Table 1.

Adapted GRISP framework for rapidly closing the immunization gap in the COVID-19 pandemic era

GRISP Action Areasa	COVID-19 Pandemic-Related Action Areasb
Maximize Reach • Detect and reach the unreached • Design services to reach all equitably • Build capacity of vaccinators and managers • Ensure vaccine quality and availability • Create synergy with special vaccination efforts • Integrate immunization services	• Make data-informed decisions on the best approaches to quickly and safely boost vaccination status in communities with poor coverage • Train, remotely as much as possible, service providers and vaccinators in advance of restarting campaigns and routine immunization services • Ensure availability of adequate infection prevention and control measures at all fixed sites, including functional handwashing stations, PPEs, sanitizers, designated waiting areas, and patient flow patterns to minimize contact with health workers and vaccinators • Provide influenza vaccination for health workers and vulnerable population groups • Prioritize epidemic-prone vaccines (measles, polio, diphtheria-pertussis) if necessary and extend intervals between doses in a multiple-dose vaccine series
Manage the Program • Secure political commitment and partnerships • Plan, budget and mobilize resources • Ensure excellence in national leadership • Set program policy and guidance	• Update national and local microplans to identify and develop appropriate plans for addressing resource gaps • Plan for a phased transition towards full-scale campaigns and supplemental immunization activities (SIAs) as deemed safe. • Communicate and distribute context-specific, written guidelines, and job aids to support health workers in delivering immunization services safely • Implement and monitor adherence to infection prevention and control measures, new patient flow patterns, and screening and referral for COVID symptoms • Adopt innovative supportive supervision strategies
Mobilize People • Engage communities and create demand • Mobilize and communicate for vaccination • Address vaccine hesitancy and false perceptions	• Sensitize communities, using popular and culturally-acceptable media strategies, on the availability of essential services and routine immunization with location and schedules • Communicate COVID-19 risk mitigation strategies adopted for service delivery (e.g., physical distancing, IPC, new patient flow patterns) with communities to gain confidence • Engage stakeholders and community partners in collaborative efforts to address polio vaccine-preventable disease outbreaks and COVID-19
Monitor Progress • Monitor program performance and disease occurrence • Evaluate the program through surveys and reviews	• Strengthen surveillance and reporting systems for polio, measles and other VPDs • Utilize VPD outbreak data to plan appropriate response strategies • Continuously monitor COVID-19 infections in local areas to identify, isolate, refer and trace contacts of those infected with the virus • Assess coverage data regularly for catch-up vaccination planning • Monitor regularly vaccine stock, cold chain, and related immunization supplies

^aExisting GRISP recommendations;

^bAdditional recommended action areas from WHO and Polio Eradication Initiative guidelines.