National Expanded Program on Immunization (EPI) has been in place for many years, challenges remain.

Firstly, there is not yet experience of population-wide vaccination efforts, and it is likely there are not sufficient health workers to vaccinate the entire population, particularly since a correct interval is required between the two doses.

Secondly, the EPI’s high staff turnover means there are many new workers without adequate training.

Lastly, the adverse events following immunization (AEFI) currently focuses only on children and pregnant women, and so there is a need to strengthen the AEFI regime to cope with a vaccine rollout of this scale and novelty.

With regard to the cost, the government can cover only 60-70 percent of the EPI, and so the country will possibly need to mobilize funds, develop standard procedures and build capacity, which could be difficult in the short time available.

Obviously, there are significant challenges that Vietnam faces to ensuring an equitable, safe and efficient delivery system.

The first resource that has become available is the vaccine readiness assessment tool, which includes an excel template for health ministries to complete, with support from local WHO and UNICEF offices if needed.

Covax is developing materials for guidance, training and advocacy.

Other upcoming resources include guidance and tools to plan for Covid-19 vaccine acceptance and demand, manage supply, logistics and distribution and monitor vaccination.

A concrete and transparent plan is urgently needed at this stage to ensure an equitable, safe and efficient delivery system for the precious vaccines.

* Dr Thu Anh Nguyen works in the faculty of medicine and health, University of Sydney, Australia. The opinions expressed are her own.

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