Frontline Perspectives: Vaccine Surveillance with Emerald Norman

Emerald Norman started leading GHSC-PSM’s COVID-19 response efforts for Angola in May 2021. An experienced project manager, she had worked for several organizations in Angola, Namibia, South Africa, and the United States.?

“We started with pharmacovigilance activities. Because COVID-19 vaccines were not part of routine immunization, and the fact that it was a pandemic, there was urgency to boost the surveillance system to monitor adverse events following immunization.”?

“Many technicians were not trained, and the surveillance system was down, so we developed pharmacovigilance materials and training of trainer guides, and in September in 2021, we trained 23 technicians from the Ministry of Public Health and the regulatory agency,” or ARMED (A Agência Reguladora de Medicamentos e Tecnologias de Saúde).

“We then cascaded the training to about 346 technicians from the 18 provinces and 164 municipalities on pharmacovigilance, filling out the notification form, and doing minor case investigations.”?

“Because patients see surveillance centers at each vaccination point, there has been a positive response from the community, knowing that the government is taking interest in what happens to them following immunization.” Patients experiencing adverse reactions also receive follow up phone calls to monitor their recovery. “That consistency has improved vaccination uptake in the past two years.”

The surveillance program, “has been very effective because the staff that we work with are responsible for both COVID-19 vaccination and routine vaccination.” Because of lockdowns and other factors related to COVID-19, routine vaccination decreased, “so we've seen with the surveillance system more cases of illnesses like measles.”

Although COVID-19 response has been focused on one disease, the work can benefit other health areas for the long term. This is as true for pharmacovigilance as it is for other technical areas. “The work that we've been doing to boost the surveillance system has spilled over for routine vaccination, boosting staff capacity to do proper investigations and report? data to follow up cases. Right now, COVID-19 vaccines are transitioning into the routine vaccine program.”

ARMED launched in June 2021, in the middle of the pandemic, so is a new and growing agency. “Because we work with ARMED as part of our training, they saw elements of pharmacovigilance for vaccines that they could incorporate for medication, which is an area they need to branch into.”?

“Because the COVID-19 vaccines are going into the routine vaccination program, the Ministry has a high interest to expand its work for all routine vaccinations.”?

GHSC-PSM also helped boost cold and ultra-cold chains in Angola. “We carried out an assessment of the cold chain and ultra cold chain capacity to make sure that we had enough capacity to receive the vaccines. We helped install the ultra cold chain freezers that the government bought and helped with programming and training of staff in the provinces.”?

“Angola had never received ultra-cold chain vaccines before, so we rapidly had to do standard operating procedures on how to receive, store, handle the vaccines, distribute the ultra cold chain vaccines, and train staff at the central and provincial levels.”

In addition to technical support for distribution, GHSC-PSM later helped distribute vaccines. “In 2022, we received funding to distribute vaccines in all 18 provinces and all the way to 164 municipalities.” Through a third-party logistics provider, “and by equipping MOH vehicles, we have distributed over six million COVID-19 vaccines.”