School children receive oral cholera vaccine in the Cuamba District of Mozambique during a vaccination campaign in 2018. Credit: IVI
The International Vaccine Institute (IVI) and the Republic of Korea’s Global Disease Eradication Fund (GDEF) have agreed to conduct joint projects to fight cholera, which include vaccination for a total of approximately 540,000 people at risk of cholera in Nepal and Mozambique. KOICA GDEF is providing a grant of US$8.05 million to support the project entitled ‘Enhancing Cholera Control’ (ECHO).
School children receive oral cholera vaccine in the Cuamba District of Mozambique during a vaccination campaign in 2018. Credit: IVI
IVI Director General Dr. Jerome Kim expressed gratitude for Korea’s contributions, saying “IVI is very pleased to work with GDEF once again, and the Governments of Mozambique and Nepal in the fight against cholera. While COVID-19 is a global threat, for developing countries, cholera remains an additional significant endemic and epidemic burden. Our collaboration through ECHO will enable us to accelerate efforts to eradicate cholera through the use of Oral Cholera Vaccine (OCV) according to the WHO Ending Cholera Roadmap and contributing to the realization of United Nations Sustainable Development Goals, particularly Goal 3: Good Health and Well-being.”
ECHO, which runs from February 2020 to January 2024, is aimed at preventing and controlling cholera outbreaks through vaccination combined with Water Sanitation and Hygiene (WaSH) promotion, disease surveillance, and other interventions. The ECHO-Nepal project involves an OCV vaccination campaign, which targets about 210,000 residents in Kathmandu Valley and 80,000 residents in the Kailali District of Nepal.
“The ECHO-Nepal project, in collaboration with Johns Hopkins University (JHU), Group for Technical Assistance (GTA), and Epidemiology and Disease Control Division (EDCD) of MoHP, Nepal, will deliver OCV campaigns using an innovative approach called case area-targeted intervention (CATI), which integrates a rapid WaSH response with case area-targeted ring vaccination in the densely populated areas of the Kathmandu Valley,” said Dr. Jacqueline Lim, project lead for Nepal.
In addition to CATI, there are mass vaccination campaigns planned for both Kathmandu Valley and Kailali. Apart from the overall enhancement of laboratory diagnostic and surveillance capacity, about 1,160,000 residents will benefit from enhanced disease surveillance. Ultimately, the data generated from ECHO-Nepal will support the development of a national cholera control plan in collaboration with in-country stakeholders in Nepal. The ECHO-N kick-off meeting will take place on Dec. 2 virtually for partners outside Nepal and with a small in-person gathering in Kathmandu for government partners and key stakeholders. The meeting will discuss planned activities, with updated timelines and challenges, especially in light of the local COVID-19 situation.
The ECHO-Mozambique project aims to contribute to cholera prevention and control in Mozambique in partnership with the Mozambican government. This project includes a preemptive OCV introduction, targeting approximately 250,000 individuals living in cholera hotspots. The project will also strengthen and implement enhanced systematic cholera and diarrheal disease surveillance and assess new cholera cases, transmission, site-specific cholera risk factors, cholera associated health-seeking behavior, and cost of illness in cholera outbreaks. The impact and vaccine effectiveness of the OCV (Euvichol-Plus®) will also be evaluated, and the government’s rapid response and preparedness for cholera outbreaks strengthened. Over 1,370,000 residents in selected cholera priority areas will benefit from these activities, and ultimately the larger population at increased risk of cholera in the country.
“Cholera remains an equally important public health issue that may be neglected during this COVID-19 pandemic. In close partnership with the Instituto Nacional de Saude (National Institute of Health) and the Ministry of Health of Mozambique, and in liaison with the World Health Organization Global Task Force for Cholera Control (WHO GTFCC), we will also provide support for the government’s ongoing efforts to develop a national cholera control and prevention plan through a policy dialogue platform that will be set-up under this ECHO-M project,” said Dr. Se Eun Park, project lead and study principal investigator for Mozambique.” ECHO-M was officially launched November 25 with a virtual kick-off meeting, bringing together key stakeholders in a joint effort to fight cholera.
The campaigns will use the low-cost OCV Euvichol-Plus® developed by IVI and produced by EuBiologics of Korea. OCV is one of the key tools for ‘Ending Cholera—A Global Roadmap to 2030,’ an ambitious strategy launched by the World Health Organization in 2017 to reduce annual cholera deaths by 90 percent by 2030.
GDEF is raised by levying 1,000 Korean won on international flight tickets leaving Korea. The Ministry of Foreign Affairs entrusts Korea International Cooperation Agency (KOICA) to operate and manage the GDEF. In support of its ongoing commitment to the Ending Cholera initiative, GDEF has already supported the Mozambique Cholera Prevention and Surveillance (MOCA) project which provided vaccination, WaSH, and other interventions to more than 190,000 individuals living in communities at risk of cholera in the Cuamba District of Mozambique in 2018-2019.
“Building upon the MOCA project, ECHO will help prevent cholera through vaccination campaigns and training of health professionals. It will enhance surveillance capacity for the early detection and prevention of cholera through strengthened rapid response capacity. Information gathered during this effort will allow development of evidence-based policy for cholera prevention and control in the two countries,” said Dr. Julia Lynch, director of IVI’s Cholera program. “Through these efforts, we will seek to establish a model for the Ending Cholera 2030 initiative in endemic countries.”
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About cholera
Cholera is an acute watery diarrheal disease that can be potentially life-threatening. The disease is caused by ingesting food or water contaminated with the bacterium Vibrio cholerae, and often strikes vulnerable populations in humanitarian crises or countries with poor water, sanitation, and hygiene. Approximately 1.3 million to 4 million cholera cases and 21,000 – 143,000 deaths are estimated to occur every year around the world. Cholera remains endemic in over 40 countries worldwide. The disease is treatable but can kill the patient within hours if left untreated. Currently, there are three WHO-prequalified oral cholera vaccines: Dukoral®, Shanchol™, and Euvichol® (including Euvichol-Plus®), with the latter two developed via a technology transfer from IVI. Each of these vaccines requires two doses for full protection. The WHO recommends a combination of surveillance, water sanitation and hygiene, social mobilization, treatment, and vaccination to prevent and control cholera.
About GDEF
The Global Disease Eradication Fund of the Government of the Republic of Korea is based on the Air-ticket solidarity levy system which imposes a donation of KRW 1,000 on passengers departing from airports in Korea for the purpose of preventing and controlling infectious diseases in developing countries. The GDEF is partnering with diverse actors to develop, test and deliver a range of innovative products to combat global infectious diseases. The Ministry of Foreign Affairs entrusts Korea International Cooperation Agency (KOICA) to operate and manage the GDEF.
About KOICA
The Korea International Cooperation Agency (KOICA) under the Ministry of Foreign Affairs (MOFA), was established as a government agency in April 1991 and is dedicated to providing grant aid programs of the Government of the Republic of Korea. KOICA endeavors to combat poverty and support the sustainable socioeconomic growth of partner countries.
About the International Vaccine Institute (IVI)
The International Vaccine Institute (IVI) is a nonprofit inter-governmental organization established in 1997 at the initiative of the United Nations Development Programme (UNDP). Headquartered in Seoul, South Korea, IVI was the first international organization hosted by Korea. IVI has 36 signatory countries and the World Health Organization (WHO) on its treaty, including Korea, Sweden, India, and Finland as state funders.
Our mandate is to make vaccines available and accessible for the world’s most vulnerable people. We focus on infectious diseases of global health importance such as cholera, typhoid, shigella, salmonella, schistosomiasis, Group A Strep, Hepatitis A, HPV, TB, HIV, MERS, COVID-19, as well as antimicrobial resistance. For more information, please visit https://www.ivi.int
CONTACT
Aerie Em, Global Communications & Media Specialist
+82 2 881 1386 | aerie.em@ivi.int
Date:Tuesday, 29 November 2022
Objectives:
A total of 39 participants from Bangladesh, Malawi, Nepal, and Uganda participated in the webinar, together with those from IVI-RADAAR and EVIPNet/WHO.
The preparatory work outlined in Webinar 7 was to:
Session 15: Presentation of Formative Evidence Brief for Policy
The final Webinar/Session focused on the Presentation of Formative EBP. Participants from Bangladesh, Malawi, Nepal, and Uganda presented their EBP, with a peer review, and feedback and comments from the EVIPNet/K2P team. The session finished with reflections on the next steps, including the potential for scale-up.
Wrap-up and closing
Date:Thursday, 10 November2022
Objectives:
A total of 39 participants from Bangladesh, Malawi, Nepal, and Uganda participated in the webinar, together with those from IVI-RADAAR and EVIPNet/WHO.
The preparatory work outlined in Webinar 6 was to:
Feedback from country teams on preparatory work/progress to date:
Uganda, Malawi, Nepal briefly shared progress and EVIPNet/K2P team commented on the progress.
Webinar Session 13: Organizing a policy dialogue presented by EVIPNet-K2P Center, focusing on how policy dialogues influence the use of evidence in health policy and decision-making including:
Considerations for conducting policy dialogues, i.e., does the dialogue address a high priority issue? Does it provide opportunities to discuss/address the issue, and considerations for implementation? Is there fair representation among those involved in/affected by future decisions related to the issue? Are follow-up activities undertaken to support action?
Preparation for policy dialogues, i.e., informed by pre-circulated evidence on the policy issue.
Stakeholder selection, i.e., degree of involvement in/knowledge about the issue and relevant solutions; ability to constructively engage in discussions; ability to take forward recommended actions within respective constituencies; and the importance of the dialogue facilitator’s role.
Dialogue summary, i.e., tools to outline the results of the discussions during the policy dialogue; and post-dialogue summaries.
Session 14: Data visualization and role of media in policy-making
Group or individual work with support from EVIPNet/K2P
The webinar ended with Group work based upon Session 14.
Wrap-up and closing
The final Webinar (#8) will be a Simulation Meeting: Presentation of Formative EBP, with the objective:
To present the draft formative EBPs among countries teams (peer review)
To propose outreach strategies for EBPs
To reflect on next steps (including potential for scale up)
Preparatory work (prior to Webinar 8): To complete the formative EBP
Presentation slides are available here
Date:Thursday, 27 October 2022
Objectives:
A total of 42 participants from Bangladesh, Malawi, Nepal, and Uganda participated in the webinar, together with those from IVI-RADAAR and EVIPNet/WHO.
The preparatory work outlined in Webinar 5 was to:
Feedback from country teams on progress to date (10 minutes per team)
Uganda, Malawi, Nepal briefly shared progress and EVIPNet/K2P team commented on the progress.
Webinar 6 provided a ‘Refresher: from problem statement to policy options‘ on the content of Evidence-to-Policy Briefs (EBP) including the problem statement, options and elements, and implementation considerations; framing the problem, clarifying its underlying causes, the appropriate types of evidence to use in framing problems, and framing, developing, and expanding on the options/ elements to address the problem. The refresher session finished with ‘Case examples’.
The webinar then focused on
Session 11: Identifying Key Implementation Considerations Framing presented by EVIPNet-K2P Center. Session 11 included: approaches to policy implementation (i.e. ‘top-down’ and ‘Bottom-up’); identifying and addressing barriers to implementing policies; health system, and social and political constraints; and tips on developing the implementation considerations.
Session 12: Overview of EBP outline (and semi-structured interviews/litmus) including: the policy brief outline, e.g., identification of how the problem related to risk factors/disease, to a program or service, and/or to the current health system; viable policy or programmatic options to address the problem; and potential barriers that could influence implementation policy options. The session also covered: stake- holder selection framework for litmus testing, and semi-structured interviews with stakeholders.
The next steps for countries include:
To agree on preliminary timeline for the updated policy brief outlines
To coordinate with assigned team lead for each country team
Group or individual work with support from EVIPNet/K2P
The webinar ended with Group work – using the EBP template – based upon Sessions 11 and 12.
Presentation slides are available here
Date:Thursday, 15 September 2022
Objectives:
A total of 51 participants from Bangladesh, Nepal, Uganda, and Malawi attended the webinar, together with those from IVI-RADAAR and EVIPNet/WHO.
The preparatory work outlined in Webinar 4 was to:
The introduction to the webinar provided: an Overview of methodologies to measure antibiotic use, and the use of surveillance data; the link between AMR and use of antimicrobials; and the integrated national action needed on optimal use of antimicrobials, including through data, surveillance, and monitoring.
The webinar then focused on Session 10: Framing Viable Policy Options to Address a Problem: A Step-by-Step Guide presented by EVIPNet-K2P Center. Session 10 included: Content of EBPs (i.e. problem statement, options or elements, and implementation considerations); Developing options/elements to address the problem (i.e. policy options, and health system/governance/financial arrangements/delivery arrangements); Steps for developing options/elements to address the issue (literature review, thematic analysis, tailoring to the country issue/context, and selecting 3-4 options); and practical examples of AMR and underlying causes to policy options.
A Q&A session followed, with questions on the behavioural and economic dimensions of policy response and options; the specificity and feasibility of options; and appropriate types of research evidence for developing options.
The webinar ended with Group work – with support from EVIPNet/K2P and using the EBP template to:
Identify 3-4 policy options/elements to address the problem and its underlying causes
Date:Thursday, 8 September 2022
Objectives:
A total of 57 participants from Bangladesh, Nepal, Uganda, and Malawi attended the webinar, together with those from IVI-RADAAR and EVIPNet/WHO.
Webinar 4 began with the ‘Feedback on preparatory work’ outlined in Webinar 3, which was to:
Dr Fadi El-Jardali from the American University of Beirut updated participants on the progress of the four countries including: on the topics selected (Uganda on irrational antibiotic use; Nepal on AMR National Action Plan (NAP) implementation [adjudged to be more about the solution than the problem]; Malawi on the utilization of AMR evidence generated at facility/national level and translation into policy [also more about the solution than the problem]; and Bangladesh, which had not yet been reviewed. The review also included country search strategies. The feedback included questions from participants.
The webinar then focused on the next (of the 15) training sessions:
Session 9. Preparing the EBPs: clarifying and framing the problem including:
Knowledge Translation (KT). Which facilitates the process of translating research into policy and action; and KT products which allow evidence generated from systematic reviews – the basic units of KT – to be packaged in a user-friendly format, written in clear language, and with key messages to increase the likelihood of adoption by policy-makers, and resonance among different target audiences. The use of systematic reviews enable policy-makers to scan large bodies of research evidence to address key features of any policy issue of interest.
– Problem statement: A policy problem that summarizes the best available evidence to clarify the size and nature of the problem and its underlying causes.
– Options or elements: Three or more viable policy and programmatic options described.
– Implementation considerations: Potential barriers to implementing the options/elements and strategies for addressing those.
The EBP does not provide recommendations for action.
The remainder of Webinar 4 featured the Group work exercise facilitated by Racha Fadlallah from K2P Lebanon (and support from EVIPNet). The group work comprised four groups – one for each country (including representatives from WHO country offices, and observers from EVIP/RADAAR) – with the aim:
A template was provided by EVIP facilitators (based on the presentation from Session 9) with sections for completion by country groups.
Presentation slides are available here
Date:Thursday, 25 August 2022
Objectives:
A total of 59 participants from Bangladesh, Nepal, Uganda, and Malawi attended the webinar, together with those from IVI-RADAAR and EVIPNet/WHO.
Webinar 3 began with the ‘Feedback on preparatory work’ outlined in Webinar 2, which was to:
Fadi El-Jardali from the American University in Beirut updated participants on the progress of the four countries and provided further guidance for countries on completing these two crucial stages. Malawi was used as an example applicable to other countries, in terms of structuring thinking in relation to identifying the issue, the political context, what has already been done in terms of AMR, what is missing and why, and stakeholder mapping. Country participants summarised their experiences. The feedback ended with a discussion on the priority areas of focus for the Evidence Brief for Policy (EBP), with updates from countries.
Following feedback reporting, the webinar focused on the next two (of 15) training sessions:
Session 7. Designing search strategies to identify and access research evidence on priority topics including: the importance of effective searches (6,500 medical articles published daily); the use of ‘Boolean Operators (e.g., And, Or, Not); identification of search terms; building a search strategy, including formulating the question/issue, choosing appropriate databases, dividing the question/issue into 2 or 3 concepts, generating search terms for each concept, and combining concepts – and search terms within concepts – using Boolean operators; and validating/documenting the search.
An example of a ‘search’ template was presented, and which participants would complete in the group work at the end of the webinar. The template included: the Problem/Issue being addressed, the Options, the Concepts, the Search terms for each concept, and Combining concepts using Boolean operators
The importance of collecting the best available evidence for EBPs was stressed: local evidence and global research evidence from systematic reviews. Guidance was provided on where to search for such information, including local and national databases, websites of relevant organisations, search engines, ‘grey’ literature, and systematic reviews.
Session 8: Understanding the role of systematic reviews in influencing policy decisions including: the Concept of a systematic review; key databases to search – and how to search – for reviews (e.g., Health Systems Evidence, Cochrane, PubMed); a live demonstration of a search on Health Systems Evidence and PubMed databases; and assessing the quality of reviews (e.g., using AMSTAR).
The remainder of Webinar 3 featured the Group work exercise facilitated by Racha Fadlallah and
Lama Bou Karroum from K2P Lebanon (with support from EVIPNet). The group work was comprised of four groups
– one for each country (including representatives from WHO country offices, with observers from EVIP/RADAAR) – with the aim: To develop a search strategy and search key databases for systematic reviews.
A template was provided by EVIP facilitators (based on the presentation from Session 7) with sections for completion by country groups as follows: the Topic/Issue being addressed, the Concepts, the Search terms for each concept, Combining concepts using Boolean operators, and the Databases searched.
Date:Thursday, 18 August 2022
Objectives:
A total of 65 participants from Bangladesh, Nepal, Uganda, and Malawi attended the webinar, together with those from IVI-RADAAR and WHO.
After a brief introduction, Webinar 2 began with ‘Feedback on preparatory work’ outlined in Webinar 1:
The EBP Team is responsible for developing the EBP and conducting key informant interviews (KIIs), hence an appropriate mixture of expertise is key to a successful team, including members with experience in: methods of writing an EBP; administration; evidence search, appraisal and synthesis; technical expertise on the topic being addressed in the EBP; and communication. Each country must also appoint an EBP steering committee to support the EBP development process, comprising: 4-6 multisectoral, multidisciplinary and high-level stakeholders from government/policy-makers/researchers knowledgeable in the topic and able to contribute to the development of the EBP for AMR.
Each of the four countries reported briefly on the steps taken to form the Core Team, Steering Committee, and in identifying AMR stakeholders (some countries had also informed RADAAR/EVIP prior to the Webinar via email).
Following reporting, the Webinar focused on the next two (of 15) training sessions:
Session 5. Understanding the political and health system and outlining key areas to keep in mind when mapping the policy and political context including: the importance of context-specific and actionable evidence, in particular the political/policy context (e.g., characteristics of government structures, civil service – and interests of – policy-making stakeholders, societal values and external factors, such as social and economic); and health system context (e.g., evidence on health system inputs, processes, and outputs and the analysis of how they combine to produce outcomes, such as – the WHO defined – service delivery, health workforce, information, medical technologies, finance, and leadership/governance).
Session 6:Stakeholder mapping including: on stakeholder interests, i.e., concerns over how a policy may impact them; their positions, i.e., degree of agreement or disagreement with the policy; and their power, i.e., capacity to influence policy. The steps in stakeholder mapping include: defining the goal and implications of the proposed policy change; listing interest groups involved in the issue; categorizing stakeholders according to their influence and power over, and level of interest in the issue; determining a strategy to engage relevant stakeholders; conducting KIIs; and presenting stakeholder analysis.
Stakeholders identified include: decision-/policy-makers (e.g., ministries, government agencies, parliamentarians, municipalities); influencers (e.g., NGOs/CSOs, religious leaders, media, private sector); and the public (e.g., those affected by AMR).
A case example from Ghana was presented to highlight the steps in stakeholder mapping.
Webinar 2 concluded with a Group work exercise (with support from EVIPNet/K2P)
Group work was comprised of four groups – one for each country (including representatives from WHO country offices) – with the aim of:
A template was provided by facilitators with nine questions to capture the above details including: the issue; progress made in addressing the issue; previous related policies/laws/regulations; whether the issue is on the government agenda; windows of opportunity; requirements to reach the policy objective; how laws/regulations are implemented to this purpose; stakeholders involved; and the power interplay among/between stakeholders. The questions provided background information to enable completion of full ‘Stakeholder Mapping’ template (including stakeholder, description, name, power, interest).
Date:Thursday, 11 August 2022
Objectives:
A total of 88 participants from Bangladesh, Nepal, Uganda, and Malawi attended the webinar, together with those from IVI-RADAAR and WHO.
After an introduction to evidence-informed policy-making (EIP) and EVIPNet, Webinar 1 included the first four (of 15) training sessions:
Session 1. Brief overview of the policy-making process including: promoting the use of research evidence in policy-making to improve health systems; increasing country capacity in/institutionalising knowledge translation (KT); approaches to increase research utilization; developing evidence briefs to inform health policy deliberations, and assess the impacts of policy options; and the evidence-action cycle, including priority-setting, evidence, convening deliberative dialogue, and policy implementation.
Presentation slides are available here
Session 2: Understanding role of evidence in policy-making process and efforts to support use of evidence in policy-making including: policy process overview; major public policy theories/frameworks; stages in public policy making, i.e., definition, agenda setting, and policy instruments/implementation/ evaluation; importance of robust research/data/evidence, as well as KT tools/strategies; and enhancing awareness/capacity of, and engaging policy-makers/stakeholders early, and sustaining engagement.
Session 3: Knowledge generation and knowledge translation as a spectrum: evidence on establishing and/or strengthening national health research system using a systems approach and the need of cross evidence ecosystem collaboration including: the National health research system (NHRS); WHO guides/ tools; key workstreams of the evidence ecosystem, i.e., partnering for complementary support in decision-making; HO workstreams, i.e., data analytics, guidelines, health technology assessment (HTA), evidence-informed policy-making supports, modelling, and behavioral research; and the evidence ecosystem framework and policy/action cycle.
Session 4: Learning from success stories of EVIPNet Member Countries: development of evidence briefs for policy on AMR including: Slovenia case study on ‘Translating AMR data and evidence into effective policies (EBP development); driving factors, challenges, and lessons learned; importance of a multi-level/sectoral approach; the need to integrate local evidence; the crucial role of Ministries of Health to put options on the political agenda (and sufficient capacity within the MoH and NIPH).
