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tv   Public Health Experts on Rollout of COVID-19 Vaccines  CSPAN  July 17, 2021 6:58am-8:01am EDT

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strategic and international studies. >> our panelists and katherine bliss will take care of it but my real special pleasure is to welcome executive director henrietta fore who is executive director of unicef.
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you should all know that i am the global president of the henrietta fore and club, and i have been so excited, all week and i've been looking forward to this. i don't have a chance to see her much these days because she's traveling the world on behalf of humanity, into such a splendid thing that she's doing. but i'll be brief to say, brief introduction. she has the most perfect background leading unicef at this time. she had served him she's now the seventh executive director for unicef, phenomenal organization. from 2007-2009, she was the administrator of the u.s. agency for international development and the director of united states foreign assistance. that was perfect training for having background in the international community that
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reaches out to do very good things and important things for humanity. she earlier had served as undersecretary of state for management, so she knows the architecture of internationalism so very well. most important, henrietta fore is the only person i know that made money, okay? she was the director of the mint and she stamped out money left and right for many years. so this is a perfect training because right now she has to go raise money for this incredible mission. so from making money to raising money, henrietta fore is the perfect leader at this time. you know, people don't know, americans don't know, we don't appreciate the enormous good that unicef does in the world. unicef is the largest administrator of vaccines in the world. it is the central partner to the
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global health community that actually provide for the foot soldiers of the field that get out and really put the shots in kids arms and save millions and millions, billions of lives. it's that leadership she is now bringing for unicef to this global campaign to try to get in the front of the terrible pandemic, covid. life is coming back to normal in washington but it is not coming back to normal around the world, and henrietta fore is leading the charge. so i'm so very grateful that she's here today. i'm grateful for her work. executive director fore, welcome, forgive me for my long introduction but it just that so much i wanted to say about you. we're so pleased you are with us today. thank you. please, turn to you. >> thank you very much, jon. and it really is a great pleasure to see you, and thank you to you and csis for programs that foremost and educate as an
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bring the world to us, so thank you very much. so today, this morning, for me also i would like to talk a bit about how we think about act a and covax. because it can sometimes be confusing and yet it's very interesting. it's a new model for the world and we think an effective model. so let me begin. in april 2020 the access to covid-19 tools accelerator which we'd given the acronym of act a come was established in several global health partners. so that we could respond to covid-19 pandemic. it ceased to ensure for fair and i couldn't access to new covid 19 tools, particularly for low and middle income countries. acta brings together public and
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private to indicate come to find solutions, to collaborate and it's at a scale never seen before. it is a global solution for a global problem. it tends to accelerate development production and delivery across three product categories, vaccines, therapeutics, diagnostics all targeting covid-19. and it aims to score a fourth crosscutting pillar focus on health systems. each pillar is defined by specific time bound goals. covax is a vaccine pillar of acta and it is co-convened by the coalition for epidemic preparedness innovation, what we know as cepi, gabi, the vaccine allies, david weigel, and unicef. it aims to provide at least 2 billion doses of approved covid vaccine vaccines by the end of 2021 enabling
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participation economies to protect at least 20% of their populations, prioritizing frontline health workers and other high risk groups. so now let me move to unicef's role. unicef is engaged across all acta pillars, from per cubic for country readiness and for delivery. however, specifically for covax, for the vaccines, unicef plays a critical role in country delivery. and you may say why unicef? is because we currently move to billion vaccines a year for childhood immunizations, things like polio and measles. so let me now turn to supply. unicef has been the covax procurement coordinator dick it is the procurement agency for 82 countries that are a part of the advanced market commitments and
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will get their doses procured with donor funding and 20 self financing countries. not only do we procure and supply vaccines but some ranges, syringe of safety boxes when this range is spent, and cold chain equipment to aid delivery. to date 3.86 billion doses of vaccines have been secured and auction through covax. unicef has shipped 87 million doses top 131 participating countries. and due to global shortages the covax facility is now short over 200 million doses. therefore, we have been very pleased with the announcement from global leaders for additional doses and pledges announced during the g7 meeting. it really is an important step forward and we urgently need vaccine doses now.
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so for country delivery, unicef leads the country readiness and delivery group with w.h.o. at the global that we have developed guidance and tools for countries to help them introduce and scale up vaccine delivery. but we are also on the ground in over 100 countries, and based on our long-standing experience with immunization, we provide technical assistance to countries to ensure that they have the systems and the people in place and trained to receive and scale up the vaccination program here at unicef are competitive advantage is two, one, provide support in areas of in country logistics, two, to work, work on vaccine confidence with the public, (f) (3), to ensure ensure that no one is left behind and that these vaccines also reach the population living in humanitarian context. so now it is critical for all of
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us to be working together in solidarity and to ensure that all the priority groups in all countries have equal access to vaccines. and why is this? first it is for ethical reasons. there's a moral imperative to ensure that there is equal access to covid tools regardless of where you live or how rich you are. second, for epidemiological reasons though it is safe until everyone is safe. without large-scale joint action the pandemic is likely to be more prolonged. as we've seen with the delta and india south asia new ways will emerge with devastating consequences. new variants of concern are more likely to emerge which could alter the trajectory of the pandemic and it could also change the effectiveness of current arsenal of vaccines. and third come for economic reasons the global economy
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stands to lose as much as 9.2 trillion u.s. dollars if all countries cannot access covid-19 tools. even as advanced countries reach optimal vaccination levels by the second quarter of this year, we will lose up to 4.5 trillion u.s. dollars if vaccine rollout in developing countries and economies continues on its current trajectory. investing in acta covax makes sense, good investment since. so what will happen if we do not work together and find necessary action? let me highlight what this might mean for sustainable development and, of course, for children. for sustainable development, even before the pandemic we found that the world was off-track in fulfilling the sdgs across a number of the critical indicators. covid-19 is having a devastating
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impact on all 17 sdgs but especially for the most vulnerable. rolling back the program -- progress were making together for children, unicef is very concerned about the impacts of the covid-19 pandemic, both short-term and long-term, on children's lives and especially for the poorest, the most vulnerable, and the leading of a legacy of increase inequality. so let me share a few examples. we have evidence that essential services have been disrupted as well as critical system such as health, nutrition, water and sanitation, education, child protection and social protection. for example, childhood immunization. while most countries resume delivery of routine immunization services, few have caught up and if reached their pre-pandemic coverage of levels. as you are all aware, education
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has also been severely disrupted during covid-19. a recent unicef report finds that schools are more than 168 million children globally have been closed for almost a full year. young girls especially will pay the heaviest price. and this is why we must work together and now to ensure equitable access to vaccines here but at the moment we are far from this subjective comments let me share a few numbers. number one, to date high income countries have on average administered vaccines the 60 per 100 people, compared with .9 per 100 people in low income countries here that is the differential of 67 times. and second, africa in particular has been left behind. so far the continent has administered around 32 million doses as of june 1, while
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worldwide over 1.9 billion doses have been administered. in other words, covid-19 vaccine inequality is much worse than already existing income inequality. and while we see progress in many countries, now that they've started their vaccination programs, we've also found there are implementation challenges. so here are a few highlights. first, there is a lack of operational funding to plan and to deliver vaccines. without these funds, countries faced challenges to open up enough vaccination sites and have too few qualified vaccinators to scale up the vaccination program. and second, there is a low confidence in government and in the vaccine products, and that is hampering the rollout. we've seen a surge of misinformation and rumors online
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and off-line, and we are observing vaccine hesitancy among health workers but also among presidents and political leaders. and third, with limited supply and his ability in to win the next is coming, many countries have reduced their short-term ambitions for their vaccine programs. charles martha at chad to all talk about their country experiences, but we now see two extremes in our world. some countries have fully used up all of their doses and had to actually stop their vaccination programs due to lack of supply. on the other hand, there are also several countries that signaled that they would not be able to fully utilize their doses before the expiration date. and unicef and partners are working hard to support these countries to quickly export their access vaccine doses to
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other countries who are in need and can utilize them. so going forward we will see a major increase in the number of doses that are shipped until the end of the year. something like a tenfold increase. while this is promising news it will seriously challenge the weakest systems and will once again highlight the inequities and the urgent need to strengthen local primary health care systems. so in conclusion, john, we must work together to build robust and resilient healthcare systems. not only as as a means to ene current pandemic, but to prepare for future pandemics while making sure that every person has access to the health system that they deserve. thank you very much. [inaudible] >> thank you, henrietta fore, for a review of the work unicef is doing globally and at a
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country level. so for the procurement and distribution of covid-19 vaccine come about through covax and the actor so great and by helping countries prepare for the challenges the living vaccines to the calculations. i am so pleased that you are able to join our conversation today. i am a katherine bliss, senior fellow with the csis global health policy center, and as henrietta fore emphasized in opening remarks, , turning the tide on the covid-19 pandemic globally depends to a very great extent on an equitable global distribution of the covid-19 vaccines. last spring in 2020 when covax was established as a vaccine polar of the acta ex libris to give all countries access to what at that point or vaccines still in development. now there are several vaccines available both through covax and on the open market but equitable access particularly for the lower and lower middle income countries has been elusive with supplies limited.
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nearly 200 countries have started delivering covid-19 shots to the population but as henrietta fore emphasized, coverage varies considerably. high income countries and prepared many billions of doses of vaccine and high rates of coverage and nearly 50% of all people who have received at least one dose of covid-19 vaccine are from europe or north america. last week in the g7 countries pledged to donate millions of doses to lower income countries through covax and through bilateral mechanisms but that's not enough to cover the gap and supply. and supplies on the part of the equation. planning, training, delivery and demand for vaccines are equally important elements to consider. go here to join the conversation with henrietta fore and to share their views and perspectives on the rally of rolling out covid-19 vaccines at the country level are three experts with deep experience in managing immunization programs, training health workers and responding to
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outbreaks of diseases. doctor charles akataobi is an epidemiologist and field coordinator with the african field epidemiology network based in nigeria. and it brings a background in preventing and responding to disease outbreak including ebola, cholera and polio and his work leading training and technical support to community health programs into starting to the outbreak of covid-19 in nigeria and delivering covid-19 vaccine. ms. martha and in gaza. chief for international vaccination and travel medicine within ministry of public health in cameroon where she supports the ministries worked won epidemiologist and provides technical assistance to communities seeking temperament and strengthen immunization services including the delivery of covid-19 vaccines. and doctor delta variant is a coordinator -- doctor shyam raj upreti in nepal.
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he brings his experience as a head of fixed and program on immunization and a focus on child health to his efforts to support the response to the covid-19 outbreak and the rollout of covid-19 vaccine. so thank you all for joining the conversation today and thank you to henrietta fore for setting the stage for our discussion. so charles akataobi let me start with you if i could. as of last week nigeria had administered at least one dose of covid-19 vaccine to just 1% of the population. i wanted to ask you to start out by saying, telling us a bit about the status of vaccine deliveries in nigeria. beyond covax has nigeria worked with the african union to secure additional doses? while waiting for vaccines to arrive what activities have you been undertaking in training health workers at the district and local levels to begin to prepare for their distribution?
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>> thank you, katherine. i'm really, really grateful -- [inaudible] especially for the covax to give -- [inaudible] many front-line workers are as also. i want to say thank you. just to answer your question, so we launched -- a lot of experience. one of the things we try to do prior to getting the vaccine was try to -- [inaudible] now when we go out we also identify the capacities especially at the lowest levels.
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[inaudible] including distribution of the vaccine. so what we have done is dropped from that experience especially from this report from senior-level and lower-level, including myself. so sit back to review some of those we had an initial -- and when a significant challenge was we did -- at that allow people to be quickly -- for the vaccine. electronic management of immunization in nigeria. that platform allowed people to -- so we can also avoid
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crowding. [inaudible] and so there's been some issues because that was -- [inaudible] that help us, which we reviewed prior to receiving another batch of vaccine. again, we're going to have or vaccines because we are -- [inaudible] national, state and -- so at national level we have that platform giving the level of -- at that level.
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and and i have sought to manae cost. i've also reduced physical contact but at that level we will be having physical training for those preference and then we will also try to review our training materials downward because primarily on the core thinks -- [inaudible] so in a nutshell i think the country is on track to prepare to receive this batch, and then hopefully we should be completely the rollout of the first stage where a lot of the more -- for the covid -- [inaudible] >> thank you. so martha, let me turn to you. charles akataobi as emphasized the work in nigeria has been taking place in order to really
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develop the ability to schedule people rolling out technology and data systems to begin to prepare for and undertake the delivery of vaccines. you have been focusing your work at the regional level in cameroon where less than 1% people have been able to access doses so far. i just wanted to ask you to say a livid about the vaccine of delivery in the regions n working. do facilities have the storage necessary and our health workers confident that the training they can deliver them? what do you see as the greatest opportunities and needs in the region where you are? >> thank you, katherine, for the question also my colleague from nigeria. at the regional level that the subnational level, where we have come at the level we have, so
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far we have been having up to last friday the 18th we had 2% cooperation for the vaccination for covid-19. so far the delivery status on the level of, from the level because -- and then on the 17th we had also -- so for the region we had 83 doses of the vaccine that was delivered for the region. the main criteria for facilities, for vaccination throughout the country was that they have the function. so for the southwest region where i am, we have 23 vaccination sites. so all of them have function
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that can be able to store vaccine because we don't need -- these vaccines can be stored close to -- which is normally used for immunization. for this region, 185,000 people get that for the covid-19 vaccination. based on the fact we have population greater than 18 including healthcare workers and people with factors such as -- and the rest. this was the target. so far so good. this has been as i said a bit successful despite the fact that a lot of disinformation in rumor. one of the regions in the
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country where it is humanitarian city, that is we have this crisis that has been going on, this is a political crisis for the past four years. it has not been easy. i think from the record we had last week from the southwest region is the least region that has vaccinated for the whole country with four regions out of the 18 health districts -- [inaudible] against covid-19. all this due to the insecurity because a lot of insecurity. these are areas that people -- [inaudible] flee to other parts of the region. so far just 92,000 people have been vaccinated.
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85,000 -- [inaudible] that has been targeted for the covid-19 vaccination. as to what are the greatest needs. we see already from the time that vaccine was introduced in the country,. [inaudible] by april we started already vaccinating in our region. i work as front-line worker. i am really involved in the vaccine. i can say for the time the vaccine came there was no time to set up minimum conditions for introduction. so we paired had did not even have to register, for example, to with copy of the register. [inaudible] we just had to improvise.
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even the trading for the health workers, this training only came two weeks after and there was a lot of inconsistency in this training. so there was a lapse in communication. there was a little time to scale up -- we know any case where we had disinformation and we were, this was not the case so it was really challenge, really still a challenge because without effective communication -- go anywhere with covid-19 vaccine allow in the region which already does that have confidence in the government that is why we have political crisis. we just have everywhere -- it could be worse. what we really need is that communication to scale up and
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the communication should not be that kind of unilateral communication because already we see that relief package -- the most hesitant group. we see community members coming up -- so like yesterday we had to meeting and we would talk about strategy to which health worker, should be communication. for example, what do the medical doctors need to know about the covid-19 vaccination? because not all of them are involved in immunization i get they have to take vaccine because they meet people daily basis. there's a kind of communication that should be focused what should nurses though, what should site is our technician or paramedic staff, everybody should be kind of communication beginning from have national or using national or -- see how
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this go -- importance of the sexting. because one of the challenger is that this is a region of over 3 million people but i think our covid vaccine -- we don't have more than 200 -- it's really difficult for people -- [inaudible] so i'm telling you outreach many people -- [inaudible] and also things that make matters worse is also -- the government is taking serious beginning this year because --
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it is important to communicate this to the people. i think also infrastructure, human resources because we've always had the problem of staffing. country always has facilities understaffed. people understand they are there with immunization with kids, infants. [inaudible] so of a challenge. one owe two facilities for supervision. [inaudible] there is no room, no space. lastly, what i think the region also need as well as a country is a proper committee to manage.
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i part of their committee at regional level but but i tes not -- people from the community -- so i think communication also involve people is a part of the committee it becomes transparent and this helps also develop -- thank you. >> martha, thank you. shyam raj upreti, let me turn to you. martha inco has just emphasize some of the challenges around shifting from a focus, not shifting from a a focus on children in routine but building on that and really focusing on adults. over the past few months nepal has seen a surge of covid-19 cases while also addressing flooding and landslides and working to secure dozens of
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vaccines busy country has administered i think roughly dosis roughly 10% of the population. but could use a bit about what you were seeing in terms of the demands on health workers and the help system prepared is to administer doses of vaccine to adults? and what are you seeing in terms of the status of planning for ensuring delivery to remote or hard-to-reach areas, including those affected by the recent floods? >> thank you very much. first of all i like to thank csis to give me the opportunity to -- really tends to be director for very -- address. [inaudible] the immunizations program in the past is remus strong. [inaudible]
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they are in each and every place. these vaccines are supported by the committee help chamber. they are around half a million. [inaudible] they are trained in doing the covid-19 vaccination we had taken training. this is the way the system is working. second, -- [inaudible] and the distribution network from province to district. so vaccine distribution we are working. and what you say about the landslide -- crisis but usually the immunization system has been -- [inaudible] so that way we have the trained
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healthcare worker, soon the immunization vaccine, really easy to dole out all over the country. >> so henrietta fore, let me turn back to you. charles akataobi, martha go and shyam upreti of all presented some country snapshot but unicef is really working on a global level, long could vaccine for the gavi eligible countries but now as you said to covax the procurement for the advanced market commitment countries, i set of self-sustaining countriee really kind of the ship from a focus on childhood immunizations to adults. what has that expansion been like for the staff and the organization? and beyond working on the procurement of vaccines
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themselves, what activities, how is unicef really working with countries to deliver those vaccines to adults in a way that might be different than the work with children? >> it's a very important question. [inaudible] so joint plan we work together. we're supporting -- so there supported actually so vaccine dissipation system are being supported by -- but covid-19 vaccine also conducting -- [inaudible]
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[inaudible] that application already exist. maybe by july we -- [inaudible] nepal will allow 19 walk-in cooler. that will expand the capacity from the -- [inaudible] so government of japan is supporting nepal to include. [inaudible]
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[inaudible] second, very important -- vaccine confidence. they have supported the government. i support the government to contact many with the media and cooperation. [inaudible] other important think they're doing is social media -- [inaudible] so that way unicef -- very
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supporting the media relations and also this covid-19 vaccinations. >> thank you very much. we are starting to see some questions coming from the audience, but henrietta fore, i want to ask you to say bit about what this expansion has been like for unicef globally, and also all of our speakers have really touched on this issue of vaccine confidence and the work that unicef has done to support the vaccination demand. let me ask you to say a a bit about that work at the global level. >> so thank you, katherine. and as shyam just said, there are complexities when you're on the ground of one of the first ones that you come to us how to finance it. and i think for us globally as unicef, if you are doubling the number of vaccines that come
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through your doors and the amount of personal protective equipment, diagnostic kits, other things that i just needed urgently by the world at large, financing immediately comes to mind for unicef, just as comes to mind to nepal, cameroon or a nigeria. so getting advanced market commitments out means that you have to have some money in the bank, but you can say to a manufacture yes, we will buy-a thousand doses, or 200 million doses of your vaccine when it is ready, and we needed to ship on these terms. so creating good public-private partnerships is one of the most important things that we have learned about in unicef during this pandemic. we already had good public-private partnerships, but we did more of them. they need to be faster, more effective, more at scale.
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and funding is really important for both the country level as shyam just mentioned, but also for unicef at the global level. there's a secondary that we have seen a lot of need for common something that charles spoke about. digital health is coming. it's coming to every country, but not every country as yet can afford it or can put in place. planet, it's very important but you like you some of the digital tools are not available. so we see that there are some initiatives globally such as connecting every school to the internet which would allow every village to be connected, which would allow every hospital or private health clinic to be connected. and these kinds of digital tools can help the world in this pandemic and then the next one. primary health care can use digital innovations, innovations
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that are both frugal and innovations that her sophisticated but did you platforms of country will be very important. and then katherine to your point about vaccine hesitancy and have populations response. so martha's comments about cameroon is something that we are hearing from countries all over the world, and it is particularly strong in countries that have not seen vaccine rollout. so the longer we wait as the world, the more the misinformation gathers, the more concerns and worries. we are hearing in some rural villages they think covid is just in urban centers. rehearing and others they think it is just an adult persons disease, it doesn't catch children, but it does. so what shyam has mentioned about nepal is what we would hope to do in every country, which is to work with the government, to build trust among
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the people, and to make sure that everyone realizes that vaccines save lives and they should come in and be vaccinated. but we're going to need a lot more public-private help so we're going to need handbills on buses, at bus stops. we are going them everywhere. we need businesses to tell their employees that they should get vaccinated, and to tell the friends and the families, and to bring their families in for vaccinations, and to get this out on radio and on television and on digital phones. we will just need every possible way to talk to the populace about confidence in vaccines. >> thank you. thinking about this question of vaccine confidence at country level, charles akataobi, i want to come back to you for a second. given the limits on supplies of covax provided vaccine with the surge of infections in india,
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the thousands of exports, nigeria, the rationing doses of astrazeneca, able to wait on second doses until later this year, last week the national primary health care 11 agency noted the rationalist a logger nessie and a second shipment is expected in august. but as henrietta fore has just said, the longer there is a wait, that allows more time for concerns and misinformation to be generated. i wanted to ask you to say bit about what you are seeing in terms of the financial vaccines in nigeria, and how is health workers and elderly who have been prioritized in the first portion of the campaign, they responded? what messages and communications that all of the speakers have mentioned, what kinds of communications are using is most effective, particularly for those groups? >> thank you very much. so just to highlight -- which --
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nigeria was not set, and so one of the things have did nigeria is for one, polio. we sort of had the structures in place including unicef supported communications platforms at the rural and q&a levels. one of the things really did was try to create -- to support the vaccination, and that help significantly. but then certain, initially there was also, not initially. cities -- [inaudible] and the primary health care manages immunization, so -- [inaudible] we have thought it was a given
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that -- [inaudible] [inaudible] vaccinate health care worker and frontline workers so we had -- so in this vaccine we had frontline workers for covid-19 vaccination. frontline workers -- prioritize the elderly, then later we -- [inaudible] and it subsequently -- [inaudible] that has no comorbidities. we find a lot of hesitancy even among -- so we had to come and just like --
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[inaudible] we had to develop linkages with private sector. we had to have the communication channels. then we had to communicate to thin using the communication structures internally. we had a lot of confidence in. we have to reach out to the healthcare workers at different levels of administration to talk to them and also try to bring together their profession. shyam did just mention, generally in -- including nigeria. so we have to find, and we are using -- [inaudible]
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and that did help a lot. we could also use -- [inaudible] because this is actually -- [inaudible] publicly taking the vaccine so that gives a lot of reassurance to other health workers of the health system to see if our leaders can take this. so use those to show communication that were sent out as messages, public status announcements and also engaged -- [inaudible] a lot of negative communication. to debunk some of the rumors
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with scientific evidence from cdc and others. so this is help significantly to communication in the country. [inaudible] we had challenges. all we did was reached out to -- and who were -- [inaudible] and that has helped significantly. we have not been able to meet all of the challenges. it's a challenge -- [inaudible] thank you. >> thank you.
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shyam upreti, let me turn back to you. we had a a question come in fm the audience asking about the challenges of reaching out to populations that may have language differences, border populations that may have not shared the same cultural affinities, and also just challenges of reaching populations that may be very remote or outside of sort of access to some normal government services. could you say a little bit about how some of the existing and previous work done to the program on immunization address some of the challenges and what the thinking is currently is in nepal? >> i could actually the micro plan -- so for the micro planning we have involvement of the local committee.
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same thing happen in the covid vaccination also. before vaccination each and every village -- develop a micro plan with consultation of local government. my committee, the committee. in that way the local area dropout area -- and based on that that area plan was debunked. second, for the needy we debunked the immediate in different languages. in the past visual languages -- [inaudible] to the local languages. give it in the people's media, give it in radio. so that way the outreach was
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playing. a very important thing for nepal because we've got community volunteers in each and every committee. so that committee -- [inaudible] that way we share with the outreach of the marginalize committee. we are reaching the unreached. [inaudible] like-minded communities. over. >> thank you. martha, i can come on question of reaching out to communities that we not have as much trust in the government come to mention that the region where you've been working has had a four year process of conflict and sort of a lack of trust in
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overall public services. at the same time a a recent sy of some 2500 adults in cameroon late last year set a very high percentage were hesitant to get a covid-19 vaccine and concerned about clinical trials and motives of pharmaceutical companies really underpinning people's fears. this question of misinformation has come up. what do you see as the best messages or communications to really reach those populations that already have such concerns about government services in the first place? >> thank you, katherine. i think as i last said -- we already see that level of hesitancy with people not having
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-- on the other side come underhand i talk about evolving -- involving the committee. this alone gives some kind of confidence that they are involved in what is happening. the information should be -- we saw that little, no time -- [inaudible] also -- and at that time not approved as one of the vaccine distribution.
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[inaudible] [inaudible] [inaudible] just a few weeks after -- so there's no time to communicate all these things to people. [inaudible] so i think engaging community at every level for vaccine implementation or rollout really, really important.
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because you cannot leave out -- you want to be vaccinated in whatever planning you are doing. that called for some kind of doubt especially in conflict white house. and then also the people also -- like risk assessment. their reassessment, healthcare workers, for example, healthcare workers, one of the reasons from assessment we have done, the health worker, the flood we see, covid-19 -- [inaudible] for the health workers been vaccinated, these are health workers who are --
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[inaudible] so the really needs to be, to explain to them this -- they live in the community where they spend most of the time and they come back to the place of work where there working at. so if you don't understand certain concepts come certain ideas, they don't have logic of what is happening because everybody -- then they will also affect their community. on the other hand, if the committee is also involved in what is happening, they may also affect the beef of the health worker. [inaudible] all of has to move. ..
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all of them are coming in we include them. thank you. >> thank you. you opened our session this morning with an overview of work at the global level and global needs and challenges have evolved in the past year and a half of the pandemic. let me turn to you for some final questions both on the reality of the covert vaccines, what your are most concerned
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about are optimistic about as you look ahead the next two or three years. >> thank you. i think what i'm most concerned about as many of these countries have fragile health systems for us the world to think of it is going to be like structural as you opened the remarks so it's also getting routine immunizations, clean water and a bar of soap and a school or a clinic and making sure donors don't get too fatigued but we haven't jam coming out of covert, to really reimagine the education system and our world and use remote and distant learning. we have a chance to read look at water systems so we can have better hygiene and sanitation and we have a chance to really look into mental health, it's going to be a big issue all
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around the world out of covert but especially for the young generation so you put your focus on the most important, which is the country and there was a question in the checkbox from stacy, 1 dollar spent to procure vaccine needs to be compared with $5 helping health system in our country. the local country is where the action is now. it's a race against time to try to keep the world healthy and we can use the help of anyone so anyone who can project and help, we'd appreciate and would love to add some thoughts into the check after this. thank you. >> thank you. tanya, marie, thank you for joining the conversation this
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morning. thank you all and the audience for participating in this discussion and the reality of rolling out covert vaccines thank you for participating

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