GP Roll out talk - GP version[53]

COVID-19 Update: April 2021 Dr Claire Isham

Clinical Advisor to BOPDHB Vaccine Team

Dr Cayley Ingham

Public Health Registrar Toi Te Ora Public Health

Kia hora te marino

May Peace be widespread

Kia whakapapa pounamu te moana

May the sea be like greenstone

Hei huarahi mā tātou I te rangi nei Aroha atu, aroha mai Tātou ia tatou katoa Hui e tāiki e!

A pathway for us all this day Let us show respect for each other For one another Bind us all together

Overview of the pandemic Pfizer Vaccine Vaccination Rollout plan COVID vaccination in primary care

COVID-19: April 2021 Pandemic declared 11/3/2020 >141 million cases >3 million deaths Internationally – pandemic continues Substantial numbers of new cases & deaths Lockdowns ongoing

COVID-19: April 2021 NZ so far avoided widespread COVID illness/death But economic & social cost Cases ongoing, and outbreak could occur any time Continuing action and readiness required

COVID-19 Vaccination >890 million vaccine doses administered worldwide >183,000 doses delivered in New Zealand (26/4/21) NZ has 4 pre-purchase agreements Pfizer/BioNTech Janssen (Johnson & Johnson) AstraZeneca (University of Oxford) Novavax

Pfizer-BioNTech (Comirnaty) mRNA vaccine 2 doses Minimum 21 days apart (and spaced from other vaccines) Only COVID-19 vaccine with Medsafe approval in NZ so far NZ has bought 10 million doses

Pfizer-BioNTech (Comirnaty) Who cannot have the vaccine: Previous anaphylaxis (severe allergic reaction) to this vaccine or any of its components Cautions for the vaccine: Anaphylaxis to other triggers Immune checkpoint inhibitors (nivolumab, pembrolizumab, atezolizumab and ipilimumab) – current/in last 6 months 2 week gap to other vaccines, 4 week gap to live vaccines (e.g.

MMR) – MOH has now endorsed some flexibility

Pfizer-BioNTech (Comirnaty) ~95% effective (symptomatic COVID-19) Safety: wide testing, millions doses given Risk vs benefit – global pandemic Unwanted effects similar to other vaccines – show an immune response E.g. pain at site, headache, fatigue Serious allergic reaction rare – similar rate to antibiotics

COVID-19 Vaccination - Myth Busting Pfizer vaccine does not cause blood clots It does not change your DNA It has not been ‘rushed’ International cooperation Significant financial backing Minimised roadblocks – data reviewed faster Trials able to enrol large numbers of participants easily Clinical data collected fast – because COVID-19 prevalent Manufacturing plants built in advance

Pfizer-BioNTech (Comirnaty) - Storage and delivery -70deg storage for up to 6 months - fridges in Auckland -20 deg storage for up to 2 weeks - not available yet 5 day (120 hours) - undiluted, thawed +2 to +8 deg 2 hours - pre dilution, room temperature +8 to +30 deg 6 hours - post dilution, room temperature +8 to +30 deg Must be stored in light proof box Vaccine can be moved between locations providing cold chain is maintained

COVID Immunisation Register (CIR) Online system for recording COVID-19 vaccination Requires specific training/ authorisation to access Patient booked into CIR Attends for vaccination - 3 data entry stages in CIR CIR Check in/ Vaccine administration/ Observation and departure Option to add any adverse reactions if required

Vaccination Rollout plan

COVID-19 Vaccine: NZ Aim: 80-90%+ coverage of population ≥16y by end 2021 Approx. numbers (population ≥ 15y) BOP ~210,000 Biggest task health system ever faced

Ministry of Health

Ministry of Health

COVID-19 Vaccination Group 1 - Border and managed isolation and quarantine (MIQ) workers – Now onwards • People working at the border or in MIQ, and the people they live with (household contacts).

Group 2 - High-risk frontline workers & people living in high-risk places - from late March •high-risk frontline healthcare workers •work in a long-term residential environment •live in long-term residential care •older Māori or Pacific person cared for by whānau •in Counties Manukau DHB area & >65y, underlying health condition/disability, pregnant, in custodial setting.

Group 3 - People who are at risk of getting very sick from COVID-19 – From End of May •aged over 65 •have a relevant underlying health condition •disabled •adult in custodial setting.

Group 4 - Everyone - from July •aged 16 or over

BOP Rollout Plan Tier 1 –Port vaccination (1.3.21) Tier 2 a/b – Fixed site Vaccine centres 1st Avenue, Tauranga (commenced 12.4.21), Tauranga Hospital (DHB staff) Whakatane Hospital –(DHB and community staff) Coming soon - Whakatane, Bay Park

BOP Rollout Plan Tier 3 and onwards - mixed models of vaccine delivery Fixed sites Temporary Locality sites (minimum 8 weeks at each site) Mobile services (remote community, housebound) – delivered by DHB, Iwi teams, NGO’s Primary Care/Pharmacy delivered vaccination Primary care supporting vaccination through other sites ......

What would COVID vaccination in primary care look like?

Some practical points 1. MOH will supply the vaccine Minimum 5 vials/tray (enough for 30 doses) 2. MOH will supply some consumables TBC

The following pages will be changing over the next few weeks as the MOH releases new Operational Guidelines for the delivery of vaccines through primary care

MOH Requirements as at 15.4.21 Version 8.0 Administration/Vaccinator Training Identify Staff for training (different pathways for current and future vaccinators + administrators) Each person must have an individual work email address (i.e. can’t be mickey@gmail or nurse@practice.co.nz, must be mickey.mouse@practice.co.nz) Staff set up learning account in IMAC Send staff details to DHB, Staff will be sent a code for the online Vaccinator training course or CIR Admin course On completion of online training DHB team will activate staff within CIR as authorised admin/vaccinators In person training following completion of course recommended

MOH Requirements as at 15.4.21 Version 8.0 Site requirements One way flow (entry/exit areas)through the vaccination clinic Separate area from other work if occurring in a health care facility Adequate screening area and space to allow 1m physical distancing at all stages Adequate space for vaccine storage and preparation - adhering to Cold Chain standards (can be same staff as those delivering vaccine depending on numbers) Medically equipped post vaccination observation area with dedicated staff Security A site assessment and MOH approval must be completed a minimum of 5 days prior to service starting

MOH Requirements as at 15.4.21 Version 8.0 Other requirements/considerations – provider must be able to Order vaccine 1-2 week in advance Schedule bookings and arrange second vaccination according to tier system Chase those who DNA (especially second dose) Upload details to CIR within 48 hours Provide sufficient staff depending on volumes of vaccine to be delivered Coordinate back up list to avoid vaccine wastage Access IT equipment to support CIR + smart phone (per person) to access security codes

Next Steps

Identify your practice contribution to the regional vaccine roll out Identify practice lead and team for vaccine roll out Ensure all relevant staff have individual work email addresses, resus certs etc Complete EOI form - will be available shortly Consider - Running anaphylaxis/vaccine adverse event drill - Additional resources required

COVID-19 Vaccination - Updates and Education Goodfellow unit https://www.goodfellowunit.org/events/covid-19-vaccines Ministry of Health - Awhina app

https://www.health.govt.nz/our-work/diseases-and-conditions/covid-19-novel-coronavirus/covid19-information-health-professionals/covid-19-awhina-app

Immunisation Advisory Centre (IMAC) https://covid.immune.org.nz

RNZCGP

https://www.rnzcgp.org.nz/covid19

COVID-19 Vaccination - Information Sources COVID19.govt.nz

https://covid19.govt.nz/health-and-wellbeing/covid-19-vaccines/

Ministry of Health

https://www.health.govt.nz/our-work/diseases-and-conditions/covid-19-novel-coronavirus/covid19-vaccines

Immunisation Advisory Centre (IMAC) https://covid.immune.org.nz https://covid.immune.org.nz/health-workforce/becoming-covid-19-vaccinator

World Health Organization (WHO)

https://www.who.int/emergencies/diseases/novel-coronavirus-2019