EQUITABLE, SAFE & EFFICIENT VACCINES, ON A GLOBAL LEVEL

Interviewee: DR. ANDREI BACIU Secretary of State within the Ministry of Health of Romania

Interviewer: ATLANTA MAHANTA, Sr. Multimedia Journalist, THE TIMES OF AFRICA

Q. Has COVID-19 influenced Romania’s decision to face new challenges?

A.  The past 14 months have been challenging for every country, every society, every individual. A year ago, the 73 World Health Assembly was marked by the world`s engagement to work together to fight the spread of the new virus. We have mobilized but, still, the pandemic has taken a heavy toll. And it still does. But it is today, more than a year into a historic pandemic, that there is a general, international consensus that health is a crucial foundation of any society. This acknowledgment carries an opportunity when we start rebuilding systems that proved to be flawed, unequal, and fragile, the opportunity to build back better, rethinking health, and addressing the conditions and broken systems that allowed this pandemic to happen and aggressively advance. The COVID-19 pandemic came at a difficult time for the Romanian health system, exacerbating chronic structural vulnerabilities, with long-term consequences on health and well-being. But no health system, no economy, or society, regardless of the level of development, has been truly prepared to adequately manage a crisis of this magnitude. Without the financial and material resources of other European Union member states, Romania has proven that it has the institutional capacity to act quickly, timely and efficiently to limit the spread of the pandemic. Under the strong leadership of the President of the country and with a dedicated team, with commitment and responsibility, we succeeded to build trust, manage anxiety and encourage a sense of professionalism and community orientation in an extraordinarily difficult period. Today we have real reasons for optimism and hope for new normalcy because we have the reality of COVID vaccines. The immunization process against COVID-19 represents the surest way to counter the pandemic. As restrictions begin to lift, an exercise in assessing the quality of the crisis response is needed, and we will address the critical shortcomings highlighted in order to increase preparedness for future crises. As with all health outcomes, measuring what is happening in the current crisis is essential to preparing for the future. A first reaction is that healthcare systems need to be better prepared and better targeted to deal with future emergencies. In addition to strengthening hospital capacity and intensive care, measures are needed to improve community care. New paradigms for infrastructure, the geographical distribution of care providers, telemedicine, home care, training of health workers, supply and adequate management of protective equipment, optimal flows and pathways for the delivery of care, and new flexible mechanisms of payment and reimbursement will be critical in the next step. At the heart of any discussion about future healthcare systems are issues of skills, training and education. The crisis indicates the need to rethink education and training. There is no doubt that COVID-19 will leave a significant mark on how healthcare is funded, managed and consumed. But with great challenges, great opportunities come. A positive result of the crisis is the immediate expansion of the use of digital tools. Care units could continue to offer this solution as an alternative to patients for follow-up in the post-Covid period, thus reducing stress on existing infrastructure. We also estimate that the repeated use of telemedicine during the crisis will create lasting changes in the attitude of patients and physicians towards telemedicine, a solution that will help address the clinical workforce deficiency in the current crisis, requiring significant care capabilities and critical ventilation. These technologies will make personalized healthcare even more accessible. However, governments must also play a role in unlocking the potential of these technologies. We need to ensure the sustainability of funding for the digitization of the health system. There are financial opportunities at the European level for digitization needs, which we need to capitalize on. Innovation lays at the core of the pandemic response. The window of opportunity we now have with the vaccine rollout is the merit of innovative research and biotech. We experience the same steadfast progress driven by innovative therapeutics in treating the incurables. Amidst the tumult of COVID-19, we are at the onset of a new era in healthcare that, for the first time, rightfully places the individual at its core. Personalized medicine with the deployment of artificial intelligence and new technologies are yielding new insights in various intervention areas such as oncology, rare diseases, or cardiovascular illnesses, delivering both clinical and economic benefits for patients and societies. Solidarity is key in post-pandemic recovery. At the same time, a strong partnership between regulators, academia and researchers as well as civil society is a precondition to our quest to ensure universal and equitable access to quality healthcare.

Q. How do the present procedures in the healthcare system enable cooperation and quick response?

A. Romania is a positive regional example of how, by taking comprehensive, coordinated, and timely measures, this unprecedented emergency can be managed. Despite the fact this pandemic is not short of challenges for both national authorities and society, Romania handled it very well, proving its crises management institutional capacity, community solidarity, and very important, the heroic dedication of Romanian health workers and the strong leadership of the Romanian President. We succeeded to overcome the barriers of disinformation and deep-rooted vaccine hesitancy and implement a successful vaccination campaign by communicating intensively and transparently on the vaccination campaign deployment procedures. Romania’s vaccination campaign is a straightforward example of best practices in the region. This success story is one of the best boosts in support of the European Union Health Union project. Romania is well advancing in its vaccine rollout and this is also due to the fact that the Joint EU Procurement mechanism is delivering promising results. The global health vaccination campaign is the greatest moral test of our times. As an emergent donor and global health and humanitarian actor, Romania has been engaged, in national capacity but also through Team Europe, in a solidarity effort around the world. We have been engaged in 2020 in supporting the efforts to counter the COVID-19 pandemic, through voluntary contributions to countries in our region and beyond. We have continued our efforts in 2021, and further donations are expected in the coming period, even to partners from the African territory.

Q. What key activities may be regarded as realistic for further collaboration between African and European countries?

A. The COVID-19 pandemic is one of the biggest challenges the global community has ever faced. But this is the most appropriate time to rebuild stronger and better in support of the principle of health for all. We need to work in a combined effort to ensure the rebuilding of trust, a key element for any future endeavour that will provide the means necessary to achieve our goals. Romania and Africa share close historic friendship in fields as education, especially higher education, health and interpersonal contacts and a common vision upon the future. This background can encourage a strong bilateral framework marked by convergent interests at European and international levels. We can only benefit from strengthening our partnership and encouraging the advancement of exchanges in various areas, favouring an appropriate framework for structured and diversified collaboration. We need to walk together and strengthen each other in our common quest to build a more prosperous, peaceful and sustainable future for all. Horizon Europe calls can be particularly relevant for international cooperation, especially in resetting our innovation and research agenda. Bilateral scholarships and joint investment in green transition, climate change resilience and innovative entrepreneurship could be further explored. I am confident that we are able to develop a firm collaboration in areas of interest and to build networks in new representative domains such as health, medical science, health security and pandemic preparedness.

Q. How is Romania dealing with the present situation? In the Colonia Bod, Brasov region, the authorities are now investigating a SARS-CoV-2 disease epidemic among construction workers.

A. The recent outbreak of SARS- CoV-2 among construction workers in Colonia Bod, Brasov country of 29th of April 2021 was rapidly investigated by the local public health directorate. The eight workers came to Romania from India, and five of them tested positive for COVID-19. The Brasov Public Health Directorate (DSP Brasov) started an epidemiological investigation immediately and containment measures were put in place to isolate the cases identified in the Colonia Bod village. Romania added India to the list of countries with high epidemiological risk – the so-called “yellow list” – this week. This means that travelers arriving from India are required to quarantine at home or a stated location for 14 days. Non-pharmaceutical measures are still crucial in the fight against pandemics and we are closely monitoring the situation regarding SARS-CoV-2 variants. The Alpha variant is the dominant variant in the European Union still, but particular attention is being given to the Delta variant, which seems to be progressively replacing Alpha over the past weeks. In Romania, the public authorities adopted a series of relaxation measures but we keep a public message on the importance to remain vigilant, notably regarding variants, considering the high level of uncertainty that they represent. A certain level of non-pharmaceutical interventions will also need to be maintained until sufficient vaccination coverage is reached. However, the focus must remain on vaccination rollout. 71% of the Health care workers have been vaccinated with one dose and 60% received their complete dose series. Close to a quarter of the adult population has been fully vaccinated. We also try not to leave behind the most vulnerable and we are vaccinating persons without shelter, refugees, asylum seekers.

Q. The world is concerned about its post-pandemic future; how do you see Romania’s future?

A.  The COVID-19 pandemic has humbled us and has shown the flaws in our preparedness and response systems. It has been a hard lesson and we have paid a heavy price learning it. We have to make sure that such a catastrophe would not repeat itself. We need to be better prepared to anticipate and react to emerging public health threats. And we need to make sure that our citizens understand the importance of this approach and gain their support and engagement in a collective effort. Creating a more resilient, inclusive society, prepared and responsive to threats and disasters, addressing inequalities and providing high-quality health care, and empowering all citizens to act when critical conditions imposed should lay at the core of the post-pandemic future of any country. Only a consolidated whole-of-society approach will allow us to move forward and act to counter the challenges to come. And we know that there will be new challenges. With a historical financial allocation through the European Resilience mechanism, added to the already outstanding European financial perspective 2021-2027, Romania will be part of the European Union that will be able to both ensure its preparedness to fight emerging crises and to become an influential global player. The National Program of Reconstruction and Resilience is a vital instrument aimed to improve health care coverage for the management of chronic diseases and their risk factors through strengthening health systems, health infrastructure, and crisis preparedness and to ensure that equitable integrated, people-centered service delivery systems are set in place. Building back stronger should not ignore our relationship with the environment. We must not forget that almost all the pandemics that have affected humanity and most of the emerging diseases have an animal pathogen origin. Our actions have created an unhealthy relationship with the environment, through climate change but also by reducing the natural habitats for many species and thus reducing biodiversity. Climate changes play a fundamental role in altering the patterns for some seasonal diseases, impacting the ecology and increasing the risks for new infectious diseases. We have to rethink our approach and we need to have a green build back. This could even be presented as a real preventive measure. Building back our economy is nonetheless central to our endeavors. Romania’s Prime Minister strategy aims for sustainable post-pandemic economic growth, focusing on both reforms and investments. A post-pandemic future is also about leadership and changing mentalities. We have to use the momentum to its maximum as a new generation of young politicians, part of the new governance, are the next-generation leaders, whose impactful actions can drive change in society and are able to mobilize transformation of the health system and beyond.

Dr. Andrei BACIU was appointed Secretary of State within the Ministry of Health of Romania in December 2019.

As Secretary of State, he was a part of the coordination team of COVID-19 response in Romania, being actively involved in the decision-making process during the pandemic response. Currently, he is in charge of the coordination of the national vaccination campaign rollout, acting as Vice-President of the National Committee for Vaccination against Covid-19. He is a specialist doctor in cardiovascular surgery with international working experience. He is a member of the National Liberal Party for the past six years and acts as Secretary-General of the National Health Committee.

Romania, along with the rest of the European Union member states, started the vaccination campaign against Covid-19 at the end of 2020. It was clear for us that the vaccination campaign is of complexity without precedent and its success can save lives and stop the spread of the virus. At that point, Romania was facing a significant vaccine hesitancy phenomenon. Strong leadership that inspires trust was needed. 

The first step was to generate a vaccination strategy. Since vaccine doses were limited we had to prioritize. The strategic objectives were based on ethical and medical core principles.  Thus, we defined three main vaccinations stages: first stage-medical staff, second stage-elderly population, chronically ill patients, critical sector and last stage – the general population. 

At the same time, a national communication campaign has started. Full transparency and responsibility govern all our communication actions. Complete transparency is essential in building trust between the population and authorities on such a complex vaccination campaign. Not to mention the impact of the fake news machinery. As such, doctors with great reputations played a central role in communicating the benefits of the vaccination. A top priority was keeping the medical staff well informed, by using specific, “tailor-made” communication tools, in order to ensure a high degree of vaccination rate of the employees from the medical field. This was the first important victory against the fake news “pandemic”. Subsequently, two important benefits emerged. First, the general perception towards vaccines has improved since the medical community got vaccinated. Second, based on the preexisting trust relationship between patients and doctors/pharmacists/dentists/nurses, the vaccination dialogue between them enhanced, even more, the positive perception towards the vaccination. A significant part of the population realized that vaccination is our single and best shot.

In the first couple of months, the dynamics of the campaign depended exclusively on the limited number of doses Romania had access to. As the doses gradually increased, so did the vaccinations center we have opened. Up until the end of the month of May, Romania had around 1.000 vaccination centers. Thousands of general practitioners joined the vaccination efforts. This defined our main approach so far, the paradigm where people moved towards the vaccination centers. Presently, anybody can get vaccinated at any vaccination center without any prior reservation.

At this point, one out of four Romanians have gained immunity following vaccination; as a matter of fact, from now on we will strive to increase the vaccination rate by focusing on a pragmatic approach, going forward to those who wanted to get vaccinated but did not initiate the process so far. Even this preliminary vaccination rate had impacted the transmission rate of the virus, which declined significantly. Just another proof, if needed,  that vaccines work. And are the only solutions we’ve got to end this grey chapter of our lives.

Starting with the 15^th of May some of the most important epidemiological social restrictions had been lifted off. The relaxation of restriction measures continued with a second phase at the beginning of June. Following these important changes, people’s mobility had already increased. The cultural and sport environment opened up again. 

The vaccination campaign will, therefore, focus on such areas of concentration by opening vaccination centers near subways, highways, train stations and bus stops in order to increase the accessibility to vaccination. Additionally, museums, theaters and sports arenas are opening vaccination centers. We have to make vaccination an easy choice. 

Half of the Romanian population inhabits the rural areas. This requires a different approach. ever since April this year, we have deployed mobile teams/mobile centers traveling from village to village to provide direct and immediate access to vaccination to everybody. A strong partnership with local authorities and leaders is essential for overcoming the immunization challenge in rural areas. We all have a role to play in this vaccination campaign, it’s a responsibility for all of us.

So far, regarding the vaccination with the full regimen, Romania has managed to be and stay at the top of European countries according to the European level and amongst the top 20 countries at a global level.   However, the hardest part in reaching herd immunity is yet to come. Moving forward, only a team effort will manage to terminate the transmission of the virus.  Romania is acting in solidarity and unity, and as such, has already donated more than 300.000 vaccine doses to the Republic of Moldavia. As a part of the European Union, we will continue to support the international efforts, by providing vaccines to other countries and regions that need them. 

Team Europe already announced that it aims at donating at least 100 million doses too low- and middle-income countries by the end of 2021. We have to keep in mind that nobody is safe until everyone is safe. Therefore, we have to identify together global solutions for this global problem – the Covid-19 pandemic.  Africa – the second largest continent is facing other types of risks and challenges. Together with Team Europe, the United States announced that it will donate 80 million doses. COVAX and the World Health Organization are supporting the vaccination campaign in several countries in Africa. Still, so far, an unacceptable small percentage of doses of the Covid -19 vaccine has reached Africa. Financial resources are, of course, something to consider but they cannot represent a “deal-breaker” in such an existential crisis. At the point where vaccine supply is an issue, prioritization is the key. Getting vaccines to high-risk people should be a top priority. The beautiful continent of Africa is a place of contrasts. The efficiency of the Covid-19 vaccination campaign will, most likely, be very diverse. To overcome this disadvantage, it is essential to act in UNITY.

The global health vaccination campaign is the greatest moral test of our times.

We have only one top priority: equitable access to safe and efficient vaccines, on a global level. We need to continue our work together to leave no one behind.