General Vaccination and Active Prevention of COVID-19 Epidemic at the Primary Health Care Level: The Fifth Step of the National Mobilization Program against COVID-19

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Extended Abstract
Background
The coronavirus disease 2019 (COVID-19) pandemic has affected the health systems of all countries worldwide. Different countries have made different changes in the structure of their health programs in an attempt to strengthen the health system, available resources, and check the severity of the disease outbreak. The successful control of the COVID-19 epidemic requires coordinated community-based strategies aimed at changing behavior, monitoring the situation, and providing services. One of the most effective ways to prevent COVID-19 is to perform general vaccination and actively prevent the outbreak at the primary health care level. Therefore, the present study aimed to investigate the measures taken in Iran during the fifth step of the national mobilization program against COVID-19 from April to September 2021.
Methods
The present cross-sectional and descriptive study was carried out at the national level from April to September 2021. Data related to COVID-19 vaccination, prevention, care, and outpatient services were collected from databases, including first level electronic health record systems (SIB, SINA, NAB, and PARSA), the portal of Health Network Management Center, the portal of Communicable Diseases Management Center, and the portal of Health Observatory Center (including Corona Hub and Vaccination Hub). The data collected from the mentioned systems included the development process of creating and developing aggregated COVID-19 vaccination databases, the number of COVID-19 vaccines administered monthly, the number of intercepted people at risk of close contact, the number of rapid tests for COVID-19, the number of patients cared for at home, the activities of the monitoring teams (such as the number of warnings issued and the number of trading, industrial, or administrative units sealed), the number of PCR tests performed, and the number of COVID-19 convalescent centers along with the number of their beds. The target population of the study included medical universities and schools in Iran. Using a census sampling method, all 63 medical universities and schools in the country were included in the study. The Statistical Package for the Social Sciences (SPSS) version 16 was utilized to analyze the collected data.
Results
At the fifth step of the national mobilization program against COVID-19, a total of 1,228 vaccination centers were established in 63 medical universities and schools in Iran. At this stage, around 20,000 health workers and volunteers provided immunization services in 6,490 stations. In these centers, more than 47 million doses of the COVID-19 vaccine were injected (32,593,218 first shots and 14,690,553 second shots) based on the national vaccination priority strategies (the national COVID-19 vaccination program). According to the collected data, an average of 7,870,780 doses of COVID-19 vaccines were injected per month.In this step, a total of 15,011,610 people who had close contact with infected people were intercepted, which averaged about 625,000 people per week (ranging from 295,000 to 1,035,000). From April to September 2021, on average, one in four of all COVID-19 tests was positive. To track the people with a close contact with COVID-19 patients, interdepartmental teams were used, which comprised health workers in rural (Behvarz) and urban (Morageb-e-salamat) areas with the participation of various organizations. In this area, 21,796 contact tracing teams throughout Iran tracked people in close contact with infected individuals (or exposed people). These teams consisted of 70,790 members, including health workers (45%), Basij (28%), health ambassadors (16%), neighborhood health liaisons (8%), private sector (1%), the Red Crescent (1%), and others (1%). At the fifth step, 532,551 people received home care (more than 22,000 people per week on average). In each selected health center for COVID-19, a home care team was formed with the participation of first-year assistants in all disciplines except infectious, internal medicine, and emergency, along with final year of medical students, nursing, midwifery, and laboratory science students. Moreover, other institutions and organizations such as the Basij, Red Crescent, and volunteers were involved in home care teams.Supervisory teams were led by environmental health or occupational health experts and were manned by the Basij, public volunteers, and the Red Crescent volunteers. The primary responsibility was to oversee service centers, food preparation and distribution, as well as administrative units, trade unions, and organizational units. Over one million warning slips were issued for the inspected units, of which 73,443 were sealed.According to the collected data, during six months (from April to September 2021), 30,843 vulnerable households received support packages, including families with COVID-19, those in need of reverse quarantine, and those affected by COVID-19. In addition, about 265 quarantine units equipped with 10,532 beds were established throughout Iran to provide in-patient services to people with COVID-19 who were not capable of creating isolated conditions at home. During this period, an average of 11,127 beds were ready to serve patients in COVID-19 quarantine units. Also, more than six million rapid COVID-19 diagnostic tests were performed (in homes and health units).
Conclusion
The national mobilization program to combat COVID-19 in Iran focused on the community and primary health care system. The program was successful in strengthening the health system to expand vaccination and actively prevent COVID-19 epidemic. Providing evidence-based interventions in communities and primary health care facilities improved the responsiveness of the Iranian health system and mitigated the COVID-19 epidemic. As a result, the number of infections reduced and the transmission of the virus decreased.
Practical Implications of Research
The experiences of the fifth step of the national mobilization program against COVID-19 showed that the applied reforms led to strengthening of the Iranian health system in responding immediately to the COVID-19 epidemic. Also, the establishment of vaccination centers in Iran by responding quickly to immunization needs and preventing disruption of routine health care was a successful experience in health system reform.
Ethical Considerations
In this study, we considered all fidelity and honesty protocols related to data extraction from the databases.
Conflict of Interest
This article is the result of an independent study and has no conflict of interest with other organization and individuals.
Acknowledgments
The researchers would like to thank all the universities and schools of medical sciences and the Iranian Health Observatory for the sincere collaboration in providing the needed data. We also thank all the staff and organizations involved in the front line of community vaccination, who sincerely cooperated in implementing the program.