NATIONAL COVID-19 DEPLOYMENT AND VACCINATION PLAN - SURINAME 2021

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NATIONAL COVID-19 DEPLOYMENT AND VACCINATION PLAN - SURINAME 2021
NATIONAL
    COVID-19
DEPLOYMENT AND
VACCINATION PLAN
    SURINAME 2021
NATIONAL COVID-19 DEPLOYMENT AND VACCINATION PLAN - SURINAME 2021
Endorsement

COVID-19 started at the end of 2019 in Wuhan, Hubei Province in China. Due to the rapid
spread to several countries with, increasing reports of morbidity and mortality, the World
Health Organization (WHO) declared the disease a Public Health Emergency of International
Concern on January 30, 2020, and a global pandemic on March 11, 2020.

Suriname detected its first case of the disease on Friday, March 13, 2020. Since December
2020, the country is experiencing the second wave of the disease, and the increasing cases
and deaths are of concern to the country. In the absence of definitive therapeutic options for
the management and control of this disease, vaccination as a primary prevention measure is
a good option for the control of the disease in terms of saving lives through reduction of
severe disease and deaths.
The COVAX Facility is a mechanism for the equitable access to various vaccine options, and
Suriname has signed onto this facility to receive allocation of vaccine doses which have
received approval from the WHO and other Stringent Regulatory Authorities.
In order to protect the population against the disease, the Government of Suriname has
appointed the “Technical Advisory Commission Immunization Policy COVID-19” for the
general management and monitoring of the COVID-19 situation in Suriname, and a
“Vaccination Committee” to develop a vaccination plan and to guide the implementation of
this plan.

Relevant Ministries of the Government of Suriname, and relevant public and private
institutions have been involved in the planning of the campaign, and will continue their
support to the further implementation of this plan. Specific measures with regard to funding
of the campaign, as well as facilitating the approval of the vaccine for use by the Registration
Commission, tax exemptions, customs clearance, safe arrival, receipt, and storage of the
vaccine and ancillary needs, have been taken.

The vaccination campaign will start soon after the arrival of the first batch of vaccines, that
will cover up to 3% of the population, beginning with the first priority group of frontline
healthcare workers.

Suriname is open to consider at due time the availability of other vaccines that may be
beneficial in terms of cost, dosing schedule, cold chain storage requirements and other
factors. The vaccination plan has been developed to consider all possible options.

The Ministry of Health is thankful for the efforts made, and those that will continue to be
made by all stakeholders and partners towards a successful fight against this disease.

A. Ramadhin, MD
Minister of Health
Republic of Suriname

                                                1
Table of contents

Contents

Endorsement .............................................................................................................................. 1
Table of contents ........................................................................................................................ 2
Executive summary .................................................................................................................... 3
   1. Introduction ........................................................................................................................ 7
   2. Regulatory preparedness................................................................................................... 11
   3. Planning and coordination of the vaccine introduction .................................................... 13
   4. Resources and funding...................................................................................................... 15
   5. Target populations and vaccination strategies .................................................................. 17
   6. Supply chain management and health care waste management ....................................... 36
   7. Human resource management and training ...................................................................... 39
   8. Vaccine acceptance and uptake ........................................................................................ 42
   9. Vaccine safety monitoring and management of AEFI and injection safety ..................... 44
   10. Immunization monitoring system ................................................................................... 45
   11. Disease surveillance ....................................................................................................... 46
   12. Evaluation of introduction of COVID-19 vaccines ....................................................... 46
   Annex 1: Detailed budget for the COVID-19 Vaccination Campaign ................................. 48
   Annex 2: ESAVI................................................................................................................... 53
   Annex 3: Terms of Reference for the National Coordination Team .................................... 58
   Annex 4: Implementation Plan ............................................................................................. 61

                                                                     2
Executive summary

Since December 2019, there have been more than 101 million cases of COVID-19
worldwide, including more than 1.2 million deaths. In order to control the pandemic, in
addition to preventive hygiene measures, effective vaccines are needed to protect against
COVID-19, especially in the pursuit of a situation without restrictions on international travel
and trade including lockdowns, quarantine and isolation.

A global effort to develop vaccines has been underway since the start of COVID-19. Several
vaccine candidates are in various stages of development and to date, some of these have
already received Emergency Use Listing by the WHO. Others are expected to receive similar
approval for emergency use in the very near future.
Suriname has committed itself to the COVAX Facility, the vaccine arm of the Access to
COVID-19 Tools Accelerator (ACT) which aims to facilitate equitable access to 2 billion
doses of vaccines for countries by the end of 2021.Through this agreement, Suriname
already has the guarantee of receiving vaccines to be able to vaccinate 20% of its
population.

This plan carefully develops the important processes and procedures required for vaccine
regulatory approval, arrival, storage, distribution, administration, registration, logistics,
surveillance, reporting, safety monitoring and evaluation. This documentation is necessary in
preparation for a responsible and successful course of the national COVID-19 vaccination
campaign. The plan follows the “WHO Guidance on Developing a National Deployment and
Vaccination plan for COVID-19 vaccines” and contains the following main components, with
an estimated budget of USD 16,047,881 for the vaccination of the identified priority groups.

  Component
  1. Introduction
  2. Regulatory preparedness
  3. Planning and coordination of the vaccine introduction
  4. Resources and funding
  5. Target populations and vaccination strategies
  6. Supply chain management and health care waste management
  7. Human resources management and training
  8. Vaccine acceptance and uptake
  9. Vaccine safety monitoring and management of AEFI’s and
      injection safety
  10. Immunization monitoring system
  11. Disease Surveillance
  12. Evaluation of introduction of COVID-19 vaccines

The National COVID-19 Deployment and Vaccination Plan is an important and necessary
condition to receive the COVID-19 vaccine. The Technical Advisory Commission
Immunization Policy COVID-19 is a multidisciplinary group of national experts responsible
for providing independent, evidence-based advice to policy makers and program managers
on policy issues related to immunization and vaccines. The committee is able to review the
international and regional policy guidelines of the WHO’s Strategic Advisory Group of
Experts on Immunization (SAGE) and the PAHO Regional Technical Advisory Group on
Immunization (RITAG), taking into account the national context, national priorities and
disease epidemiology. The committee will regularly review, revise and update its
recommendations to national policymakers, as new evidence becomes available.

                                                3
The Government of Suriname is committed to follow international actions and procedures to
save lives, and mitigate the effects of the COVID-19 pandemic, by implementing all relevant
actions, including vaccination of its population, in order of priority groups that have been
identified by the Technical Advisory Commission Immunization Policy COVID-19. Supporting
sub-committees and teams have been identified to support the work of this Technical
Advisory Commission:

   -   The National Coordination team to present this Plan and lead the campaign
       activities, with support of sub groups for:
           • Personnel: mobilization, training, evaluation.
           • Finances: Funding, budget management, coordination of payments to service
                providers and personnel.
           • Information/Education: Development and dissemination of informational
                material and messaging to generate demand.
           • Logistics and Transportation: Vaccine clearance, mobilization of
                transportation, distribution schedules.
           • Supply chain management: Forecasting procurement, stock management,
                materials for the teams and vaccination sites.
           • Secretarial support: keeping notes of meetings, consolidation of reports by
                supervisors, consolidation of administrative information, and supervision of
                the end report.
           • Partnerships: Coordination of contact with external organizations, mobilization
                of private sector, donations and sponsoring.

   -   The Implementation Team, with the rayon (district area) coordinators of the Medical
       Mission Primary Health Care Suriname (MM), the Regional Health Services (RGD),
       the Bureau of Public Health (BOG) and the hospitals, for operations management
       including monitoring and supervision.

   -   The Central Administrative Team at the BOG.

   -   The Vaccination Teams at the health facilities managed by the MM, the RGD, and
       other public and private health facilities.

For the National Immunization Program (NIP) of Suriname, the “Bedrijf Geneesmiddelen
Voorziening Suriname (BGVS)” (State Drug Supply Company) is responsible for all actions
towards preliminary administrative matters, payment of fees and taxes, customs clearance
and transportation of the vaccines received through the PAHO Revolving Fund for Access to
Vaccines, following rules of cold chain, from point of arrival to point of storage.
Within this authority, the BGVS will do the same for the vaccines and dry store items that will
be received for the COVID-19 vaccination campaign.

The received vaccines will be stored in the facilities of the Wanica Streekziekenhuis that
complies with cold chain regulations, and has sufficient Ultra Cold Chain (UCC) and regular
storage capacities for the expected number of vaccines. The Wanica Streekziekenhuis also
has secured space and facilities available for administrative matters of the distribution of
vaccines and supply items that need to be kept in stock for the vaccination campaign.

                                               4
The distribution of the vaccines will follow the guidelines and procedures as outlined in this
plan of action. In summary:

    Day of arrival of vaccines   Arrival and storage of the vaccines at the Wanica
                                 Streekziekenhuis, under responsibility of the National
                                 Immunization Program.
    Two to three days leading    The National Coordinating Team will provide an overview of
    to vaccination               the scheduled dates and vaccination sites, and the needed
                                 quantities of the vaccines and ancillary items. The
                                 vaccination sites will have received prior approval by the
                                 National Coordinating Team to receive, store, and further
                                 distribute these to the outreach sites under their
                                 responsibility. Vaccination sites will be inspected to ensure
                                 that the site complies with the protocols for COVID-19
                                 vaccination.
    Day before Vaccination/      The Supply Chain Manager of the National Coordinating
    Day of vaccination           Team will distribute the requested quantities of vaccines to
                                 the vaccination sites, taking into account the rules with
                                 regard to cold chain management.
    After vaccination            All unopened vials, reconstituted vials with unused doses,
                                 and empty vials from the vaccine sites will be returned to the
                                 Supply Chain Manager of the National Coordinating Team,
                                 taking into account the rules of vaccine safety, the open vial
                                 policy and waste management. This can also be used as a
                                 double check for the registration of the administered
                                 vaccines.

Suriname has subscribed to the COVAX Facility as a self-financing member for an initial
coverage of 20% of the population. The vaccines will be delivered in tranches and
proportional to the population.

•     The first tranche expected in the second half of 2021 is to cover vaccination of
      healthcare and social workers which is estimated at 3% of the population.
•     The second tranche is to cover vaccination of high-risk adults (elderly 60 years and over,
      and adults with underlying conditions) estimated at 17% of the population.
•     The third tranche will cover vaccination for other priority groups.
To cover more than 20% of the population will depend on the disease context in the country,
participants’ vulnerability and the COVID-19 threat. Subsequent doses will become available
in the course of this year and 2022. The regimen for the expected vaccine depends on the
vaccines to be received, in general 2 doses per person. During the process, the country
might decide to access other vaccines to cover a larger proportion of the population, as they
become available. If so, then this plan and budget, and the implementation details will be
adapted accordingly.
The target estimated date for the first administration of the vaccine in the country is 7 (seven)
days after arrival, provided that all other needed items, such as appropriate syringes,
needles, diluents (if needed), and the logistics are in place.

Table 1 provides an overview of the target groups in order of priority, as identified by the
National Coordination Team, and the doses that will be needed to vaccinate these risk
groups in two rounds, including a wastage rate of 10%.

                                                5
Table 1: Priority groups and vaccine doses needed for 2 doses regimen

 Priority   Population                                                      Persons    Doses needed
 Group 1    Healthcare workers, first line                                     1,497           2,994
 Group 2    Healthcare workers, second line                                    3,794           7,588
 Group 3    Military, police, penitentiary officers, Government Officials      3,500           7,000
 Group 4    Populations in elderly homes, including dialysis patients          2,900           5,800
 Group 5    Elderly sixty years and over, national level                     90,170          180,340
 Group 6    Adult population, based on medical grounds/risk factor           30,000           60,000
            (Diabetes Mellitus, High Blood Pressure, Sickle Cell
            Anemia, Cardio vascular Diseases, COPD, Oncologic
            Diseases, Indigenous population. (40 – 59 years)
 Group 7    Adult population, based on medical grounds/risk factor           11,000           22,000
            (Diabetes Mellitus, High Blood Pressure, Sickle Cell
            Anemia, Cardio vascular Diseases, COPD, Oncologic
            Diseases, Indigenous population, ….) (18 – 39 years)
 Group 8    Other risk groups                                                 1,100            2,200
 Group 9    Healthy population (18 - 59 years) (estimated)                  265,779          531,558
 Total                                                                      409,740          819,480
 Wastage rate 10%                                                                             81,948
 Grand total                                                                                 901,428

The leading week will also be needed for preliminary activities, before the actual date of
commencement of vaccination.
The first batch of vaccines to be received will be administered to the health workers,
identified as the first priority group. These health workers will preferably receive their
vaccination in the institutions where they are employed.

The procurement of the vaccine and the vaccination against Covid-19 will be done within a
national strategy, with joint funding from the Government and the private sector. A national
fund will be set up, whereby fundraising will be done with the joint effort of the Government,
the business community, and other stakeholders. To this end, consultation has already been
held with various stakeholders, investors, insurance companies, gold mining companies and
the business community. The Government has accepted the willingness of these partners to
support local fundraising.

The estimated budget for the campaign is summarized as follows:

Table 2: Estimated budget by category
 Category                                                         Budget
 Political priority and legal framework                           (USD) 50,000
 Planning and coordination                                               68,000
 Biologicals (vaccines) and supplies                                 11,433,913
 Cold chain                                                              72,600
 Training                                                                27,000
 Social mobilization                                                    333,150
 Operating costs                                                      2,017,530
 Supervision and monitoring                                             145,000
 Epidemiological surveillance (including AEFI                           195,140
 management)
 Information   systems                                                  186,650
 Research                                                                12,000
 Evaluation                                                              48,000
 TOTAL                                                               14,588,983
 Miscellaneous 10%                                                    1,458,898
 Grand total                                                         16,047,881

                                                   6
1. Introduction

COUNTRY BACKGROUND

The Republic of Suriname, bordered by French Guyana in the east, Brazil in the south,
Guyana in the west and the Atlantic Ocean in the north, is located on the northeast coast of
South America. The country has a total area of 163,820 km2 and consists of narrow coastal
plain with swamps, hills and tropical rainforest.
The country is divided into ten administrative districts that are subdivided into 62 regions.
The coastal area comprises 2 urban districts and 6 rural districts, and the interior has 2
                                                 districts. The 2 urban districts, the capital city
                                                 Paramaribo and Wanica, cover 0.5 % of the
                                                 landmass and contain 70% of the total
                                                 population.

                                                  The vital statistics profile by the Algemeen
                                                  Bureau voor de Statistiek (General Bureau of
                                                  Statistics) shows a mid-year population in
                                                  2018 of 590,100.

                                                  The number of registered live births is about
                                                  10,000 to give a crude birth rate of 20 per
                                                  100,000 and a total fertility rate of 2.5.
                                                  Mortality has remained relatively stable at
                                                  around a crude death rate of 6.5 to 7 per
                                                  100,000. Life expectancy at birth for males is
                                                  69.34 years and for females, 75.01 years.

Demographic Characteristics of the population
The Suriname population has many ethnic backgrounds composed of
   - Hindustanis            (27.4%)
   - Creoles                (17.7%)
   - Maroons                (14.7%)
   - Indonesians            (14.6%)
   - Mixed                  (12.5%)
   - Amerindians            (3.7%)
   - Chinese                (1.8%)
   - Others                 (7%)

Sranan Tongo is the ‘’native language”, the main and unofficial language of the population.
The official language is Dutch, and English is widely spoken.

Health Care Delivery System
The Ministry of Health (MOH) is responsible for the health sector and health system
management, specifically the availability, accessibility and affordability of health care. The
main responsibilities of the MOH are planning, policy development, inspection, coordination,
monitoring and evaluation and setting of standards in the health system. The core-
institutions of the Ministry of Health are the MOH Central Office, the Inspectorates (Medical,
Nursing and Pharmaceutical) and the Bureau of Public Health (BOG).

                                                 7
Primary Health Care and Prevention
The Ministry of Health is responsible for coordinating the national health care system. The
Bureau of Public Health coordinates preventive health care, supervises and executes
programs that provide information on the distribution of diseases. The Epidemiology Unit
operates a surveillance system on communicable diseases in close cooperation with the
Regional Health Services and the Medical Mission. This system relies on weekly reports
from 31 sentinel stations. At the operational level, the government health care providers
include the government subsidized primary health care organizations such as the Regional
Health Services, covering the population living in the coastal area, and the Medical Mission,
covering the population living in the interior. Primary health care is also provided by the large
group of private General Practitioners, especially in the urban districts of Paramaribo and
Wanica.

Regional Health Services
The Regional Health Services (RGD) has 46 clinics in 8 districts in the coastal area and
provides primary health care services and selective prevention activities to mainly the poor
and near poor. Approximately 150,000 poor and near poor who are registered with the
Ministry of Social Affairs, are covered by a basic package of health services, organized by
the State Health Insurance Fund (SZF). The other clients (estimated 250,000) insured by
the State Health Insurance Fund (government employees, retired civil servants and their
dependents), can also use the services of the RGD, especially in the coastal districts.

Medical Mission Primary Health Care
The Medical Mission Primary Health Care Suriname (MM) is responsible for the primary
health care and selective prevention activities in the interior. This NGO operates 52 clinics in
the interior, with a coordinating center located in Paramaribo, and is subsidized by the
Government. They cover about 60,000 people living in the large interior. Their target group is
mainly Indigenous and tribal people living in close proximity of the rivers and dispersed in the
high lands of south Suriname.

Secondary and Tertiary Health Care
The Ministry of Health operates two general and one psychiatric hospital in Paramaribo, and
three district hospitals in the western coastal district of Nickerie, in the eastern district of
Marowijne, and in the coastal district of Wanica. One of the general hospitals in Paramaribo
is also specialized in Maternal and Child Care. There are also 2 private hospitals in
Paramaribo, the Diakonessenhuis (DH) and the St. Vincentius Ziekenhuis (SVZ). These
eight hospitals have a total of 1500 hospital beds, 3.0 beds/1000 inhabitants. The average
bed occupancy rate is approximately 85%. The average length of stay is 7.9 days.
There are 40 dedicated ICU beds available in 4 of the hospitals.

The first case of COVID-19 was confirmed in Suriname on 13 March 2020. The cases that
followed were quickly traced and isolated, and their contacts were placed in controlled
quarantine. Measures were also announced, air traffic was stopped, and Suriname was
placed in a 'bubble'. Since the start of the epidemic, the government has applied two
important measures to curb the epidemic, namely isolating infected individuals and placing
their close contacts in home quarantine. General measures included wearing mouth-nose
masks in public places, keeping physical distance, prohibiting public transportation and
limiting the number of persons who are allowed to gather in one place.

In the month of December 2020, the 2nd wave of COVID- 19 cases began in Suriname. The
reproduction rate (R) quickly climbed to 3.3. Strict measures were promulgated to bring this
back down, due to a strict enforcement policy from the government. The reproduction rate
went down, but the many cases that were already present in society resulted in many
patients. In the second week of January 2021, 91 people with COVID-19 had been admitted
to hospital, 10 of whom were in intensive care, and in addition, 299 people with COVID-19

                                                8
were in isolation. The reproduction rate in the second week of January 2021 was still above
one (1), which means that the number of COVID-19 cases will continue to increase.

With the second wave that started in the first week of December 2020 there was a fairly
sharp increase in the number of hospital admissions from the third week of December 2020
onwards.

Up to 11 January 2021, a total of 138 people has died from COVID-19, with 21 people dying
during the second wave that started in December 2020. The picture in these deceased has
not changed from the 1st wave of the epidemic in terms of risk factors; the case fatality rate
(CFR) till early December was ~2.2%. For the new wave, counting from mid-December, the
CFR is ~ 2.0%.
The average age of the admitted patients was 69 years and 80% was 60 years and older.
The youngest person was 45 years old. More than 80% of these individuals suffered from
underlying conditions. More than half had both diabetes and hypertension in their history.
Among these individuals, more than half had already suffered complications from these
chronic diseases such as stroke and chronic kidney failure. There were 4 patients on dialysis
included in this group. A number of people that were admitted due to poor clinical condition,
died shortly after admission.

Graph: Cumulative Hospital admissions COVID-19, 27 July 2020 – 9 January 2021

In this second wave of COVID-19, the spread occurred much faster in a shorter time than
during the first wave. Partly, this is because people wait too long to seek testing, and
therefore stay longer in their infectious and clinical period before seeking care. Isolating
infected people is less effective. It is therefore important to start testing as soon as possible,
preferably on the day of onset of symptoms. It has not yet been established if the fast spread
could be the result of a more infectious virus strain.

The most affected age groups of the confirmed cases remain primarily the productive age
groups of 30 – 39 years, followed by 20 - 29 years, 40 - 49 years and 50 - 59 years. These
age groups account for 79.7% of all cases. There is a slight rise of infections among the age
groups between 20 - 49 years, since the second wave commenced.

                                                9
Lessons learned from Influenza A-H1N1 and other relevant activities

The country has had previous experience regarding vaccination in response to a pandemic
and will benefit from the lessons learned during that campaign. The Influenza A-H1N1
vaccination campaign in 2010 had targeted 23,000 recipients in specific risk groups. Only
20.2 % of these target groups were vaccinated, as follows:
Health workers and other essential workers:         29.8%,
Chronic diseases:                                   14.6%,
Pregnant women:                                      6.4%,
Healthy population 5 -19 years:                      9.6%.

The low intake may have been the result of a mix of factors related to readiness of the
health institutions and the acceptance of the target population, as well as negative
campaigning against the vaccination.
In planning towards the COVID-19 vaccination campaign, which is also receiving negative
publicity, it is therefore important to focus, with regard to the current pandemic, on (mass)
communication to all categories of targeted recipients, including health workers, the elderly,
community leaders, community workers, social workers, religion leaders, the options
available to fight the situation, and advocacy towards vaccination.
The communication has started as early as possible, with a targeted risk-based approach.

Towards this end, the Ministry of Health has in production some public service
announcements that appear on social media, social networks, radio and television
channels. The messages are being communicated in the two main languages, Sranan
Tongo and Dutch. Towards the implementation of the campaign, the messages will be
expanded to include the ethnic languages widely spoken in the several ethnic groups in the
country.

                                              10
2. Regulatory preparedness

Most regulatory functions of a National Regulatory System or Authority (NRA) recommended
by the WHO are limited or non-existent in Suriname, i.e., market surveillance (MS),
pharmacovigilance (PV), Quality Control (QC) and Information (Figure 1). The functioning of
the Registration and Pharmaceutical Inspection (PI) is limited due to lack of capacity and
resources.

Figure 1

In January 2021, a new Medicine Registration Committee (RC) was installed, based on a
Resolution of the President of Suriname. The new committee is in the process of reviewing
the current arrangements for registration of health products. The MOH has plans to
strengthen the existing PI and to include a Sub-Directorate for Pharmacy which is to carry
out most other NRA functions.

In Suriname, vaccines are exclusively being procured by the National Immunization
Programme (NIP) of the Ministry of Health (MOH) through PAHO’s Revolving Fund for
Access to Vaccines (PAHO-RF), almost since its launch in 1977. The parastatal Medicine
Supply Company Suriname (Bedrijf Geneesmiddelen Voorziening Suriname, BGVS) is
charged with immediate clearance on arrival and transport of the vaccines to the storage
facilities of the NIP. This system has functioned well over the years and challenges are
limited to issues with storage capacity, late payments, or errors in forecasting and planning.

Formally, medicines, including vaccines, have to be registered before they are allowed to be
imported and used in te country (Medicine Registration Law 1973). For the import of
medicine, the Pharmaceutical Inspection (PI) issues a Certificate of Registration to an
authorized importer as a ‘no objection for importation’ to the licensing body, the Ministry of
Economic Affairs, Entrepreneurship and Technological Innovation, Department of Import,
Export and Foreign Exchange Control. The PI further physically checks import samples to
ensure that imported medicines are the same as what is stated in the import permits.

                                              11
However, vaccines supplied through the PAHO-RF have never been registered. For each
procurement, waivers (exemption of registration) are granted by the Pharmaceutical
Inspection acting for the Director of the MOH, relying on PAHO-RF’s system for quality
assurance for vaccines including pre-qualification by WHO. This procedure may be used as
long as vaccines have received approval from WHO and are obtained through the PAHO-
RF, which is the expectation for vaccines to be obtained through the COVAX Facility.
Alternatively, when other mechanisms are being considered for procurement of COVID-19
vaccines, the country will rely on technical guidance for assessments of these products by
qualified organizations, like WHO, PAHO and the Caribbean Registration System (CRS)
which rely on the WHO Prequalification Programme’s product approval or approval by
Stringent Regulatory Authorities (SRA) acknowledged by the WHO.

Pharmacovigilance and Information
1. The PV and Information functions will be executed as much as possible based on the
   recommendations of global, regional and subregional bodies (WHO, PAHO and CRS);
   and,
2. should be done together with the entities undertaking ESAVI & AEFI management.
3. Local pharmacists with expertise on PV and Information functions will be recruited.

In summary:
    ● COVID-19 vaccines may be imported using the current regulatory arrangements
      similar to vaccines supplied through PAHO-RF
          ○ if obtained through the COVAX Facility.
          ○ if assessments by qualified organizations are available
          ○ if, in the long-term, registration of vaccines by the RC is realized.
    ● In-country regulatory arrangements for MS, PV and QC are to be organized based on
      the existing international technical guidelines, making use of locally available
      expertise.

The Ministry of Health has received approval of the Ministry of Finance, for tax exemptions
regarding this shipment and future shipments of COVID-19 vaccines for this campaign.
No such challenges should be expected in the distribution to and storage of the vaccines at
local storage points prior to vaccination, since these storage and vaccination sites already
are equipped with the proper means to secure the cold chain process.
The central storage facility at the Wanica Ziekenhuis is one of the facilities in the country
that has UCC storage capacities, and therefore will be in charge of the storage and
distribution of the vaccines. They have already taken proper actions towards safe handling
during this process. A distribution plan is in the making, and will be implemented as soon as
the exact dates of the vaccination campaign have been decided. The transportation of the
vaccines to the districts and the hinterland will need specific attention with regard to keeping
of the cold chain.

The existing national regulatory processes and procedures for the import of vaccines for the
national vaccination program will be in force, in order to expedite vaccine availability in the
country. The formal procedures for the import of the COVID-19 vaccines are to be finalized
by the Ministry of Health.

                                               12
3. Planning and coordination of the vaccine introduction

Following is the organizational chart in place for the coordination mechanism at national and
local level.

COVID-19 Organizational structure and partners involved

  National                                         National COVID-19
                                                  Central Coordination:
                                                 Director of Health and       Technical Advice
                           Registration               Direcor BOG               Commission
                           Commission                                        Vaccination Policy
                                                                                 COVID-19

                                                     Working Group
                             Working group                                 Working Group
                                                       Cold Chain/
                            Prioritairy Groups                               Logistcs
                                                      Supply Chain

                                                                                                            Proces
                       Management                                Management                               Monitoring
     Planning &                                                                        Monitoring
                        cold chain,         Training and            publc                                    and
       budget                                                                           vaccinne
                       supply chain         supervision          communicati                              Evaluation
    management                                                                           safety
                         logistiek                                   on

  Coordination
  Regionaal                     Coordination                       Coordination                     Coordination
  East                          Par'bo, Wanica,                    West                             Sipaliwini
                                Para
         • RGD                         •RGD                               •RGD                           •RGD
         • MMPHC                       •MMPHC                             •MMPHC                         •MMPHC
         •Ziekenhuis                   •Hospitals                         •MMC
          Marwina

  Local
                            Coordination                                     Implementation
                          vaccination sites                                    vaccination

The Technical Advisory Commission Immunization Policy COVID-19 consists of the following
authorities:
   1. The Deputy Director of Health
   2. Infectiologist - clinical expert in infectious diseases.
   3. Epidemiologist/researcher of the Public Health discipline of the Faculty of Medical
        Sciences
   4. Registration committee - Expert regulation medicines and vaccine safety
   5. Microbiologist
   6. Manager of the National Immunization Program
   7. Manager of the Epidemiology Unit of the Bureau of Public Health

                                                           13
The Commission is a multidisciplinary group of national experts responsible for providing
independent, evidence-based advice to policy makers and program managers on policy
issues related to immunization and vaccines.
The Commission is competent and able to review and contextualize the international and
regional policy guidelines of the WHO Strategic Advisory Group of Experts on Immunization
(SAGE) and the PAHO Regional Technical Advisory Group on Immunization (RITAG), taking
into account the national context, national priorities and disease epidemiology. The
commission will need to regularly review, revise and update its recommendations to national
policy makers as new evidence becomes available.

Responsibilities of the commission, especially in response to the current COVID-19
pandemic, include:
   • Review of recommendations from SAGE, the RITAG regarding COVID-19 vaccine
       use in the response.
   • Periodic review of the national/regional epidemiology and sero-epidemiology of
       COVID-19, including laboratory confirmed cases, hospitalization and deaths
       associated with COVID-19, and natural immunity data within selected population
       groups.
   • Advise the Ministry of Health on priority groups and vaccination strategies based on
       scientific information and available international and regional guidelines.
   • Updating the advice and, in particular, providing vaccine specific recommendations
       based on new information/updates on:
      o The characteristics of COVID-19 vaccines under development, including efficacy
          and effectiveness
      o The vaccine safety related to different age and risk groups, effect of the vaccine
          on infection and transmission of infection, available vaccine supply and
          predictions of vaccine production.
      o COVID-19 vaccine specific recommendations from SAGE and RITAG.
   • Advising the Ministry of Health on the best communication approaches regarding the
      introduction of COVID-19 vaccines, taking into account the characteristics of the
      vaccine and the dynamics of public acceptance.
   • Reviewing and advising on cases of serious vaccine adverse events (AEFI’s and
      Adverse Events of Special Interest (AESI) identified by the passive and active
      vaccine safety surveillance conducted and examined by the National Immunization
      Program.
   • Advising on communication approaches to communities on vaccine safety and
      vaccine side effects for which no clear answers are yet available.
   • Reviewing and making recommendations on the development of the National
      COVID-19 Vaccination Plan.

In preparation for the vaccination campaign, the country has adopted and adapted as
needed, the existing national governance mechanism which are in force for the regular
immunization program in the country. The Technical Advisory Commission Vaccination
Policy COVID-19 is the national coordinating commission, with representation of relevant
institutions, as described above.

The NITAG has been dormant for quite a while, needing renewal of its representation and its
mandate. There is also no active Inter-agency Coordinating Committee. However, past
members of both these committees are involved in the National Coordination Team for the
campaign. Technical guidance has also been sought from international organizations e.g.
PAHO and UNICEF.

The vaccines to be used for the vaccination campaign will be selected upon criteria adopted
by the Ministry of Health and upon approval from the Registration Committee.

                                            14
4. Resources and funding

Financing COVID-19 vaccination

The procurement of the vaccine and funding of the vaccination program for Covid-19 will be
done within the framework of a national strategy using Government financing and
partnerships with the private sector. A national fund is being established, involving
fundraising with the joint effort of the Government, the business community and other
stakeholders. This decision regarding the fund resulted from a meeting between the
President, the Minister of Health, and the Minister of Foreign Affairs, International Business
and International Cooperation. Consultations were held with various stakeholders, investors,
insurance companies, gold mining companies and the business community. They will
collaborate in local fundraising, which is accepted by the government.
The fundraising will take place through a national fundraising campaign and the fund will be
jointly managed by the business community and the government, resulting in transparency.

Other resources have been made available through the regular budget of the Ministry of
Health, the Ministry of Finance, and other related Ministries, related to this matter.

Budgeting and funding COVID-19 vaccination campaign preparations and implementation

Table 3 summarizes the category of activities and the costs estimated for the implementation
of the Plan. The budget is estimated on best practices and experiences. The detailed budget
for phase 1 is provided in annex 1.
The budgets for the other groups in remaining 3 phases follow the same template, however,
these budgets were adapted to the specific circumstances for these remaining groups, and
taking into account that certain items were already covered in the first phase. It is noted that
this budget will be adapted accordingly, based on the cost of the vaccine to be used in the
first phase and the subsequent phases.

Table 3: Summary of campaign budget (USD)

 Summary all 4 phases                          Phase 1     Phase 2     Phase 3     Phase 4          Total
 Political priority and legal framework           20,000      10,000      10,000      10,000       50,000
 Planning and coordination                        17,000      17,000      17,000      17,000       68,000
 Biologicals and supplies                        326,315   2,516,216   1,174,832   7,416,550   11,433,913
 Cold chain                                       72,600           -           -           -       72,600
 Training                                         27,000           -           -           -       27,000
 Social mobilization                              89,300      67,950      87,950      87,950      333,150
 Operating costs                                 315,226     616,726     315,226     770,352    2,017,530
 Supervision and monitoring                       25,000      40,000      25,000      55,000      145,000
 Epidemiological surveillance and laboratory      56,250      38,790      28,100      72,000      195,140
 Information systems                              98,850      29,100      29,350      29,350      186,650
 Research                                          3,000       3,000       3,000       3,000       12,000
 Evaluation                                       12,000      12,000      12,000      12,000       48,000
 Total                                         1,062,541   3,350,782   1,702,458   8,473,202   14,588,983
 Miscellaneous 10%                               106,254     335,078     170,246     847,320    1,458,898
 Grand Total                                   1,168,795   3,685,860   1,872,704   9,320,522   16,047,881

                                                    15
Table 3a: Summary by phase

 Group         Description                                        Phases    Target    Budget
 Group 1       Healthcare workers, first line                     Phase 1   11,691    1,168,795
 Group 2       Healthcare workers, second line
 Group 3       Military, police, penitentiary officers,
               Government Officials
 Group 4       Populations in elderly homes, including dialysis
               patents
 Group 5       Population sixty years and over, national level    Phase 2   90,170    3,685,860
 Group 6       Population, based on medical grounds/risk          Phase 3   42,497    1,872,704
               factors (40 – 59 years)
 Group 7       Population, based on medical grounds/risk
               factors, (18 – 39 years)
 Group 8       Other risk groups
 Group 9       Healthy population (18 -59 years) (estimated)      Phase 4   265,779   9,320,522
 Grand Total                                                                409,740   16,047,881

Partners and Financing
   • Ministry of Health through its institutions: BOG, MM, RGD and others.
   • Ministry of Regional Development: Meetings with District Commissioners, District
      Council, Resort Council, local transportation (hinterland).
   • Ministry of Education: Schools, additional vaccination sites, …
   • Medical Faculty of the ADEK University of Suriname (MWI): Support staff,
      vaccinators.
   • Public and Private Hospitals, Nursing schools: Support staff, vaccinators.
   • Ministry of Public Works: Logistics.
   • Ministry of Defense: Logistics, Security.
   • Ministry of Justice and Police: Security.
   • Private sector, Service Clubs: Sponsoring of human and financial resources,
      logistics, public announcements, food, refreshments, advertisements, document
      duplication, data input, computer hardware, internet facilities.
   • International Agencies.

                                                 16
5. Target populations and vaccination strategies

The following groups have been identified by the National Coordination Team, to be
included in the vaccination campaign. Vaccination will be free of charge and will be
accepted on a voluntary basis (out of free will). Table 4 summarizes the target groups in
order of priority.

Table 4. Summary total persons by priority group, to be vaccinated in one round

 Priority   Population                                                                 Persons
 Group 1    Healthcare workers, first line                                               1,497
 Group 2    Healthcare workers, second line                                              3,794
 Group 3    Military, police, penitentiary officers, Government Officials                3,500
 Group 4    Populations in elderly homes, including dialysis patents                     2, 900
 Group 5    Population sixty years and over, national level                             90,170
 Group 6    Population, based on medical grounds/risk factor (Diabetes Mellitus,        30,000
            High Blood Pressure, Sickle Cell Anemia, Cardio vascular Diseases,
            COPD, Oncologic Diseases, Indigenous, ….) (40 – 59 years)
 Group 7    Population, based on medical grounds/risk factor (Diabetes Mellitus,        11,000
            High Blood Pressure, Sickle Cell Anemia, Cardio vascular Diseases,
            COPD, Oncologic Diseases, Indigenous, ….) (18 – 39 years)
 Group 8    Other risk groups                                                            1,100
 Group 9    Healthy population (18 -59 years.) (estimated)                             265,779
 Total                                                                                 409,740

The following tables details on where the priority groups will be vaccinated, the estimated
teams to be deployed and the basic inventory needed by a team.

For the calculation of number of teams, the following assumptions/criteria are used:

   -   It will take 5 minutes to register, including questioning on contraindications, of one
       person in an outside facility.
   -   In one hour, 1 vaccinator can vaccinate 15 persons, personal break time included.
   -   One vaccination session will start at 8.00 am and end at 4:00 pm, in total 8 hours,
       minus 1 hour break time, a day. Facilities will be open until the last person has been
       vaccinated. So, overtime and consumption for the team have been included in the
       budget.
   -   Accordingly, one team can vaccinate 3 x 15 x 7 = 315 persons in a one-day session.
   -   Some clinics with small populations can be joined together, taking into account the
       geographic possibilities.
   -   Since there is no system of postcodes or other criteria to daily organize the flow to
       the facility, it might happen that all those needing the vaccination, will show up on
       one day, if not well informed or organized properly. In order to address this issue, it
       would be practical and cost saving to do a district in 1 day, by the available teams in
       that district area, assisted by additional teams from other districts, or the RGD, or
       volunteers, provided that there is sufficient transportation organized.
   -   For the city and other communities, it can be decided to do a vaccination day with so
       many teams simultaneously, as practically organizable. Given this reasoning, it is
       advisable thus that the vaccination is organized by district.
   -   It must be noted that smooth flow of vaccine recipients through the phases of
       registration, vaccination and observation post-vaccination, will need adaptation to the
       situation during the activities. A practical issue would be that, if for example 15

                                               17
persons receive the vaccination in one hour, these 15 persons will have to spend the
         required 15 – 30 minutes in the observation area. A continuous flow of the recipients
         in the observation area will pose practical issues with regard to accommodation of all,
         at once and to ensure adherence to the COVID-19 public health measures.
    -    The same process will be repeated for the second dose to be given 3 - 4weeks later,
         depending on the vaccine being used.

The following table gives a breakdown of what would be the basic inventory for 1 vaccination
team. More than 1 team may be deployed to one site, in order to facility smooth operation.

Table 5: Breakdown of the basic inventory needed for a team
 Item                                               Unit price        Needed          Total
 Vaccine carrier                                             40            1            40
 Thermos box (where needed)                                                               0
 Ice packs, at least 4 per carrier                           10             1           10
 Laser thermometer                                           75             1           75
 Cotton rolls                                                 5             1             5
 Disinfectants                                                2            10           20
 Hand sanitizers                                              2            10           20
 Paper towels, toilet paper                                   5             2           10
 Band aids (box of 100)                                       1             5             5
 Vaccination cards, at least 500 per session                0.1           500           50
 Stamp and stamp pad                                         25             1           25
 PPE Equipment (masks only)                                   1           100          100
 Disposable gloves                                            2            15           30
 Safety boxes                                                10             5           50
 Waste bags                                                   5            10           50
 Manuals, intake forms, ESAVI surveillance,
                                                            10              1              10
 writing materials,
 Total                                                                                 500

The following tables give an overview of vaccination sites where the priority groups will be
vaccinated. More than 1 team may be deployed to one site, in order to facility smooth
operation.

Table 5a. Group 1: Health Care workers, first line

                                                                                            Basic
 Hospitals/Health Centers
                                                     To Vaccinate         Teams     Days    Inventory
 Militair Hospitaal
 Academisch Ziekenhuis Paramaribo                                  422          2      1         1,000
 Diaconessenhuis                                                   200          1      1          500
 Lands Hospitaal                                                   115          1      1          500
 St. Vincentius Ziekenhuis (RKZ)                                   188          1      1          500
 Wanica Ziekenhuis                                                 138          1      1          500
 Mungra Medisch Centrum Nickerie                                    44          1      1          500
 RGD                                                                65          1      1          500
 Medische Zending                                                  100          1      1          500
 PCS                                                                25          1      1          500
 Others (MOH team, Swab teams, and others)                         200          1      1          500
 Total                                                            1,497      11       10         5,500

                                               18
Table 5b. Group 2: Health care workers, second line.

 Hospitals/Health Centers                               To Vaccinate        Teams   Days     Cost
 Militair Hospitaal                                              1,200          4                   2,000
 Academisch Ziekenhuis Paramaribo                                  630          2                   1,000
 Diaconessenhuis                                                   340          1                    500
 Lands Hospitaal                                                   276          1                    500
 St. Vincentius Ziekenhuis (RKZ)                                   375          1                    500
 Wanica Ziekenhuis                                                 120          1                    500
 Mungra Medisch Centrum Nickerie                                   200          1                    500
 RGD                                                               590          1                    500
 Medische Zending                                                      63       1                    500
 PCS
 Total                                                           3,794         13        1          6,500

Table 5c. Group 3: Military, police, penitentiary officers, Government Officials

 Hospitals/Health Centers                               To Vaccinate        Teams   Days     Cost
 Militair Hospitaal                                              2,000          5        1          2,500
 Academisch Ziekenhuis Paramaribo                                                        1
 Diaconessenhuis
 Lands Hospitaal
 St. Vincentius Ziekenhuis (RKZ)
 Wanica Ziekenhuis                                               1,000          3        1          1,500
 Mungra Medisch Centrum Nickerie                                   500          2        1          1,000
 Other vaccination sites, public and private

 Total                                                           3,500         10    4              5,000

Table 5d. Group 4: Populations in elderly homes, including dialysis patents
Target: 2,050 and 850 persons respectively.

 Hospitals/Health Centers                               To Vaccinate        Teams   Days     Cost
 Militair Hospitaal for the Dialysis patients                      850          4        1          2,000
 Academisch Ziekenhuis Paramaribo
 Diaconessenhuis
 Lands Hospitaal
 St. Vincentius Ziekenhuis (RKZ)
 Wanica Ziekenhuis
 Mungra Medisch Centrum Nickerie
 Other vaccination sites, public and private                     2,050         10        1          5,000
                                                Total            2,900         14        1          7,000

                                                  19
Table 5e. Target group 5: Population 60 years and older, national level

 District              Resorts            Communities         Target
 Brokopondo                           6                  7               1,171
 Commewijne                           6                 37               5,163
 Coronie                              3                  4                 574
 Marowijne                            6                 29               2,843
 Nickerie                             5                 22               6,060
 Para                                 5                 45               3,458
 Paramaribo                          12                114              45,148
 Saramacca                            6                 36               2,784
 Sipaliwini                           6                 41               4,811
 Wanica                               7                135              18,158
 Total                               62                470              90,170

Vaccine and related costs for the population 60 years and older

This list is based on two sources:
    1. The Central Bureau for Public Affairs (Centraal Bureau voor Burgerzaken) (CBB) with
         an overview of all persons over 60 years, as registered in the respective districts,
         resorts (district areas), and communities.
    2. The Medical Mission Primary Health Care, with all their clients registered in the
         respective districts and resorts.

For further elaboration of this risk group, both sources have been used. For the population of
the Medical Mission, their sources have been used, while for the remaining RGD resorts, the
CBB data have been used. The total number of persons over 60 years as provided by the
CBB, have not been altered for the general analysis.

Teams and sessions for the implementation of the campaign, of the population over
60years old

According to CBB data, the total population in this age group is 90,170 living in 10 districts,
in 62 resorts, and 470 communities. Most of these communities have health facilities
operated by the Regional Health Services (RGD) in the coastal area, and the Medical
Mission in the hinterland. (The hospitals and private facilities are excluded here).

The facilities in the coastal area are in general geographically easily accessible, while only a
part of those in the hinterland can be reached by road. Most of the communities/villages in
the hinterland can only be reached over water or by air.
In planning the logistics of the campaign, transportation over water and air constitute a
significant part of the costs. Transportation over road from village to village was taken into
account, when planning the number of teams needed per district.

The basis of the planning for human resources, is that a fixed/mobile/outreach team will
consist of:
3 vaccinators, 1 administrative support, 1 driver and 1 “gatekeeper”.
The administrative support and the “gatekeeper” can be recruited from the local facilities, or
other support services available there.
The teams operating in Paramaribo and parts of some districts can move easily from facility
to facility, by road transportation.

                                               20
Table 5e-1: Number of vaccination sessions needed per district, resort and population
in the service area of the Medical Mission.

Note: The information in this table for the MM is derived, based on the information from the
table by CBB. The CBB table is left in its original format, minus the sessions in the MM area,
to indicate the (total) population size in all districts.

 RESSORT                               CLINIC                         SESSIONS       TOTAL
 BROKOPONDO                            BROWNSWEG                                 1
                                                                                        2
                                       NW. KOFFIEKAMP                            1
                                       KLAASKREEK                                1
                                                                                        2
                                       Nw. LOMBE (boat)                          1
                 Brownsweg
                                       MARCHALLKREEK                             1      1
                                       PHEDRA                                    1      1
                                       POWAKKA                                   1
                                                                                        2
                                       REDI DOTI                                 1
                                       BROKOPONDO                                1      1
                                       ASIGRON                                   1      1
                 Brokopondo
                                       BALINGSOELA                               1      1
                                       LEBIDOTI                                  1      1
 Bovenlandse     Bovenlandse           SIPALIWINI (air)                          1
 Indianen en     Indianen                                                               2
                                       ALALAPAROE (air)                          1
 West
                                       PALUMEU (air)                             1
 Suriname                                                                               2
                                       PELELE TEPOE (air)                        1
                                       PULEOWIME (air)                           1
                                                                                        2
                                       KAWEMHAKAN (air)                          1
                                       COEROENI (air)                            1
                                       KWAMALASAMUTU (air)                       1      3
                                       AMOTOPO (Air)                             1
                                                                                 1      1
                 WEST SURINAME         WITAGRON
 Boven           DEBIKE                DEBIKE                                    1
 Suriname                              HEKOENOENOE                               1      3
                                       KAMBALOA                                  1
                                       PIKIEN SLEE                               1      1
                 DJOEMOE               DJOEMOE (air)                             1
                                                                                        2
                                       KAJANA (air)                              1
                                       SEMOISIE (boat)                           1      1
                                       POKIGRON                                  1
                                                                                        2
                 LADOANI               DOEWATRA                                  1
                                       GOEJABA (boat)                            1
                                                                                        2
                                       LADOANI (boat)                            1
                                       SOEKOENALE (boat)                         1      1
                                       JAW-JAW                                   1      1
                                       BIGI POIKA                                1      1

                                              21
PIKIN SARON                                           1        1
 MIDDEN              MIDDEN          KWAKOEGRON                                            1        1
 SURINAME            SURINAME        POESOEGROENOE (by air)                                1        1
                                     NJ JACOB KONDRE (by air)                              1        1
                                     DRIETABIKI (air)                                      1        1
                     DRIETABBETJE    GODORO (air)                                          1        1
                                     KARMEL (air)                                          1        1
                                     AGAIGONI (boat)                                       1        1
                                     APOEMA (boat)                                         1        1
 OOST                                COTTICA (boat)                                        1        1
 SURINAME                            GAKABA (boat)                                         1        1
                     STOELMANSEILAND GONINI (boat)                                         1        1
                                     LANGATABIKI (boat)                                    1        1
                                     LAWATABIKI (boat)                                     1        1
                                     NASON (boat)                                          1        1
                                     STOELMANSEILAND (air)                                 1        1
 Total sessions                                                                           52             52

Table 5e-2. Number of vaccination sessions needed per district, resort and
population, using CBB data

 DISTRIKT         RESSORT                     POPULATION     Sessions needed, based      Total
                                                             on target population size   sessions
                                                             and geographic              needed
                                                             accessibility
 Brokopondo       Brownsweg                            340
                  Centrum                              282                                Included in
                  Klaaskreek                           227                               the previous
                  Kwakoegron & Klaaskreek                                                 table of the
                                                       125                                    MM
                  & Marshallkreek
                  Sarakreek                            197
 Commewijne       Alkmaar                              915                           2
                  Bakie & Margaretha                   189                           1
                  Meerzorg                          1835                             5         12
                  Nieuw Amsterdam                   1167                             2
                  Tamanredjo                        1057                             2
 Coronie          Johanna Maria & Totness &
                                                       574                           2         2
                  Welgelegen
 Marowijne        Albina                            1038                             2
                  Galibi                               143                           1
                  Moengo                            1246                             3         8
                  Moengo Tapoe                         137                           1
                  Patamacca & Wanhati                  279                           1
 Nickerie         Groot Henar                          419                           1
                  Nieuw Nickerie                    2391                             6         13
                  Oostelijke Polders                1006                             2

                                                  22
Wageningen                          592                     1
              Westelijke Polders               1652                       3
 Para         Bigi Poika                           75
              Carolina                             77                           Included in
                                                                               the previous
              Noord                            1118
                                                                                table of the
              Oost                             1195                                 MM
              Zuid                                993
 Paramaribo   Beekhuizen                       2911                       6
              Blauwgrond                       7113                      13
              Centrum                          5342                      13
              Flora                            3713                       9
              Latour                           3807                       9
              Livorno                          1299                       3
                                                                                   104
              Munder                           3045                       9
              Pontbuiten                       2573                       6
              Rainville                        5340                      13
              Tammenga                         2750                       6
              Weg Naar Zee                     3043                       7
              Welgelegen                       4212                      10
 Saramacca    Calcutta                            242                      1
              Groningen                           520                      2
              Jarikaba                            822                      2
                                                                                     8
              Kampong Baroe                       407                      1
              Tijgerkreek                         534                      1
              Wayamboweg                          259                      1
 Sipaliwini   Boven Coppename                      78
              Boven Saramacca                     109                           Included in
              Boven Suriname                   2279                            the previous
              Coeroenie                           185                           table of the
              Kabalebo                            297                               MM

              Tapanahony                       1863
 Wanica       De Nieuwe Grond                  4080                       10
              Domburg                          1234                        4
              Houttuin                         2300                        5
              Koewarasan                       3046                        7        47
              Kwatta                           2349                        6
              Lelydorp                         3456                       10
              Saramacca Polder                 1693                        5
                TOTAL                         90170                     194              194

Thus, the total number of sessions for the 60+ group on national level is (52 + 194) x 2 = 492
sessions for both vaccination rounds.

                                             23
Transportation costs will be added depending on the geographical area of the site.

Table 5e-3: Roundtrip transportation cost Medical Mission

 TRANSPORTATION COSTS MEDICAL MISSION – 1 round (USD)
 Poesoegroenoe and Nw Jacob kondre (air)                                       1,353
 Kwakoegron/ Witagron / Pikin Saron (road)                                       440
 Bigi Poika and Pikin Saron (road)                                               220
 Sipaliwini/ Alalaparoe (air)                                                  2,428
 Pelele Tepoe/ Palumeu (air)                                                   2,150
 Puleowime/ Kawemhakan (air)                                                   1,620
 Coeroeni/ Amotopo/ Kwamalasamutu (air)                                        2,324
 Kajana/ Djoemoe (air)                                                         1,526
 Djoemoe/ Semoisie (boat)                                                        100
 Debike/Hekoenoenoe/ Kambaloa/ Pikin Slee (boat)                                 250
 Ladoani/ Goejaba (boat)                                                         178
 Pokigron/ Duatra (road)                                                         430
 Brownsweg/ nw. Koffiekamp (road)                                                240
 Klaaskreek/ nw. Lombe (road/boat)                                               176
 Marchallkreek/ Phedra (road)                                                    155
 Powakka/ Redi Doti (road)                                                       154
 Brokopondo/ Balingsoela (road)                                                  200
 Brokopondo/ Asigron (road)                                                          30
 Brokopondo/ Lebi Doti (road/boat)                                               300
 Stoelmanseiland/ Gonini/ Agaigoni (air/boat)                                  1,783
 Drietabbetje (flight)/Stoelmanseiland (drop vaccines)/
 Cottica /Lawatabiki                                                           2,156
 TOTAL USD                                                                    18,213

                                                 24
Based on these criteria, the following overview is presented in table 5e-4.

Table 5e-4: Costs for reaching out to vaccination sites (USD) for the 60+ target group

                                                                                              Overtime/
 District               Population      Sessions                    Inventory   Transport
                                                                                              Consumption
 Brokopondo                                                   12       6,000                          1,800
                              1,171
 Bovenlandse Indianen                                          9       4,500                          1,350
 West Suriname                                                 1         500                            150
                                                                                   18,213
 Boven Suriname                                               12       6,000                          1,800
 Midden Suriname                                               6       3,000                            900
 Oost Suriname                                                12       6,000                          1,800
 Commewijne                   5,163                           12       6,000          300             1,800
 Coronie                       574                             2       1,000          500               300
 Marowijne                    2,843                            8       4,000          500             1,200
 Nickerie                     6,060                            13      6,500          700             1,950
                                        Included in specification
 Para                         3,458
                                        by MM
 Paramaribo                  45,148                           104     52,000          200            15,600
 Saramacca                    2,784                             8      4,000          200             1,200
                                        Included in specification
 Sipaliwini                   4,811
                                        by MM
 Wanica                      18,158                            47     23,500          500             7,050
 Total                       90,170                                  123,000       29,583            36,900

Vaccine and related costs for the 60+ population

The components in the following table have been included in the detailed budget and this will
be programmed separately. Fine tuning will be needed, once the prices for the ancillary
items have been determined.

Table 5e-5: Vaccine doses needed (including 10% wastage rate) per district for the
population of 60 years and older

                Population    Vaccine     Syringes/                    If reconstitution needed
 District                       doses      needles           Diluent vials     Syringes 5ml         Needles
 Brokopondo          1,171   incl.20%
                                2,576         2,576                10515
                                                                       ml    reconstitution
                                                                                        515    reconstitution
                                                                                                          515
 Commewijne          5,163      waste
                               11,359       11,359                 2,272              2,272             2,272
 Coronie               574      1,263         1,263                   253               253               253
 Marowijne           2,843      6,255         6,255                1,251              1,251             1,251
 Nickerie            6,060     13,332       13,332                 2,666              2,666             2,666
 Para                3,458      7,608         7,608                1,522              1,522             1,522
 Paramaribo         45,148     99,326       99,326                19,865             19,865           19,865
 Saramacca           2,784      6,125         6,125                1,225              1,225             1,225
 Sipaliwini          4,811     10,584       10,584                 2,117              2,117             2,117
 Wanica             18,158     39,948       39,948                 7,990              7,990             7,990
 Total              90,170    198,374      198,374                39,675             39,675           39,675

                                                      25
Table 5e-6: Vaccine and syringes/needles cost for a vaccine that costs 10.50 USD per
dose (example)

 District        Population       Vaccine        Syringes/        Vaccines     Syringes/   Total USD
 Brokopondo               1,171   doses 2,576    needles
                                                       2,576          32,460   Needles
                                                                                     185           32,646
 Commewijne               5,163   incl.20%
                                        11,359        11,359         143,118         818          143,936
 Coronie                    574   waste 1,263          1,263          15,911          91           16,002
 Marowijne                2,843          6,255         6,255          78,808         450           79,258
 Nickerie                 6,060         13,332        13,332         167,983         960          168,943
 Para                     3,458          7,608         7,608          95,856         548           96,404
 Paramaribo              45,148         99,326        99,326       1,251,503       7,151       1,258,654
 Saramacca                2,784          6,125         6,125          77,172         441           77,613
 Sipaliwini               4,811         10,584        10,584         133,361         762          134,123
 Wanica                  18,158         39,948        39,948         503,340       2,876          506,216
 Total                   90,170        198,374       198,374       2,499,512      14,283       2,513,795

Table 5f. Group 6: Population, based on medical grounds/risk factor (Diabetes
Mellitus, High Blood Pressure, Sickle Cell Anemia, Cardio vascular Diseases, COPD,
Oncologic Diseases, Indigenous) (40 – 59 years)

Target: 30,000 persons

The details with regard to where these persons are located, where they will be vaccinated,
and what will be the cost for this group, will be confirmed when full information about this
group becomes be available.

 Hospitals/Health Centers                               To Vaccinate     Teams      Days   Cost
 A designated location or tent on the grounds of the
 hospital or near the hospital, where the patient can
 go after visiting the specialist                               10,000         10     10          5000
 Outreach (mobile) clinics for surrounding
 villages/polders.                                               5,000          5     10          2500
 Designated outpatient clinics (separate location in
 the clinic, or a tent on site).                                 5,000          5     10          2500
 Temporary clinics or mobile outreach teams                      5,000          5     10          2500
 Other vaccination sites, public and private                     5,000          5     10         2500
 Total                                                          30,000         30              15,000

Table 5g. Group 7: Population, based on medical grounds/risk factor (Diabetes
Mellitus, High Blood Pressure, Sickle Cell Anemia, Cardio vascular Diseases, COPD,
Oncologic Diseases, Indigenous) (18 – 39 years)

Target: 11,000 persons

The details with regard to where these persons are located, where they will be vaccinated,
and what will be the cost for this group, will be determined when full information about this
group will be available.

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