Systems Strengthening for Effective Coverage of New Vaccines in the Pacific Project

Systems Strengthening for Effective Coverage of New Vaccines in the Pacific Project is sponsored by Asian Development Bank (ADB) / UNICEF. This regional project aims to improve immunization outcomes in Pacific countries, including Samoa (distinct from American Samoa but relevant to the region).

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Systems Strengthening for Effective Coverage of New Vaccines in the Pacific Project # Regional : Systems Strengthening for Effective Coverage of New Vaccines in the Pacific Project #### Sovereign Project | 50282-001 The Systems Strengthening for Effective Coverage of New Vaccines in the Pacific Project (the project) adopts a regional approach to improving immunization outcomes by introducing three vaccines in Samoa, Tonga, Tuvalu, and Vanuatu.

It supports the countries in (i) pooling the procurement of the human papillomavirus (HPV) vaccine, the pneumococcal conjugate vaccine (PCV), and the rotavirus vaccine through the United Nations Children's Fund (UNICEF); (ii) strengthening primary health care and the capacity to deliver vaccination programs; and (iii) increasing community awareness and the population's knowledge of and attitude toward vaccines.

The project will reduce the burden and minimize outbreaks related to vaccine-preventable diseases, integrate immunization programs into broader health systems, and improve access to primary health services. ### Latest Project Documents Request for information&officer=%20klam@adb.

org&division=%20Human%20and%20Social%20Development%20Sector%20Office%20(SD3-HSD)&projectcountry=%20Regional) * 50282-002Systems Strengthening for Effective Coverage of New Vaccines in the Pacific * 50282-003Systems Strengthening for Effective Coverage of New Vaccines in the Pacific Project under the Asia Pacific Vaccine Access Facility (Additional Financing) Project Name Systems Strengthening for Effective Coverage of New Vaccines in the Pacific Project Project Number 50282-001 Country / Economy Project Status Active Project Type / Modality of Assistance Source of Funding / Amount Grant 0623-REG: Systems Strengthening for Effective Coverage of New Vaccines in the Pacific Grant 0624-REG: Systems Strengthening for Effective Coverage of New Vaccines in the Pacific Grant 0625-REG: Systems Strengthening for Effective Coverage of New Vaccines in the Pacific Grant 0626-REG: Systems Strengthening for Effective Coverage of New Vaccines in the Pacific Grant 0787-REG: Systems Strengthening for Effective Coverage of New Vaccines in the Pacific Grant 0788-REG: Systems Strengthening for Effective Coverage of New Vaccines in the Pacific Grant 0789-REG: Systems Strengthening for Effective Coverage of New Vaccines in the Pacific Grant 0790-REG: Systems Strengthening for Effective Coverage of New Vaccines in the Pacific Loan 3736-REG: Systems Strengthening for Effective Coverage of New Vaccines in the Pacific * Inclusive economic growth * Gender Equity and Mainstreaming * Governance and capacity development * **Health** / Disease control of communicable disease - Health system development Gender Gender equity theme Description The Systems Strengthening for Effective Coverage of New Vaccines in the Pacific Project (the project) adopts a regional approach to improving immunization outcomes by introducing three vaccines in Samoa, Tonga, Tuvalu, and Vanuatu.

It supports the countries in (i) pooling the procurement of the human papillomavirus (HPV) vaccine, the pneumococcal conjugate vaccine (PCV), and the rotavirus vaccine through the United Nations Children's Fund (UNICEF); (ii) strengthening primary health care and the capacity to deliver vaccination programs; and (iii) increasing community awareness and the population's knowledge of and attitude toward vaccines.

The project will reduce the burden and minimize outbreaks related to vaccine-preventable diseases, integrate immunization programs into broader health systems, and improve access to primary health services.

As a response to the coronavirus disease (COVID-19) pandemic, the governments of Samoa, Tonga, Tuvalu, and Vanuatu have been preparing for the imminent arrival of COVID-19 vaccines, and have requested additional financing from the Asian Development Bank (ADB) to further strengthen immunization programs and prepare for the vaccine rollout.

The additional financing will build on the original project to support the four governments in meeting their urgent needs. Project Rationale and Linkage to Country/Regional Strategy Human papillomavirus (HPV) causes almost all cervical cancers through communicable disease transmission.

Cervical cancer is a major cause of premature death in the Pacific causing nearly 500 deaths in 2010 and is therefore a leading cause of death among women in 2010 across the Pacific region. It is largely preventable through cost effective interventions of early detection and HPV vaccination. Immunization is pro-poor, providing relatively larger benefits to low-income households.

The governments of Samoa, Tonga, Tuvalu, and Vanuatu have incurred considerable costs to prevent the entry of COVID-19 through travel restrictions, while mitigating the pandemic's effects on their economies.

The additional financing expands the scope of the original project, i.e., to include the introduction of COVID-19 vaccines, which will enable the gradual reopening of borders and economies, and reestablish the free movement of people both nationally and internationally.

Incidence and prevalence of cervical cancer in the Pacific region reduced; healthy lives ensured and well-being for all at all ages promoted; and SARS-Cov2 virus spread, morbidity and mortality reduced, and confidence of citizens restored. Immunization coverage of vaccines increased RCCE activities have continued into routine immunization following the mass catch up campaigns.

Focus is now on improving HPV coverage via school-based and door-to-door campaigns. The project supported dengue fever response community engagement campaigns to Samoa in 2025 while Tonga and Tuvalu in 2026.

#### Implementation Progress Description of Project Outputs Regional vaccine procurement strengthened Health systems strengthened Community awareness improved Status of Implementation Progress (Outputs, Activities, and Issues) Samoa/Tonga/Tuvalu/Vanuatu: All 3 vaccines, buffer stock present at regional warehouse. Supplies for catch-up plans need to be considered and re-evaluated to avoid any stock-outs.

Tonga: Established at regional level (UNICEF Nadi regional cold chain storage) Tuvalu: On track; buffer stock established in UNICEF Nadi warehouse Vanuatu: Established at regional level (UNICEF Nadi regional cold chain storage) Amended UNICEF VII Agreement signed Samoa/Tonga/Tuvalu/Vanuatu: Achieved VII agreements have been extended until Dec 2026 for all 4 countries.

All 4 countries have started to collect the sex-disaggregated immunization data and to be reflected in the national reports. Sex-disaggregated immunization data is available at the national level in Samoa, Tonga and Tuvalu. VAN: Incomplete.

Little progress through immunization reporting at national level. Not consolidated into annual reporting. VAN will need to incorporate EPI data into NHIS.

Government are looking to incorporate reporting in its new electronic immunization register. Facility-level microplanning training have been completed in all four DMCs but to be implemented at the outer island levels in Samoa, Vanuatu, and Tuvalu. Samoa: Achieved.

Community based microplanning exists in all health facilities Q3 2025. Tuvalu: Achieved. all microplans have been formulated June 2025 Vanuatu: On track.

Microplan has been completed at 87% of all facilities. All 4 national immunization polices have been updated in 2021. Samoa: Achieved.

EPI policy updated in 2020. Child register updated in 2021. Child immunisation booklet last updated in 2022.

HPV, PCV, RV guidelines completed and implemented during roll-out. Tuvalu: Delayed; both national PI and cold-chain policy have been revised but pending cabinet endorsement, expected by December 2024. Vanuatu: EPI policy to be further updated following HPV roll-out.

Child register updated. Child immunization booklet updated. HPV guidelines implemented during roll-out.

1 single incident of stock out of Rotavirus in Samoa in 2022 due to unforeseen logistic issues related to COVID-19. No stock out observed in other 3 countries. Samoa: Achieved.

PCV, RV, and HPV stocks in-country; one stockout of RV in 2022 recorded due to COVID19 outbreak. Tonga: No stock outs reported since the last review mission in 2023. Tuvalu: No stock-outs recorded as of 2024.

Vanuatu: PCV, RV, and HPV stocks in-country. No national stockouts. On track to meet cold chain inventory targets in all 4 countries.

EVMA has been conducted in all four DMCs in 2023, and the CIP will inform any additional cold chain upgrades for the remaining of the project. Samoa: Achieved. Cold chain equipment has been delivered and installed in 2020.

Support for maintenance and repair ongoing. Future expansions as recommended by EVMA report are being considered. Tuvalu: Completed.

Recommendations from the recently concluded EVMA, and its continuous improvement plan, will inform of any additional improvement to vaccine management practices, temperature morning, gaps in infrastructure, recording, reporting, monitoring, capacity building, HR in immunization, or supply chain management, as required. Vanuatu: Cold chain equipment has been delivered and installed. Support for maintenance and repair ongoing.

All cold chain installed. Completed in all 4 countries and revised in 2022. Training on collecting and reporting of adverse events following immunization has commenced.

Collation of data from facility level to national level has commenced. Samoa: Achieved. Sex-disaggregated AEFI data is collected and activity still ongoing.

Tuvalu: Completed; AEFI database is available through Tamanu Vanuatu: Similar to indicator 2d, collection of disaggregated AEFI data is still ongoing. Completed (with support via COVID-19 vaccine roll-out). At least two health promotion activities have been conducted for the three new vaccines as well as for COVID-19 vaccine introduction.

Samoa: Achieved. Community engagement and health promotion activities ongoing for PCV, RV, HPV, and COVID-19 vaccines. TV, Radio, print, and IEC materials produced for all three new vaccines and mass media activities ongoing.

Tonga: Intensified HPV campaigns will be conducted in August/September 2024. TV, Radio and print materials produced and mass media activities ongoing. Tuvalu: Completed; community engagement undertaken with Ministry of Education, local government and community groups, CSOs (Tuvalu Red Cross and Fusi Alofa Association) to increase community awareness.

Ongoing: TV, Radio and print materials produced and mass media activities ongoing for HPV campaigns Vanuatu: Community engagement ongoing for PCV, RV, HPV, and completed for COVID-19 vaccines. TV, Radio and print materials produced and mass media activities ongoing. COVID-19 information materials have been rolled-out in ongoing campaigns, and has reached at least 50% population in SAM, TON, TUV, and VAN.

SAM: Achieved. Mass media campaigns are ongoing and likely to have reached at least 80% of target population. Environment C Involuntary Resettlement C Indigenous Peoples C ### Summary of Environmental and Social Aspects Environmental Aspects The project will have no adverse environmental impacts.

Involuntary Resettlement The project will have minimal or no adverse social impacts. Indigenous Peoples The project will have minimal or no adverse social impacts. #### Stakeholder Communication, Participation, and Consultation During Project Design The project will impact women and children.

During project preparation, consultation and participation will include: (i) group discussions with (potential) beneficiaries, health workers, and community-based organizations; (ii) consultation of health staff and district health managers, sub-national level government administration, central ministries, and partners; and (iii) where appropriate, workshop with ministries, partners, and nongovernment organizations.

During Project Implementation Project outputs include increase in awareness of vaccines in key stakeholder groups. Support will be provided to Ministries of Education and Health and nongovernment organizations/civil society to develop health promotion strategies on the importance of vaccination/screening.

Responsible ADB Officer Lam, Ki Fung Kelvin Responsible ADB Department Sectors Department 3 Responsible ADB Division Human and Social Development Sector Office (SD3-HSD)Executing Agencies Ministry of Finance Ministry of Finance & Economic Management Ministry of Finance and Economic Development Ministry of Finance, Commerce, Trade & Tourism Concept Clearance 10 Jan 2017 Fact Finding 10 Apr 2018 to 19 Apr 2018 MRM 09 Aug 2018 Approval 08 Nov 2018 Last Review Mission - Last PDS Update 07 Aug 2026 **Project Data Sheets (PDS)** contain summary information on the project or program.

Because the PDS is a work in progress, some information may not be included in its initial version but will be added as it becomes available. Information about proposed projects is tentative and indicative. The Access to Information Policy (AIP) recognizes that transparency and accountability are essential to development effectiveness.

It establishes the disclosure requirements for documents and information ADB produces or requires to be produced. The Accountability Mechanism provides a forum where people adversely affected by ADB-assisted projects can voice and seek solutions to their problems and report alleged noncompliance of ADB's operational policies and procedures.

In preparing any country program or strategy, financing any project, or by making any designation of, or reference to, a particular territory or geographic area in this document, the Asian Development Bank does not intend to make any judgments as to the legal or other status of any territory or area.

### Safeguard Documents See also: Safeguards Safeguard documents provided at the time of project/facility approval may also be found in the list of linked documents provided with the Report and Recommendation of the President. None currently available. ### Evaluation Documents See also: Independent Evaluation None currently available.

None currently available. The Access to Information Policy (AIP) establishes the disclosure requirements for documents and information ADB produces or requires to be produced in its operations to facilitate stakeholder participation in ADB's decision-making. For more information, refer to the Safeguard Policy Statement, Operations Manual F1, and Operations Manual L3.

Requests for information may also be directed to the InfoUnit. ### Protecting Children from Vaccine-Preventable Diseases in the Pacific Children in Tonga, Samoa, Tuvalu, and Vanuatu are being protected against cervical cancer, pneumococcal, and rotavirus diseases through a partnership between ADB's Asian Development Fund and UNICEF.

* 09 Aug 2021 | News Release ### ADB, UNICEF Support Rollout of Vaccines for Children in Samoa, Tonga, Tuvalu Against Infectious Diseases, Cervical Cancer The rollout of vaccines to protect children against cervical cancer, pneumonia, and rotavirus has begun in Samoa, Tonga, and Tuvalu.

* 13 Jan 2020 | Project Result / Case Study ### Vaccinating in Vanuatu for a Healthier Future A $15 million grant from an Asian Development Fund (ADF) 12 facility will reduce the burden of pneumonia and diarrhea in children and increase protection against the human papilloma virus in women.

* 06 Jan 2020 | News Release ### UNICEF Signs Agreement to Support Immunization in Samoa Under ADB-Financed Project UNICEF and Samoa have signed a grant agreement to provide support to the health sector to strengthen the country’s immunization program and procure cold chain equipment to safely transport vaccines, which is supported by ADB...

* 28 Feb 2019 | News Release ### ADB Signs Loan and Grant Agreements to Introduce New Vaccines in Vanuatu ADB and Vanuatu today signed agreements for a grant and a loan to fund the introduction of new vaccines in Vanuatu through the ADB-supported System Strengthening for Effective Coverage of New Vaccines in the Pacific Project.

* 09 Nov 2018 | News Release ### ADB Assistance to Help Prevent Cervical Cancer, Other Infectious Diseases in Pacific ADB's Board of Directors has approved a total financing package of $29. 7 million to support the introduction of new vaccines in Samoa, Tonga, Tuvalu, and Vanuatu. ADB is a leading multilateral development bank supporting sustainable, inclusive, and resilient growth across Asia and the Pacific.

Working with its members and partners to solve complex challenges together, ADB harnesses innovative financial tools and strategic partnerships to transform lives, build quality infrastructure, and safeguard our planet. Founded in 1966, ADB is owned by 69 members—50 from the region.

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