Periodic Reporting for period 6 - EBODAC (Communication strategy and tools for optimizing the impact of Ebola vaccination deployment – Sofia ref.: 115847)
Reporting period: 2020-01-01 to 2020-11-30
The Ebola virus disease (EVD) epidemic infected more than 28,000 people and killed more than 11,000 from March 2014 to December 2015, most of them in Guinea, Liberia and Sierra Leone (WHO Ebola Situation Report June 10, 2016). To date two vaccines for the prevention of EVD have received approval from the European Commission, the Johnson and Johnson (2020) and the Merck vaccine (2019). The Merck vaccine has also received approval from the Food and Drug Administration (FDA) in 2019. The overall objective of EBODAC is to develop a communication and community engagement strategy, including the development and deployment of appropriate technologies and tools, to maximize the impact of Ebola vaccination. Complex social and cultural hurdles may impact vaccine acceptance by local populations. In the scenario of an Ebola vaccine deployment, ensuring adequate population coverage is essential. Vaccination acceptance and compliance with the 2-dose vaccination regimen is critical to high vaccination coverage. This includes the development of solutions for correctly identifying individuals returning for their second vaccination and reminding them of clinic visits. Given the current regulatory status no national deployment of the J&J vaccine has taken place yet but a large-scale campaign targeting two districts in Rwanda has been supported by EBODAC. EBODAC deliverables include the development and implementation of:
1. A communication and community engagement strategy and tools to increase acceptance of and compliance with Ebola vaccination and build trust in vaccination with the broader population,
2. A mobile technology platform to allow effective recall of vaccine recipients to receive the second vaccination in the context of a heterologous prime-boost vaccine regimen,
3. An identification tool that ensures that the right person will receive the second vaccination in the context of a prime-boost vaccine regimen.
Given the new EVD outbreak declared by WHO in DRC, EBODAC have assessed support they can deliver in DRC and surrounding countries: Uganda and Rwanda.
1. A communication and community engagement strategy and tools to increase acceptance of and compliance with Ebola vaccination and build trust in vaccination with the broader population,
2. A mobile technology platform to allow effective recall of vaccine recipients to receive the second vaccination in the context of a heterologous prime-boost vaccine regimen,
3. An identification tool that ensures that the right person will receive the second vaccination in the context of a prime-boost vaccine regimen.
Given the new EVD outbreak declared by WHO in DRC, EBODAC have assessed support they can deliver in DRC and surrounding countries: Uganda and Rwanda.
EBODAC supported the EBOVAC-Salone vaccine study and the PREVAC study until 29th June 2019 and November 2019 respectively. Both studies were undertaken in Kambia, Sierra Leone. All 3 components of the EBODAC project have been developed and adapted to the different age cohorts that were recruited in the studies.
Potential barriers & opportunities for the clinical trials have been identified and communication has been adapted accordingly. Messages, communication materials & strategies have been updated in line with the evolution of the trial designs.
Due to the community engagement activities and efforts since the beginning of the project, enrolment into the EBOVAC-Salone and PREVAC trials was completed in 2018.
The mobile technology platform supports the clinical team to effectively recall participants to receive the 2nd vaccine or attend clinic visits and has been successfully deployed and adapted to the needs of a multilingual population with a high rate of illiteracy and lack of familiarity with clinical trials. The ability of the mobile platform to generate daily clinic reports for the clinical trial staff has also been of added value to the clinical team.
A biometric identification (ID) tool combining fingerprint and iris scan was chosen, accepted by study participants and successfully used to register & recognize EBOVAC-Salone clinical trial participants. A mobile version of the biometric ID tool using iris scan on a portable tablet is currently in use in PREVAC.
A Mobile Training and Support (MOTS) service aims to strengthen the training Ministry of Health and Sanitation (MoHS) provides to Community Health Workers (CHWs). Trainings, initially focusing on the importance of immunization & outbreak response, are given through mobile phones without the need of a Smartphone. A pilot of MOTS was executed in Bo, Sierra Leone and was subsequently rolled out to CHWs in Kambia, Sierra Leone and to the Umurinzi campaign in Rwanda. The goal is to make MOTS a mobile phone flexible training tool that can be expanded in terms of content, geography and transferred to Sierra Leone MoHS and other countries as a legacy of EBODAC. MOTS was transferred to Sierra Leone MoHS in 2020.
Following extensive stakeholder engagement and dialogue, official MoHS permission to implement EBODAC’s Gap Analysis Project has been granted in Sierra Leone, Senegal and Uganda and Project Steering Committees have been convened in each country. A rapid literature review and expert consultation activities have been conducted across the three project countries, engaging more than 220 individuals. The results from both processes have been synthesised and triangulated to build a sound evidence-base for the development of a Gap Analysis Tool for EVD. The tool was drafted, and training of moderators and facilitators was conducted, subsequently, the tool was piloted in Sierra Leone, Senegal and Uganda in October 2019. A quick assessment with the tool has been performed in DRC to determine real utility in an outbreak setting. In addition, a digital Gap Analysis tool has been developed in 2020 for use by MoHS across sub-Saharan Africa to help determine readiness to deploy an Ebola vaccine.
A request has been made by WHO to the Janssen partners to customize the iris scanning tools developed in EBDOAC to help support their trial to assess COVID-19 vaccines.
Potential barriers & opportunities for the clinical trials have been identified and communication has been adapted accordingly. Messages, communication materials & strategies have been updated in line with the evolution of the trial designs.
Due to the community engagement activities and efforts since the beginning of the project, enrolment into the EBOVAC-Salone and PREVAC trials was completed in 2018.
The mobile technology platform supports the clinical team to effectively recall participants to receive the 2nd vaccine or attend clinic visits and has been successfully deployed and adapted to the needs of a multilingual population with a high rate of illiteracy and lack of familiarity with clinical trials. The ability of the mobile platform to generate daily clinic reports for the clinical trial staff has also been of added value to the clinical team.
A biometric identification (ID) tool combining fingerprint and iris scan was chosen, accepted by study participants and successfully used to register & recognize EBOVAC-Salone clinical trial participants. A mobile version of the biometric ID tool using iris scan on a portable tablet is currently in use in PREVAC.
A Mobile Training and Support (MOTS) service aims to strengthen the training Ministry of Health and Sanitation (MoHS) provides to Community Health Workers (CHWs). Trainings, initially focusing on the importance of immunization & outbreak response, are given through mobile phones without the need of a Smartphone. A pilot of MOTS was executed in Bo, Sierra Leone and was subsequently rolled out to CHWs in Kambia, Sierra Leone and to the Umurinzi campaign in Rwanda. The goal is to make MOTS a mobile phone flexible training tool that can be expanded in terms of content, geography and transferred to Sierra Leone MoHS and other countries as a legacy of EBODAC. MOTS was transferred to Sierra Leone MoHS in 2020.
Following extensive stakeholder engagement and dialogue, official MoHS permission to implement EBODAC’s Gap Analysis Project has been granted in Sierra Leone, Senegal and Uganda and Project Steering Committees have been convened in each country. A rapid literature review and expert consultation activities have been conducted across the three project countries, engaging more than 220 individuals. The results from both processes have been synthesised and triangulated to build a sound evidence-base for the development of a Gap Analysis Tool for EVD. The tool was drafted, and training of moderators and facilitators was conducted, subsequently, the tool was piloted in Sierra Leone, Senegal and Uganda in October 2019. A quick assessment with the tool has been performed in DRC to determine real utility in an outbreak setting. In addition, a digital Gap Analysis tool has been developed in 2020 for use by MoHS across sub-Saharan Africa to help determine readiness to deploy an Ebola vaccine.
A request has been made by WHO to the Janssen partners to customize the iris scanning tools developed in EBDOAC to help support their trial to assess COVID-19 vaccines.
Communication and engagement strategies are often developed along with vaccination programs, but the specific context of a clinical trial in an outbreak setting was a unique situation with major challenges that have been successfully overcome. Lessons learnt from this experience, and on the use of enabling technologies, have been shared during the EBODAC symposium. An online training tool and guidebook have been developed to further share these learnings. In 2020 the consortium held a virtual colloquium and developed an EBODAC manuscript and webstory which provides a comprehensive overview of the project and lessons learned. An educational module was developed from the colloquium material and will be disseminated to public health, medical and nursing schools in the US, Europe, Asia, Latin America and Africa with a target of 500 screenings, 100,000 audience members and 500,000 online viewers. At the point of writing this report the biometric identification tools are being customized for use by WHO in their Covid -19 vaccine evaluation study.
The external impacts of EBODAC & EBOVAC1 encompass capacity building for Sierra Leonean staff in Kambia through employment, experience, and training on clinical trials, community engagement, use of mobile, biometric identification (ID), development of MOTS for CHWs and other technological tools.
Local capacity-building efforts to prepare for trials in Sierra Leone and to train local Kambian staff will contribute to building research capacity in the country, including capacity to conduct research in epidemic/outbreak conditions. The successful implementation of educational measures, communication strategies, and mechanisms to ensure proper handling of clinical data will contribute to the optimal performance of clinical trials in Sierra Leone in the future.
The external impacts of EBODAC & EBOVAC1 encompass capacity building for Sierra Leonean staff in Kambia through employment, experience, and training on clinical trials, community engagement, use of mobile, biometric identification (ID), development of MOTS for CHWs and other technological tools.
Local capacity-building efforts to prepare for trials in Sierra Leone and to train local Kambian staff will contribute to building research capacity in the country, including capacity to conduct research in epidemic/outbreak conditions. The successful implementation of educational measures, communication strategies, and mechanisms to ensure proper handling of clinical data will contribute to the optimal performance of clinical trials in Sierra Leone in the future.