1. Independent Monitoring of the Switch
A training module for Independent Monitors for
the switch from trivalent OPV to bivalent OPV
Version: 2 February 2016
For adaptation and use by regions and countries

2. What is covered in this Presentation?
At the end of this presentation, switch monitors will understand: 1
What is the switch? 2
What is the purpose of monitoring? 3
What do monitors do?
Two issues of sterilization and inertization
Disposal 4
How do I complete monitoring tools?

3. Polio eradication and the switch from trivalent OPV to bivalent OPV
What is the switch?

4. We are close to the eradication of polio
Immunization efforts have reduced the number of polio cases globally by more than 99% over the last two decades.
There are three types of polio viruses: 1, 2, and 3.
Type 2 wild poliovirus has been eradicated. The last type 2 wild poliovirus was detected in 1999.
To the facilitator:
“We are close to the eradication of polio.
Immunization efforts have reduced the number of polio cases globally by more than 99% over the last two decades.
The transition from trivalent OPV to bivalent OPV is part of the polio eradication strategy.
Together, we can eradicate polio.”
Together, we can finish the job of eradicating all types of polio. 4

5. Oral Polio Vaccine (OPV) and Inactivated Polio vaccine (IPV)
Both oral (OPV) and injectable (IPV) vaccines are used to fight against polio today.
Trivalent OPV (tOPV) provides protection against types 1,2, and 3 poliovirus while bivalent OPV (bOPV) protects against types 1 and 3 poliovirus.
bOPV provides stronger protection against types 1 and 3 poliovirus than tOPV and is safer.
Because type 2 poliovirus has been eradicated, the world can now stop tOPV use and begin bOPV use (i.e., Switch)

6. The switch from tOPV to bOPV must occur at the same time across the country and the world
Switch in April 2016
To the facilitor:
“The Switch from tOPV to bOPV”.
Please point out to participants that the tOPV droplet has the numbers “1, 2 and 3” inside of it. And the bOPV droplet only has the numbers “1 and 3”. And say: “By switching from tOPV to bOPV, we are removing the type 2 component of the oral polio vaccine.” Next, show how IPV contains a “1, 2 and 3” and emphasize that IPV protects against all three types of poliovirus.
“We are removing the type 2 component of OPV because it causes the majority of cVDPVs. By using bOPV along with IPV, children are protected against all three types of the poliovirus and have a lower risk of paralysis caused by vaccines.”
Switching from tOPV to bOPV at the same time across the country and the world is the safest strategy 6

7. [INSERT COUNTRY] Information
Switch day: [INSERT SWITCH DAY(S)]
IPV introduced: [INSERT PAST OR FUTURE DATE]
bOPV distribution: [EXAMPLE: TO DISTRICT LEVEL STORES]
*Adapt this slide to provide country context

8. Independent Monitoring Overview
What is the purpose of monitoring?

9. Monitoring should prevent ongoing use of tOPV after the switch
Objectives of Switch Monitoring
Ensure withdrawal of tOPV (Primary)
Assess introduction of bOPV and IPV (Secondary)
Provide national authorities with data to Validate the Switch
Switch monitoring ideally should prevent:
Storage of large stocks of tOPV at district level and subsequent distribution to service points after switch
Ongoing use of tOPV at service delivery level
Use of scavenged tOPV after the switch
Mention Validation and supportive supervision

10. Government conducts independent monitoring and takes corrective action
Independent monitors contribute to the first of three Steps to National Validation
National Switch Date
Government conducts independent monitoring and takes corrective action
National Validation Committee (or equivalent) reviews and provides validation recommendation
Government takes corrective action as necessary and submits validation report to WHO 1 2 3

11. Strive to complete monitoring within the first week of the Switch Date
National Switch Date
Independent monitoring completed
Data available at National level (for review by Validation Committee)
Government submits Validation report submitted to WHO
Government takes immediate corrective action if tOPV is identified
Typically within 3-5 days
Typically within 7-10 days
Within 14 days

12. Monitors are an important part of the switch!
Independent monitors are responsible for key activities reduce risk of polio. These activities include:
Providing an unbiased, credible assessment of how well the switch has been performed
Ensuring that no tOPV is being administered after switch day
Correcting problems that may arise during implementation of the switch

13. Independent Monitoring Strategy and Implementation
What do monitors do?

14. Overview of sites with tOPV storage or use
Primary
(National) stores:
Sub-national
(Regional or Provincial) stores:
Lowest distribution level
(District) stores:
Service points
(health facilities)

15. Overview of Recommended Monitoring Strategy
The strategy is to rapidly identify facilities with large stocks of tOPV post-switch and implement immediate corrective action
National stores down to District level:
Verify tOPV is removed from cold chain in ALL vaccine cold chain stores down to the district level
Service delivery points:
Due to large number of service points, higher risk facilities will be selected for independent monitoring by the Monitoring Coordinator/Supervisor
A key component
of a successful switch involves effective monitoring of cold chain storage points after the national switch date in all countries to ensure that tOPV is no longer available for administration
•  of developing a monitoring strategy is to identify storage points most at risk for continuing use of tOPV after the Switch. Prioritization criteria can be used to develop a list of these storage points. Section 2 (pg. 11) of the monitoring guidelines provides example prioritization criteria, along with step by step guidance on the planning, preparing, and collecting and reporting data, and corrective actions for the switch monitoring.

16. Summary of the Monitoring Process
Primary (National) stores:
Independent monitors
Sub-national (Regional or Provincial) stores:
Visit 100% of the vaccine stores
Lowest distribution level (District) stores:
Service points
(health facilities):
Monitor only delivery points selected by the Supervising Official

17. Preparation Prior to facility visits, independent monitors will…
Receive list of cold chain stores and service points from coordinator/supervisor
Review and finalize micro-plan for visit schedule to sites
Instructions, transportation, cell phone, data collection instruments
Receive and review protocols for:
Follow-up of sites that cannot be visited on schedule
Corrective action if tOPV is found
Retrieve Independent Monitoring Data Collection Tool (Form 1) to record each site visited

18. [INSERT COUNTRY] Protocols
Protocol for follow up of sites that cannot be visited on schedule:
[INSERT INFORMATION ON PROTOCOL]
Protocol for corrective action if tOPV is found :
*Adapt this slide(s) to reflect country protocols

19. Visit Places that Store Vaccines
Complete separate form for each administrative level assigned to you by the Official (national, subnational, district or service delivery points with fixed vaccination services)
Fill out date of monitoring, name of monitor, select level of cold chain, name of administrative level
List store name or location
Ask staff at site to show you the vaccine storage equipment
Examine contents and complete line listing for facility
Don’t forget to check for bOPV and IPV
Obtain information on number of vials disposed (stock ledger or other record), disposal method and corrective actions
Determine if a follow-up visit is needed for the site
Tally the totals for columns B-F

20. Report Findings
Send SMS or call Monitoring Coordinator/Supervisor on a daily basis or more frequently if concerns are identified
Submit forms daily to monitoring coordinator/supervisor
Complete any follow-up visits as requested

21. Site Visits and Corrective Action by Independent Monitor
Stop and Report to Supervisor No
tOPV vial (opened or unopened)
Visit and monitor all cold chain stores down to the district level
Dispose of tOPV according to instructions and report to Supervisor for follow-up activities
Yes
Visit and monitor the selected 10% of Service Points

22. Practical Session
How do I compete forms?

23. 1 form: Independent Monitoring Data Collection Tool
Completed by: Independent Monitor
Reported to: Monitoring coordinator/supervisor
Reporting frequency: Daily during monitoring
Number of forms: Separate table for each administrative level being monitored (primary, subnational, district and service delivery points with fixed vaccination services)

24. Independent Monitoring Data Collection Tool
Date of Monitoring: ____________________ Name of Monitor: _____________________________
Level of cold chain: Primary: _____ Sub-National (Regional/Provincial): _______ Lowest distribution level (District): ______ Service Delivery Point (Fixed site): ________
Name of administrative level: ____________________________
Store Location or Name
tOPV in cold chain (Yes = 1 No = 0)
tOPV out of cold chain without label “Do not use” (Yes = 1 No = 0)
bOPV in cold chain (Yes = 1 No = 0)
IPV in cold chain (Yes = 1 No = 0)
# vials disposed or pending disposal at time of monitoring
# vials destroyed at service point by report date
Disposal method (Multiple codes okay)*
Corrective actions** (Multiple codes okay)
Status (ongoing or completed
Due date, if ongoing A B C D E F G H I J 1 2 3 4 5 6 7 8 9 10
TOTAL # stores
*Codes for disposal method: (1): Autoclave (2): Boiling (3): Incineration (4): Encapsulation (5): Burial (6): Burning (7): Other
**Codes for corrective action: (1): tOPV withdrawn (2): Onsite re-training (3): Officials at higher administrative level notified (4): Other (please specify)

25. Contact Details for Daily Feedback
Monitoring coordinator: [INSERT CONTACT NUMBER]

26. The End
Thank you !