July 27, 2021
Lebanon’s National Vaccination Plan: Public and Private Perspectives

 
Following the recent Government Monitor focusing on Lebanon’s COVID-19 response and the national vaccination plan, LCPS researcher Ali Taha interviews Dr. Abdul Rahman Bizri and Dr. Georges Ghanem to investigate different aspects of the vaccination campaign from two perspectives: the public and private sectors.
 
Interview with Dr. Abdul Rahman Bizri, head of Lebanon's National Committee for the Coronavirus Vaccine
 
The Ministry of Public Health (MoPH) is set to vaccinate 80% of the population by the end of 2021, however only 23% of the population is registered on the ministry’s vaccination platform. Is this a realistic target? How is the government planning to encourage more of its citizens to register for the vaccine?
The number of people registered on the MoPH platform has as of June 2 exceeded 23%, which is still a low number compared to what we were hoping for. This was due to several reasons, such as vaccine hesitancy, and the existence of other platforms, which attracted parts of the population.
 
A number of politicians (political parties), for example, provided vaccines for some of their followers after registering them on separate platforms. Certain municipalities tried to establish their own database, but realized they have to refer back to the MoPH platform. Furthermore, the military and the internal security forces have—in agreement with the National Vaccination Committee and the MoPH—established their own platforms and database, which they will merge with the main MoPH database at a later stage.
 
My belief is that ultimately, most of those who want to be vaccinated will either pre-register or will be signed up during the vaccination process, similar to what we are doing with the walk-in marathons. This is an ambitious scheme, however it is important to place a high target to secure good results. Furthermore, when developing any immunization strategy, especially in the case of a new vaccine, it should be taken into consideration that a large part of the population will be hesitant or undecided, and thus might need a push. There are also many people, especially above the age of 40, who want to register but find it difficult to use the platform’s interface, unlike younger generations who are technology oriented. Now, we know that we have exceeded 10% vaccination in some age groups. If you didn't have this platform, you wouldn't be aware of this information. For example, we know that around 70% of the group above 75 have been vaccinated, leaving 30% for us to target. The initial target for our vaccination campaign was to cover 20% of this population, because, according to the World Health Organization (WHO), this is the group that is considered to be at the highest risk for COVID diseases. This was the reasoning behind the establishment of the COVAX initiative, which aimed at ensuring fair distribution of vaccines to developing countries, in order for them to inoculate 20% of their populations.
 
This, however, does not mean we have to stick to that target, because ultimately you want to achieve suppressed viral circulation in the community by vaccination. COVID is considered to be a good example of how dynamic medicine is: Every week, day, and hour, we are getting new information that compels us to change some of our assumptions. In the past 2-3 weeks, people have become more interested in natural immunity than ever before, with recent data emerging from the National Institute of Health (NIH) and WHO showing that natural immunity can last for 10 months or more. This is considered encouraging in terms of our assessment of herd immunity in a society, because you have to account not only for vaccinated people, but also those who have contracted the disease. The idea is to achieve herd immunity either naturally or by way of the vaccine. Definitely, the vaccine is safer, because with natural immunity, many people will suffer from severe complications.
 
Thirty percent of the population in Lebanon is non-Lebanese, however, as of April 5, they made up only 5.36% of those registered and 2.86% of those vaccinated. How does the Lebanese government intend to bring more of this segment of the population into the national COVID-19 vaccination plan?
This should be attempted primarily via collaboration with the UNRWA, UNHCR, the International Labor Organization, and the foreign labor force in Lebanon. Surely, relevant ministries have to do their part, like the Ministry of Labor and General Security, both of which are fulfilling their duties in this regard. Moreover, the vaccination marathons were a good example of how to encourage participation without requiring pre-registration on the platform, especially among non-Lebanese groups, who made up 35% of the total number of people vaccinated during the first marathon.
 
As for non-Lebanese individuals who fear that their registration on the government platform will have repercussions, we have assurances from the various authorities that this is not an immigration issue, rather, this is a health issue. And furthermore, General Security has promised us that they will work to facilitate the vaccination process, not obstruct it.
 
What is the cause of the slow vaccine rollout? After all, the Lebanese government has reserved vaccines, not only through COVAX, but also through separate agreements with the producing companies in the hope of speeding up the process.
I don t think there is a slow rollout. I think there is a limited amount of vaccine. When the supply of vaccines increases, we will see more activity. There were plans to develop walk-ins, mega-centers, and marathons. This tells you that the problem was not the plan, the problem was in the amount of vaccine. I think we are doing much better than many European countries, and this will become more apparent soon. The number of people who will get vaccinated will keep on rising.
 
 
Interview with Dr. Georges Ghanem, Chief Medical Officer of the Lebanese American University (LAU) Medical Center - Rizk Hospital and Clinical Professor in Cardiology at the LAU Gilbert and Rose-Marie Chagoury School of Medicine
 
What role is the private healthcare sector playing in support of the vaccination efforts in Lebanon, and how would you assess the level of coordination with the Ministry of Public Health (MoPH) in the implementation of the national vaccination campaign?
The private healthcare sector is the pillar of the national vaccination plan on the ground, although less so on the organizational level. This is despite the fact that the majority of the specialists who developed the plan for the national vaccination campaign come from major university hospitals. The implementation of the campaign was carried out in coordination with hospitals across Lebanon, especially in the Beirut area, where the five major hospitals were deeply involved, and contributed a lot of resources in terms of infrastructure, facilities, and human resources, without fees or charges to the MoPH or the public. They certainly did a good job with regards to the delivery of vaccines, which despite being slightly slow at the beginning of the campaign, ended up accelerating at later stages.
 
Furthermore, the major universities in Beirut have joined efforts to directly procure vaccines for their students, faculty, and staff, in order to reopen their campuses for the fall semester. Once the vaccination process among their own community is complete, these universities plan to extend their vaccination efforts to include underprivileged groups, peripheral areas, and special segments of society, such as prisoners. On a global scale, the vaccination phase saw more success in coordinating efforts between the private healthcare sector and governments than during the earlier COVID-19 pandemic response. Despite the challenges of the earlier stages of the global vaccination campaign, in terms of getting the COVAX platform running, the overall performance was good, because we relied on scientists. In Lebanon also, Dr. Abdul Rahman Bizri and all the physicians and technical experts who developed the national plan, as well as those who are involved in the organizational and executional aspects of the plan, like Dr. Petra Khoury, have all done a great job.
 
Learning from the mistakes of the COVID-19 response, the vaccination plan was more transparent, involved extensive coordination between the public and private sectors, and it saw a greater role for international bodies (World Bank, International Red Cross) in financing and supervising the vaccination process. Considering the crises that we are going through and the failures of governance on different levels and in many areas, having a supervisory third party was a key element in the success of this campaign. The deployment speed is still slow in my opinion, especially that the new variant is at our door, and a third wave is in sight in the coming months. This underlines the need to accelerate the campaign and open it to all age categories.
 
In April, the Lebanese American University launched its “Time to Vaccinate Lebanon” campaign, which was meant to accelerate vaccination among its students, faculty, and staff, in addition to the general public. Can you brief us about the progress of the campaign and the difficulties you are facing in the procurement and deployment of the vaccines (particularly as a private entity)?
We developed our project at the beginning of January this year, however it did not materialize until May, when we signed a deal, and then in June, when we started receiving batches of the vaccine in small quantities. The process was laborious and lacked transparency, especially because there was no clear protocol of coordination at the level of the MoPH.
 
At first, we attempted getting the Pfizer vaccine directly from the company, however, that proved impossible, so we had to go through the MoPH. This was due to the emergency use clearance that the COVID-19 vaccines have, and the preference of pharmaceutical companies to legally protect their contractual commitments by dealing exclusively with governmental bodies. Negotiations with MoPH were lengthy and faced many problems, which we were able to overcome. Even during the implementation phase, we encountered many hurdles, like the delay in the delivery of vaccines for a few weeks, which slowed our campaign and compromised our efforts to immunize our students, faculty, and staff for next fall.
 
The consortium of universities and hospitals—made up of the Lebanese American University, American University of Beirut, Saint Joseph University, Saint George Hospital, and Maaounat Hospital—was established to negotiate with vaccine companies as one party, with a single goal and a united vision, to eventually establish better conditions for a deal. To date, our hospital (Rizk Hospital) has had 80% of its staff vaccinated through the MoPH campaign, which targeted healthcare workers. As for LAU, we hope that all faculty and students will be fully vaccinated by September.
 
What is your overall assessment of the government COVID-19 vaccination plan, and what are the lessons learned for Lebanon’s future preparedness?
We started this vaccination campaign without having all the knowledge we needed, and with every hidden piece of information, there were a myriad of problems lurking behind. This knowledge gap is the weakest point of a government’s intervention. The first lesson we learned is that the most important element of a country’s disease response preparedness is to have policies and protocols in place to mobilize resources and coordinate efforts, and to be transparent about the action plan put in place in that regard.
 
The second is that the partnership between the private and the public healthcare sectors is crucial, especially when the public sector is weak, as is the case in Lebanon. For this reason, I think that the major university hospitals should be the backbone of such public health campaigns, as they have the infrastructure, the resources, and the know-how. It was this partnership that allowed us to reach the inoculation levels that we have achieved during this vaccination campaign.
 
The third lesson is the importance of supervision by an international body, especially in the presence of a caretaker government without any clear definition of responsibilities. The oversight of an international authority helps avoid ineffective governance or mismanagement.