Additional Financing for Ethiopia COVID-19 Emergency Response Project

active

The selection of the target population and vaccine deployment process seek to ensure equity in access for vaccines among key eligible populations. Health inequity is intertwined with the impact of COVID-19 where certain populations are at increased risk of severe illness or death. At the national and sub-national levels, data are showing a disproportionate impact of the pandemic on populations already disadvantaged by virtue of their age, health status, residence, occupation, and socioeconomic status and hence the vaccine introduction strategy has given consideration to these disproportionate impact in the selection of vaccine deployment strategies. Phase 1 (20% total population coverage): Phase 1 has a reasonable scenario of the target groups to achieve the goal of reducing mortality and morbidity. It includes the following target groups: • Frontline workers in health care, schools, and other social care services • People over the age of 55 years; and • People under the age of 55 years with underlying conditions that expose them to higher COVID-19 related mortality risk Frontline workers will be prioritized as they are essential to treat and protect the population and come in close contact with infected individuals and provide care for high-mortality risk groups. Initial epidemiological data has shown that adults over 55 years of age and those with certain co-morbidities are at the highest risk of dying from COVID-19. The strategy to be used to reach each of the priority groups will be using the existing primary healthcare approach and other innovative approaches tailored to the context the priority groups. Existing vaccine delivery strategies which are used in the routine EPI system which includes Static (at health facilities or community level); Outreach (fixed community outreach and/or mobile community outreach) However, door to door strategy will also be used for those priority groups who are above the age of 55 and immobile and those bedridden peoples with co-morbidity. The government has made further prioritization of those target groups in phase 1 taking in to account different scenarios of vaccine availability and based on analysis of global and local epidemiological and scientific evidences and defined who should receive the vaccine sooner than others. Accordingly, those target groups in phase 1 are grouped into Phase 1a and Phase 1b that would have progressive access to the vaccine, based on descending priority. a. Phase 1a (1-10% of total population coverage): is a scenario of very limited vaccine availability for initial distribution. Since frontline workers are not just at risk of being infected but also pose a higher risk of transmitting the virus, it is recommended they are initially prioritized. This is with the assumption that demand for COVID-19 vaccines is likely to outstrip supply, at least initially, it estimates that if COVID-19 vaccines are made available to the country, priority will be given first to protect 3% of the population, this is expected to be sufficient to protect every health and social care worker in the country. This phase also targets those population groups aged > 65 years of age (7% of the population). The major objective of covering those priority groups in Phase 1a is with an objective of protecting the integrity of the health care system, other social care settings and reducing severe morbidity and mortality by reaching out to those who are at most risk (age >55 years). b. Phase 1b (additional 11-20% of population coverage): is a scenario as vaccine supply increases but availability remains limited. This group included those individuals with critical co-morbidities (10%) such as those with HIV/AIDS, TB, Diabetes Mellitus and other chronic diseases.The COVID 19 vaccine introduction strategy has given a higher emphasis to ensuring gender equity. While at a biological level COVID-19 is currently assumed to pose similar risks to men and women, social factors and the distribution of co-morbidities across age and gender introduce different disease burdens from COVID-19 for different population groups. For example, Ethiopia’s health system is highly dependent on female health workers (represent 70% of health sector workers) which puts them in a higher risk of exposure to COVID-19. In line with the global trend, local data confirmed that the pandemic disproportionately affected those with compromised immunity either as a result of age (>55 years of age) or co-morbidities. Hence, the vaccine deployment strategy employs house-to-house visit to reach those who have limited ability to visit health facility or outreach sites to receive the vaccine. Proposed New Activities Component 1. Medical Supplies and Equipment [current allocation US$ 51.4 million; proposed AF allocation US$ US$132.1 million]: the project will provide support for the implementation of priority activities under the Emergency Preparedness and Response Plan, related to inter alia, case management and infection prevention and control, including through the provision of: (a) Project COVID-19 Vaccine in quantities sufficient to vaccinate at least 4% of the Recipient’s population; (b) vaccination supplies needed for activities outlined in the Vaccine Delivery and Distribution Manual including, inter alia, diluents, syringes, and medical supplies associated with the vaccination response; (c) climate-friendly cold chain inputs, including inter alia, LED lamps and refrigerators, (d) maintenance of existing cold chain equipment; (e) infection prevention and waste management; and (f) Project COVID-19 Vaccine storage and transportation. Component 2. Preparedness, Capacity Building and Training [current allocation US$16 million; proposed AF allocation US$63.2 million]: the project will strengthen disease preparedness, coordination and capacity including through support for: (a) Operating costs; (b) the development of a COVID-19 vaccination card, COVID registry, report and analytical tools; training plan for vaccine introduction; (c) deployment of health professionals and training on surveillance, supply chain, and emergency preparedness for climate hazards; (d) development of micro-level Project COVID-19 Vaccine deployment plans at national and sub national levels ; (e) establishment of regulatory measures for the procurement/ importation of Project COVID-19 Vaccine and related supplies; vaccine safety, licensure pharmacovigilance; (f) Project COVID-19 Vaccine inoculation training for front line health personnel; (g) supervision on Project COVID-19 Vaccine safety and Adverse Event Following Immunization (AEFI) monitoring for regulators and EPI officers; (h) strengthening of regional AEFI investigation task force and support for AEFI case investigations; (i) preparation of data protection guidelines (including Personal Data), draft consent forms, developing standard operation protocols (SOP); (j) developing innovative registries for key Project COVID-19 Vaccine target groups, identification of target populations; monitoring and evaluation including establishment of a mechanism to track adverse reactions to Project COVID-19 Vaccines.Component 3. Community Discussions and Information Outreach [current allocation US$6.5million; proposed AF allocation US$2.4 million]: the project will provide support for: (a) human resource capacity for risk communication, (b) the development of social mobilization and community engagement strategies (using local languages) to increase Project COVID-19 Vaccine acceptance and COVID- 19 prevention behaviors; (c) monitor Project COVID-19 Vaccine acceptance/hesitancy; (d) establish compliant handling mechanisms at all levels (Federal MOH, Regional Health Bureau, Woreda Health Office and Facility); and (e) deployment of risk communication officers and other human resources to expand and accelerate Project COVID-19 Vaccine deployment efforts. .Component 4. Quarantine, Isolation and Treatment Centers and regulatory infrastructure [c