Public Health Preparedness and

Response to COVID-19 for

UNHCR’s Operations

40th Global Webinar - PHS

27 April 2022
Agenda
General overview of Global Situation

Update on COVID-19 Cases and Vaccine Rollouts

Humanitarian Buffer/Delivery Partnership/NFC update
COVID-19 Vaccine Coverage Assessments, RBAP- Vincent Kahi

COVID-19 Vaccine Coverage Survey, Egypt – Nesrine Bascales

Guidance on Assessing COVID-19 Coverage

Rapid Antigen diagnostic test needs and update

Discussion and AOB

Global Update
COVID-19 Cases and Vaccinations among PoCs
(Week 15)

• Cumulative cases: 257,009 • Cumulative vaccinations:

8,857,811
• Cumulative deaths: 3,159
• Number of persons vaccinated:
• Weekly new cases: 839 5,063,846
• Weekly new deaths: 0 • Weekly new vaccinations: 91,141
• UNHCR has confirmed
*
vaccinations of PoCs in 152
countries
*The internal COVID-19 Dashboard is
14 countries updated each week and provides a
reported case and regional and country overview -
vaccination data this COVID-19 Dashboard
week
Persons Vaccinated – National vs Refugee

Refugee
National Refugee

*UNHCR data as of Week 15 (April 17th )

*National data per WHO https://covid19.who.int/table April 27
General updates on COVAX
• The Delivery Partnership is focusing on 8 countries (rotating) for intensified
support but 34 countries eligible
– below 10% coverage mid-January and off track to reach 70%. 10 countries
identified for immediate support – Afg, BF, DRC, Ethiopia, Ghana, Kenya,
Nigeria, SL, Somalia and Sudan
• Entry points for UNHCR at country level are through WHO and UNICEF.
• Assistance can be sought
o Populations excluded from the rollout;
o Key challenges in realizing higher vaccine coverage in the settings where we are
working
o Urgent funding gaps to support operational priorities
o support the bundling of vaccination with other health priorities and
interventions
• Will rely on humanitarian actors including UNHCR to provide data to justify
request for support
Humanitarian buffer
• 8 applications, five approvals but only two deliveries (Iran and Uganda) and
two withdrawals
• Iran campaign finished in January and Uganda will start in May.
• Other countries are still pending the finalization of the legal agreements
between applicants and Gavi
• Total number of approved doses is 3,387,600 of which 2,451,600 (72%) have
been delivered and 936,000 pending.
o Main problems are post-approval
o Legal guidance developed for applicants
o Aim is to reduce the delivery time to two months by end of May
• Though UNHCR continues to be engaged in the IASC Working Group, policy
discussions around the buffer and efforts to improve we don’t envisage a lot
of need (main value is when there has been active exclusion of populations)
No fault compensation scheme (NFC)
• All vaccines made available or procured through the COVAX Facility have received
regulatory approval or an emergency use authorisation to confirm their safety and
efficacy.
• Vaccines may in rare circumstances cause serious adverse events in some
individuals.
• Normally manufacturers would manage this risk by taking out product liability
insurance; but this is not available at the moment from insurers
• Manufacturers have not assumed liability and are asking others (usually
governments) to take this on (until June 2022 now to be extended until June
2023).
• For low-income countries this was too expensive to cover the liability of
manufacturers
• COVAX - no fault compensation scheme was established
NFC- How does it work?
• No fault compensation scheme (NFC) scheme for AMC countries.
– Only available if the vaccine was administered through COVAX
– In the event of permanent impairment or death
– Easier, faster, simpler, cheaper lower burden of proof for applicants so expected to
reduce claims on manufacturers and through national courts
– Applicants can file claims directly without going through national authorities without
having to go through a lengthy and expensive legal process.
• Any individual in an AMC-eligible country who suffers from a serious adverse
event following vaccination with a COVAX-supplied vaccine can file a claim via the
Program’s web portal: www.covaxclaims.com
• Please reach out to regional public health staff/focal points or HQ if any questions
Assessing COVID-19 Vaccination Coverage
– Asia and the Pacific
Vincent Kahi
China – coverage survey overview
Setting the stage
• Address initial barriers
• Determine RCCE strategies
• Establish needs for surveys in other operations (urban/inclusion)
• Monitoring and evidence-based approaches

• Among the 455 POCs, 417 were aware of the vaccination campaign, and 194 knew
that they could register for the vaccination.
• 79% of POCs were willing to receive the vaccination, and 20% had received at least 1
dose of the vaccine
• Those who were willing but had not yet received indicated
– 1) do not know how to make an appointment (42%)
– 2) are still waiting for the appointment (25%)
– 3) cannot afford the vaccination (13%)
• Unwilling to be vaccinated mainly because they
– 1) are afraid of possible side effects (66%)
– 2) suffer from comorbid health conditions (24%)
– 3) do not think the vaccine is effective (6%)
– 4) cannot afford it (2%). A few refugees only wanted to receive vaccination before their resettlement
departure (2%)
Strategies adopted
Develop an information page about COVID-19 vaccination, including Q&A
on side effects, effectiveness, age and health requirements, and useful links
and hotline numbers.

Discuss the possibility to reimburse POCs for COVID-19 vaccination costs.

Advocate with the central Government for POCs to receive vaccines free of
charge as they have limited financial means.

Advocate on a case-by-case basis with local authorities for those who

cannot get vaccination due to lack of valid identity documents to allow them
to register at the community health centre with their UNHCR certificate.
Iran – coverage survey overview
Participation analysis
UNHCR Iran conducted the Covid-19 Vaccination Coverage Survey in February 2022
focusing on Afghans residing in Iran countrywide.
Iran coverage survey – geographical analysis
# of respondents/HHs residing in % of respondents/HHs by provinces
settlement/urban area (urban area)
Iran coverage survey – vaccination analysis
# of adult members received vaccine % of respondents who received vaccine by
province

Types of vaccines received

Iran coverage survey – vaccination analysis
Reasons for NOT receiving vaccine
Are you interested in being
vaccinated?
(The responders who did not
receive the vaccine)
Malaysia – coverage survey overview
• Multiple/Triangulated Coverage >18 as of 17 Dec 2021
Data Source: Partially
vaccinated
– mySejahtera 1%
database from
Ministry of Health,
Malaysia Not
vaccinated
– Self-update from 40%
POC
Vaccinated
– Data collected by 56%
staff when POC
approached the
office for
processing Vaccinated with booster
3%
Vaccinated Vaccinated with booster Not vaccinated Partially vaccinated
 n
29316
Kedah
5945

Kelantan 160
Distribution Perak
2425
Terengg…

of POC who
3065
1586

are fully
vaccinated Selangor
Pahang
2885
29316

Negri
Sem…
1329
971
Johore
7847

Powered by Bing
© GeoNames, Microsoft, TomTom
 Perlis
48.9%
%
60.4%
Kedah
39.2% 48.5%

Penang Kelantan
37.6%
36.7%
37.9%
Terengg
Perak
%
anu…
50.3%

unvaccinated
by state Selang
Pahang
39.6%
or…

Kuala
Lumpur Negeri
39.7% Sembil…

Melaka
41.5% Johor
36.7%

Powered by Bing
© GeoNames, Microsoft, TomTom
Malaysia – coverage as of April 25th 2022
Partially vaccinated Coverage among adults >18
1%

Not vaccinated
36%

Vaccinated
60%

Vaccinated with booster

3%

Vaccinated Vaccinated with booster Not vaccinated Partially vaccinated

 Lessons learnt
• Length of questionnaire – Has since
been revised
• Attrition for serial surveys
• Easy/quick/Can be integrated into
other surveys
• Evidence-based (barriers), and
supplements administrative data
• Very useful in urban dispersed
population
• Sample size and level of
disaggregation required
• Sampling frame – Reliable database
Upcoming Surveys
• Thailand Survey – 362 individuals
interviewed, 80.7% vaccinated.
Report due next week
• Pakistan – HAUS (in June/July)
• Repeat Iran/China Vaccination
Coverage Survey
• Integration in other surveys
(SES/Nutrition Surveys, etc.)
COVID-19 Vaccine Coverage Survey –
Egypt
Nesrine Bascales
COVID-19
Situational Analysis
§ The situational analysis was conducted
via phone interviews during the period
of November 11-21, 2021

§ A systematic, random sample was

selected from the registered refugees
according to nationality, gender and
governorate of residence.

§ The target was to randomly select a

sample of 1516 refugees who are
registered in the UNHCR database.

§ UNCHCR proGres database was used

to draw the samples.
Main Findings
• The main reason for not receiving the vaccine was ‘Don’t know how to register’.

Main Reasons for not obtaining the vaccine

Don't know how to register 55%
Yes
10.3% Don't know about the availability of a
31%
Covid-19 vaccination
Concerned about vaccine safety and
24%
side effects
Registered to take the vaccine but
No 9%
89.7% have not yet received an SMS
Not knowing that the vaccine is for
3%
free
Not knowing that the vaccine is
1%
available for non-Egyptians
0% 10% 20% 30% 40% 50% 60%
Main Findings
• The percentage of uptake of the vaccine increased by age of the participant.

Obtaining any of the Covid-19 Vaccines by Sex of the participants

Yes No

Female-Headed 7.7% 92.3%

Male-Headed 11.8% 88.2%

Obtaining any of the Covid-19 Vaccines by Age of the participants

Yes No
50 and more 21.5% 78.5%

30-49 9.3% 90.7%

Less than 30 6.9% 93.1%

Main Findings
§ Vaccine uptake increased by the level of education of the participant. It also
increased between Arabic speakers compared to non-Arabic speakers (16% vs. 6%
respectively).

Obtaining any of the Covid-19 Vaccines by Education Level of the

participants
Yes No

university and above 24.2% 75.8%

intermediate 12.3% 87.8%

less than intermediate 6.5% 93.5%

Obtaining any of the Covid-19 Vaccines by Language

Yes No

Arabic Speaker 15.6% 84.4%

Non Arabic Speaker 5.9% 94.1%

Main Findings
• The lack of knowledge about the registration process was higher among younger
participants, while concerns about vaccine safety or its side effects were reported
more by older participants.
Reasons for not obtaining the vaccine Reasons for not obtaining the vaccine by
by sex of the head age of the head

61.6%
52.1% 54.7% 52.6%

34.6%
28.9%
21.6% 20.1%
18.3%
14.7%
10.4% 8.5% 8.6%
6.4% 4.9%

Male-Headed Female-Headed Less than 30 30-49 50 and more

Do not know how to register for the vaccine Do not know how to register for the vaccine
Concerned about vaccine safety or side effects Concerned about vaccine safety or side effects
Do not know about COVID-19 vaccination Do not know about COVID-19 vaccination
Main Findings
• 58% of Participants with an intermediate education had challenges registering for the
vaccine, while 26% of those with a university and above level of education tend to be the
most concerned about vaccine safety or side effects
• The percentage of participants not knowing how to register for the vaccine is high
among non-Arabic speakers (71% vs. 31% respectively), however Arabic speakers are
more concerned about vaccine safety or its side effects (31% vs 10% respectively).

Reasons for not obtaining the vaccine Reasons for not obtaining the
by education level of the participants vaccine by language

71%
54% 58%

36%
26% 31% 31%
18% 20%
9% 7%
5% 12%
10%
3%
less than intermediate university and above
intermediate Arabic Speakers Non Arabic Speakers
Do not know how to register for the vaccine Do not know how to register for the vaccine
Concerned about vaccine safety or side effects Concerned about vaccine safety or side effects
Do not know about COVID-19 vaccination Do not know about COVID-19 vaccination
Egypt Updates § Health Partners supported PoCs
(mainly those with language barriers
and/or lack of internet access) to
register for vaccination via the online
MoHP platform
§ To date, almost 5,000 PoCs have
successfully registered

§ UNHCR together with partners

regularly promote vaccine uptake
through community meetings and
social media

§ Key messages developed and

circulated to all partners to
communicate with communities and
support the registration process

§ UNHCR collaborated with the MoHP,

UNICEF, and WHO to conduct a
social media campaign
Egypt Updates
§ COVID-19 taskforce for the ‘Risk
Communication and Community
Engagement’ group
§ 'COVID-19 vaccination and demand
generation for social and community
workers’ document.
§ UNHCR supported MoHP efforts to
digitize COVID-19 vaccination
information and other relevant
health programmes
§ As of April 16th, 2,521 PoCs received
COVID-19 vaccine doses among
those who registered with the help
of Health Partners
§ 185 received their first dose of
vaccine
§ 2,336 PoCs have been fully
vaccinated
Challenges

Continuous efforts to address vaccine hesitancy

Communicating with communities – multiple languages

(around 65 nationalities)

Refugees and asylum seekers can access vaccination

services directly from MoHP vaccination sites
• Unavailability of disaggregated data for monitoring vaccination uptake
trends for PoCs (registration and vaccine inoculation is integrated with
MoHP)
 UNHCR Guidance note – Assessing COVID-19
Vaccination coverage amongst refugees
Monitoring method What does it measure Limitations Recommendations for use Resources/ tools

1 Routine monitoring
Administrative/ health facility data from Number of doses administered (1st, 2nd, Relies on accuracy of data. Limited use All countries for routine monitoring
UNHCR/ partners or MoH 3rd/booster and coverage) for out of camp settings, unregistered
refugees

https://enketo.unhcr.org/x/AGDNhNCE

Self-reported data from refugees/asylum Number of doses administered (1st, 2nd, Relies on self-reporting, not Countries with limited access to administrative data,
seekers 3rd/booster and coverage) systematic, limited accuracy high out of camp population

2 Surveys

SENS survey Covid-19 module Coverage and reasons for not receiving All countries implementing nutrition surveys https://enketo.unhcr.org/x/cnMqtyRp
vaccine

HAUS survey Covid-19 module Knowledge, attitude, practices and Countries conducting HAUS plus any other country https://enketo.unhcr.org/x/ZQL27lAI
coverage

Standalone Covid-19 module for rapid Knowledge, attitude, practices and Lack of statistical significance and For rapid sampling, can use the Covid -19 module from https://enketo.unhcr.org/x/61ZnwJVE
convenience survey coverage potential bias but provides useful info HAUS alone through call centres, at registration sites,
etc.
UNHCR Guidance note – Assessing COVID-19
Vaccination coverage amongst refugees
Rapid diagnostic test needs & update

• Regional Bureaux compiling

additional country needs not
covered by current orders/
fund unavailability

• Quantity, types of test used in

country

• Unsolicited donations and PSP

cultivation of suppliers
Discussion – questions?

AOB
Save the Date – May 25th
Next Global Webinar

Annual reports and feedback

*12-1:30pm (1.5 hours)