#1KEMENTERIAN KESEHATAN REPUBLIK INDONESIA OPPO A9 2020 DPR SELAMAT HA LANJUT US NASION 29 MEN ROSONGKAN DD 3218 VU 02-22 KOSONGKIN Well ventilated immunization session at community-based health post Drive through COVID-19 vaccination targeting elderly Actions taken/proposed to improve routine immunization coverage and VPD surveillance following the COVID-19 pandemic Speaker: Prof. Dr. Sri Rezeki Hadinegoro/ Head of NITAG Country: INDONESIA#2Overview • Indonesia at a glance • Impact of covid-19 pandemic on the national immunization and vaccine preventable disease surveillance programme • COVID-19 vaccine roll-out in the country • Conclusions • NITAG activities KSI Nda LA KEMENTERIAN KESEHATAN REPUBLIK INDONESIA A pregnant woman received COVID-19 vaccine at North Maluku#3KEMENTERIAN KESEHATAN REPUBLIK INDONESIA INDONESIA AT A GLANCE Population Density Indonesia Source: *Primary Health Center Data 2020, Ministry of Health, Republic of Indonesia ** Indonesia Health Profile 2019, Ministry of Health, Republic Indonesia ***Population target of health program 2021, Ministry of Health, Republic of Indonesia Legend No Data 0-25 km square 25-75 km square 75-150 km square 150-300 km square 300-500 km square 500-700 km square 700-1500 km square >1500 km square Total area: 1.919.440 km² with 17.508 islands 34 Provinces 514 Districts 10.134 PHC⭑ 2877 Hospitals** Total population: 272.248.454*** Live birth: 4.443.095 Under-1: 4.383.561 Under-5: 17.508.398#4KEMENTERIAN KESEHATAN REPUBLIK INDONESIA A child received IPV at Posyandu in North Sulawesi Impact of covid-19 pandemic on the national immunization and vaccine preventable disease surveillance programme#5GERMAS ● • KEMENTERIAN KESEHATAN REPUBLIK INDONESIA Key challenges Routine Immunization 74% decrease on demand related to COVID-19 pandemic due to parents' fear of contracting COVID- 19 Closing of posyandu (community- based health post) and schools Repurposing of health worker and other resources Health workers contracted COVID- 19 Limited supervision and monitoring due to COVID-19 pandemic • Vaccines stock out . • Actions taken/ongoing PETUNJUK TEKNIS PELAYANAN IMUNISASI PADA MASA PANDEMI COVID-19 DIREKTORAT SURVEILANS DAN KARANTINA KESEHATAN DIREKTORAT JENDERAL PENCEGAHAN DAN PENGENDALIAN PENYAKIT KEMENTERIAN KESEHATAN 2020 Developed national guidelines on Immunization during COVID-19 pandemic, May 2020 Finalization of catch-up immunization guidance (on going process) • Increase IEC materials dissemination, promotion and advocacy through social media, cadre, journalist, professional organization • Ministry of Home Affairs instruction letter to support continuation of RI to reopen posyandu and other immunization posts . • Online workshops and trainings on IPC (infection prevention control), defaulter tracking, demand generation New vaccines introduction: PCV and HPV roll out to across country in stages and rotavirus is in planning#6Significant decrease of VPD surveillance performance Cases Cases 250 200 150 100 50 AFP Case Finding 2019-2021 2019 (N= 1879) 2020 (N = 568) 2021 (Jan - Jun; N = 211) 0 Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec 1000 900 800 700 600 500 400 300 200 Suspected Measles Case Finding 2019-2021 2019 (N=8828) 2020 (N=3434) 2021 (Jan-Jun; N= 644) Non Polio AFP Rate 2.5 Discarded Rate 3 2 1 2.66 77.1 NP-AFP Rate & Specimen Adequate 100 90 78.7 80 68.1 70 60 50 40 0.74 30 0.37 20 10 0 0 2019 2020 2021 Non Polio AFP Rate Specimens Adequate 1.9 2 0.5 Discarded Rate - MR 1.01 0.37 100 2019 2020 2021 0 Discarded Rate Target (2/100.000 population) Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Specimens Adequate Decrease case findings in 2020 compared to 2019, 70% of AFP and 61 % of MR • At province level, 32 provinces could not meet NP-AFP and MR discarded rate target in 2020 . • Improved percentage of adequate stool specimens in 2020 26% decreased of polio. environmental specimens tested in 2020 *NP-AFP and MR discarded rate for 2021 is annualized rate Two among 5 MR elimination strategic priorities are off track which are MCV coverage and MR surveillance components KEMENTERIAN KESEHATAN REPUBLIK INDONESIA#7GERMAS KEMENTERIAN KESEHATAN REPUBLIK INDONESIA Key challenges VPD surveillance Repurposing of human resource and funding for surveillance to COVID-19 response (COVID-19 surveillance and vaccination) Higher turnover of surveillance staff during pandemic. Active surveillance (HRR) in hospitals and VPD reporting from private health facilities is not yet optimal Delayed in specimen shipment as due to changes in shipment regulation following COVID-19 pandemic • • Actions taken/ongoing PETUNJUK TEKNIS PELAKSANAAN SURVEILANS PENYAKIT YANG DAPAT DICEGAH DENGAN IMUNISASI (PD31) SELAMA PANDEMI COVID-19 KEMENTERIAN KESEHATAN REPUBLIK INDONESIA TAHUN 2020 Developed national guidelines on VPD surveillance in COVID-19 pandemic, August 2020 to integrate VPD surveillance and COVID-19 surveillance VPD Desk Review to evaluate performance and to formulate strategy in each provinces and district Involving more health workers in health facility (state-owned and private-owned) Increase capacity building of new officers Ensure availability of laboratory supplies for VPD by elaborating external support Strengthen coordination with partners for supporting VPD specimen delivery#8KEMENTERIAN KESEHATAN REPUBLIK INDONESIA COVID-19 vaccine roll-out in the country An elderly received COVID-19 vaccine on a traditional three wheels transportation (becak) at vaccination center#9Coverage (%) 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% 1,468,764 KEMENTERIAN KESEHATAN REPUBLIK INDONESIA Coverage of COVID-19 vaccination (1st Aug 2021) Total Target Population of COVID-19 Vaccination in Indonesia 208,265,720 Stage 1 Stage 2 Health workers Essential public service workers Older people (above 60 years old) Stage 3 Vulnerable population & general Children (12-17 years old) population 1% 32.7% 25.7% 15.0% 40.7% 65.1% 91.3% 90.1% DKI Jakarta 17,327,167 141,211,181 East Java Jambi Gorontalo INDONESIA Central Kalimantan South Sulawesi West Papua Bangka Belitung Islands 15.2% 36.1% 9.6% 24.0% 10.0% 23.9% 9.5% 21.9% 10.4% 21.5% 8.7% 21.4% 11.7% 20.2% 9.2% 19.3% 8.4% 19.1% 8.6% 18.8% 11.0% 18.5% 7.5% 18.3% 11.6% 17.9% 11.0% 17.9% 21,553,118 Banten Southeast Sulawesi Riau 9.8% Bali Riau Islands DI Yogyakarta North Sulawesi Data as of August 1st,2021, 6.30 pm Source: onedata dashboard: https://pen-prod.udata.id/; 1st Dose 26,705,490 87% 12% East Kalimantan Central Java North Kalimantan 17.6% 7.9% West Sulawesi 2nd Dose 17.0% 7.2% 16.9% 6.8% 16.2% ☐ 8.9% 16.0% 7.5% 16.0% 7.2% 15.3% Aceh North Sumatera West Java Target Bengkulu East Nusa Tenggara 7.6% ■ Moderna Sinopharm National coverage: 1st dose: 21.5% 2nd dose: 8.7% 15.2% 8.3% 15.0% Maluku South Sumatera 6.0% West Nusa Tenggara 14.8% 5.5% South Kalimantan 14.4% ☐ 8.1% Central Sulawesi 14.2% 6.8% 14.1% West Sumatera 5.3% 14.0% 6.8% 14.0% Papua West Kalimantan 6.6% North Maluku ■ AZ Sinovac 11.5% 4.6% 9.2% 5.7% Lampung#10Doses administered Doses administered Number of people vaccinated 6,000,000 50% 150.1% 2,000,000 150% 28,000,000 160% 4,851,729 108.9% 40% 26,011,124 1,600,000 120% 99.3% 1,200,000 1,598,963 90% 1,458,546 800,000 400,000 60% Coverage (%) Doses administered 4,500,000 3,179,986 30% 22.5% 3,000,000 14.8% 20% 1,500,000 30% 10% Coverage (%) Doses administered 21,000,000 120% 14,000,000 7,000,000 67.5% 80% 11,687,354 40% 0 0% 1st Dose 2nd Dose Health Workers Doses administered Coverage (%) 0 0% 1st Dose 2nd Dose Older people Doses administered Coverage (%) 0 0% 1st Dose 2nd Dose Essential Public Service Workers Doses administered Coverage (%) 16,000,000 12,000,000 14,106,503 8,000,000 4,000,000 0 100% 963,396 1,000,000 80% 800,000 60% 4,358,074 40% 20% 10.0% 3.1% 0% 2nd Dose 1st Dose Vulnerable population & general population Doses administered Coverage (%) Coverage (%) Doses administered 600,000 400,000 200,000 100% 80% 60% 40% 8,869 20% 3.6% 0.0% 0 1st Dose 0% 2nd Dose Children (12-17 years old) Doses administered Coverage (%) Coverage (%) 2,225,083 (39.3% of the targeted 5,659,560) teachers has received 1st dose; 1,734,363 (30.6%) has received 2nd dose 203,366 army has received 1st dose; 144,912 has received 2nd dose Data as of August 1st,2021, 6.30 pm Source: onedata dashboard: https://pen-prod.udata.id/; Coverage (%)#11KEMENTERIAN KESEHATAN REPUBLIK INDONESIA Vaccine name (Name of manufacturer) Total number of doses given Vaccine safety monitoring (as of 13 July 2021) Cumulative number of AEFI reported Number of AEFI reported for 100,000 doses Serious AEFI (cumulative) Total number of serious AEFI reported Number of Serious AEFI reported per 100,000 doses Number of serious AEFI investigated Causality assessment completed on serious cases Proportion of causality assessment conducted AstraZeneca- 7 350 987 2 888 39.29 37 0.50 37 32 86.49 SKBio Sinopharm (BIBP) 266 073 1 0.38 1 0.38 1 1 100.00 Sinovac 40 862 871 10 108 24.74 254 0.62 254 241 94.88 Causality assessment: • Total 28 cases were classified as vaccine product related assessment, 1 was related to Astrazeneca, 27 were related to Sinovac. • 7 anaphylaxis cases were related to Sinovac, no death.#12GERMAS KEMENTERIAN KESEHATAN REPUBLIK INDONESIA COVID-19 vaccine roll out Key challenges • Vaccine hesitancy in elderly Vaccine safety rumors • Limited accessibility for vaccination Unfamiliar of online registration Rapid changes of reporting and recording mechanism • Procurement and production of vaccine by stages . . • Actions taken/ongoing ROADMAP COVID-19 VACCINATION IMPLEMENTATION AT NATIONAL LEVEL-V.01 Ministry of Health Republic of Indonesia January 2021 • Moving vaccination post closer to community Facilitate transportation for elderly to vaccination center Increase daily target of COVID-19 vaccination (from 1 million to 2 million per day) • Multiple stakeholders coordination and collaboration • Involvement of private sector to accelerate coverage ● • Support from COVAX facility on vaccines and cold chain equipment#13KEMENTERIAN KESEHATAN REPUBLIK INDONESIA COVID-19 vaccine roll out COVID-19 vaccination for people with disability Monitoring COVID-19 vaccination center by the President of Republic of Indonesia Vaccination post at school building targeting elderly BALAI RW Kelurahan Simo Muyo Innovation to use children's carriage (odong-odong) to transport elderly to COVID-19 vaccination post#14NITAG activities in COVID-19 Vaccination • Involved in road map development and implementation of COVID-19 vaccine introduction Involved in technical guidance development of COVID-19 vaccine implementation Active in training of COVID-19 vaccine implementation to healthcare worker Active in adverse event following immunization training to healthcare worker Make review, analysis and recommendations (catch up and school based immunization, support COVID-19 vaccine introduction) KEMENTERIAN KESEHATAN REPUBLIK INDONESIA#15KEMENTERIAN KESEHATAN REPUBLIK INDONESIA Conclusion 1. Improve immunization and VPD surveillance programme performance . Update immunization guidance to include catch up vaccination starting from missed children identification, defaulter tracking and catch up vaccination • Intensify promotion of routine immunization involving local government, professional organization, private sectors, local community and religious leaders and cadre • Optimize supportive supervision using online platform for easy access and real time data monitoring • Integrate VPD and COVID-19 surveillance to optimize case findings and improve community-based surveillance#16KEMENTERIAN KESEHATAN REPUBLIK INDONESIA Conclusion 2. Accelerated measles and rubella elimination effort • Implement national MR SIA in phases to close immunity gap as described in national MR strategic plan Reactivate MR elimination national working group Disseminate fever and rash case definition for suspected measles-rubella case findings especially in health facility. • Ensure availability of MR laboratory supplies#17KEMENTERIAN KESEHATAN REPUBLIK INDONESIA Conclusion 3. COVID 19 vaccine roll-out in the country Increase human resources quantity and capacity to support the vaccination implementation Increase and maintain collaboration with private sectors/institutions to provide vaccination centers Improve and maintain a constant vaccine distribution flow to sub-national levels • Capacity building on new platform of COVID-19 vaccines • Improve communication strategy targeting elderly and other high risk population Strengthening SAE and SAE Special Interest monitoring in the country Sustain data analysis and evaluation of COVID-19 vaccine effectiveness among target population#1813 Terima kasih