Update on COVID-19 vaccination in Syria, 14 June 2021

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Update on COVID-19 vaccination in Syria, 14 June 2021

1. Vaccination rollout in Syria

Syria received the first batch of COVID-19 vaccines (256,800 doses of AstraZeneca SII COVIDSHILD) on 21 April 2021, which were delivered as part of COVAX mechanism. 203 000 doses were allocated for Syrian governorates, including northeast Syria and 53 800 were allocated through Gaziantep to target populations in northwest Syria. In the first phase, the vaccines were allocated for frontline health workers as a priority group.

The online pre-registration platform in Government of Syria-controlled areas was launched on 5May 2021 with support of WHO. The platform is not considered mandatory, and anyone who belongs to priority groups can get the vaccine without pre-registration.

The Ministry of Health started vaccination with AstraZeneca on 17 May 2021. The first governorate to start the vaccination was Aleppo followed by other governorates. As of 2 June, 46 397 individuals in Government-controlled areas received their first dose of vaccination. Overall, the aim is to vaccinate over 100 000 of people in the priority groups. 203 000 doses are divided into 2 phases with the first dose administered in May-June and the second administered within 2 months after the first dose as vaccines will expire in late August. There are currently no clear details as to when the second batch of AZ vaccines will arrive.

2. Northeast Syria

COVID-19 vaccination in northeast Syria is implemented as part of the national immunization programme of Syria, which serves as an overall vaccination framework in all of Syria regardless of areas of control.

The first batch of AstraZeneca vaccines provided to Syria through the COVAX mechanism has been airlifted to Qamishli (Al-Hassakeh governorate) on 3 May 2021. In total, 17 500 doses arrived in Qamishli airport. Out of these 17 500 doses, around 13 320 doses were allocated for Al-Hassakeh governorate, and 4180 doses were allocated for Self-Administration controlled areas of Der-Ez-Zor governorate. Additionally, 6200 doses have been delivered by road to Ar-Raqqa governorate.

Allocated doses for northeast Syria are sufficient to cover 100% of the health workers (approximately 8900) with two doses, which is more than what other governorates received (around 80%). The target vaccination groups are all healthcare workers in public and private health facilities, including those affiliated with the Government of Syria’s Department of Health, Self-Administration’s Local Health Authority, Kurdish Red Crescent, cross-border international nongovernmental organizations, and health workers based in camps.

Prioritizing health care workers is an essential component of COVID-19 vaccination activities in northeast Syria. Health care workers are the frontline service providers who serve local populations as the first point of care in health facilities around Northeast Syria. They play a crucial role in fighting the pandemic; hence their vaccination is of utmost importance.

Health authorities in northeast Syria approved the vaccination for all health workers in Al-Hasakeh, Ar-Raqqa and Deir-ez-Zor governorates as well as parts of Aleppo governorate (Manbij and Ain Al-Arab).

Coordination challenges between health authorities in northeast Syria have been faced since the vaccination campaign was launched. WHO intervened and mediated with health authorities in northeast Syria to agree on operational and technical elements of the vaccination campaign. After a full day of negotiations, WHO was able to bring both sides for the vaccination in Al-Hassakeh Hospital on 25 May 2021, where several health care workers from the Self-Administration were vaccinated by the Department of Health. This has been a trust building exercise and WHO hopes to gradually build upon this first step and expand vaccination to greater number of individuals representing target vaccination groups.

In Al-Hassakeh governorate the vaccination rollout started on 18 May 2021 in limited fixed vaccination sites in areas controlled by the Government of Syria and Self-Administration targeting mostly health workers from the Department of Health. A wide-scale COVID-19 vaccination campaign was launched in Al-Hassakeh governorate on 23 May 2021. A mix of fixed and mobile vaccination teams have been deployed. The vaccination teams are targeting all health workers in the governorate irrespective of their affiliation (government and self-administration). While the Department of Health has mentioned that they would target elderly, people with comorbidities and health workforce as part of the first phase of the vaccination, WHO advocated for prioritization of healthcare workers, before the vaccination was offered to the next priority group (elderly people aged 55+).

As of 9 June, more than 1600 people were vaccinated with AstraZeneca in Al-Hassakeh governorate. Vaccination was administered through seven vaccination points including those based in Al-Hassakeh, Qamishli, Darbasiyah and Amouda.

In Ar-Raqqa governorate, the vaccination in eastern part of the governorate has started on 7 June. The Department of Health has vaccinated approximately 1000 people with AZ. Around 8 fixed vaccination teams in areas controlled by the Self-Administration have been deployed and WHO is following up with the health authorities to get the most up-to-date information.

In the eastern part of Deir-ez-Zoir governorate the vaccination started on 1 June 2021. About 12 fixed vaccination teams are deployed in various areas controlled by Self-Administration to vaccinate the healthcare workers. Several mobile vaccination teams are also deployed. WHO is in contact with health authorities to expand the vaccination efforts. As of 7 June, 809 people have been vaccinated in eastern part of Deir-Ez-Zor.

In Aleppo governorate, 2 vaccination teams are on stand by to access Ain Al-Arab and Manbij, pending the approval from the Self-Administration.

Vaccination priority groups in northeast Syria

Governorate	Population
Governorate	Total population	Over 55	Healthcare workers	Quantity of vaccine (2 doses/prs + wastage)
Al-Hasakeh	988 139	15 472	2951	6492
Deir-ez-Zor	766 453	50 733	2289	5036
Ar-Raqqa	684 196	35 057	2043	4495
Aleppo (Menbij and Ain Al-Arab)	561 364	50 711	1677	3688
Total	3 000 152	241 972	8960	19 712

3. Vaccination process in the camps

Al-Hassakeh governorate

Al-Hol camp

The vaccination campaign started as planned on Sunday, 6 June 2021. Two vaccination points were deployed: one in phase 1 and the second one in phase 3.

The total number of the population over 60 years old is 1168.

There are more than 1600 patients with comorbidities.

Al-Areesha camp

The vaccination campaign started on Sunday, 6 June 2021 in the tents (7 tents for 7 phases).

The total number of the population is 14 200, including 301 above 60 years old.

There are 300 patients with comorbidities.

Deir-ez-Zor governorate

Abu Khashab camp

The vaccination campaign started on Saturday, 5 June 2021.

The total number of the camp residents is 11 296, including 340 over 50 years old.

4. Challenges and mitigation measures in Government-controlled areas and in northeast Syria

Challenges	Mitigation measures
Reaching northeast Syria (especially areas not under Government control)	Active engagement with Government and explore alternate delivery mechanism moderated by WHO hub in northeast Syria. Vaccination activities started targeting health care workers initially; camps as well as older age group might be allowed based on the population turnout.
Insufficient funds to maintain operational costs as Syria is not supported by the World Bank (COVAX does not fund operational cost)	Engaged potential donors, some funding has been secured.
Misinformation, vaccine hesitancy and refusal of vaccination (reach beyond traditional age groups) especially areas out of GoS control.	WHO and UNICEF teams are working on robust demand, risk communication and community engagement strategies. RCCE messages especially in northeast Syria under self administration have been intensified.
Clarity on the future vaccine allocations and type of vaccine that will be shipped to Syria.	The COVAX facility is communicated for upcoming commitments. WHO approached the Ministry of Health to expedite the regulatory processes for potential COVAX vaccines. WHO is in close contact with the Ministry of Health who is providing timely data on the stock dispatches and expiry dates.

5. Northwest Syria

53 800 doses (AstraZeneca SII) are allocated to northwest Syria.

Targeted groups are 21 313 health workers and 25 000 community workers.

Micro-plans for the first targeted group (health care workers) are finalized.

93 newly assigned vaccination teams with 4 members/team were deployed.

Training of service providers took place.

More than 495 health facilities are covered (285 in Idlib and 210 in Aleppo).

Each team vaccinates the health staff of defined health facilities and community workers in non-health NGOs.

More than one visit to each health facility will be conducted to vaccinate the staff.

On Adverse Effects Following Immunization (AEFI) pre-vaccination checklist was developed to be signed by each vaccinated person. Post vaccination monitoring for 20-30 minutes by a designated team member is ensured. Each team has anaphylactic shock kit. 93 AEFI doctors were selected and assigned (one for each team). The AEFI advisory committee of three doctors in each governorate, in addition to a central committee (ERC) was established. Training for Idleb and Aleppo AEFI doctors was conducted.

Supporting supervision will be offered by 9 central supervisors, 2 governorate supervisors, 12 district supervisors, and 23 field supervisors.

The campaign started on 1 May as planned with two teams (one in Idleb and one in Aleppo).

As of 5 June, a total of 17 593 health and social workers were vaccinated.

In Afrin 11 teams were identified after being granted the needed approvals and trained. The campaign started in Afrin on 29 May 2021.

The next target group to vaccinate will be NCD patients.

Vaccination priority groups in northwest Syria

6. Challenges in northwest Syria

There was some hesitancy among the health staff due to the negative effect of rumours in the social media, there is gradual increase in the numbers of vaccinated beneficiaries.

There were some difficulties in coordination with non-health NGOs.

United Nations resolution renewal.

Unclear future of vaccine shipments (dates and quantities).

Vaccinating beyond the 20% of population supported by GAVI.

Fund availability.