Webinar Series on COVID-19 vaccine: Jointly organized by Malaysian Society of Infection Control and Infectious Diseases (MyICID) & Institute for Clinical Research (ICR), NIH Speaker: Dr. Norzaihan binti Hassan, Family Medicine Consultant working in Klinik Kesihatan Bandar Kota Bharu, Ministry of Health Malaysia.

1. LESSONS LEARNT FROM
PHASE 1 ROLL-OUT OF
COVID-19 VACCINES
Dr. Norzaihan Hassan
Family Medicine Specialist

2. Disclaimers
•This slide was prepared for the Webinar Series on
COVID-19 session on 5th
May 2021, by
Dr.Norzaihan Hassan, Family Medicine Specialist,
Klinik Kesihatan Bandar Kota Bharu, Malaysia.
•This is intended to share within healthcare
professionals, not for public.
•Kindly acknowledge “Clinical Updates in COVID-19
http://www.nih.gov.my/covid-19” should you plan to
share the information obtained from this slide with
your colleagues.
Jointly organized by Malaysian Society of Infection Control and Infectious Diseases (MyICID) & Institute for Clinical Research, NIH

3. Outline:
•Introduction
•Planning for phase 1
•Set up Mass vaccination
•Challenges and how to overcome
•Summary

4. Introduction
•28.2.2021 - Vaccine injection to the vaccinator
•Vaccine storage centre (Pusat Simpanan Vaksin -
PSV) in Kelantan (total 4)
• Kota Bharu
• Pasir Mas
• Kuala Krai
• Gua Musang
•Vaccine administration centre (Pusat Pemberian
Vaksin - PPV) in Kota Bharu
• Klinik Kesihatan & Hospital

5. Planning for phase 1
Preparation as vaccine storage
centre (pusat simpanan vaksin - psv)
▪ Suitable place for ultra low temperature
freezer (ULTF) and top loading.
▪ Strengthening the electrical
system-generator
▪ Security (CCTV)
▪ Security (mobile police station)

6. PREPARATION: MANPOWER
Vaccinator team - designated responsibility
• FMS, MO – clinical management
• Matron, staff nurse, assistant medical office (AMO or
PPP) – vaccination process
• Community nurse (JM), pembantu tadbir– registration and
return
Priority
• Vaccinators from school health team (UKS) and MCH
• MO with experience/ trained in emergency care
Back up
• Pharmacist - for consent station

7. PREPARATION:TRAINING
•Information about COVID-19 Vaccine
• Efficacy, side effects, contraindication and frequently-asked
question
• Facilitate in taking consent
•Simulation of vaccine and emergency management
• Vaccine preparation and handling-role play
• Observation and anaphylaxis management-role play
• Cross-audit between PPV in district-CHECKLIST
•Webinar for MyVas database and MySejahtera.
• Focus on registration and verification in MyVas
• Troubleshoot during system breakdown🡪 manual entry into Excel
to be
■ submitted to KKM MySejahtera team

8. PREPARATION: EQUIPMENT
•Vaccination set
• specially designed low-dead volume syringe (ldv)
•Equipment for monitoring and emergency
management
• checklist

9. Checklist for vaccinee
•Proper attire
•Identity Card
•Updated MySejahtera- ensure name as per IC
•Vaccine card (2nd
dose)

10. CLIENT FLOW CHART
CONSENT
TRIAGE
BRIEFING-PRE-RECORDE
D VIDEO WITH SLIDES

11. MYVAS
REGISTRATION
VACCINATION
OBSERVATION
VACCINE CARD
DIGITAL
CERTIFICATE

12. SET UP MASS VACCINATION
▪ MANPOWER - MOBILISATION OF STAFF
Pharmacist- consent
Dental officer- MyVas
Dental assistant- vaccine cards
PPK/IK- navigators
▪ LOGISTIC
Venue: single vs double floor
Time: shift system for full day event
▪ BRIEFING
PIC agencies: flow chart, linelisting,
Staff: work schedule and responsibilities, contingency plan
▪ FLOOR PLAN

13. FLOW
CHART

14. COLLABORATION
•Person in charge (PIC) various
agencies – eg : verification of line
listing
•Police-escort the vaccine from PSV

15. Technology
• Pre-recorded video with slides
– information for consent
• MyVas helpdesk
• IT personnel standby
• Computer
• Mobile broadband

16. LINE LISTING
•Priority group
• All medical frontliners
• High risk institution: prison, nursing home
(rumah orang tua)
•Back up
• 1st
dose: those in the priority group.

17. Management of immediate side effects
•Printed algorithm for management of
anaphylaxis
•ADR form and Covid-19 AEFI investigation form

18. RETURN- doses of vaccine tally with myvas
COLOR-CODED
TAGGING

19. OUTCOME 1ST
COHORT (28/2/2021-25/3/2021)
•KPI: zero wastage
•2nd
dose: total 71 (3.37%) not turn up
•Back up plan
•Planning for catch up 2nd
DOSE
REASON NUMBER
PREGNANT 6/2035
SYMPTOMATIC-urti 32/2035
TO INJECT IN HEALTH FACILITY (Pre-vaccination assessment) 4/2035
Moderate allergic reaction 1/2035
REFUSED (moderate SE- dizziness) 1/2035
OTHERS (outstation, admission-heart problem, overwarfarinisation,
post- op, medical condition)
27/2035

20. OUTCOME 1ST
COHORT…cont
▪ 322 out of 2035 vaccine recipients had co-morbidity and were
successfully vaccinated.
▪ Dm only = 109, Hpt only = 106, DM & Hpt = 24, Asthma = 30,
Heart disease = 12, obesity = 12, others
▪ None had anaphylaxis.
▪ only one person with dizziness was sent to the yellow zone
emergency department for observation.
▪ 2 clients experienced immediate side effects vomiting and
dizziness within 30 minutes post vaccination.

21. OUTCOME 1ST
COHORT…cont
▪ None got COVID-19 after the first dose.
▪ 2 health care workers were infected with COVID-19 after the
2nd dose of vaccine.
▪ Those who have had anaphylaxis but not to drugs or
substances containing PEG or polysorbate have been
successfully vaccinated in hospital.

22. Challenges and how to overcome
Challenges How to overcome
some clients do not follow staggered
appointment, difficult to follow SOP and
new norm.
PIC the agency needs to remind their staff
to come according to the staggered
appointment
Some agency does not provide PIC hence
our staff must call each client to remind or
confirm attendance
need a PIC of each agency
Clients being forced and try to skip vaccine
station
be more vigilant in controlling each station
to avoid skipping stations.
Use chip /line listing number to be
collected at vaccine station to identify
those who actually being injected.

23. Challenges and how to overcome
Challenges How to overcome
Not enough vaccinee for 1 vial, refused or to
the last minute drop out .
Prepare backups everyday , not to come until
called
Wrong data entry during registration by staff
eg. name, IC, batch number
Training by MyVas team and have the same
staff for 3 days mass vaccine and use physical
IC for verification
No case of true anaphylaxis but there were
cases of ISRR which similar presentation to
allergic reaction eg cvs symptom-dizziness,
palpitation, near syncope)
Training or CME how to differentiate
anaphylaxis or ISRR
Patients with co-morbid-dilemma who should
be screened for BP, time and manpower
limitation.
Prioritized for known HPT and history of
allergy.

24. Challenges and how to overcome
Challenges How to overcome
Data management :
status in myvas are not complete or in
progress, need to call vacinee, some do
not answer the call or give the wrong
number, some do not go to the
verification station, in other words, they
do not follow the client flow hence this
cause the PIC to take a long time to
correct the data.
Have to find out the reason for each
vaccinee with status arrived or in
progress in myvas:
- client miss stations
- or due to poor internet connection.
Need staff to show directions to ensure
client goes to each designated station

25. WAY FORWARD
▪Use of card reader for 1st
dose registration - minimize
technical error in MyVas
▪(Info from IT officer Kelantan State Health Dept (JKNK):
need access to MyVas coding - not feasible at the
moment)

26. Summary:
•Planning is more important than ever
• Vaccine: cold chain
• Line listing
• Manpower
• Vaccination schedule
•Organisation:
• Vaccinator team
• Mass vaccine set up
•Standard operating procedure (SOP)
•Organised record keeping
•Return

27. Acknowledgement