Global goods and vaccinations: Difference between revisions

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Digital technologies can act as accelerators for the introduction, deployment, and scale-up of vaccines in countries to assist health workers, communities, and other stakeholders. The use of digital tools and the data they enable facilitate rapid, iterative, and scalable approaches to ensure vaccines are safely delivered to health facilities, that health workers are equipped to administer them, and that communities are informed and confident in their efficacy.
=Global Good Adaptations for COVID-19 Vaccine Introduction=
=Global Good Adaptations for COVID-19 Vaccine Introduction=
The following table summarizes the adaptions made by global goods to support COVID-19 vaccine introduction, including COVAX.  
The following table summarizes the adaptions made by global goods to support COVID-19 vaccine introduction, including COVAX.  


'''Last update: February 5, 2021'''  
'''Last update: July 14, 2022'''  


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| '''DHIS2'''||  
| '''DHIS2'''||  
: DHIS2 has several ready-to-install digital data packages to support COVID-19 vaccine delivery (including for COVAX) based on WHO guidelines. All packages are optimized for Android or web-based data collection, including in offline mode. The DHIS2 toolkit for COVID-19 vaccine delivery expands field-tested designs and tools from the WHO DHIS2 immunization data toolkit to enable countries to rapidly update existing systems to support the equitable delivery of COVID-19 vaccines at scale, while strengthening existing national DHIS2-based immunization systems for sustainable impact across all aspects of vaccine preventable disease interventions. The toolkit supports:
: DHIS2 has several ready-to-install digital data packages to support COVID-19 vaccine delivery (including for COVAX) based on WHO guidelines. All packages are optimized for Android or web-based data collection, including in offline mode. The DHIS2 toolkit for COVID-19 vaccine delivery expands field-tested designs and tools from the WHO DHIS2 immunization data toolkit to enable countries to rapidly update existing systems to support the equitable delivery of COVID-19 vaccines at scale, while strengthening existing national DHIS2-based immunization systems for sustainable impact across all aspects of vaccine-preventable disease interventions. The toolkit supports:
* Measure uptake, coverage & equitable distribution over time, by geography and across risk groups: The DHIS2 WHO EPI module has been expanded for COVID-19 vaccine data for routine facility data on vaccination utilization, wastage, cold chain & outreach data
:* Measure uptake, coverage & equitable distribution over time, by geography and across risk groups: The DHIS2 WHO EPI module has been expanded for COVID-19 vaccine data for routine facility data on vaccination utilization, wastage, cold chain & outreach data
* Supply chain readiness & traceability of vaccines down to points of service delivery: Facility & last-mile logistics data module: WHO approved health logistics metadata with barcode/QR scanning capabilities
:* Supply chain readiness & traceability of vaccines down to points of service delivery: Facility & last-mile logistics data module: WHO approved health logistics metadata with barcode/QR scanning capabilities
* Ensure that individuals can be monitored for the full course of multi-dose regimen: Immunization eRegistry (EIR) package for longitudinal tracking & follow up of individuals
:* Ensure that individuals can be monitored for the full course of multi-dose regimen: Immunization eRegistry (EIR) package for longitudinal tracking & follow-up of individuals
* Provide a personal vaccination record/certificate: Electronic Health Certificates linked with Immunization eRegistry and integration with digital vaccination cards
:* Provide a personal vaccination record/certificate: Electronic Health Certificates linked with Immunization eRegistry and integration with digital vaccination cards
* Multiple distribution strategies; novel & innovative distribution approaches: Mass campaigns & supplemental immunization activities monitoring adapted for COVID-19 distribution strategies
:* Multiple distribution strategies; novel & innovative distribution approaches: Mass campaigns & supplemental immunization activities monitoring adapted for COVID-19 distribution strategies
* Vaccine safety monitoring: Adverse Events Following Immunization (AEFI) Tracker: WHO approved module for strengthening vaccine safety surveillance
:* Vaccine safety monitoring: Adverse Events Following Immunization (AEFI) Tracker: WHO approved module for strengthening vaccine safety surveillance
The DHIS2 team has created training materials for the EIR and AEFI packages. Packages translations are available in French, Spanish, and Portuguese. Additional languages can be added on demand.  
 
: The DHIS2 team has created training materials for the EIR and AEFI packages. Packages translations are available in French, Spanish, and Portuguese. Additional languages can be added on demand.  
||
||
:* [https://dhis2.org/covid-vaccine-delivery/ COVID-19 vaccine delivery page]
:* [https://dhis2.org/covid-vaccine-delivery/ COVID-19 vaccine delivery page]
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:* [https://dhis2.org/covid-training-material/ Training materials]
:* [https://dhis2.org/covid-training-material/ Training materials]
|-
|-
|'''Bahmni'''
|'''iHRIS'''
||
||
In Nepal, Bahmni has been adapted for COVID-19 response in a few government hospitals:
: iHRIS, used to track and manage health workforce data to improve access to services, is being adapted to track health worker vaccination data. Data can be used to help determine the vaccination needs of health workers across justifications and align vaccination efforts.  Using data from iHRIS, Demographic and Health Surveys, and other national data to World Health Organization planning tools, governments have been able to model the timing and magnitude of the COVID-19 pandemic. As a result, ministries of health can determine when and where frontline health workers should be available and how many are needed. Having accurate and available health workforce data allows the
:* Creation of a COVID-19 screening template
government to rapidly mobilize and prepare health workforces to address COVID-19 while minimizing the negative impact on essential health services such as HIV/AIDS, family planning, and maternal and child health.
:* Data is synced in near-real time to dashboards.
||
||
:* [https://nepalehr.atlassian.net/wiki/spaces/NEPALEHR/blog/2020/03/25/43090009/Updating+NepalEHR+in+response+to+COVID19 Updating NepalEHR in response to COVID19 (web article)]
:* [https://www.ihris.org/ iHRIS website]
:* [http://covid19.nepalehr.org/public/dashboards/Rg4dsdHoKRU3ktqjOCuq8zK7Y9NxoFCtNAE1UHTn?org_slug=default Nepal COVID-19 Dashboard]
|-  
|-  
| '''CommCare'''
| '''Instant OpenHIE'''
||  
||  
:* Creation of a template application which provides a full implementation of the WHO FFX Contact Tracing protocol which is available for immediate adoption and customization through the platform. Currently working on ensuring that there is a wide array of translations available for the text.
: Instant OpenHIE has been adapted to include a COVID-19 immunization tracking package that extends off the core Instant OpenHIE solution, with scripts to set up a containerized set of components and configuration scripts enabling the demonstration of patient and COVID-19 immunization tracking within a health information exchange and case reporting aligned with WHO standards and submission of laboratory results within a health information exchange
:* Working on additional template applications for further response and recovery workflows that will become available as they are validated.
:* The team is trying to secure free messaging for COVID-19 response to support self-reporting workflows for positive cases once cases overcome the tracing capacity of health systems.
:* CommCare will be releasing a WhatsApp integration in the near future.
||
||
:* [https://www.dimagi.com/blog/covid-19-equitable-vaccine-delivery/ Read how CommCare is being adapted for '''COVID Vaccine Deployment''']
:* [https://github.com/jembi/covid19-immunization-tracking-package Instant OpenHIE COVID-19 Immunization Tracking Package''']
:* [https://confluence.dimagi.com/display/commcarepublic/CommCare+for+COVID-19 Wiki]
:* [https://www.dimagi.com/blog/coronavirus-covid-19-response-initiative/ Projects tackling COVID-19 can access free full subscriptions.]
:* A video demo and write-up of data models and workflows are available in the app.
:* Contact information and to request template apps: [mailto:covid19@dimagi.com covid19@dimagi.com]
|-  
|-  
| '''Community Health Toolkit (CHT)'''
||
:* Developing CHT reference applications as starter apps for implementers to contextualize, and readily deploy and scale for their needs. These are as follows:
:**  Surveillance and Detection: Port of Entry Screening, Event-Based Surveillance, Contact Tracing, and Community-Based Symptom Screening Apps and systems
:**  Patient Care: Rapid Diagnostic Testing App, Referral systems, and Isolation Messaging systems, and
:**  Protecting Community Health Workers: PPE Projections and Daily Health Checks
:*  Accompaniment through secondment of technical staff, supporting our colleagues in Ministries of Health.
:*  Continue expanding the use cases and workflows supported by the CHT for COVID-19 response efforts.
:*  Coordination with the wider digital health community between existing digital health tools, systems, and standards.
||
The CHT Team has created two use case demonstrations: Port of Entry (PoE Screening and CHT Rapid Diagnostic Teat (RDT) workflow for community health workers.
:* [https://www.youtube.com/watch?v=6cttBMlNqxU&feature=youtu.be PoE demo]
:* [https://www.youtube.com/watch?v=G3iqlMmt3eU&feature=youtu.be RDT demo]
:* [https://medicmobile.org/blog/covid-19-and-medic-mobiles-response Medic Mobile's Response]
|-
| '''DHIS2'''
||
:*DHIS2 has several ready-to-install digital data packages to support COVID-19 surveillance & response based on WHO guidelines. All packages are optimized for Android or web-based data collection. The COVID-19 digital data package includes standard metadata aligned with the WHO’s technical guidance on COVID-19 surveillance and case definitions and implementation guidance to enable rapid deployment in countries. Ready-to-install DHIS2 digital data packages to support COVID-19 surveillance & response based on WHO guidelines. All packages are optimized for Android or web-based data collection. The packages support:
:** 1) Case-based Surveillance:  DHIS2 has released a digital data package to accelerate case detection, situation reporting, active surveillance and response for COVID-19. The package is inspired by the Ministry of Health Sri Lanka’s pioneering design of DHIS2 tracker for COVID-19 case detection and draws on years of collaboration with the World Health Organization (WHO) to develop information system standards for case-based disease surveillance.;
:** 2) Contact tracing program to facilitate operations of contact tracing and with built in relationships to the case-based tracker for enhanced analysis;
:** 3) Ports of entry screening and follow up
:** 4) Automated analysis of core indicators & dashboards for response planning. The package also includes options for aggregate and event-based surveillance; countries can transition between data models according to realities on the ground while still capturing most critical data points.
:* Team has created training materials and videos for the above configurations
:* Packages translations are now available in French, Spanish, Portuguese, Arabic, Russian and Norwegian. Additional languages can be added on demand.
:* Existing immunization registries can rapidly be adapted for '''COVID vaccine deployment'''. Information on the immunization registries can be found [https://www.dhis2.org/immunization here]  The newly released DHIS2 Vaccine Delivery Toolkit can be found [https://www.dhis2.org/covid-vaccine-delivery here].
||
:* [https://www.dhis2.org/covid-19 Main page]
:* [https://www.youtube.com/playlist?list=PLo6Seh-066RxF59ButL_1UjlEEt5Q39Sq Video demos of key features and workflows]
:* [https://covid.dhis2.org/demo/dhis-web-commons/security/login.action Interactive demo]
:* [https://community.dhis2.org/c/implementation/covid-19/41 DHIS2 Community of Practice COVID-19 Information]
:* [https://www.dhis2.org/covid-success-stories User stories from national implementations]
:* Packages are accompanied by [https://docs.google.com/document/d/12-pex7VOMoRAnsiIcTLq0mTD6UTSfVBZWIX0vufIt6I/edit System Design Documentation] and [https://docs.google.com/document/d/1iILgYYYDXDKpizkxY08syMfrw_9POzMMIMwd5Nb7yl4/edit Installation Guides]
:* [https://drive.google.com/file/d/1vigXHkP7L2hJ2lrZpdf9u4csQtppMH16/view Metadata mapping to WHO COVID-19 Metadata Dictionary]
:* election Sessions from DHIS2 September 2020 Annual Meeting.  [https://youtu.be/5g1vbxNEeEc Plenary on global Covid-19 response], [https://youtu.be/_HbaXnzdegY  National and regional Covid-19 implementations], [https://youtu.be/Cv9X5LpwEgU  Francophone Covid-19 presentations]  [https://youtu.be/0je2GdHJ5EM  Building eIDSR in Sierra Leone], [https://youtu.be/vIqxccehxbQ  Norway Covid-19 response],  [https://youtu.be/-baRs86Mbqc Local Covid-19 innovations - local apps], [https://youtu.be/FHCRXVF-2g4 Measuring the impact disease outbreaks], and [https://youtu.be/BgMp04yuqcc  Strengthening disease surveillance beyond Covid-19]
:* Contact info: [mailto:covid@dhis2.org covid@dhis2.org]
|-
| '''Logistimo'''
||
:* Logistimo SCM has been adapted to include data capture for the COVID-19 supply chain (about 70 products and equipment), which has been deployed across a few states in India.
:* Additional data capture available for supplies to laboratories for tests.
:* Logistimo has created specific COVID-19 dashboards (that we call bulletin boards) which help in easy surveillance for control towers.
:* Several partners have been assessing how effectively COVID-19 bio-medical waste is being handled and disposed using Logistimo Snapshot.
||
:* [https://medium.com/logistimo/covid-19-adaptations-of-the-logistimo-platform-667ed7f5326f Logistimo COVID-19 updates]
|-
| '''GOFR'''
||
:* Overview of GOFR tool for facility reconciliation
||
:* [https://www.facilitymatch.net/ Facility Match]
|-
| '''mHero'''
| '''mHero'''
||
||
:* Deployed in Liberia in support of the COVID-19 response.
: mHero has been launched in Liberia, Kenya, and Uganda (and soon DRC) for COVID-19 communication between health workers and ministries of health (or other institution that oversees cadres of health workers, such as UNICEF). In Kenya, mHero is being used as part of an information campaign to promote uptake of the COVID-19 vaccine among health workers in two counties. Additionally, the mHero team has also collaborated with the OpenHIE COVID-19 Task Force to build a library of FHIR-compliant workflows that align with global COVID-19 reporting standards, and is also working with FLOIP to ensure that FLOIP results from FHIR-compliant workflows can be accessed in mHero.
:* New mHero architecture has been developed.
:* Adding additional features including:
:** COVID-19 disease surveillance workflows
:** Ability to send messages from any FHIR compliant database such as OpenMRS
:** Ability to update any FHIR compliant database with new respondent information
:**Ability to respond to messages via WhatsApp and Facebook Messenger
||
:* [https://www.mhero.org/ mHero website]
:* [https://www.mhero.org/ mHero website]
|-
|-
| '''Mobile WACh'''
| '''ODK-X'''
||
||
:* Provide up-to-date guidance by SMS (push messaging) on symptoms, social distancing, and care-seeking to the general population, as well as HCWs in need of guidance.
: ODK-X developed a vaccine cold chain information system using the ODK-X frameworks to help countries track and improve their vaccine cold chain equipment used to store vaccines (e.g., COVID-19 vaccines) for Gavi, the Vaccine Alliance and WHO. During COVID-19 shutdowns, Red Cross used ODK-X to track beneficiaries and distribute money and goods to vulnerable populations affected by COVID-19 in several countries.  
:* Provide interactive triage of patient symptoms by 2-way SMS with a HCW, based on international guidance to determine whether and how patients should seek care, and avoid unnecessary risk and strain on the medical system.
:* Continue supporting pregnant and postpartum women, neonates and people living with HIV or other chronic conditions with SMS curricula we have already developed at a time when they will experience even more pronounced shortages of in-person medical care.
||
||
:* [https://globalhealth.washington.edu/interactive-map/projects/1580/Mobile-WACh-NEO-Communication-Empowering-Mothers-and-Newborns?health_topics=454 Mobile WACh on the University of Washington website]
:* [https://odk-x.org/ ODK-X website]
|-
|-
| '''ODK'''
| '''OpenFn'''
||
||
:* ODK's lead developer, Nafundi, is offering pro-bono help to anyone working on the COVID-19 response.
: For COVID-19 vaccine support, OpenFn implementations are configured to connect vaccine eligibility, request, and delivery data across systems and to facilitate the transfer of vaccine-related supply chain data between systems.For COVID-19 response, OpenFn implementations are adjusted to connect online and offline community health worker tools with cloud-based health information systems, facilitating better disease surveillance.
:* Rapidly digitizing forms from the WHO and CDC protocols and making them available for others to use and build on.
||  
:* Offering support for ODK for contact tracing, decision support, community education, strategic mapping, and case management.
:* [https://www.openfn.org/ OpenFn website]
:* Demo available on how the WHO minimum reporting form running in ODK Collect (Android) and Enketo (Web) send data to an ODK Central server, which then flows data to a live updating dashboard in PowerBI and a spreadsheet in Excel.
||
:* [https://docs.google.com/forms/d/e/1FAIpQLSfTUUqtFge_i_ptAAFeri0riuJq19aoKX1xzcbO2HNP5mBrmA/viewform Request for pro-bono help]
:* [https://forum.opendatakit.org/t/who-covid-19-minimum-reporting-form/25647 WHO COVID-19 Minimum Reporting Form demo]
:* Contact info: [mailto:yanokwa@nafundi.com yanokwa@nafundi.com]
|-
| '''OpenConcept Lab'''
||
:* Published a value set, "COVID-19 Starter Set," based on the Columbia International eHealth Laboratory (CIEL) interface terminology
:* Rushed multiple large terminology curation and import processes to support publication of this value set.
||
:* [https://openconceptlab.org/orgs/CIEL/collections/COVID-19-Starter-Set/concepts/ CIEL COVID-19 Starter Set]
|-
| '''OpenELIS'''
||
:*OpenELIS Global has added COVID-19 metadata for laboratory testing and resulting, including LOINC codes for interoperability via HL7 2.5. Metadata will be included in the default test catalog with the next release of OpenELIS.
:*Users can immediately use the Administration Menu: Test Management function in the software to add tests for the corona virus (SARS-CoV-2) to their laboratory test catalog to facilitate tracking of laboratory tests and results.
||
:* To learn more about the OpenELIS adaptations for Covid-19, [http://openelisglobal.org/ visit the OpenELIS website.]
:* [http://docs.openelisci.org/en/latest/install/ Installation instructions]
:* [https://www.who.int/emergencies/diseases/novel-coronavirus-2019/technical-guidance/laboratory-guidance Laboratory guidance from the World Health Organization]
:* [https://www.cdc.gov/coronavirus/2019-ncov/lab/index.html Laboratory guidance from the United States Center for Disease Control and Prevention]
|-
|-
| '''OpenHIM'''
| '''OpenHIM'''
||
||
:* Coming soon - generic support for COVID-19 data exchange with the OpenHIM by extending the OpenHIM Mapping Mediator offerings, supporting a range of use cases around case reporting, surveillance and contact tracing that require an exchange of data between information systems.  
: The OpenHIM is adapted to support COVID-19 vaccination tracking within an HIE through a set of custom mediators supporting ingestion of patient and immunization data, persistence to an FHIR data repository, and interfacing with a Client Registry. The OpenHIM is adapted to support COVID-19 data exchange within a health information exchange through a set of mediators covering COVID-19 case reporting aligned with WHO standards and submission of laboratory results, supporting ingestion of case reports and laboratory data, and persistence to both an FHIR data repository and DHIS2.
:* OpenHIM will support standardized data schema that supports the WHO standards, and in turn FHIR.
||
||
:* [http://openhim.org/ OpenHIM.org]
:* [https://docs.google.com/document/d/1hcQbfBLG6KLHyNXJPCJJto85vVl0npQVNHkJ9ltQIW4/ COVID-19 Immunization OpenHIM Architecture]
:* [https://docs.google.com/presentation/d/1PBPIxR4iLIVTMVhDxwz-zvu5nRdkmGXUg2y-0ZCeWj8/edit#slide=id.g75779796cf_1_0 Presentation on OpenHIM adaptation for COVID-19]
|-  
|-
| '''SanteIMS'''
| '''openIMIS'''
||
||
:* openIMIS was customized to act as a management information system to manage a government to people cash transfer scheme as a part of the COVID-19 response of the Government of The Gambia. openIMIS has been used to enrol beneficiary households into the system and keep track of the payments being made to these households. The scheme currently covers 80,000 households in The Gambia, but is slated for a nationwide scaleup soon, and it is anticipated that the openIMIS based tool will be continued to be used for the management.
:SanteIMS is a proven highly scalable immunization and vaccination program management platform that is used for national EPI programs and supports any type of vaccine delivery, including C-19 vaccines, to an entire country's population. It's key features include:
:* Offline-First Design enabling seamless uninterrupted work offline without any loss of functionality when internet connectivity is interrupted or not available
:* ''Once and done'' point of care data entry which eliminates the need for manual indicator gathering and reporting and automatically updates stock management data
:* Full functionality and UI consistency across multiple platforms (tablet, desktop etc.) and operating systems, allowing leveraging of existing technology investments and use of the most appropriate hardware platform to support each workflow and context
:* Supports cloud based, hybrid or on premise implementations* Real-time implementation of clinical decision and care guidelines
:* Intelligent facility visit scheduling and forecasting
:* Extended problem reporting (AEFI, COD, FEVER, etc.)
:* Facility planning tools
:* Stock & Order Management which fully integrates with national logistics management systems to help eliminate stock-outs and maximize cost effective use of vaccines and related supplies
:* Facility level dashboards and automated data feeds to data visualization tools like DHIS2
:* Built-in support for interoperability following OpenHIE standards and out-of-the-box integration with the SanteMPI Client Registry
||
||
:* A detailed description of the adaptation can be found on [https://openimis.atlassian.net/wiki/spaces/OP/pages/1704853521/The+Gambia the openIMIS wiki.]
:For an overview of SanteIMS's capabilities please see the [https://www.youtube.com/watch?v=NGRCLpk4cGs&feature=emb_logo GAVI produced video of Tanzania's TiMR EIR] (part of the PATH led BID initiative). TiMR is based on the initial version of our software.
|-
|-
| '''OpenLMIS'''
| '''SanteMPI'''
||
||
:* OpenLMIS is responding by supporting OpenLMIS countries to optimize their use of the software to encourage good supply chain management of COVID supplies. A separate, simplified OpenLMIS instance has been launched called OpenLMIS COVID-19 Edition, which is a lighter weight and quicker start up tool to help countries get started right away to manage COVID-related commodities (based on the WHO product list).  In addition, the OpenLMIS team continues to conduct outreach to existing users to ensure they know how to quickly:
:SanteMPI has been adapted to support national COVID-19 response through implementation of national unique health ID's for vaccination registration, generation of vaccination "Yellow Card" and facilitation of data sharing and interoperability with other supporting solutions.
:** Add new Products
:** Initiate emergency requisitions
:** Configure and manage inventory of Kits (anticipating the need for COVID kits)
:* The OpenLMIS core team will prioritize any configuration or work related to these functions. Future product committee meetings could be used to share lessons across countries to see how they are preparing their supply chains for COVID.
||
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:* [https://nam12.safelinks.protection.outlook.com/?url=https%3A%2F%2Fopenlmis.atlassian.net%2Fwiki%2Fspaces%2FOP%2Fpages%2F821100553%2FOpenLMIS%2BCOVID-19%2BEdition&data=02%7C01%7Cabendor%40path.org%7C409973e54274461226fb08d82322f34d%7C29ca3f4f6d6749a5a001e1db48252717%7C0%7C0%7C637297981092049952&sdata=QjbxDNnEL%2F5rqwpJsLq%2Bl8JyB%2B4ZS%2FK38SE7G8uTu6g%3D&reserved=0/ Updated wiki with OpenLMIS COVID-19 Edition Information]
:* [https://santesuite.com/ SanteSuite website]
:* [https://nam12.safelinks.protection.outlook.com/?url=https%3A%2F%2Fwww.youtube.com%2Fwatch%3Fv%3DVHG55mE-rqE%26t%3D17s&data=02%7C01%7Cabendor%40path.org%7C409973e54274461226fb08d82322f34d%7C29ca3f4f6d6749a5a001e1db48252717%7C0%7C0%7C637297981092049952&sdata=Kt49PgmAcah1Rq5vo2mAC128YatjgMxfsnNjWSVtBNQ%3D&reserved=0/ YouTube Demo Video of OpenLMIS COVID-19 Edition]
:* [https://openlmis.org/ OpenLMIS webiste]
:* [https://drive.google.com/file/d/14SHMJ1f_faMl4tRDXx33Aq8V76xYXyYU/view USAID Global Health Supply Team COVID-19 Brief]
|-
|-
| '''OpenMRS'''
| '''Tamanu'''
||
||
:* The OpenMRS community's goal is to support extension of current functionality that will make it easier for 5,500 existing implementations to a) screen, test, and manage patients and b) report data out efficiently to DHIS2 for public health surveillance.
:* New vaccine recording screens for COVID-19 vaccines (part of our existing vaccine campaigns module)
:* Active COVID-19 Response Squad is working to identify existing work within the OpenMRS community that can be rapidly adapted by implementers and packaged as a suite of COVID-19 Public Health Response Tools. Informatics experts, business analysts, UI/UX designers, developers, and implementers are encouraged to join the conversation, weekly meetings, design forums, and work with the COVID-19 Response Squad.
:* New forms for capturing COVID-19 specific Adverse Events Following Immunisation
:* The following OpenMRS COVID-19 Public Health Response Tools under development and discussion include:
:* Vaccination certificate
:** CIEL concept dictionary with COVID-19 concepts
:* New reports
:** COVID-19 Public Health Response Module
:* New visualisations including; number vaccinated by village, % vaccinated by village, disaggregation by age and sex.
:** COVID-19 Public Health Reporting System Interfaces
:* Standard content related to COVID-19 included in the recent release of Reference Application 2.10.0.
||
||
:* [https://wiki.openmrs.org/display/projects/COVID-19+Public+Health+Response OpenMRS COVID-19 Public Health Response Project Page]
:* [https://www.tamanu.io/ Tamanu website]
:* [https://talk.openmrs.org/c/projects/covid-19/66 OpenMRS Talk: COVID-19]
:* [https://openconceptlab.org/orgs/CIEL/collections/COVID-19-Starter-Set/concepts/ Open Concept Lab presentation of CIEL's COVID terminology]
|-
|-
| '''OpenSRP/Akuko/Canopy'''
| '''OpenBoxes'''
||
||
:* Develop use of Ona Data/RapidPro + Canopy for secondary response.
: OpenBoxes is an open-source supply chain management system used to manage supplies and medications for healthcare facilities and disaster relief efforts. This ensures that health workers have the right quantities at the right time to save lives. Beyond supply chain management, OpenBoxes has diversified its functionality to include the ability to track cold chain items. This includes icons that flag an item as cold chain and the ability to indicate temperature requirements and create bin locations, which are pivotal features in the effective delivery of COVID-19 vaccines.
:* Create OpenSRP/Reveal and an RDT reader for contact tracing and Akuko data storytelling platform for data viz platform for information sharing.
:* Working with clients in Malawi government to adapt the ODP module for COVID-19 in the future
||
||
:* [https://ona.io/home/ Ona website]
:* [https://www.openboxes.com/ OpenBoxes website]
|-
| '''Reveal'''
||
:* Modified forms to incorporate COVID-related data
:* Modifications completed for the planning module to support Reveal's ability to get resources to vulnerable populations (food aid, economic aid, sanitation resources as well as routine health resources), which is crucial given the quarantine and lock-down restrictions many countries are facing.
:* Support to attain high vaccination coverage achieving last mile delivery
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:* [https://nam12.safelinks.protection.outlook.com/?url=http%3A%2F%2Fwww.revealprecision.com%2F&data=02%7C01%7Cabendor%40path.org%7C4d4f985b18a54a2b165708d7ed3a41a5%7C29ca3f4f6d6749a5a001e1db48252717%7C0%7C0%7C637238708005139347&sdata=0sMjdDJICVEvw9eBTgu3dSBtPBxn8dChSEABzdGiYEc%3D&reserved=0 Reveal Precision]
|-
| '''SORMAS'''
||
:* Ensuring availability of validated real time surveillance data which would in turn lower the disease burden through enabled contact tracing while monitoring the potential for future cases.
:* Offering easy-to-use, multifunctional mobile health (mHealth) and electronic health (eHealth) applications, which provide real-time data availability and compatibility with standard surveillance systems.
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:* [https://sormas.helmholtz-hzi.de/sormas-ui/login Demo version of SORMAS]
|-
|-
|}
|}
=COVID-19 Community Coordination=
Digital Square is pleased to share resources sourced from the Digital Health Community to facilitate alignment and coordination in the COVID-19 response, and to support countries choosing digital tools to aid in their own response efforts.  If you have a resource you would like us to host on the wiki, please contact [mailto:abendor@path.org Amanda BenDor].
===UNICEF Country Mapping for COVID-19 Response===
UNICEF has initiated a '''country mapping''' of relevant Digital Health solutions that can be leveraged to support frontline health workers in their response to COVID-19 and that can be used by countries to support Risk Communication and Community Engagement on COVID-19. The mapping can be accessed [https://docs.google.com/spreadsheets/d/1GbM1nuHxnCvoc1hLLcQAt7QOoQxnAXdI3hdP3Qt7KUg/edit?usp=sharing here].  If you want to update the country mapping, please use the comment function and the UNICEF team will update the information accordingly.
Likewise, a '''partnership landscaping''' has also been done to map where implementing partners are working to support digital tools for frontline health workers and which digital solutions they are supporting. This mapping can be accessed [https://docs.google.com/spreadsheets/d/1Y6fl3Uqvn0lcFhBlYPXLKKi2HXi79kw8pWR_h8PwE3s/edit?usp=sharing here]. If your organization is missing from the partnership landscaping, you can add the information directly in the spread sheet.
Both these mapping tools are free to use by anyone who wish to know which solutions already exist at country level and that can be deployed for frontline health workers for COVID-19 response and recovery efforts.
=Comparison of Digital Tools used in the COVID-19 Response=
Countries have access to a large, complex ecosystem of digital platforms that can support COVID-19 response. The process of selecting the most appropriate platform for a country's specific needs or context can be overwhelming without clear information about the benefits and limitations of the options. Several new resources have been developed to support in-country assessment and decisions about digital technologies for COVID response.
===Johns Hopkins assessment===
In July 2020, Johns Hopkins published an assessment of digital platforms that have an established presence in several low- and middle-income countries (LMIC), and either have been or could be rapidly reconfigured to address COVID-19 related case management and contact tracing needs.  The assessment includes a review of the following tools: CommCare, Community Health Toolkit (CHT), DHIS2 Tracker, Go.Data, ODK, OpenSRP, RapidPro, SORMAS, and WelTel. The platforms were selected based on their existing deployment, flexibility, and adaptability for COVID-19 use cases, their ability to support multiple languages, and stakeholder interest in how these applications can be leveraged in response to COVID-19. The full report can be accessed [https://drive.google.com/file/d/1yCP7t1di_ofQ0YhuPAD1Oqcj1aTo74k5/view here].
===Digital Square efforts===
In recognition that this is a rapidly evolving landscape, Digital Square has been working across donors to collate a comparison of digital tools that are currently used in the COVID-19 response. Included in the comparison is an analysis of a number of functional and non-functional requirements.  Including in this document are the following digital health tools: DHIS2, SORMAS, Go.Data, EpiInfo, CommCare, ODK, Kobo Toolbox, Excel and non-digital paper tools. This comparison is a dynamic document meant for community updates that can be accessed [https://docs.google.com/spreadsheets/d/1cMQAZO94uTe4HULLmBRN80fPnNUwayqw3e2UT-voJbw/edit?usp=sharing here].  If you would like to make updates including adding additional tools or information to tools included, please contact [mailto:cfourie@path.org Carl Fourie].
====Map & Match====
The USAID-funded Map & Match project helps countries, donors, implementing partners, and the global digital health community at large to leverage and adapt existing digital tools in response to the COVID-19 pandemic. As the world learned during the West Africa Ebola outbreak response, prioritizing the reuse and adaptation of existing digital tools is vital to quickly scale access to time-sensitive disease information and data.
[https://digitalsquare.org/covid19-map-match '''Find Map & Match resources on the Digital Square website here.''']
*In March 2021, Digital Square published the [https://static1.squarespace.com/static/59bc3457ccc5c5890fe7cacd/t/603d549f3e5f2c2800651483/1614632096462/DATEC-FINAL.pdf ''Digital Applications and Tools Across an Epidemiological Curve'']. This resource provides a strategic framework for governments, investors, implementing organizations, and the digital health community to better understand how existing digital tools can be adapted and used during different phases of an outbreak.


=Country Support=
=Country Support=


==Mali==
==Mali==
With funding from USAID Mali, Digital Square is working closely with the Mali Ministry of Health and partners such as CDC, Gavi, UNICEF and Global Fund to support adaptation and scale of digital health tools to support the rollout of the COVID-19 vaccine. Through the end of 2021, Digital Square is specifically supporting the following activities:
With funding from USAID Mali, Digital Square is working closely with the Mali Ministry of Health and partners such as CDC, Gavi, UNICEF and Global Fund to support adaptation and scale of digital health tools to support the rollout of the COVID-19 vaccine. Through the end of 2021, Digital Square is specifically supporting the following activities:
 
#Adapt and scale existing health information systems for COVID-19 vaccine rollout to enable real-time monitoring of vaccine availability and vaccine coverage.
# Adapt and scale existing health information systems for COVID-19 vaccine rollout to enable real-time monitoring of vaccine availability and vaccine coverage.
#Support MOH to transition existing paper-based systems to digital platforms (focus on digital tools for monitoring adverse side effects).
# Support MOH to transition existing paper-based systems to digital platforms (focus on digital tools for monitoring adverse side effects).
#Harness digital tools to identify and locate persons eligible for vaccination.
# Harness digital tools to identify and locate persons eligible for vaccination.
#Identify tools and applications to be made interoperable.
# Identify tools and applications to be made interoperable.
#Contribute to an evaluation of a vaccination campaign in Bamako.
# Contribute to an evaluation of a vaccination campaign in Bamako.
 
For more information on these activities or to coordinate with the Digital Square team, [mailto:cbowman@path.org please contact Caitlin Bowman].
 
 
=Additional COVID Resources=
 
==COVID-19 Webinars==
'''October 28, 2020 | Global Good COVID-19 Adaptations Part III (OpenLMIS and OpenELIS)'''
 
This webinar focuses on how both OpenLMIS and OpenELIS have adapted their technologies to respond to the COVID-19 pandemic.
 
*[https://wiki.digitalsquare.io/images/f/fe/Digital_Square_Webinar_Global_Good_COVID-19_Adaptations_Part_III_%28OpenLMIS_and_OpenELIS%29.pdf Find the slides here]
*[https://lib.digitalsquare.io/handle/123456789/77711 Watch the recording]
 
'''October 7, 2020 | Global Good COVID-19 Adaptations Part II  (DHIS2 and mHero)'''
 
This webinar focuses on how both DHIS2 and mHero have adapted their technologies to respond to the COVID-19 pandemic.
 
*[https://wiki.digitalsquare.io/images/e/e5/Digital_Square_Webinar_Global_Good_COVID-19_Adaptations_Part_II_%28DHIS2_and_mHero%29.pdf Find the slides here]
*[https://lib.digitalsquare.io/handle/123456789/77709 Watch the recording]
 
'''June 16, 2020 | Can Image-based AI Meaningfully Impact COVID-19 Response in Low Resource Settings'''
 
This webinar explores the opportunities and challenges for the use of imaged-based AI tools in the COVID-19 response. Panelists discuss the broader context for the application of these tools; explore how they are being developed and evaluated; and identify what steps need to be taken to maximize the potential of image-based AI while mitigating the risks.
 
*[https://www.youtube.com/watch?v=O8ZV2T5P9GU Watch the recording]
 
'''June 15, 2020 | Understanding the Unique Challenges & Opportunities of Combating COVID-19 in LMICs'''
 
*[https://www.amia.org/sites/default/files/AMIA%20COVID19%20Webinar%20Series_GHI_2_0.pdf Find the slides here]
*[https://vimeo.com/429736624/d2aa6b5c88 Watch the recording]
 
'''April 30, 2020 | Private Sector Digital Adaptations for COVID-19 Response'''
 
In this webinar, leaders from the Digital Impact Alliance, Facebook, mClinica, Microsoft, and Tableau shared how to leverage private sector tools and technologies to strengthen health systems in COVID-19 response efforts.
 
*[https://wiki.digitalsquare.io/images/f/f5/Digital_Square_Webinar_Private_Sector_Digital_Adaptations_for_COVID-19_Response.pdf Find the slides here]
*[https://lib.digitalsquare.io/handle/123456789/77710 Watch the recording]
 
'''April 7, 2020 | Managing the Global COVID-19 Pandemic with Health Informatics'''
 
In partnership with AMIA, this webinar shares informatics responses and challenges within the COVID-19 pandeimc.
 
*[https://www.amia.org/sites/default/files/AMIA-COVID19-Webinar-Series-Global-Health-East-Asia.pdf Find the slides here]
*[https://vimeo.com/405504903/3ee88a5139 Watch the recording]
 
'''March 30, 2020 | Global Goods Adaptation for COVID-19 Response Part I'''
 
This webinar features a set of Digital Square-approved digital health global goods that have adapted their technologies to respond to the COVID-19 pandemic.
 
*[https://drive.google.com/file/d/14bqGbDwXnMNWSAZMNUmGLCbcFkIsjPVU/view?usp=sharing Find the slides here]


'''March 26, 2020 | Re-utilizing PEPFAR Investments during the COVID-19 Response'''
For more information on these activities or to coordinate with the Digital Square team, please contact [mailto:cbowman@path.org Caitlin Bowman].
This webinar showcases how PEPFAR investments can be re-utilized in the COVID-19 response. During this session, we will feature a mix of digital tools including DATIM, Patient Level Monitoring, and the Global Open Facility Registry, and how they can be harnessed in the COVID-19 global response.


*[https://wiki.digitalsquare.io/images/0/0a/Digital_Square_Webinar_Reutilizing_PEPFAR_Investments_during_the_COVID-19_Response.pdf Find the slides here]
=Additional Resources=


==Digital Square Web Articles==
*[https://static1.squarespace.com/static/59bc3457ccc5c5890fe7cacd/t/608ac93304b6b65a5f42ba36/1619708211811/Vaccine+deployment+annex-210422.pdf '''Digital Tools Supporting Vaccine Deployment:'''] This document (developed as part of [https://digitalsquare.org/covid19-map-match Digital Square's Map & Match project]) illustrates how digital tools can support activities aligned to five use cases focused on vaccines.


*[https://digitalsquare.org/blog/2020/3/4/global-goods-addressing-outbreaks-sormas-and-covid-19 Global Goods Addressing Outbreaks: SORMAS and COVID-19]
==UNICEF/WHO Digital Health Center of Excellence (DICE)==
*[https://digitalsquare.org/blog/2020/5/21/lego-lessons-for-covid-19-making-data-click LEGO lessons for COVID-19: Making data click]
Many countries do not have fully functioning digital systems or solutions required to address health and information systems priorities in the context of the COVID-19 pandemic, as well as post-pandemic health systems’ needs. Digital Square and the newly formed UNICEF/WHO Digital Health Center of Excellence (DICE) are proactively looking for opportunities to collaborate to support countries’ wanting to invest in sustainable and scalable deployments of carefully chosen digital solutions for COVID-19 pandemic response plans. DICE is committed to supporting countries harness appropriate digital public goods, many of which are mature and already integrated into national systems, to provide substantial multilayered support to the COVID-19 pandemic using a health system strengthening lens; from planning distribution of commodities and vaccines, tracking supplies, surveillance and case detection, monitoring coverage of services, and communicating to generate demand and reduce misinformation. . Digital Square’s Mission is to connect health leaders with the resources they need for digital transformation. Through our collective partnership, we aim to not only support country needs now, but also to help country leaders build stronger, more sustainable digital systems, which will improve health outcomes beyond the current pandemic.”
*[https://digitalsquare.org/blog/2020/6/1/will-covid-19-accelerate-digital-transformation-5-ways-the-development-community-can-build-back-better Will COVID-19 accelerate digital transformation? 5 ways the development community can "build back better"]
*[https://digitalsquare.org/blog/2020/5/21/using-dhis2-for-covid-19-point-of-entry-screening-and-travel-pass-printing-in-uganda Using DHIS2 for COVID-19 point of entry screening and travel pass printing in Uganda]

Latest revision as of 10:09, 21 September 2022

Digital technologies can act as accelerators for the introduction, deployment, and scale-up of vaccines in countries to assist health workers, communities, and other stakeholders. The use of digital tools and the data they enable facilitate rapid, iterative, and scalable approaches to ensure vaccines are safely delivered to health facilities, that health workers are equipped to administer them, and that communities are informed and confident in their efficacy.

Global Good Adaptations for COVID-19 Vaccine Introduction

The following table summarizes the adaptions made by global goods to support COVID-19 vaccine introduction, including COVAX.

Last update: July 14, 2022

Global Good Adaptation Resources
CommCare
Dimagi has developed a template solution for Equitable and Effective COVID-19 Vaccine Delivery. The solution tracks and supports every client before, during, and after the vaccination process while providing analytics and visualizations to monitor the progression of vaccine delivery. It provides direct digital support to health providers administering vaccines (via apps), people getting vaccinated (via messaging), vaccine managers and supervisors (via analytics and dashboards), and community advocates (via apps or messaging).
DHIS2
DHIS2 has several ready-to-install digital data packages to support COVID-19 vaccine delivery (including for COVAX) based on WHO guidelines. All packages are optimized for Android or web-based data collection, including in offline mode. The DHIS2 toolkit for COVID-19 vaccine delivery expands field-tested designs and tools from the WHO DHIS2 immunization data toolkit to enable countries to rapidly update existing systems to support the equitable delivery of COVID-19 vaccines at scale, while strengthening existing national DHIS2-based immunization systems for sustainable impact across all aspects of vaccine-preventable disease interventions. The toolkit supports:
  • Measure uptake, coverage & equitable distribution over time, by geography and across risk groups: The DHIS2 WHO EPI module has been expanded for COVID-19 vaccine data for routine facility data on vaccination utilization, wastage, cold chain & outreach data
  • Supply chain readiness & traceability of vaccines down to points of service delivery: Facility & last-mile logistics data module: WHO approved health logistics metadata with barcode/QR scanning capabilities
  • Ensure that individuals can be monitored for the full course of multi-dose regimen: Immunization eRegistry (EIR) package for longitudinal tracking & follow-up of individuals
  • Provide a personal vaccination record/certificate: Electronic Health Certificates linked with Immunization eRegistry and integration with digital vaccination cards
  • Multiple distribution strategies; novel & innovative distribution approaches: Mass campaigns & supplemental immunization activities monitoring adapted for COVID-19 distribution strategies
  • Vaccine safety monitoring: Adverse Events Following Immunization (AEFI) Tracker: WHO approved module for strengthening vaccine safety surveillance
The DHIS2 team has created training materials for the EIR and AEFI packages. Packages translations are available in French, Spanish, and Portuguese. Additional languages can be added on demand.
iHRIS
iHRIS, used to track and manage health workforce data to improve access to services, is being adapted to track health worker vaccination data. Data can be used to help determine the vaccination needs of health workers across justifications and align vaccination efforts. Using data from iHRIS, Demographic and Health Surveys, and other national data to World Health Organization planning tools, governments have been able to model the timing and magnitude of the COVID-19 pandemic. As a result, ministries of health can determine when and where frontline health workers should be available and how many are needed. Having accurate and available health workforce data allows the

government to rapidly mobilize and prepare health workforces to address COVID-19 while minimizing the negative impact on essential health services such as HIV/AIDS, family planning, and maternal and child health. 

Instant OpenHIE
Instant OpenHIE has been adapted to include a COVID-19 immunization tracking package that extends off the core Instant OpenHIE solution, with scripts to set up a containerized set of components and configuration scripts enabling the demonstration of patient and COVID-19 immunization tracking within a health information exchange and case reporting aligned with WHO standards and submission of laboratory results within a health information exchange
mHero
mHero has been launched in Liberia, Kenya, and Uganda (and soon DRC) for COVID-19 communication between health workers and ministries of health (or other institution that oversees cadres of health workers, such as UNICEF). In Kenya, mHero is being used as part of an information campaign to promote uptake of the COVID-19 vaccine among health workers in two counties. Additionally, the mHero team has also collaborated with the OpenHIE COVID-19 Task Force to build a library of FHIR-compliant workflows that align with global COVID-19 reporting standards, and is also working with FLOIP to ensure that FLOIP results from FHIR-compliant workflows can be accessed in mHero.
ODK-X
ODK-X developed a vaccine cold chain information system using the ODK-X frameworks to help countries track and improve their vaccine cold chain equipment used to store vaccines (e.g., COVID-19 vaccines) for Gavi, the Vaccine Alliance and WHO. During COVID-19 shutdowns, Red Cross used ODK-X to track beneficiaries and distribute money and goods to vulnerable populations affected by COVID-19 in several countries.
OpenFn
For COVID-19 vaccine support, OpenFn implementations are configured to connect vaccine eligibility, request, and delivery data across systems and to facilitate the transfer of vaccine-related supply chain data between systems.For COVID-19 response, OpenFn implementations are adjusted to connect online and offline community health worker tools with cloud-based health information systems, facilitating better disease surveillance.
OpenHIM
The OpenHIM is adapted to support COVID-19 vaccination tracking within an HIE through a set of custom mediators supporting ingestion of patient and immunization data, persistence to an FHIR data repository, and interfacing with a Client Registry. The OpenHIM is adapted to support COVID-19 data exchange within a health information exchange through a set of mediators covering COVID-19 case reporting aligned with WHO standards and submission of laboratory results, supporting ingestion of case reports and laboratory data, and persistence to both an FHIR data repository and DHIS2.
SanteIMS
SanteIMS is a proven highly scalable immunization and vaccination program management platform that is used for national EPI programs and supports any type of vaccine delivery, including C-19 vaccines, to an entire country's population. It's key features include:
  • Offline-First Design enabling seamless uninterrupted work offline without any loss of functionality when internet connectivity is interrupted or not available
  • Once and done point of care data entry which eliminates the need for manual indicator gathering and reporting and automatically updates stock management data
  • Full functionality and UI consistency across multiple platforms (tablet, desktop etc.) and operating systems, allowing leveraging of existing technology investments and use of the most appropriate hardware platform to support each workflow and context
  • Supports cloud based, hybrid or on premise implementations* Real-time implementation of clinical decision and care guidelines
  • Intelligent facility visit scheduling and forecasting
  • Extended problem reporting (AEFI, COD, FEVER, etc.)
  • Facility planning tools
  • Stock & Order Management which fully integrates with national logistics management systems to help eliminate stock-outs and maximize cost effective use of vaccines and related supplies
  • Facility level dashboards and automated data feeds to data visualization tools like DHIS2
  • Built-in support for interoperability following OpenHIE standards and out-of-the-box integration with the SanteMPI Client Registry
For an overview of SanteIMS's capabilities please see the GAVI produced video of Tanzania's TiMR EIR (part of the PATH led BID initiative). TiMR is based on the initial version of our software.
SanteMPI
SanteMPI has been adapted to support national COVID-19 response through implementation of national unique health ID's for vaccination registration, generation of vaccination "Yellow Card" and facilitation of data sharing and interoperability with other supporting solutions.
Tamanu
  • New vaccine recording screens for COVID-19 vaccines (part of our existing vaccine campaigns module)
  • New forms for capturing COVID-19 specific Adverse Events Following Immunisation
  • Vaccination certificate
  • New reports
  • New visualisations including; number vaccinated by village, % vaccinated by village, disaggregation by age and sex.
OpenBoxes
OpenBoxes is an open-source supply chain management system used to manage supplies and medications for healthcare facilities and disaster relief efforts. This ensures that health workers have the right quantities at the right time to save lives. Beyond supply chain management, OpenBoxes has diversified its functionality to include the ability to track cold chain items. This includes icons that flag an item as cold chain and the ability to indicate temperature requirements and create bin locations, which are pivotal features in the effective delivery of COVID-19 vaccines.

Country Support

Mali

With funding from USAID Mali, Digital Square is working closely with the Mali Ministry of Health and partners such as CDC, Gavi, UNICEF and Global Fund to support adaptation and scale of digital health tools to support the rollout of the COVID-19 vaccine. Through the end of 2021, Digital Square is specifically supporting the following activities:

  1. Adapt and scale existing health information systems for COVID-19 vaccine rollout to enable real-time monitoring of vaccine availability and vaccine coverage.
  2. Support MOH to transition existing paper-based systems to digital platforms (focus on digital tools for monitoring adverse side effects).
  3. Harness digital tools to identify and locate persons eligible for vaccination.
  4. Identify tools and applications to be made interoperable.
  5. Contribute to an evaluation of a vaccination campaign in Bamako.

For more information on these activities or to coordinate with the Digital Square team, please contact Caitlin Bowman.

Additional Resources

UNICEF/WHO Digital Health Center of Excellence (DICE)

Many countries do not have fully functioning digital systems or solutions required to address health and information systems priorities in the context of the COVID-19 pandemic, as well as post-pandemic health systems’ needs. Digital Square and the newly formed UNICEF/WHO Digital Health Center of Excellence (DICE) are proactively looking for opportunities to collaborate to support countries’ wanting to invest in sustainable and scalable deployments of carefully chosen digital solutions for COVID-19 pandemic response plans. DICE is committed to supporting countries harness appropriate digital public goods, many of which are mature and already integrated into national systems, to provide substantial multilayered support to the COVID-19 pandemic using a health system strengthening lens; from planning distribution of commodities and vaccines, tracking supplies, surveillance and case detection, monitoring coverage of services, and communicating to generate demand and reduce misinformation. . Digital Square’s Mission is to connect health leaders with the resources they need for digital transformation. Through our collective partnership, we aim to not only support country needs now, but also to help country leaders build stronger, more sustainable digital systems, which will improve health outcomes beyond the current pandemic.”