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Cover and document design by Nik Nikam Photo credits: shutterstock.com 02 DIGITAL CONNECTIVITY AS AN ENABLER FOR COVID-19 VACCINE DEPLOYMENT CONTENTS ACKNOWLEDGMENTS...................................................................................................................................................................... 2 CONTEXT ...................................................................................................................................................................................... 3 Leveraging Digital Connectivity for Vaccine Delivery .................................................................................................................................. 3 SOLUTIONS ...................................................................................................................................................................................... 5 Approaches to increasing access rapidly........................................................................................................................................................ 5 Country examples ................................................................................................................................................................................................ 6 10 Service Delivery in Offline Environments........................................................................................................................................................ CONSIDERATIONS FOR IMPLEMENTATION................................................................................................................................11 CONCLUSION ......................................................................................................................................................................................14 CONTACT ......................................................................................................................................................................................14 ANNEX FOR WORLD BANK TTLS .................................................................................................................................................. 15 15 Generic language for PADs.................................................................................................................................................................................. Checklist for Effective Implementation ..........................................................................................................................................................16 1 DIGITAL CONNECTIVITY AS AN ENABLER FOR COVID-19 VACCINE DEPLOYMENT ACKNOWLEDGMENTS This note was prepared by Sharada Srinivasan and Hyea Won Lee as part of an ongoing collaboration between the Digital Development and the Health, Nutrition and Population Global Practices on digital safeguards and enablers for COVID-19 vaccine delivery. This note benefited greatly from the inputs and reviews of World Bank Group staff, including Doyle Gallegos, Audrey Ariss, Sui Nom Tam, Matthew Hulse and Tania Begazo Gomez, and was prepared under the supervision of Vyjayanti Desai. This work is supported by the Digital Development Partnership, administered by the World Bank. For more information or how you can receive assistance with these topics, please contact Digital4Vaccines@worldbank group.org. The Digital Development Partnership (DDP) offers a platform for digital innovation and development financing. DDP brings public and private sector partners together to advance digital solutions and drive digital transformation in developing countries.To find out more about the DDP, visit http://www.digitaldevelopmentpartnership.org. WITH SUPPORT FROM: 2 DIGITAL CONNECTIVITY AS AN ENABLER FOR COVID-19 VACCINE DEPLOYMENT CONTEXT Pathways to a green, resilient, and inclusive recovery from the COVID-19 pandemic begin with global vaccination efforts. Accelerating vaccine equity can save lives and drive a faster and fairer trajectory for economies both rich and poor. According to the United Nations, low-income countries would add US$38 billion to their GDP forecast for 2021 if they had the same vaccination rate as high-income countries1. Inequities in manufacturing, scale-up, and distribution currently jeopardize prospects for global economic recovery, as new variants take hold and adversely impact the health and economic prospects of the poorest and most vulnerable populations. Digital connectivity can play an essential role in scaling up and facilitating vaccine delivery, when deployed with attention to existing digital divides. In this context, digital connectivity is an important and cost-effective complement to existing vaccination programs against COVID-19. It allows countries to leverage digital technologies to accelerate and monitor vaccination efforts. Governments, development organizations, and healthcare institutions have an opportunity to bridge both vaccine inequities and enhance access to basic services delivery, setting the stage for a robust economic recovery. This note provides an overview of the role of connectivity in vaccine delivery efforts, and potential short-term solutions to provide Internet access in areas where DSL, cable and fiber networks are out of reach. It includes implementation considerations and highlights some alternative low-tech solutions when connectivity cannot be achieved in the short-term. Its intent is not to provide recommendations on ways to design or implement universal access policies and programs, but rather more immediate measures that can facilitate vaccine delivery.. Leveraging Digital Connectivity for Vaccine Delivery Internet connectivity can enable national immunization programs at all stages of the vaccine lifecycle – planning and management, supply and distribution, program delivery, and post-vaccination monitoring. As vaccination efforts progress globally, country-level vaccine distribution plans can effectively cater for under-connected and often marginalized communities. Connectivity can also help leverage digital platforms for logistics and dose tracking, enable registration and timely follow-up by priority group sequencing, support efforts to combat misinformation, and provide access to vaccine safety evaluations post vaccination. Figure 1: Digital tools across the vaccine lifecycle Source: Digital Development Global Practice , World Bank, 2021 1 The World Health Organization, 2021. https://www.who.int/news/item/22-07-2021-vaccine-inequity-undermining-global-economic-recovery 3 DIGITAL CONNECTIVITY AS AN ENABLER FOR COVID-19 VACCINE DEPLOYMENT The table below describes the importance of digital connectivity at each stage of the lifecycle: from logistics tracking, rural access, to improving vaccine safety evaluations, to helping tackle vaccine misinformation and hesitancy. Life- Use Case Benefits Implementation Requirements Key stakeholders cycle Planning & Identification of priority Effective use and Existing connectivity and data on National Statistics Manage- ment communities for prioritization of limited demographics and healthcare service Office vaccinations resources to have the capacity uploaded onto government most impact databases and platforms Improved logistics and Maintenance of the cold Connectivity on transit vehicles and • Ministry of Supply Chain & dose tracking chain for safety RFID for tracking vaccines in transit Transportation Distribution Connectivity at health care centers, • including via satellite in rural/remote areas Timely replenishment of • Barcodes for dose tracking and Ministry of Health supplies replenishment Availability of vaccine Ensuring timely Connectivity through public access wi-fi Ministry of Health scheduling information registration and vaccine hotspots, subsidies for mobile access, to the public and distribution based on USSD-based information campaigns, enabling access to online available supply zero-rated applications and websites, registration and connectivity at vaccine registration centers Program Delivery Timely assessment of Monitoring trends in Existing connectivity via wi-fi hotspots Academia and population-level vaccine vaccination delay and and 3G+ connectivity for end-users and civil society confidence vaccine hesitancy at health centers to collect real-time organizations, data on vaccine distribution and delays community groups in arriving for shots where needed Behavioral messaging to Better targeting of Existing connectivity via phones and at Ministry of Health improve take-up of the messages using data on vaccination centers; analytics capabilities vaccines vaccine confidence for using large scale data feeds from non- specific populations with traditional data sources such as public social low adoption rates media feeds Civil Society organizations Digitization of Dose tracking and Zero-rated applications for dose- • Ministry of Health immunization data follow-up tracking and follow-up Ability to use vaccine Existing digitized clinical information in • records for varied health centers Post-vaccination purposes Integration with overall healthcare records for population level statistics Improvement of vaccine Better reporting of Free applications and connectivity at Ministry of Health safety evaluation adverse events following healthcare centers for the real-time immunizations in diverse sharing of data on adverse events populations following immunization 4 DIGITAL CONNECTIVITY AS AN ENABLER FOR COVID-19 VACCINE DEPLOYMENT SOLUTIONS The pandemic has already been detrimental for many communities who lack reliable, high-speed Internet. As a result, vaccine delivery programs incorporating solutions to increase digital connectivity should be specific to the country’s context and targeted to the level of available baseline resources. Fortunately, the pandemic has provided a plethora of examples and case studies that leverage Internet access in numerous innovative ways. For the purposes of connectivity in the supply chain, existing logistics tracking solutions that rely on global positioning system (GPS) and mobile networks (2G/3G/4G/5G) may be used. The level of connectivity at the health center and within the communities targeted may vary dramatically and have important implications for the kinds of program delivery modalities to be implemented. As a baseline, 2G connectivity enables data speeds of up to 64 kbps and allows text messaging but no multimedia. 3G, on the other hand, allows for data speeds up to 2 Mbps, allowing for more content to be shared, including photos, low-resolution videos, and emails. 4G connectivity allows data speeds of 20 Mbps or more, supporting interactive multimedia, voice, and video conversations. Approaches to increasing access rapidly The following solutions can be easily adapted to help scale up vaccination programs in short response times: 1. Satellite connectivity in areas without readily available fixed or mobile broadband infrastructure to enable WiFi; 2. Wi-Fi hotspots, either making existing hotspots free through pro-bono private sector contribution, government regulation or incentives to operators for new locations; 3. Purchasing network capacity for government and health service providers to increase capacity; 4. Subsidies for digital devices/services for health staff and to address gaps in access for poor and vulnerable populations; 5. Zero-rating: allowing free access to specific websites or applications. These measures require active collaboration with regulators, as new operators or approaches may require emergency approvals to bring service online at short notice. For example, regulators around the world temporarily assigned unused frequency spectrum so operators could provide enhanced services during the early stage of the pandemic to meet with the surge in data demand and usage. 5 DIGITAL CONNECTIVITY AS AN ENABLER FOR COVID-19 VACCINE DEPLOYMENT Country examples The following table provides case studies and country examples where solutions to bridge the connectivity gap have been implemented successfully in client countries. Effective delivery of vaccine scheduling information to the public Setting up satellite In the areas without readily available fixed or mobile • India: Digital connectivity at existing Common Service Centers set up under the Digital India scheme to provide last mile access of internet services to people internet in key public broadband infrastructure to enable WiFi, satellite in rural and remote areas without smartphones are helping citizens register for COVID-19 vaccinations. Data suggests that most of these registrations are at the institutions or health backhaul connectivity can be considered. Panchayat (village) level where mobile and Internet access is comparatively poor. centers • More information Satellite connectivity is particularly advantageous as it • Oman: In 2020, Oman Broadband Company implemented a project to provide fixed wireless internet services to a number of villages and via satellite and build can cover large geographic areas. the infrastructure for the communications network in these villages to close digital divides amid COVID-19 and facilitate access to marginalized communities. • More information However, satellite Internet unit cost is still relatively high. Government can purchase capacity in bulk and negotiate at scale (40-80% discount potential) to lower its cost Vaccine registration, information dissemination, and timely assessment of vaccine confidence Providing end- Providing access to the Internet to the public for • WorldLink Communications, Nepal’s largest Internet Service Provider (ISP), has announced a partnership with Facebook Connectivity to provide Wi-Fi services user access to wi- registration for immunization, as well as for accessing to its users. Facebook Connectivity’s free Express Wi-Fi service has already been implemented at 7,500 of WorldLink’s existing 10,000 access points in Nepal, fi hotspots by all vaccine related information can be easily accomplished providing services to more than half a million users and enabling the ISP to further expand its Wi-Fi services across the country. service providers by opening access to all Wi-Fi hotspots by mobile • More information service providers via government regulations. Purchase network If the identified facilities or institutions already have • In Afghanistan, the the government provided capacity upgrades to the national Internet Exchange Point to support higher traffic needs during the COVID-19 capacity to public internet connectivity but low bandwidth capacity, it is pandemic. institutions or health possible to purchase and source capacity from internet The cost of the contract for 2Gbps international bandwidth procurement was estimated at about US$250,000; this number varies country-to-country based on clinics where there service providers. Capacity purchases increase the cost of Internet bandwidth. is limited internet quality of connectivity and enable the delivery of high- bandwidth capacity bandwidth services, going beyond making connectivity available. Provide subsidy to Providing direct subsidy to poor households to • In the United States, the U.S. Federal Communications Commission introduced the Emergency Broadband Benefit Program recently to provide a discount of acquire equipment purchase the device (e.g. cellphones or computer) and up to $50 ($75 for Tribal lands) per month towards broadband service for eligible households. They will also give a one-time discount up to $100 to eligible directly to pay for the basic Internet subscription fees address the households to purchase one device (e.g. laptop, tablet, computer). This benefit aims to help families struggling to afford Internet service during the pandemic households Internet usage gap and online job, healthcare service and education information. • More information 6 DIGITAL CONNECTIVITY AS AN ENABLER FOR COVID-19 VACCINE DEPLOYMENT 7 DIGITAL CONNECTIVITY AS AN ENABLER FOR COVID-19 VACCINE DEPLOYMENT Behavioral messaging to increase take-up Making health service To circumvent the cost barrier of data cost and make • Colombia: The Government of Colombia has made access to 20 Internet sites including health information websites free for all Colombians with mobile postpaid and vaccination Internet services more affordable, many Internet plans for effective dissemination of health information. information free of companies such as Google, Facebook and Wikipedia charge – zero rating started to provide access to their application with • In Ghana, Djibouti, and South Africa, zero-rating services have been provided at the outset of the COVID-19 outbreak to ensure the access to information on no associated data costs. Other mobile applications COVID-19, including on vaccines. (whatsapp) etc. are zero-rated (free to use) in several countries at present. They can provide zero- rating service to allow free access to the websites or applications for vaccination information and appointments scheduling Digitizing Immunization Records Install WiFi hotspots in Creating free public WiFi spots in hospitals, health • In Malawi, the government provided free Wi-Fi connectivity to 30 critical public institutions, including hospital and schools by purchasing bandwidth capacity health clinics or other centers, schools, libraries, post offices and community and equipment for Wi-Fi hotspots through the ongoing Digital Malawi project, which aims to provide free Wifi connectivity in 500 public institutions. community facilities centers is a cost-effective way to increase connectivity. This is a quick and reliable method provide connectivity The overall estimated cost to support 30 public free Wifi hotspot is estimated at around 1.3 million for three years for people who live in rural areas. 3G service can be set • More information up in 2 weeks. Setting up 4G service may take around 6-8 months Post-Vaccination: Vaccine safety evaluations Making vaccine safety Governments can provide zero-rating service to • South Africa: the MedSafety app is a mobile application available as a free download for Android and iOS devices that allows for the electronic reporting of evaluation applications allow free access to the websites or applications for adverse drug reactions (ADRs) for medicines, adverse events following immunisation (AEFI) and can be used by both healthcare professionals and the public and follow-up tools free vaccination information, appointments scheduling and (for ADRs). The application can function offline without internet connection. It allows users to create reports and submit when connected, and access newsfeed of charge and via zero reporting adverse effects offline​. rating 8 DIGITAL CONNECTIVITY AS AN ENABLER FOR COVID-19 VACCINE DEPLOYMENT 9 DIGITAL CONNECTIVITY AS AN ENABLER FOR COVID-19 VACCINE DEPLOYMENT Service Delivery in Offline Environments Fully offline environments pose separate challenges that may require innovative approaches to access connectivity. Real-time data during vaccination programs is key in order to maintain adequate supply and timely delivery of care. However, some newly authorized vaccine providers (e.g., pharmacists) and setting types (e.g., mass vaccination sites) may experience enrolment and reporting challenges due to a lack of technical functionality and connectivity. Further, vaccination centers in rural areas may not have Internet access consistently to meet documentation and reporting requirements. Resolving these challenges should include options to update databases through multiple modes under limited broadband capacity – including the ability to bulk upload data at regular (every 24 hour) intervals. Some existing systems, such as the DIVOC system in use in India, store data regularly in local back-up storage to accommodate lower performing and older devices that may be in use at vaccine deployment stations in rural areas. Back-up plans for providers that may have limited internet access include the set up and use of mobile hot spots (where feasible) or paper records that can be easily scanned and uploaded to existing systems. Other examples include manual data entry into data platforms through web form using paper data collected at site, and access to a downloadable excel template for offline use and delayed upload to data platforms. Smart Paper Technology that standardizes the collection and scanning of data through a uniform template solves challenges such as poor quality and use of data. Shifo is one such solution that has been tested in Afghanistan, Uganda, and The Gambia, with promising results. Whilst these are useful solutions, service delivery in offline environments can create additional impediments and inefficiencies in program delivery. For example, data from paper records or offline programs create fragmented data backlogs of vaccination records that need to be incorporated into vaccination rolls, creating a new strain on often limited resources. Ensuring minimal data requirements for digital processes and platforms and assessing the impacts on processes in offline environments is key to limiting the burden. 10 DIGITAL CONNECTIVITY AS AN ENABLER FOR COVID-19 VACCINE DEPLOYMENT CONSIDERATIONS FOR IMPLEMENTATION As of 2021, just under half of the world’s population – 3.7 billion people – do not use the Internet. This divide is most pronounced in low- and middle-income countries, where the world’s poorest communities live. According to the International Telecommunications Union (ITU), 87 percent of Internet users live in developed countries, compared to 44 percent in developing countries. Further, there are spatial and demographic disparities within countries. While urban areas are covered with mobile and fixed networks, rural areas are often not. In the world’s least developed countries, 17 percent of the rural population live with no coverage at all, while 19 percent only have access to a 2G network. In contrast, 72 percent of households living in urban areas have access to the Internet. There is a gender gap in Internet access as well, which prevents women and girls from having the same level of access as men do, and this gap is largest in Sub-Saharan Africa and South Asia – countries where vaccination rates lag other regions. Assessing connectivity baselines There are existing tools and initiatives that would be helpful for assessing the connectivity baseline. For example, GSMA network coverage map1 provides last-mile mobile network coverage by geographic areas in countries. Similarly, Network Startup Resource Center (NSRC)’s African Undersea and Terrestrial Fiber Optic Network2 data can help identify locations in Africa along the terrestrial backbone network of fiber optic cables. At the site-level, GIGA Project, a joint initiative by ITU and UNICEF, supports the expansion of school digital connectivity across countries, a model that could be benchmarked and replicated for health clinics. It is important to note connectivity baseline assessment may not be sufficient to identify detailed connectivity needs and barriers as it does not provide information about the internet quality, speed, and actual internet usage in the given area. For instance, if cell towers providing mobile services rely on wireless backhaul technologies, such as microwave and satellite, the internet signal speed and capacity that become available to end-users will be lower. Understanding the connectivity quality is particularly important for addressing digital divides in vaccine delivery programs as the level of internet speed and capacity required for logistics and supply chain (e.g. warehouses, trucks, distribution centers), health clinics, and general population will vary. Nevertheless, assessing connectivity baseline and mapping connectivity status is a useful first step to conduct adequate due diligence processes, which will be critical to ensuring universal access in the long-run. The lack of connectivity baseline data may be an entry point for dialogues with the client on the value of mapping digital infrastructure in the country. Governments can play a key role not just in mapping digital infrastructure, particularly around the potential aggregation points such as health clinics, but also making it available as a public good. Ensuring equity of access Vaccine delivery programs must thus carefully consider these inequalities in access to connectivity and digital technologies in their design and implementation. Designing vaccination programs and their delivery in such a way that would restrict access to vaccine or critical post-vaccination services to those with Internet access will leave some people behind—often the ones who need the services the most. To distribute the vaccine to all, we must meet communities and people where they are, including if they are offline. Vaccine delivery programs can play a critical role in ensuring that existing digital divides do not create or exacerbate vaccine inequities. Digitization can add exclusions, affecting vulnerable communities, rural populations, and the digitally illiterate. To prevent this, connectivity baseline should be assessed at three distinct levels, for the purposes of vaccine delivery. First, connectivity at the level of warehouses, trucks, and distribution centers is essential 1 GSMA Network Coverage Maps. Available at: https://www.gsma.com/coverage/ 2 Network Startup Resource Center (NSRC). Available at: https://afterfibre.nsrc.org/ 11 DIGITAL CONNECTIVITY AS AN ENABLER FOR COVID-19 VACCINE DEPLOYMENT for logistics and supply chain management in real time. Second, connectivity at health centers helps facilitate program delivery and enables timely registration as well as dose tracking. Finally, connectivity levels of the general population can help patients with checking eligibility, registration, recording their vaccine shots, as well as with efforts to disseminate accurate information and messaging to improve take-up. Smart mapping technologies and GIS-based tools today can help determine spatial coverage gaps to Internet connectivity, and local institutional knowledge and context can help inform specific demographic vulnerabilities that may need to be accounted for within mobilization and information dissemination programs during vaccine deployment. Drivers of adoption: affordability, skills, content Beyond assessing technological capacity, it may be essential to understand dimensions of affordability, skills, and local content in target communities. According to surveys conducted across, LMICs, there are several barriers to usage, but the three primary ones pertain to skills, affordability, and relevance. Digital illiteracy and lack of digital trust can be a major barrier to connectivity. Studies show that older people and marginalized communities often suffer from greater barriers to Internet access due to a lack of digital literacy. Poor digital content and the absence of local language content are also important factors that prevent people from accessing the Internet. When developing the content for vaccination programs – both for public dissemination and for vaccine registration and follow-up, it is essential to provide the population’s native languages and make the application more user-friendly. Translations and pictures help people access information, reach wider target populations, and help bridge gaps in terms of literacy. The high cost of mobile phones and data also often act as barriers to access. While this is often a challenge for both women and men, women’s lack of access to economic opportunities tends to exacerbate exclusion. For e.g., 42% of female mobile users in Uganda who are aware of mobile internet cite the cost of handsets as the most important barrier to them using it, vs. only 29% of men. Vaccination programs must thus account for these; including by setting up public kiosks, wifi hotspot zones at public places, and providing access to free registration at public centers which can then automatically update data in real time. 12 DIGITAL CONNECTIVITY AS AN ENABLER FOR COVID-19 VACCINE DEPLOYMENT Safe and Secure Vaccine Delivery On the other side of the rapid take-up of digital technologies during the pandemic was the increase in cyberattacks and the proliferation of disinformation and fake news regarding vaccination. Because vaccine registration requires collecting some level of personal data, it is important to ensure regulatory safeguards are in place for data protection and requesting consent for data collection. Also, securing end-devices that are collecting data will be crucial to prevent data breaches and cyberattacks. Basic cyber-hygiene training should be provided to health clinic staffs to minimize the cybersecurity risks stemming from human factors. Digital technologies can also play a key role in combating misinformation and improving trust. For example, developing communications campaigns in partnership with local community networks and organizations can help combat context-specific concerns and disinformation regarding the side effects of vaccines. This can be done at the national level, but leverage internationally available resources. For instance, Digital platforms such as U-report hosted by UNICEF can serve as a tool to encourage dialogue, share information, and develop joint solutions to community-level vaccine skepticism. 13 DIGITAL CONNECTIVITY AS AN ENABLER FOR COVID-19 VACCINE DEPLOYMENT CONCLUSION Ensuring health equity by consulting with local experts and affected communities will remain key to ensuring equitable vaccine delivery and should be consulted in the design of delivery programs that leverage digital connectivity to ensure that the programs can anticipate and design around equity challenges. Providing multilingual, offline options for vaccine registration, including options that ensure that vaccine appointments can be booked by phone, text, or in person, will remain key. Reserving appointments for offline booking for families without Internet connectivity should be accommodated within the program, as should there be options for third-party bulk registrations through facilitated via non-governmental organizations/volunteers. Where possible, government agencies and health departments can engage with community level partners to ensure that the offline populations are targeted and included within the wider immunization effort. Finally, ensuring that existing digital processes do not require large amounts of data use for those with limited data capacity, and ensuring that platforms’ required details be kept to a bare minimum, will be key to include those without mobile numbers, email addresses, or even home addresses. Any short-term measures implemented as part of the pandemic response and in support of vaccine delivery efforts should be in line with broader measures to address digital divides, which include revising national broadband targets and implementation plans to address coverage and affordability issues (e.g. data cost, smartphone/ devices affordability) and updating national digital/broadband plans to accelerate digital transformation through facilitating the transition to 4G/5G, upgrading backhaul capacity, and transitioning to cloud services2. The vaccine delivery challenges are immense in low- and middle-income countries, with many barriers to ensuring universal coverage. Using technological solutions can play a key role and should be leveraged to make existing systems more efficient. At the same time, catering to vulnerable and offline populations can and must ensure options for universal coverage, with connectivity used to leverage and promote equity. Contact • Sharada Srinivasan – ssrinivasan11@worldbank.org • Hyea Won Lee - hlee20@worldbank.org • General: Digital4vaccines@worldbank.org 2 Pandemic in the Internet age: From second wave to new normal, recovery, adaptation and resilience. 2021. ITU. Available at: https://www.itu.int/ hub/publication/D-PREF-EF.PANDEMIC_01-2021/ 14 DIGITAL CONNECTIVITY AS AN ENABLER FOR COVID-19 VACCINE DEPLOYMENT ANNEX FOR WORLD BANK TTLS Project support may include mapping the connectivity demand and identifying connectivity gaps, assessing technical solutions to provide health institutions with connectivity, modeling financing needs, and providing capacity building resources to potential partners. Steps to Undertake during Project Preparation Engage with the Department of Information Technology or the Department maintaining any existing electronic health information systems (such as DHIS2) within client counterparts to understand the status of connectivity to healthcare facilities, especially rural and remote healthcare facilities. Engage, if needed, with the Ministry of ICT and/or the sector regulator to understand detailed coverage of mobile and Internet access across various parts of the country, to adapt digital means of monitoring supply, information dissemination, and registration, where possible, and develop alternatives for areas without connectivity. Engage with the Ministry of Health (especially with the public outreach teams in charge of vaccine-related information dissemination) and the Ministry of ICT (if needed) on digital modes of disseminating vaccine related health information cost effectively in areas with high Internet use through a cost-effective social media/SMS campaign and complement with offline modes of dissemination in areas with lower usage. Consult with Digital development colleagues to identify activities that could be supported by a WB project, or to provide TA to government where financing is being provided by another source. Incorporate language into the Project Appraisal Document including in components and in the results framework emphasizing the projects’ use of digital connectivity in vaccine delivery. Generic language for PADs In component descriptions: The Project will seek to leverage Internet connectivity at all stages of the vaccine lifecycle – planning and management, supply and distribution, program delivery, and post-vaccination monitoring. Connectivity can help leverage digital platforms for logistics and dose tracking, enable registration and timely follow-up by priority group sequencing, support efforts to combat misinformation, and provide access to vaccine safety evaluations post vaccination. In the results framework, as an intermediate results indicator: Number of health facilities with improved Internet connectivity Sample language from the Fiji COVID-19 Emergency Response MPA Project (approved June 2020, restructured January 2021) “Component 1: The Project will seek to… f) implement effective risk communication campaigns for mass awareness and education of the population to tackle the COVID-19 emergency and enhance internet connectivity across health facilities. Procurable expenditures include: … (f) provision of enhanced internet connectivity across health facilities” Intermediate results indicator: Number of health facilities with improved connectivity for case reporting and public health surveillance 15 DIGITAL CONNECTIVITY AS AN ENABLER FOR COVID-19 VACCINE DEPLOYMENT Checklist for Effective Implementation 1. Speak to the Digital Development country team to understand whether there is an ongoing engagement, and whether financing is being provided for critical institutional facilities within Government (including healthcare facilities). Seek out information on any COVID-19 emergency responses that the government may have enacted that have made Internet access or specific information relating to vaccines free for public consumption 2. Assess that the program and delivery plans do not reduce access to vaccine for non-connected population. 3. Leverage existing connectivity at public institutions and existing databases as against developing new ones or rolling out new connectivity, where possible. This is both cost-effective and timesaving, in most instances. Bandwidth capacity purchases for mass vaccination centers can be quickly procured for the purposes of monitoring the supply chain, updating relevant vaccination information, and vaccine safety evaluations. Avoid large infrastructure rollout. 4. Even in countries where the World Bank is not financing the vaccine procurement and delivery, technical assistance on leveraging digital connectivity may be a potential mode of engagement with client governments who are engaged in the vaccine rollout 16 DIGITAL CONNECTIVITY AS AN ENABLER FOR COVID-19 VACCINE DEPLOYMENT A COLLABORATION BETWEEN: Di it l D v lopm nt H lth, Nutrition & Popul tion