Operational guidance: Health workforce and security

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MAY 2021 Operational guidance:

Health workforce and security

This document is part of a series of operational guidance

modules developed to support WHO Member States in

the European Region in preparing for and implementing

COVID-19 vaccination. The modules were developed by a

working group convened by the WHO Regional Office for

Europe and consisting of experts from WHO, partner agen-

cies, academia, Member States and other stakeholders.

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CONTENT

Objective 1

Rationale 1

Key actions 2

Resources 5

Document number: WHO/EURO:2021-2403-42158-58088

© World Health Organization 2021

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Objectives

To provide national health authorities responsible for COVID-19 vaccination with guidance to:

• ensure that a skilled, trained and motivated workforce for COVID-19 vaccination is deployed in good time and in appropriate locations;

• reduce the risk of SARS-CoV-2 transmission associated with vaccination activities.

Rationale

Routine immunization activities (e.g. childhood vaccination, annual influenza immunization campaigns) are usually conducted as part of the regular activities of primary health care (PHC) teams. Because of the moderate target group size in a geographical area for routine vaccination, this represents a fraction of the overall daily workload of the teams, except during vaccination campaigns.

Disruption of routine health services, including vaccination, during the COVID-19 pandemic should be prevented. Scope may exist for these PHC teams to provide some COVID-19 vaccination services, but it is very unlikely that these teams can cover the entire target population within the expected short time period. Reinforcement of the existing teams and creation of additional ones is the only way to ensure that a considerable share of the population is covered within a reasonable timeframe.

Several vaccines for COVID-19 are available, each with different characteristics (e.g. storage, intervals between doses). Various population groups, amounting to millions of people in most countries, will be prioritized, requiring large-scale logistical planning, including the need for innovative vaccination approaches. Vaccine availability will increase with time, intensifying the associated workload, as larger population groups are targeted for vaccination. Staff involved in these activities will require specific training to organize, deliver and monitor vaccination events.

The recruitment of staff to reinforce existing teams or to create ones should be designed to ensure minimum quality requirements are met. Moreover, this process should be quick enough to enable vaccination activities to be implemented in the shortest possible period of time. This may include the use of flexible, innovative and adaptable strategies. In some contexts, the health system may have to rely on volunteers, retired health workers or professionals not usually involved in vaccination (e.g. pharmacists). Experienced existing staff may be priceless in the coordination, integration, training and support of newly recruited or reintegrated workers.

Staff compensation and other associated costs (e.g. insurance, allowances) are likely to be the main expenditure linked to COVID-19 vaccination, after the cost of the vaccines themselves. In some contexts, staff costs have to be shouldered by local health authorities, who may not have sufficient funds to cater to such additional expenses from their regular budgets. Extraordinary financial allocations should be used so that vaccination can be made affordable.

Mass vaccination at this scale may take the form of large events and attendance at vaccination sites. Vaccination sessions, in themselves, may pose a risk of SARS-CoV-2 infection, both for health workers and the vaccine recipients. Health authorities should ensure that the necessary measures are taken to prevent vaccination-related contagion.

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Key actions

Update protocols to organize vaccination sites

• Following the guidance described in the WHO/Europe’s operational guidance on service delivery (e.g. on resource planning, drafting of user flows, production of guidelines by type of vaccine, etc.), national COVID-19 vaccination managers should produce vaccination site protocols.

• The health workforce component of the protocols should define minimum teams and their composition: for example, core vaccination teams comprising a supervisor, vaccinators, auxiliary and administrative/information personnel, which may be assisted by complementary personnel for medical care (in case of emergencies if the vaccination site is not a health facility), site management, transportation, cleaning, etc.

• Involved staff should have clear job descriptions defining their tasks and responsibilities by category.

• In some contexts, where specific COVID-19 vaccine products are indicated for specific target population groups, teams can be organized by vaccine type. This may reduce training needs (focused on one vaccine type) and facilitate delivery organization.

Develop and implement an operational plan, ensuring the availability of adequate staff for the planned vaccination period

Assess the workload (present and potential) that can be absorbed by existing vaccination teams

Vaccination services are usually integrated with the routine activity of PHC (and in some cases hospital) teams. An assessment of the capacity of the existing teams to implement COVID-19 vaccination should be conducted. Issues to consider include the possibility of task shifting, increasing the efficiency of existing operations (e.g. by concentrating some activities in specific periods, changes in working hours, etc.), or reducing non- essential activity – although ideally, the regular service profile (including screening, routine vaccination and others) should be maintained as far as possible. The aim is to estimate how much time could be freed for COVID-19 vaccination. WHO has developed a tool to facilitate workload assessment and projections of staff needs as part of the overall costing

toolhttps://www.who.int/publications/i/item/who-2019-ncov-vaccine_deployment_tool-2021.1

Plan for additional staff needs

Most likely, additional staff will be required to conduct COVID-19 vaccination. Depend- ing on the adopted delivery strategies, new team members may reinforce existing teams or comprise additional teams (e.g. to conduct vaccination in mobile teams or serve care homes). The plan should cover a period sufficiently long to ensure that the entire target population groups can be reached.

Ensure sufficient availability of properly skilled staff

Recruitment procedures may need to be accelerated while maintaining minimum standards of quality, in line with country regulations. Simplified accreditation criteria (e.g. proof of attendance on a recognized online training course) could be enforced.

Vaccination site schedules (described in the operational guidance on service delivery)

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should be used to plan staff deployment and should consider the need for staff re- deployments to meet operational requirements. Depending on local regulations, use of volunteers, retired health workers and others may be considered. The tasks these personnel are able to perform should be clearly defined. Health worker projections should take into account that health worker availability at any one point of time may be reduced because of SARS-CoV-2 infections among the health staff, staff absenteeism due to minor side effects from vaccination or health workers who are at high-risk for COVID-19 due to age or underlying medical conditions.

Team building

Core COVID-19 vaccination teams may be composed of three types of staff:

• vaccinators and supervisors, able to organize and deliver the vaccines

• auxiliary personnel, in charge of preparation and storage, crowd management, etc.

• administrative support, dealing with the call system, registration and vaccination records, etc.

Additional staff may be required to manage the specific requirements of the vaccination sites and ensure transportation, etc. The role of each team member should be described and a simplified job description should be produced.

Staff costs

Existing health staff who are involved in COVID-19 vaccination activities may be entitled to additional allowances because of overtime or displacement from their usual work lo- cation. Staff newly recruited for this campaign may be entitled to compensation accord- ing to national/local standards. Other costs to be considered may include insurance, liability, etc. Additional financial needs should be part of a budget proposal covering the expected period of activity. Usually, extraordinary funds should be made available rather than relying on the regular, allocated budgets. Integration of private sector staff may also have financial implications.

Human resources management

Despite the relatively short operational time, the performance of the COVID-19 vaccination teams should be regularly assessed. Targets can be set for team members, as well as for vaccination sites and areas. Effective monitoring should part of the management responsibility at all levels.

Develop training materials and implement training courses (online and others)

Develop training materials by type of vaccine product

Training tools should cover a range of subjects, which may be different for different team components. Table 1 shows a list of potential topics, from the characteristics of each vaccine to communication with potential users or the community, as well as the in- tended recipients of the training. Job aids have been developed by COVID-19 vaccine manufacturers. Links to access these aids are provided in the Resources section.

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Design and implement short training courses

Skills transfer through hands-on training is preferable if the deployed staff are not familiar with vaccination. However, organizing courses for a relatively large workforce in a short time may be difficult. Online courses are suitable if internet access is available, with the advantage that they can be taken whenever the trainee has the time. Links to several training options are provided at the end of this document.

Possibly make certified training a requirement to join COVID-19 vaccination teams

This training could include, but not be limited to, the experienced vaccinators already providing vaccination services. A list of the courses offered should be made available for prospective vaccination workers. The training materials for such courses should be examined by health authorities, and a certificate of completion should be issued.

Implement IPC measures in all venues where vaccination is conducted Implement/strengthen IPC measures during COVID-19 vaccination activi- ties

Standard IPC measures as per the national guidelines should be implemented by all health workers during any vaccination activity, including COVID-19 vaccine delivery. Ad- ditional IPC precautions are necessary for health workers in the context of the COVID-19 pandemic to reduce the risk of SARS-CoV-2 transmission. Vaccination teams should receive adequate information and training regarding IPC measures for safe COVID-19 vaccine delivery. A clean, hygienic and well-ventilated environment, with appropriate waste management and adequate spaces that facilitate best IPC practices (e.g. physical Table 1.

Potential COVID-19 vaccination training subjects and recipient team members

Subject Vaccinators

/ supervisors Auxiliary Admin support

Vaccine specifics (by type of vaccine product) Priority target groups (eligibility)

Indications, contraindications and precautions Legal issues (e.g. signed consent)

Transportation, storage, preparation and administration Wastage prevention

Side effects

Appointment for second dose

Appropriate use of PPE

Infection prevention and control (IPC) – use of personal protective equipment (PPE), distance- mask-ventilation, waste management

Recording, reporting and tracking of defaulters

Communication with vaccine recipients/communities

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Deploy screening and vaccination scheduling strategies

Screen all staff and individuals arriving for vaccination for signs and symptoms of COV- ID-19. Implement a robust scheduling process for vaccination appointments to avoid overcrowding and facilitate physical distancing and adherence to national IPC practices.

Resources

General guidance

Guidance on developing a national deployment and vaccination plan for COVID-19 vaccines. Geneva: World Health Organization; 2020

https://www.who.int/publications/i/item/WHO-2019-nCoV-Vaccine_deployment-2020.1 , accessed 8 April 2021.

Strategic considerations in preparing for deployment of COVID-19 vaccine and vaccination in the WHO European Region. Copenhagen: WHO Regional Office for Europe; 2020 https://apps.who.int/iris/handle/10665/335940

accessed 8 April 2021.

Training materials and courses

Standard Competencies Framework for the Immunization Workforce. Geneva: World Health Organization; 2018

https://www.who.int/immunization/programmes_systems/workforce/standard_competen- cies_framework/en/

Training recommendations for COVID-19 vaccinators. London: Public Health England; 2020 https://www.gov.uk/ government/publications/covid-19-vaccinator-training-recommendations/training-recommendations-for-covid-19-vaccinators

COVID-19 vaccination training for health workers [online course]. Geneva: World Health Organization; 2021

https://openwho.org/courses/covid-19-vaccination-healthworkers-en accessed 8 April 2021.

COVID-19 vaccines and vaccination explained [online video resources]. Santiago de Com- postela: WHO Collaborating Centre for Vaccine Safety; 2021

https://www.covid19infovaccines.com accessed 8 April 2021.

Job aids by vaccine brand

https://www.euro.who.int/en/health-topics/disease-prevention/vaccines-and-immunization/covid-19-vaccines-and-vaccination/training-materials/covid-19-vaccine-job-aids-and- fact-sheets-for-health-professionals

Pfizer-BioNTech COVID-19 Vaccine [job aids]. NewYork/Mainz: Pfizer-BioNTech; 2021 https://www.cvdvaccine-us.com/product-storage-and-dry-ice

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Preparing the Pfizer-BioNTech COVID-19 vaccine. In: IA Watch [website]. Immunization Academy; 2021

https://watch.immunizationacademy.com/en/videos/759 accessed 8 April 2021.

Staff needs and costs

COVID-19 vaccine introduction and deployment costing tool (CVIC tool). Geneva: World Health Organization; 2021

https://www.who.int/publications/i/item/who-2019-ncov-vaccine_deployment_tool-2021.1 accessed 8 April 2021.

Infection prevention and control

Aide-memoire: infection prevention and control (IPC) principles and procedures for COVID-19 vaccination activities. Geneva: World Health Organization; 2021

https://apps.who.int/iris/handle/10665/338715 accessed 8 April 2021.

Mitigating the impact of COVID-19 on control of vaccine-preventable diseases: a health risk management approach focused on catch-up vaccination. Copenhagen: WHO Region- al Office for Europe; 2020

https://apps.who.int/iris/bitstream/handle/10665/334248/WHO-EURO-2020-1086-40832- 55187-eng.pdf?sequence=1&isAllowed=y

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The WHO Regional Office for Europe

The World Health Organization (WHO) is a specialized agency of the United Nations created in 1948 with the primary responsibility for international health matters and public health. The WHO Regi- onal Office for Europe is one of six regional offices throughout the world, each with its own programme geared to the particular health conditions of the countries it serves.

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