 Okay, I'm very, very happy to wish you welcome to this webinar on data-driven development of COVID-19 vaccines, achieving equity, coverage and sustainability with DHS2. And of course, we are very happy and I think it's very timely as a natural consequence is that the natural next step after us publishing this COVID-19 surveillance packages, now also working with the vaccine. And I hear that in a couple of weeks time, the first package will be demoed. So this is a natural step in the pandemic that while we're waiting for the vaccine to arrive in countries to plan and prepare for doing the vaccine campaigns and also routine vaccine program. And it's very important for us in the DHS2 community and here at the University also that we are, of course we are working with the partnership already existing, like the WHO, we are working closely with them and also leverage the GAVI's current investment for the immunization program that we have worked with for a long time. But also, nor has catalytic funding is very important for us that we have been able to do this. So what we always do and the reason for the pretty much of a success as of now is actually that we are always focusing on strengthening existing systems and tools and capacity. So we start with the countries that are already using DHS2 that we can add to them to the health information system and the capacity in country and integrate it into the existing information structures that are established for national immunization programs. That's very important in order to be able to scale and succeed and sustain. So with that, of course, we will learn from early local expertise and innovation and we, of course, will be able to be resilient in order to be understanding what we can do in order to be better than we are already. So I'm very happy to hand over the word over to Rebecca Potter that are heading this work for us. And then thank you over. Thank you, Kristen. And thank you all for taking the time to join today. I know many people are very busy. So thank you, Kristen, for the introduction. And we just wanted to take a little time to share with our global community. What it is that we were thinking as countries are really preparing and developing their national delivery and vaccine plans for COVID-19 with a couple of vaccines on the horizon. So our principles around this are really to work through the established technology. We have more than 45 countries that already use DHIS-2 for their national immunization programs. And 36 countries are using DHIS-2 to support their COVID-19 surveillance. We want to work through the existing capacity that's within countries, provide that technical support as close to the field as possible through the ministries themselves and their core teams as well as the 13 regional history groups. And we are looking at a suite of customizable tools. So a lot of what we'll go through today is the existing immunization toolkit that is developed for a range of routine vaccinations that are part of the expanded program on immunization. But seeing how we would be able to expand these designs that are already there and customize a bit to allow the COVID-19 vaccines to be integrated within that. As Kristen mentioned, HIST does collaborate with WHO. We are a collaborating center on health information systems strengthening and implementation research. And part of that has been the development of these health data toolkits with DHIS-2 that are aligning to the WHO's global standards and providing a platform through DHIS-2 to help disseminate those standards for national HMIS systems. We also believe that we're trying to look towards sustainable investments. So we do know that we can use these unprecedented opportunities with the pandemics, with outbreaks that have happened before with Ebola, for example, to be able to strengthen the entire health information system. So rather than build up a parallel solution that is only going to work for COVID-19, using a lot of this momentum around the COVID-19 vaccine delivery to strengthen the entire vaccination delivery platform and systems that are in countries. And lastly, we just think that DHIS-2 being a free and open source global public good, that we will be able to support that in a way that's sustainable for countries. So many of you are already aware, many of you might be coming from countries where DHIS-2 has been implemented to support COVID-19 surveillance and response. But over the last several months, beginning in January of 2020 this year with Sri Lanka, who implemented DHIS-2 for points of entry monitoring and screening for COVID-19, we have expanded a toolkit, a COVID-19 surveillance toolkit that's been adopted by 36 countries. And this is one of the first times we've really tested this WHO health data toolkit at scale in such a short period of time. And so we've had a lot of lessons learned from this experience on the surveillance side that we are hoping to leverage and repurpose for our work with vaccine delivery. So to give us a little bit of a framework for where it is, we are focusing our global toolkit. We took some time as well as many meetings with content experts at the WHO and at CDC to understand a little bit better the recently released interim guidance from the WHO on the national delivery and vaccine plans. So this is a document that's now up on the WHO website and will continue to evolve over the next weeks and months as we learn more about the COVID-19 vaccines. But several things came out pretty clearly. And so some of these goals is that we know that countries will need to be able to measure the uptake coverage and particularly equitable distribution over time and by geography and across risk groups. So we looked at our existing WHO EPI module and we think that there are opportunities to take a well-established design that has been adopted by more than 30 countries at national scale to be able to collect and analyze this routine facility data or other points of service delivery on utilization, wastage, cold chain and outreach. So we think this is probably really the bread and butter of the monitoring framework for these national plans. We know that the logistics component is going to be really significant and that readying the supply chains and being able to support traceability of vaccines throughout the supply chain is going to be a major focus. And so DHAs too is not really meant to replace an electronic logistics management information system, but it has been implemented with quite a bit of success in many countries for supply chain solutions at the last mile. So looking at those service delivery sites and particularly from community and facilities and how we could use DHAs too as a stopgap for that last mile service delivery and also being able to link that with existing electronic LMIS and with the HMIS overall. Ensuring that individuals will be able to be monitored for the full course of a multi-dose regimen. It's looking right now that the vaccines that are being approved or have efficacy data are multi-dose vaccines. So being able to track that people get those vaccines and both of them will be pretty important. And we have several immunization registry programs that have been deployed at scale for example in Rwanda. Providing a personal vaccination record and certificate. So this generation of health certificates linked with e-registries. For us we consider this a bit of a local innovation with DHAs too at this point. And that is to say we don't currently have a generic global solution for this but we have seen multiple countries in their COVID-19 responses using their DHAs to case-based data to generate these official electronic health certificates such as generating travel passes in Uganda, Guinea-Bissau and Rwanda based on the negative testing data. We know that these plans are going to require multiple distribution strategies and there might be novel and innovation distribution approaches. So we have looked back at some of the use cases around mass campaigns which may become one of several distribution strategies applied in a country to achieve coverage and be able to target the populations that they will be prioritizing and disaggregating in their micro plans. So we'll hear a little bit more from the Uganda and a bit on the Bangladesh use case that's ongoing. And lastly monitoring vaccines safely. Safety, we have worked with the WHO with Madhav and his group at headquarters level to develop an adverse events following immunization tracker based on these global standards. And we've had some early discussions with WHO AFRO as well in how to support national systems to strengthen vaccine safety surveillance. So we believe that this is an opportunity to bring COVID-19 into a framework, into sort of an integrated system for adverse events monitoring. So to summarize our approach we are aiming to build on our established approaches and partnerships. So leveraging the WHO collaboration, but also leveraging Gavi's investments in the DHIS toolkit for immunization program data solutions. This has really been the baseline of our global toolkit of DHIS to configuration design. And the idea is that we take what's been built that's around 90 percent there and be able to reorient and customize and improve for the COVID use case. In addition we have been very fortunate to have some catalytic funding from NORAD to support the COVID-19 response efforts. And we would like to really strengthen the existing systems and tools and capacities of countries. So primarily we are looking at countries who are already using DHIS too for their immunization programs. That's where we think we have the most value to add and where we can actually accelerate progress and strengthening in country. And lastly we want to be able to leverage local expertise and innovation. And this is really the component around how much we as a global public good are learning through local implementation. So those health certificates were one example that I think are really critically important. So we are developing at a global level but we are consistently investing in these feedback loops so that we can understand what approaches are working in countries and how we can use our platforms to disseminate those approaches to other countries to adapt as well. So I will start with just a little bit of overview on a couple solutions and then hand off to several colleagues. So at this part in the presentation we want to share some of what's in our existing immunization toolkit and describe a bit how we might see this being adapted for COVID-19 vaccine delivery. So one of the real, I would say probably the foundation of this toolkit is this WHO metadata package for the expanded program on immunization. And so this is a standard metadata package developed through the collaboration with WHO. And it's been implemented and installed in 30 countries in their national HMIS to support the immunization program monitoring. So this toolkit, it already includes, it focuses on facility level reporting and analysis. Of course, the analysis can scale up through that hierarchy. So facility to district to province to national level. But we are capturing vaccinations and target populations for those vaccinations to understand how the vaccines are being administered among key populations. There's a basic stock component that I'll talk about a little more. Capturing data on the cold chain. So the functional refrigerators and alarms at facility level. As well as some kind of basic data around outreach sessions and adverse events. And so these indicators and analytical outputs that come with these standardized dashboards and packages include a lot of the key ones that we know are also included in the NDVP guidance, which is the coverage rates, the vaccines administered, cold chain wasted rates in particular, and also understanding dropout rates for multi regimen vaccines. So this is a bit of a snapshot of what one of those dashboards looks like now. So as you can see, we're able to analyze a lot of this data across the different components of immunization programs. So an immunization program manager would need to be able to understand things like the vaccine coverage, but also be able to understand the stock status down to facility level, understand which facilities are with adequate stock or which ones are experiencing stock out in order to plan some response. You can see some of the cold chain components here with the temperature alarms. We know the cold chain requirements for the COVID vaccine might actually even be more challenging for countries to monitor and implement and develop infrastructure for as well as bringing in these wasted rates and the dropout rates. So the main point here is to be able to have all these key components of your immunization program and be able to analyze this in an integrated way. So I'll give you a little bit of a snapshot included in this basic facility package, this EPI package. There's already included some key stock data at that facility level. So as I was saying, where DHIS2 is able to fill the gap at the last mile and capture some of these key logistics data at facility level and then for countries to be able to put that alongside their ELMIS. But for example, we are really trying to promote this facility level that is that is a gap for many countries, but also really critically important for those programs to be able to develop their supply chain interventions and to be able to get the stocks where they are needed and ensure that stocks are available in appropriate quantities for that facility's catchment area. In addition to some of that basic logistics work, there's also some more innovative approaches. And so there are countries like, I believe it's Kenya who implemented sort of a tracker based Seastock system. And this here that I'm showing is an example from Yemen from ICRC where we are seeing countries, particularly at that facility level, taking advantage of the functionality of DHIS2 and also with the Android app to be able to support some of these vaccine catalogs in DHIS2 at the facility level where another electronic system might not be in place. So in tandem with the Android app, what we're able to do here is generate a product catalog that include pictures. So it's quite easy for the pharmacy managers or the stock managers at facility level to understand what their product catalog is and be able to facilitate this supply in reporting and the supply out reporting. Generally, what might be recommended is to be able to do this on a daily basis. And by integrating some of this functionality of the DHIS2 Android app, so there is barcode searching functionality. This also works for QR codes. This can potentially support the use case around traceability down to the facility level. Although we do know based on the guidance we've read so far that likely having these barcodes at vial level seems that it's not going to be likely, at least in the short term. But there might be some solutions here around how facilities are capturing the supply in and supply out for their stock stores within that facility. And so the app also allows you to do some basic data entry, the supply in supply out, and then also be able to generate these automatic notifications. So for example, when there are stock outs or emergency resupply workflow support, of course all of the data captured in DHIS2, these indicators can be calculated on the fly. So things like the average consumption, the stock status per facility or stock out days, they can be monitored on these dashboards at district or even higher levels. So this is just a time to remind everyone that the DHIS2 Android capture app it's natively integrated with DHIS2. So any country is able to develop a configuration or adopt a standard package and customize that configuration to their needs. And depending on the infrastructure that's available in different levels of the health facility, these different packages that data collection can be optimized for Android if it's mobile devices, or it can also be optimized for your web-based data entry and analysis as well. So with all of these packages it will be good to keep in mind that countries will always have the option without needing any sort of interoperability layers to have that mobile data capture option. And so with this, I'm happy to hand over to my colleague, Mike Frost, who's the tracker product manager to talk through a couple of these solutions that are tracker-based for the COVID immunization toolkit. Thank you. Great. Thanks, Rebecca. So we've been, as Rebecca says, working closely with a number of groups that are focused on the requirements for COVID vaccine delivery and monitoring. We've been operating off of the WHO interim guidance that just came out in mid-November. We're working closely with the CDC, conversations, of course, with our partners at Gaby, also the Brighton collaboration. So a number of different groups that are thinking this through from many different angles, and we're trying to operationalize those. And as Rebecca said, building it on top of existing tools and making this, you know, as robust as possible to be easy to adopt and to sustain. So one of the requirements that seems like it's going to be very important is, of course, the individual level data as we're rolling out the COVID vaccine, particularly longitudinal, knowing that the persons has completed the regimen, they've received the multi-dose for the various vaccines that are coming online and going to be adopted. So we've put together right now a starting registry for the COVID vaccine. This is building off of work that we've done for a couple of years now with Gaby and with UNICEF to make a full immunization registry. That work, which a number of countries have adopted, is, of course, focused on the childhood vaccines. And it's actually quite a complex and sophisticated program that's making recommendations about which vaccines a child receives based on their risk factors, based on their age, all of these different things. For the COVID registry, it actually doesn't need to be integrated with that necessarily. It can be a very simple standalone COVID vaccine registry with a lot less in terms of complexity, in terms of the various kind of program rules and things that people would use to do decision support. And it collects just the required and kind of minimum data set at this point. We will, of course, adapt this over time as more requirements become firm and clear. But just saying from our design perspective, we want this to be something that can easily be, you know, modular. It can fit in with, you know, what other tracker programs the country may be running. It would share a pool of tracked entities or people that have been registered. So if you already are running tracker for TB, HIV, disease surveillance, any number of topics, this program could just sit alongside those others. If you do a search within the program, it would bring up from that same pool of people. And you would be able to follow them. You can see the three kind of grade boxes there would be the three stages for being registered into the program, screen for eligibility, and then receiving your two doses. Along with this program would be accompanying notifications that can be sent to the person to remind them to come back to receive their second dose, giving them some information about where and why to receive that second dose. And like all of the tracker programs, this is natively functional with Android as well, which would be the recommended solution for those cases where you have intermittent connectivity or you're offline, you can operate on Android and still retain this information. This of course is something that we're thinking of in terms of the vaccine being integrated in kind of a routine delivery approach, whether it's coming from the facility level or some other kind of integrated approach. That's where this really is the most likely venue to be using tracker. This does match up with our expectations about how the vaccine will be rolled out. It's going to be a phased rollout in most countries where there's not enough vaccine for the entire population, but instead you're focusing on high-risk groups, you're focusing on health workers, trying to make sure that you're rolling out the vaccine in the areas where it will have the most impact. And so again, tracker can be very helpful in this regard and identifying the right individuals, noting what the risk factors are for that individual, making sure that they receive all of their doses. Next slide. So we know that with the completion of these doses, it's of course very important also for the person that has received them to be able to demonstrate that they have completed, particularly for their ability to travel, for their ability to be able to demonstrate that they've been fully vaccinated. As Rebecca made mention, this is something that has already been going on in Rwanda, Uganda, and Guinea-Bissau in terms of being able to produce a barcode, a QR code, some kind of official documentation that they have been treated or that they've been tested in the existing COVID work. And it's a fairly straightforward effort to then extend this to vaccination as well. You're seeing a couple of the examples from these different countries that have been built on to, for example, the case-based surveillance COVID package, the ability to produce a PDF that has the digital signatures demonstrates who has provided this. These, again, have been innovations that have come up from the countries themselves and they're implementing partners. We're looking now about a standardized way to integrate that into DHS2, but it also was something that was fairly straightforward to introduce in the first place. We may have some people on the call that actually worked on these. If questions come up, we can refer you to them. There's also a link that shows you a write-up here from the slide. We'll be sharing these slides with everybody that joined the webinar. You can follow up and read a bit more about how this was integrated, but it's definitely part of what we're thinking is a common part of the package that should be offered, and we'll be working on more generic ways to stay implement this. Next slide, please. One of the WHO packages that we had already built over the last couple of years, working very closely with WHO and with Gaby, is for recording adverse events following immunization, AEFI. We had previously built this package, and in fact it was due to be published now, and it's based entirely on the WHO workflow, which has been adopted by most countries. You can see a picture of the actual pay reform that is used to follow up an investigation behind an adverse event, identifying where the immunization was received, which immunization it was, which batch it comes from, expiry date, dilute, and all of this information, and of course the adverse reaction itself, what was caused. This is going to be very important for the COVID vaccines, which as everyone knows have been developed very rapidly. There is good data and testing behind them, but still we want to keep a global eye on any adverse events and be quick to react. This package already follows the workflow recommended by WHO, allowing for the different levels, those that first receive the patient that is having an adverse event, to those that need to do the investigation follow up, the notifications associated with an adverse event, and accompanying dashboard with all of the indicators that are recommended by WHO. So this package is actually available and ready to go. The only thing it's lacking right now are the names of the COVID vaccine, which of course can very easily be added based on which vaccine the country is using. So this one is something that we think is fairly ready to go and will be made available soon. One important part of this is that there is a global database for reporting adverse events for immunizations that is supported by WHO, it's called Vigibase. Vigibase has an accompanying piece of software called Vigiflow that many, many countries are using to report to this global repository. We've been working with the people behind Vigibase and Vigiflow for the last six weeks or so to adopt the E2B standard for reporting these adverse events and have this as an integrated part of the package so that if you are a country that has a requirement to report to this adverse events global repository, then you should be able to do so using this package, which again will have I think very importance, high importance globally. There's a lot of interest in making sure that the COVID vaccines are safe and that there can be a quick response if there is an uptick in adverse events. And with that, let me just see. I'm not sure if we ended up getting prospered to join us so I can talk about the next slide. So one other method of delivery for the COVID vaccine may be mass campaigns. Again, it may actually be kind of a tandem approach where you have a phased rollout where you're doing kind of targeted smaller campaigns and different geographies based on the amount of the vaccine that you have and the population you're trying to reach. What we've done for this is a built off an approach that was led by our HIST group in Uganda. You're seeing a dashboard that they created for monitoring mass campaigns. This is meant to be a real-time dashboard. You're seeing pictures from the command centers both at the national level and the district level as the campaign is proceeding, being able to monitor the delivery of the vaccines and keeping an eye on when they're reaching their coverage levels, making sure that you're making decisions about repositioning of supplies based on need, and making sure that you have a sense of when the campaign can actually end if you've reached the goals that have been established for the campaign. The dashboard that you're seeing here originally was customized by HIST Uganda, but the functionality that it's demonstrating here is something that's native to DHS-2 as of 234 and can be configured in there for any vaccination campaign. Again, the COVID is one that you can configure for specifically, but it also can support other campaigns as well. We're working on making sure that we can have an offer of something of this sort for the prior versions of DHS-2 as well, so taking the work that HIST Uganda has done and turning it into, for example, a basic app that you could use for the COVID vaccine. One word about all of these individual level versions of DHS-2, whether you're using tracker or events for campaigns or for routine, all of this is, you know, we're very aware that the COVID vaccine is going to be massive, that the uptake is expected to be, you know, global, that every country is trying to hit a very high target population. And so we have on our mind performance and an emphasis on ensuring that the DHS-2 system is able to handle the high number of records and the, you know, the persistent connection that is required. We're learning right now from a massive campaign for MMR that is going on in Bangladesh using the Android application and events. We're working closely to make sure that that runs smoothly and to identify any pain points for that. We've also, in the last couple of years, worked closely with a number of the largest-scale tracker implementations running globally and have made already a number of performance improvements. We're forming a bit of a task force on our side of the university to make sure that we continue to do that, that we learn from these very large COVID packages that have been rolled out in 36 countries already. And we can have some more definitive statements about what the kind of limitations and parameters are for the tracker platform, for events, for Android, so that countries can have clear information about, you know, when and where to scale, and what kinds of infrastructure are needed to support it. So you'll see more information about performance and kind of what the parameters are as we publish these packages and we put forward those efforts. So with that, I think I will now turn to our colleague Anna, who's going to talk us through a bit of the implementation side and how to move this forward for your country. Thank you very much, Mike. So I will talk briefly on what it takes to operationalize this and implement it at the national level. So there are three levels of operationalizing DHS-2 for COVID. We have the global development of global goods, including the DHS-2 software itself and the digital packages for COVID that my colleagues have presented based on WHO guidance. And this also includes actively seeking experience from the field implementations to improve them as we progress. And also to install, to update implementation guides and develop standard training materials. Then we have expert expertise on regional level through the HIST groups that can support adaptation of these packages to the local settings. And the HIST groups can support on several things. They can do host regional academies, for example, conduct training of trainers at the national level. And they also have close working relationships with the ministries of health. And then of course, it's the work at the national level to implement the toolkits to the national and local contexts. And that includes activities such as training and supporting end users and to actually deploy these local innovations and to procure and maintain devices to mention a few. Next slide, please. And using DHS-2 for COVID management when the country is already using DHS-2 has several advantages. It reduces the barrier to entry and training required as the health personnel is already trained and familiar with DHS-2. It's reusing existing technology and infrastructure. So most places there are already existing devices that can be reused. It leverages the Ministry of Health Corps, HMIS teams, their capacity to customize the software and the toolkits. And it's also working through the existing immunization program processes where there's already a lot of work ongoing on several other areas around immunization. And then it's also reinforcing and strengthening the overall data management in use for immunization program. We do believe that working with data management in use of COVID data would also benefit the rest of the immunization program as a whole. And then the example budget to the right that highlights some of the core costs associated with implementing in a country. It includes TA costs, of course, but the majority of the costs are associated with end-user trainings and potentially new devices. And the HISP groups, they can also assist countries in planning and budgeting for projects like this. So please do reach out to us and we can also help with that. And with that, I will give the word back to Rebecca. Thanks, Anna and Mike. So we will be sharing this slide deck after this webinar. But we wanted to point you guys in a few different places. So we have just updated our website to also have a COVID vaccine delivery sub-page in the way that we did with the surveillance so that we can continue to add information there, start to post the different packages, things like that. There's a community of practice channel that's been started. It was actually shared with this webinar invite. So that's the place where we will go to continue having some different discussions. And of course, you're welcome to contact us by email at any time. I'm sure people, we don't understand that countries are really in a large planning phase themselves right now. And we wanted to give you a sense of what our timelines are looking like. So we have the base of this immunization toolkit already developed. So what we will be working on in the next few weeks, for example, is to be able to get some sort of demo site up. So the standard packages, they actually exist. They just don't have COVID data elements yet. So we'll make sure to reshare some of those links. But we will be working on these in a works in progress on developing some prototypes to be able to help our partners visualize and interact with these packages and start to see how COVID-19 might roll into it. But I will also have to say that at this time, University of Oslo, we're working with the content expert groups to really understand what these metadata requirements are going to be. So this is going to be a bit of an iterative phase we think over the next month until after the holidays, probably, to understand a bit more precisely the monitoring framework that's going to accompany that WHO guidance for national delivery and vaccination plans, and then be able to understand a bit more precisely what the metadata requirements are, what the potential disaggregations will be, apply those to some of our standard metadata, but also be able to start documenting some of the implementation guidance for countries to be able to adapt that to their context. So just one example of that might be national plans will have to determine sort of the prioritization and rollout across different types of at-risk groups. So countries will end up defining what those at-risk groups are and where they are targeted in sort of a phased rollout plan, but we will be aiming to provide some standard metadata that provides a framework for that and something to kind of pick and pull from. So this entire toolkit, it's very modular. It's intended to be a toolkit that countries can choose which components are going to make sense for them and also to work through where they might be able to integrate these with existing systems that are in place. So with that in mind, I know we have some, probably, some ministry of health that have joined this webinar. Many of us already have contact with regional HIST groups. So if you have any questions about specific country-specific plans related to DHIS2 or you would just like some more information to start that conversation going, you're, of course, welcome to contact the regional HIST groups. Or if you're a country that doesn't have an existing contact with a HIST group, you're also welcome to email us at our COVID-at-DHIS2.org email and we can start to get you connected with the different HIST groups that are supporting in a regional way. So finding HIST groups that would meet your language needs and also a geographic proximity.