Dr. Vandine is the Chair of the Ad-Hoc Committee for Rolling Out COVID-19 Vaccination Throughout the Country (ACC-19), and Chair of the Sub-Committee of Education, Training, and Public Communication and Spokesperson of the Inter-Ministerial Committee to Combat COVID-19.
Safe and efficacious vaccines are essential tools for responding to the COVID-19 pandemic. While vaccines were still under development in early 2020, the Royal Government of Cambodia (RGC) had started developing a national deployment and vaccination plan (NDVP). Despite the limited availability of vaccines globally, in January 2021, the RGC targeted to vaccinate 10 million population aged 18 years and above by June 2022.
After the completion of the NDVP, the Ministry of Health also developed the Operational Guidelines, Protocol and Vaccine Risk Communication and Community Engagement Plan to assure the safe delivery of vaccines and ancillary items, vaccinate priority target populations, and implement a successful vaccination rollout.
Leadership matters! Samdech Akka Moha Sena Padei Techo Hun Sen, Prime Minister of the Kingdom of Cambodia (Samdech Prime Minister), has been continuously providing his extraordinary leadership, strategic advice and guidance for the COVID-19 vaccination rollout. He instructed the whole-of-government approach and engaged the armed forces, volunteers, and the private sector for COVID-19 vaccine deployment and vaccination. During the planning, the RGC set the principles for the COVID-19 vaccine deployment and vaccination plan and these include:
- Recognise that safe and efficacious vaccines are powerful tools for preventing COVID-19 cases and ending the pandemic.
- Government leadership and country ownership and coordinated partners’ support.
- Adopt measures with a country context and a practical approach.
- Fully utilise existing systems, mechanisms, resources, capacities, and structures.
- Identify additional capacities and resources needed for uncertain situations to ensure successful implementation.
- Use COVID-19 vaccination as an opportunity to improve and advance the national immunisation programme, with capacity building and enhancing the health system for the future, including strengthening the management, storage, and distribution of vaccines.
- Use vaccines as a public health measure and tool.
The COVID-19 vaccination campaign, which is free of charge, was announced for roll out by Samdech Prime Minister and commenced with four national hospitals on 10 February 2021. Within a month, vaccination services expanded to six national hospitals, all Provincial and Operational District referral hospitals. Immediately after the announcement by Samdech Prime Minister to establish the Ad-Hoc Committee for Rolling-out COVID-19 Vaccination throughout the Country (ACC-19), vaccination services were quickly expanded to selected health centres. Vaccination through mobile and outreach sites in the whole country was launched on 1 April 2021, starting from the capital city, as guided by the “Blossom Strategy” of Samdech Prime Minister.
The COVID-19 vaccination rollout started with priority target groups such as health care workers, frontline government officials, from February, and the elderly, from early March. Then later, the rollout was combined with a geographical approach, based on virus transmissions, through fixed, outreach, and mobile sites. The RGC implemented mandatory vaccinations for government officials and persons occupying government positions from 6 April 2021.
For a faster and more efficient rollout, the five sub-committees of the ACC-19 were nominated by the Chair of the ACC-19 in March 2021. This Ad-Hoc Committee, among many of its responsibilities, has been instrumental in policy and decisionmaking, coordination, sectoral approach, capacity building, implementation, and monitoring and evaluation. After successfully administering the first dose to at least 75 per cent of the targeted 10 million population by end of July, Cambodia decided to include children aged 12 years old to under 18 years to help protect against COVID-19 infection from 1 August 2021. In addition, due to some evidence of waning immunity and the detection of variants of concern, Cambodia also decided to provide booster doses to frontline health care workers and government officials, the elderly, and other vulnerable groups from 8 August 2021.
In early 2021, with the guidance of Samdech Prime Minister, the RGC established the Inter-Ministerial Committee on Vaccine Procurement. This committee developed the procurement plan with different scenarios, considering global supply constraints and the COVAX facility’s proposed support and bilateral donation. Since then, the committee has been negotiating with different countries and manufacturing companies to secure the vaccines.
As of 4 September 2021, Cambodia has successfully received 29,606,600 doses of COVID-19 vaccines from three sources, of which 23 million or about 78 per cent of the total doses, were procured by RGC. The adequate and timely availability of the bilaterally procured vaccines is found to be efficient and effective in vaccinating targeted populations. Our thanks to China, Japan, the United Kingdom, the United States of America, and the COVAX Facility, as well as other partners, who have donated COVID-19 vaccines to Cambodia.
Equity is the central point of COVID-19 vaccination rollout in Cambodia. With multi- sectoral approaches, local authorities were visiting each household to register the eligible target population and ensuring their visit to vaccination sites. In addition, there were numerous efforts to establish mobile and outreach sites in remote areas to vaccinate targeted and unreached populations.
The RGC has put all its efforts to vaccinate identified priority target groups like health care workers, the elderly, and individuals with comorbidities, among others. Local authorities are engaged to ensure that older persons, 60 years old or above, including those living in remote villages, are registered and vaccinated. A “Respectful Centenarian Award” has been initiated to encourage the elderly to be vaccinated without hesitation, thus helping to protect the most vulnerable. Selected elderly populations aged 100 years and above who have already received the vaccine are given the Samdech Prime Minister’s award which is combined with cash, food and groceries. This initiative also demonstrates the values of Cambodian society and culture, especially people’s respect and care for the elderly.
Risk communication and community engagement are keys to the success of the vaccination rollout. The RGC developed communication materials and use every platform for information dissemination to increase public awareness, acceptance and involvement. Moreover, the Chair of the Ad Hoc Committee and spokesperson of the Ministry of Health has been giving regular media interviews and announcements to share guidance, and updating information to prevent misinformation and vaccine hesitancy. Furthermore, the Ad Hoc Committee conducted an education campaign in August 2021.
In recognition of achievements in the vaccination roll-out, a “One-Million Milestone COVID-19 Vaccination Award” has been established to encourage best practices and speedy COVID-19 vaccination rollouts. Each millionth person who receives a vaccine is given a Samdech Prime Minister’s award.
As of 4 September, Cambodia has administered more than 20 million doses. It has achieved 95.33 per cent and 88.77 per cent vaccination coverage, for first and second dose respectively, of 10 million target population of 18 years of age and above. By 4 September 2021,
- 98 per cent HCWs were fully vaccinated. 95 per cent and 78 per cent elderly received f irst and second dose respectively;
- 84.42 per cent of the target population of nearly 2 million targeted children between 12 and under 18 years of age were vaccinated with the first dose;
- 94 per cent and 74 per cent of the target population of almost 12 million targeted population aged 12 years and above 98 per cent HCWs were fully vaccinated. 95 per cent and 78 per cent elderly received f irst and second dose respectively;
- 84.42 per cent of the target population of nearly 2 million targeted children between 12 and under 18 years of age were vaccinated with the first dose;
- 94 per cent and 74 per cent of the target population of almost 12 million targeted population aged 12 years and above.
During the last seven months, there has been huge progress in vaccination coverage. It is observed that the vaccination rollout might be completed by October 2021, eight months ahead of schedule. However, the RGC will continue to provide booster doses to other vulnerable groups, provide vaccination to children under 12 years old, as per scientific evidence and global recommendations.
At the same time, epidemiological data reveals that the number of cases and deaths are declining in Cambodia due to a combined approach of vaccination response, risk- based and targeted non-pharmaceutical interventions, improved health care capacities, and risk communication and community engagement.
While remarkable progress has been made in the vaccination rollout, RGC is planning to conduct mop-up vaccinations, by making public announcements, and getting health facility staff and local authorities to conduct house to house visits in villages where vaccination had been completed.
Experiences and lessons learned from the COVID-19 vaccination rollout are an asset for Cambodia and will be widely used for advancing the existing immunisation and health systems. The Cambodia National Immunisation Programme of the Ministry of Health is developing the National Immunisation Strategy (NIS) for 2021-2025 and using lessons learned and best practices from the COVID-19 vaccination rollout. With many others, the RGC has been planning to transform the COVID-19 e-system to an e-immunisation registry for routine immunisation of life course; develop a framework to reach the unreached for childhood immunisation; expand immunisation delivery for adults, especially the elderly; and enhance the adverse event following immunisation (AEFI) surveillance system, particularly in improving detection and reporting.
Cambodia’s high vaccination coverage among priority target groups and percentage coverage among the entire population places it as one of the highest performing countries in the WHO Western Pacific Region. Leadership, early and effective planning, good governance, sectoral approach, coordination, timely secure adequate vaccine supplies, involvement of local authorities, volunteers such as Samdech Techo Voluntary Youth Doctor Association (TYDA), Cambodian Youth Federation and the armed forces, community engagement and monitoring are crucial to the success of the COVID-19 vaccine rollout in Cambodia. Strong and brilliant leadership support from Samdech Prime Minister, proactive hard work and collaboration from the various committees and the local authorities, especially under the management of the ACC-19 Chair, and the contribution and participation of the Cambodian people are paying off. All these are critical to the success of the nation in the COVID-19 vaccination campaign.
It is important to acknowledge the unprecedented efforts and investments by the World Health Organization and other partners to develop and make vaccines available in the shortest possible time, along with the overall effort of the country in rolling out its vaccination campaign as part of the global response to the COVID-19 pandemic.
