Protecting Populations around the Globe: The Role of Field Epidemiologists in COVID-19 Vaccination

The largest vaccination campaign in human history is currently in progress, and Field Epidemiology Training Programs (FETPs) around the globe are playing a major role in making it happen. As the pandemic has raged on, FETP graduates and trainees have deployed to the front lines, playing a critical role in flattening the curve through sustained efforts around disease surveillance, contact tracing, and administration of safe and effective vaccines. Public health systems are still contending with the emergence of new variants of the novel coronavirus, burnout of health care workers, and lack of access to immunizations. FETP residents and alumni, along with millions of other dedicated public health workers from every country, have taken heed to the call for ensuring that immunizations are being administered and health systems are being strengthened.

During TEPHINET’s virtual COVID-19 teleconferences in February and March, FETPs in Brazil, China, Ghana, Guatemala, Honduras, and Pakistan shared their experiences supporting national immunization campaigns in their countries. 
 

Brazil Field Epidemiology Training Program (EpiSUS)

Healthcare workers around the world are contending with increased vaccine hesitancy and misinformation as they work to immunize the global public against COVID-19. Countries have  begun to prioritize adverse event surveillance, utilizing field epidemiologists to investigate post-vaccination adverse events (PVAEs). This is a critical step in increasing vaccine acceptance and better understanding the causal relationship between immunizations and the undesirable and unintentional events that may follow. In Brazil, the Ministry of Health (MoH) enlisted the support of FETP Brazil (EpiSUS) to conduct field investigations in the regions of Parana (11 deaths under investigation), Goias, and Bahia (three deaths) following implementation of the national vaccination campaign. The team worked to confirm outbreak occurrence, describe the event, calculate the incidence of PVAE, generate hypotheses, and propose recommendations. The country has also begun to prioritize vaccines for pregnant women, those under 18 years old, and people who have had anaphylactic reaction to the first dose or any components of the vaccines. Reaching these populations requires a strong health workforce, including trained field epidemiologists from programs like EpiSUS.

China Field Epidemiology Training Program (CFETP)

Implementing a national vaccine campaign requires a strong health workforce to coordinate supply, procurement, and logistics. As people around the globe line up to receive doses of the COVID-19 vaccine, managing vaccine sites and ensuring reasonable wait times is important to public acceptance and compliance. With more than 27,000 vaccination sites in use, the ability to improve efficiency of vaccine sites and to track and monitor vaccine administration is key to building population immunity in China. The CFETP has developed online registration and inquiry forms to reduce queuing time at vaccine sites, while also integrating Electronic Vaccination Certificates into health cards through a phone app. Their dynamic monitoring on China’s Immunization Information System includes the percentage of the target population that received each dose, safety monitoring, vaccine supply, and projected needs. As of February 2021, China has three inactivated vaccines in use, has trained 700,000 vaccination professionals, and administered 40 million vaccine doses with the help of CFETP.

Ghana Field Epidemiology and Laboratory Training Program (FELTP)

As the first country to receive vaccine doses from the GAVI, WHO, CEPI and UNICEF COVAX facility, Ghana worked quickly to train and deploy teams of healthcare workers to administer vaccines. In just 10 days, immunization teams, including FELTP trainees and graduates, were able to administer 308,801 doses of the AstraZeneca vaccine. In general, the FELTP has played a key role in the country’s National Vaccine Development plan, supporting subcommittees that handle vaccination strategies, communication, deployment and immunization monitoring systems, operational research and surveillance, and supply chain processes. FELTP alumni and trainees also serve as members of the COVID-19 Vaccine Readiness and Deployment Technical Working Group.

Guatemala Field Epidemiology Training Program (FETP)

In February, the Guatemalan Ministry of Health (MoH) developed a national plan to facilitate introduction of the COVID-19 vaccine in four phases to preserve the healthcare system, reduce mortality risk and disease burden, and preserve the economy. The coordinating team involved in the national immunization efforts included the MoH, Universidad del Valle, including the Guatemalan FETP, and the Centers for Disease Control and Prevention’s Central American Regional Office (CDC-CAR).  As of March 17, 55,060 people have been vaccinated with one dose of the COVID-19 vaccine.

FETP graduates and trainees, in partnership with CDC-CAR, MoH, and Universidad del Valle, have also been working to better understand the seroprevalence of antibodies against SARS-CoV-2 in healthcare workers. They recently began a study among healthcare workers in the department of Huehuetenango prior to COVID-19 vaccination in an effort to obtain this data and capture the demographic, work, clinical and COVID-19 test access characteristics among this population.  

During the study, the group obtained informed consent, collected serological samples, preserved and transported them, and tested the samples using chemiluminescence (emission of light).

Throughout the data analysis process, the researchers ensured accuracy and completeness of the data by taking ethical considerations into account including potential risks and benefits, and protocol approval. Despite challenges such as ensuring the maintenance of a cold chain, protocol review, and COVID-19 vaccine rollout, they have been able to carry out this important work and engage in problem solving during the study.

Honduras Field Epidemiology Training Program (FETP)

Honduras began vaccinating frontline health workers against COVID-19 in February, with 5,000 doses donated internationally. By mid-March, 48,000 additional doses had been administered to members of the public and non-public health personnel. 

The Honduras Field Epidemiology Training Program (FETP) has been assisting in preparing national, regional, and municipal vaccination plans; training health workers on vaccination guidelines; conducting pharmacovigilance to monitor adverse events to COVID-19 vaccination, and supervising the vaccine rollout to health workers.

Pakistan Field Epidemiology and Laboratory Training Program (FELTP)

By March 22, 2021, Pakistan’s COVID-19 death toll was 13,863 with 630,471 confirmed cases. Vaccine rollout in the country began on February 2 with phase one (vaccinating healthcare workers). Phase two began on March 10 and focused on vaccinating the population over the age of 60. At least one dose of the COVID-19 vaccine has been administered to over 200,000 health workers and 1.5 million older adults.

The Field Epidemiology and Laboratory Training Program (FELTP) has supported Disease Surveillance and Response Units (DRSUs) in their efforts to provide technical support throughout the COVID-19 vaccination process. They have supported the establishment of a vaccine management information system, an Adverse Events Following Immunization (AEFI) surveillance system, and district vaccination centers. They have also been coordinating logistics, and campaign monitoring, supervision, reporting and data management.

A key highlight of their work has been the development of reporting tools for the frequency of data flow in the national COVID-19 vaccination management information system. They have played a key role in collecting and analyzing daily vaccine data to inform vaccination guidelines and reports for stakeholders and health care providers across Pakistan.

FELTP fellows are actively involved in monitoring and supervising COVID-19 vaccination activities in vaccine centers across the country to ensure that they are operating smoothly.