Background The COVID-19 pandemic has had a profound impact on the Indo-Pacific. Managing the social, economic and health impacts of COVID-19 remain a central challenge for the region. At the onset of the pandemic, BES acted quickly to adapt our solutions to support the COVID-19 response which has included significant investment in Tamanu. We have adapted existing Tamanu functionality to develop three COVID-19-specific modules; the COVID-19 Vaccine Module, the COVID-19 Testing Module and the COVID-19 Active Case Management Module. The COVID-19 Vaccine Module is currently being used to support the Samoan COVID-19 vaccination campaign and has been used to record vaccines for >80% of the population as of November 2021. The COVID-19 Testing Module is being used in Fiji to record and enter results for COVID-19 tests. Over 40,000 tests have been recorded in the system as of November 2021. More specifically, the COVID-19 Vaccine Module includes the below functionality: • Patient registration, including all demographic, contact and relevant clinical details • COVID-19 vaccine module enabling the recording of vaccination administration against individual records across both desktop and mobile, with all necessary fields (according to the WHO data model) • Decision support for second dosing • Adverse event following immunisation reporting • Individualised vaccination certificates • COVID-19 reporting suite, with integration to external systems as required, reporting to the household level and including metrics such as patient lists by village according to vaccination status and overdue for second dose As stated above, through the COVID-19 Vaccine Module, Tamanu can generate individualised vaccination certificates. Currently the vaccine certificate can be printed from Tamanu and includes patient details such as name, unique identifier, date of birth and gender; details on vaccination event such as vaccine brand name, dose, batch number, administering centre and person administering the vaccine. The certificate can also be configured to include a watermark. We have made significant progress in the developed of the vaccination certificate though further work is required to ensure alignment with the World Health Organization’s Digital documentation of COVID-19 certificates: vaccination status (DDCC:VS). We will also include a Visible Digital Seal (QR Code) compliant with the ICAO standard (and as an alternative, compliant with the EUDCC standard). We have already held initial discussions with IATA to ensure the VDSs in our Vaccine Certificates will be compliant with their Travel Pass app and we will use a portion of this funding to engage more broadly with other global stakeholders. In addition to the below objectives, consideration will be made to ensure that access to COVID-19 certificate and proof of vaccine status is equitable for all. Objectives To adapt Tamanu to align with WHO’s technical guidance on the digital documentation of COVID-19 certificates the following objectives will be met: - Configure vaccination certificates to include Visible Digital Seal (VDS). The VDS is an individual QR code included on the certificate which is generated using the COVID-19 vaccination information. - Develop online portal for vaccination status checking. - Adapt the Tamanu API to conform with HL-7 FHIR to enable the integration of Tamanu’s COVID-10 certificate with required systems. Deliverables The following work will be delivered: - Demonstration of COVID-19 certificate in alignment with DDCC:VS. - Demonstration of online portal for vaccination status checking. - Published API (conforming with HL-7 FHIR) - Training materials made freely available online (including manuals, training videos and webinar) Schedule February 2022: Configuration of vaccination certificate to include VDS, development of secure online portal for vaccination status checking March-April 2022: Adapt Tamanu API (already HL7 FHIR compliant) to include vaccination details in addition to test details, development of training material Risk mitigation The following have been identified as key risks relevant to the implementation of eHealth initiatives in the Pacific and of EMRs specifically. Long-term Sustainability Software solutions change rapidly, and new technologies are constantly emerging to support better healthcare outcomes. As a result, there is an inherent risk that the proposed modules around vaccine certificates become obsolete, superseded by new global tools or no longer recognised. In the context of the COVID-19 pandemic however, there is a need to accept slightly higher risks and to move more quickly than a usual consensus-gathering process might take. We have designed our tools in line with the current leading global standards and practices and need to move forward – more developed economies in the region (including Australia) have selected the same standards and proceeded with implementation and we have already met with the Australian Passport Office, Australian Department of Foreign Affairs and IATA to try and learn lessons. The work is already being used by Samoa with other planned implementations in early 2022 so we should be able to demonstrate quick scalability. Security/Data Breaches Data breaches are a major risk to any digital health project and are taken very seriously. All data in Tamanu will be encrypted at rest and in transit. Access to data within Tamanu is password-controlled. The ability to view and download data is restricted to specific user groups. We will design our vaccine certificates with all standard security features and the VDS will be encoded with a public encryption key, whilst the private key will be shared only with trusted providers. COVID-19 Certificate Fraud Certificate fraud is a high risk to all COVID-19 vaccination campaigns. The Tamanu vaccine certificate will include a VDS which will help to combat fraud and misuse. The VDS represents the ‘gold standard’ of proof of vaccination and conforms to the global standard set by the ICAO and the model is endorsed by the WHO.