When the World Health Organization (WHO) announced that this year’s Northern Hemisphere flu season was officially under way in Europe, Armenia was well prepared. Armenia joined PIVI as a partner country in November of 2014, when it received a contribution of 60,000 doses of influenza vaccine provided by Green Cross, a South Korean biopharmaceutical company and PIVI contributing partner. The vaccine arrived in early December, only a few weeks prior to the start of the Northern Hemisphere flu season, and the timing presented a challenge to the Ministry of Health (MoH) in Armenia to distribute and administer the doses as rapidly as possible. Fortunately, the MoH rose to the occasion. By leveraging its solid immunization infrastructure and good organizational relationships and planning carefully, the MoH made strategic decisions that facilitated the quick and efficient distribution and administration of the doses, providing protection against the flu for individuals in high-risk, priority populations.
A solid immunization and disease preparedness infrastructure is a key asset for an immunization campaign, providing a network of resources and personnel that the campaign can access and leverage. In Armenia, the Expanded Program on Immunization (EPI) provided that infrastructure and as a result, the vaccine was distributed and administered quickly and efficiently. The EPI in Armenia regularly collaborates with various governmental and non-governmental organizations and has decades of experience using its network to organize and facilitate vaccinations for a number of diseases, including tuberculosis, diphtheria/pertussis/tetanus (DTP), hepatitis B, measles, and polio. With the EPI leading the vaccination campaign, the MoH was able to access the EPI network and quickly distribute the doses to polyclinics and care facilities where the doses could then be administered. Ultimately, the vaccination campaign went so well the MoH is working to secure an order of vaccine doses for the 2015-2016 flu season.
At the core of PIVI’s success is the fact that it is a partnership: each partner contributes its resources and expertise to protect individuals from the flu and its complications and to provide organizations with valuable experience in pandemic preparedness. Collaboration ultimately brings progress. Armenia exemplifies the partnership aspect of PIVI: good working relationships between the MoH and other national partners provided the access and resources needed to make sure the vaccine was distributed and administered quickly and to those who would benefit most from it. Working with the Ministry of Labor and Social Affairs (MoLSA), which operates the country’s orphanages, the MoH arranged for administration and storage of both rounds of the vaccine doses needed to protect the children in their charge. The MoH also tapped into its relationships with other national partners to distribute the doses quickly and efficiently to target populations at their work sites. Good relationships between the MoH and the MoLSA as well as between the MoH and other national partners enabled the quick, organized, and comprehensive administration of a large portion of the 60,000 doses of vaccine.
Thoughtful planning was an essential part of making the influenza vaccine doses available to those who received it. With the vaccine arriving in mid-December and the flu season likely to begin soon thereafter, the MoH needed to ensure that the doses were given out immediately in order for the vaccine to be effective. Engaging other national partners was one way to make sure that happened. Another way in which the MoH ensured a smooth and effective distribution of the vaccine was in its acknowledgement of the importance of providing two doses of vaccine for children and, with that in mind, immediately allocating the appropriate number of doses for the children in orphanages that were vaccinated. By setting aside the total number of needed doses for the children right from the start, the MoLSA could easily implement the second round of vaccinations without delay. As only a portion of the doses were allocated to the government and MoLSA, the MoH needed to ensure that the remainder, intended for other risk groups, would be accepted: they needed to get the target, high-risk populations engaged and eager to be vaccinated. The MoH addressed the issue of creating demand by inviting a group of journalists from popular media and news outlets to participate in a workshop prior to the start of the vaccination campaign. The workshop gave the MoH a chance to provide the journalists with information about the vaccine and its benefits. Holding the workshop prior to the campaign start gave the journalists a chance to sensitize the public to the vaccine. Consequently, acceptance of the vaccine among target populations was high and negative press about the vaccine was non-existent.
Ultimately, the Armenian MoH was able to direct the 60,000 doses to individuals in high-risk groups, including children in orphanages, pregnant women, healthcare workers, individuals in care facilities and intensive care units, as well as to government personnel. Uptake was high overall and the MoH is already working on how it will secure more doses of vaccine for next year (a request to UNICEF for assistance in purchasing 15,000 doses for the 2015-2016 flu season is in the works) and ensure that coverage among high-risk groups – especially pregnant women – can be as comprehensive as possible. While the Armenian MoH faced challenges in the execution of this PIVI-facilitated immunization campaign they were able, nevertheless, to leverage the assets they had in order to create a well-designed, thorough distribution plan that allowed for maximum protection and minimum waste.