VERIFYING THE SWITCH FROM tOPV to bOPV: GUIDELINES FOR ROTARY

INTRODUCTION

Only two countries in the world, Pakistan and Afghanistan, still have polio (74 in 2015 compared to 334 in 2014). Of the three polio viruses that cause paralytic polio – p1, p2 and p3 – there has been no case due to p2 since 1999. Therefore, the World Health Assembly has recommended a synchronized switch from trivalent oral polio vaccine (tOPV) to bivalent oral polio vaccine (bOPV)that contains only p1 and p3 vaccinesin all 156 OPV using countries and regions during 2 weeks in April 2016.  April 25, 2016 is the date for global switch from tOPV to bOPV. A key component of a successful switch involves effective monitoring of health facilities after the national switch date in all countries to ensure that tOPV is no longer available for administration. This is a prerequisite for the global certification of the eradication of the p2 virus.

There is a two-week window (April 25 to May 9, 2016) when there is to be independent verification and validation that there is no stock of tOPV anywhere and if there are, they are to be returned to the government facilities for incineration and destruction.  The Government will then submit a report to the India National Certification Committee for Polio Eradication.  After May 9^th, that Committee will review the report and conduct its own field verification, on a sample basis, to confirm and validate the switch and submit its report to the Regional Certification Commission.

Potential role for Rotary: The two week independent validation from April 25 to May 9^th is a massive task as it will cover all the districts of the country.  The Ministry of Health and Family Welfare (MOHFW) has made an elaborate plan for implementing the switch. It seems to mainly focus on government sector cold chain storage and service facilities and not much on the private sector - paediatricians, private hospitals and clinics who provide vaccination to children, especially in urban areas.   MOHFW would welcome Rotary’s supportthrough independent monitoring of switch implementation and feedback to the Government on corrective measures.

This document provides step by step guidance on how Rotary volunteers could participate as “independent” monitors to verify if the switch from tOPV to bOPV has occurred.

2.         INDEPENDENT MONITORING AND VERIFICATION OF THE SWITCH

National Switch Day:  April 25, 2016

·         25 April 2016 has been selected as a Switch Day.

·         On this day bOPV administration will be started for all immunization purposes including travelers

·         tOPV and bOPV will not be administered simultaneously

·         This will be followed by 2 weeks validation period to check and ensure that no tOPV is available/used in the immunization program.                      

Objectives of Switch Monitoring

·         Ensure and validate withdrawal of tOPV from all facilities at all levels (primary)

·         Assess introduction of bOPV (secondary)

Verify and Validate: April 25– May 9, 2016 (During the two weeks after the National Switch Day). 

·         Monitors visit cold chain stores and service delivery points.

·         Submit completed reports to the designated supervisor

·         Data reported and aggregated

·         Develop validation report

3.         HOW COULD ROTARY HELP?

Rotary’s role would be limited to urban areas where they live and monitor the switch in private hospitals, clinics and private practitioners who normally administer OPV to children. This task is not at all technical - just checking the availability of tOPV in the facility, reporting and removing them:

A.            At the urban area / municipality level:

Rotary District/area/Polio Plus Chairman[2]

1.       Participate in State and District Task Force meetings for getting an update about the local switch plan and specific local assistance needs.

2.       Coordinate and plan with Municipal Immunization Officers and local WHO-NPSP Surveillance Medical Officers (SMOs) and obtain a list of private OPV stockists/clearing, forwarding agents and private health facilities and clinics that need to be verified.

3.       Advocate individually and with associations of private OPV stockists/clearing and forwarding agents to encourage procurement of bOPV for use in private sector after the switch date.

4.        Advocate individually and with associations of private OPV stockists/clearing and forwarding agents to declare any remaining tOPV to the CMO/DIO on the switch date.

5.        Visit OPV stockists/clearing and forwarding agents post switch to validate absence of tOPV.

B.            At the Club level

·         Obtain from the local coordinator (Rotary polio plus chairman/Rotary coordinator/local SMO) the list of private hospitals, clinics and private practitioner allotted to the club for verification.

·         Participate in a brief orientation

·         Either alone or in teams of two visit all the assigned facilities/clinics.

·         Discuss with the vaccine in charge and visit vaccine storage facilities (refrigerators, cold storage units) to check if there are any tOPV vials.

• Complete the monitoring forms provided (e.g., attached Forms A and B or those used locally)
• Submit the completed forms daily to the supervisors (Rotary Polio Plus Chairman or team leader or SMO)
• Report to supervisor details about left over of tOPV.
• Record any additional observation that may be helpful in identifying problems with the immunization program
• Remove any tOPV found on visits to cold chain stores and service points.

Selection of Volunteers and Supervisors

·         Any Rotarian/Inner wheel member/Rotaractor who has the enthusiasm, energy and some time to spare.

·         Prior participation and pulse polio or other polio related activities is an added advantage.

·         Recommend one Rotary supervisor for every 10.

·         Should have their own transport.

Orientation of Volunteers and Supervisors

·         Trainers: local Government switch coordinator/SMO and Rotary Polio Plus chairman.

·         Trainees:  Volunteer monitors and supervisors in batches of 30.

·         Curriculum: This guideline could be used as the reference.

·         Duration: 2 - 3 hours maximum

Supplies and Logistics:

·         Adequate copies of the guidelines and the verification forms (see attached Forms A and B).

·         List of facilities/clinics to be visited with address, locations and local maps if needed. (There is no need for prior appointments).

·         Plastic bag and sticker in case tOPV are found

·         Contact details of the Rotary supervisors and local SMO for backup support.

·         Volunteers will use their own transport and plan as per their schedules.

Selection of Facilities to Visit

If the list of private facilities is long then a sample of facilities can be taken with priority to the following sites:

·         Facilities where large number of children are vaccinated on a regular basis (e.g., children’s hospitals.)

·         Facilities located in densely populated low income areas (e.g., slums, migrant population areas).

·         Busy private practitioners who may be reluctant to throw away stocks of tOPV that they may have purchased.

Suggestions for successful monitoring visits

·         Explain the purpose of visit to seek cooperation.

·         If necessary carry an ID, visiting cards and an introduction letter from local authorities.

·         Be polite and courteous during interactions to ensure cooperation.

·         Do not make any critical assessment of any problems that may be encountered.

4.         SUGGESTED TIMELINE OF ACTIVITIES

Completion Date	Activity	Who is responsible
Mar 25, 2016	Send guidelines with instructions and letters to the DGs, DPPCs and Club presidents. Follow-up with phone calls.	National Polio Plus Chairman
April 1, 2016	DG/DPPC local polio plus coordinators to meet with the Municipal health authorities and WHO NPSP SMOs to plan Rotary support.	DGs/DPPCs/local polio plus coordinators
April 5, 2016	Obtain from Municipal health authorities/local SMO a list of private facilities that could be visited by Rotary volunteers for verification.	DPPCs, local Rotary coordinators
April 10, 2016	Briefing of the presidents and clubs willing to participate	DGs, DPPCs with the help of local health officials/ SMO
April 14, 2016	Identify/finalize list of volunteers and supervisors ( ideally 10-30 volunteers per city based on the size of the cities and 2-3 supervisors)	DPPCs and club presidents
April 21, 2016	2-3 hour orientation of the selected volunteers about the tasks. Assign to each volunteers or teams of two the list of facilities they should visit during April 25 – May 9, 2016.	DPPCs, local SMO and/or other volunteer trainer
April 25 – May 9, 2016	Verification/monitoring of the sites by the trained Rotary volunteers with the supervisorproviding backup support.	Volunteers and supervisors
May 10, 2016	Supervisors to check and collect the completed forms from the volunteers.	Supervisors
May 11	Submit the complete set of forms collected by volunteers to the concerned authorities – e.g. SMO or other local switch monitoring coordinator.	Supervisor
May 15	Letters of appreciation/certificates from the National Polio Plus Chairman or the DG to the volunteers.	NPPC Chairman/DGs

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[1]This guidelines is based on the WHO document: “Monitoring the Switch from tOPV to bOPV, Guidelines for Developing National Monitoring Plans”, version Feb 20, 2016.

[2] The five points given below are the suggestions from the Ministry of Health and Family Affairs. Dr. Pradeep Haldar’s office.