Covid-19 treatments, vaccines in the Middle East and North Africa

AFP , Saturday 19 Dec 2020

With Europe and the United States already beginning to vaccinate citizens against the Covid-19 disease, there are fears some countries may be left behind

Tunisians wearing masks amid COVID-19 pandemic walk by on a street in Tunis . AFP
Tunisians wearing protective masks amid the COVID-19 pandemic walk by on a street in the Kram area of the capital Tunis on May 8, 2020. AFP

With Europe and the United States already beginning to vaccinate citizens against the Covid-19 disease, there are fears some countries may be left behind.

Here is a snapshot of what vaccines are being preferred around the Middle East and North Africa, and which treatments are being used to help those infected by the novel coronavirus.

- Algeria -


Algeria opted early on to use hydroxychloroquine, along with antibiotics and cortisone treatments such as prednisolone or dexamethasone, and anti-coagulants, doctor Bekkat Berkani, a member of the national pandemic committee, told AFP.

There had been a campaign by labs to show that the anti-malarial drug hydroxychloroquine was "inefficient or risked even being dangerous," he said. But he insisted about "two billion people" take it "prophylactically for anti-malarial purposes around the world".


Algeria has not yet decided which vaccine to use. Prime Minister Abdelaziz Djerad has said his country will "acquire the vaccine which provides sure guarantees, therefore there is a need to avoid any haste or random decisions".

- Bahrain -


Bahrain has been using hydroxychloroquine. The Bahrain News Agency quoted Sheikh Mohammed bin Abdullah Al-Khalifa, head of the national coronavirus taskforce, as saying the treatment had proved its effectiveness and alleviated symptoms.

Bahrain has also used plasma therapy to treat patients, repeatedly urging those who had recovered from the virus to donate blood.


On December 13, Manama approved the use of the Chinese-made vaccine Sinopharm for frontline health workers, after already approving the Pfizer-BioNTech vaccine, developed by US pharmaceuticals giant Pfizer and its German partner BioNTech.

- Egypt -


Egyptian hospitals are using a variety of different methods, including azithromycin, paracetamol, cortisone and oral anticoagulants.


Egypt has received 100,000 doses of the Sinopharm vaccine, but has not begun vaccinations yet, according to the health ministry. The finance ministry said this week another 20 million doses had been ordered, without giving further information.

President Abdel Fattah al-Sisi said recently that Egyptians may have to wait until next July for a mass vaccination campaign to start.

- Iran -


Health Minister Saeed Namaki was quoted by official news agency IRNA as saying the country had used the anti-viral "remdesivir, which has had a relative impact on the disease".

The medication is also being produced locally. IRNA reported the Islamic republic has started producing 70,000 vials of remdesivir in a plant opened in northern Saveh on December 15. The drug was originally developed to treat Ebola.


There has been no clear indication of which vaccine may be acquired by the sanctions-hit country. President Hassan Rouhani said in early December Iran wanted to buy a vaccine but "no bank will handle the transaction".

The health minister was quoted as saying Tehran had pre-ordered about 16.8 million doses via the World Health Organization's vaccine project COVAX.

COVAX is a global collaboration involving over 180 countries working with vaccine manufacturers to ensure equitable distribution of the vaccines once approved.

Iran is also working on developing its own vaccine and human trials are expected to start soon. IRNA said this week Iran is discussing getting vaccines from three countries -- China, Russia and India.

- Iraq -


Iraqi hospitals are recommended to treat mild cases with an anti-viral drug favipiravir and plasma therapy if needed. The health ministry says severe cases should be treated primarily with remdesivir, as well as with plasma therapy and even the immunosuppressant tocilizumab.

While hydroxychloroquine does not feature among the ministry's recommendations, Covid-19 patients told AFP they had been offered it.


Iraqi health ministry spokesman Seif al-Badr told AFP authorities were still in talks with different companies, but no decision has been made yet.

"Iraq has joined the Global Vaccine Alliance (Gavi) and members will get a certain portion of them (the vaccines). We have been talking to companies day and night. We have been negotiating with Pfizer for months and we will choose a company soon," Badr said.

Western officials in Iraq told AFP Washington was putting pressure on Baghdad to choose Pfizer-BioNTech over other options.

The Geneva-based Gavi is a public-private partnership, which is working to help secure delivery of the Covid-19 vaccine for poorer countries.

- Israel -


Dr Asher Salmon, head of the international relations department at the health ministry, told AFP Israel uses steroids and remdesivir, but it has refrained from using hydroxychloroquine.

Plasma is used in some cases, but there have only been "partial results".


Israel has ordered 14 million doses of the vaccine -- covering seven million people, as two doses are required per person for optimal protection -- from Pfizer as well as US biotech firm Moderna.

Prime Minister Benjamin Netanyahu was one of the first people in Israel to get the Pfizer-BioNTech vaccine, as the country began its rollout on Saturday.

- Jordan -


In severe and critical cases, treatments such as the steroids dexamethasone or hydrocortisone are used, as well as the immunosuppressant prednisone. Remdesivir or favipiravir, as well as plasma therapy, are also used.


Jordan has approved the use of the Pfizer-BioNTech vaccine, expected to be available in the country by February.


- Kuwait -


Infectious disease specialist Mohammad Abul said Kuwait was using dexamethasone to treat serious cases, as well as remdesivir.

Blood plasma from recovered Covid-19 patients was initially used, but the method was stopped because it was not proven to be very effective, he said.


Kuwait this month approved the use of the Pfizer-BioNTech vaccine, launching a website for people to sign up to be inoculated. Reports said it was due to arrive later this month.

- Lebanon -


Lebanon is using mostly dexamethasone as it is "cheap, available in the market and studies show it is efficient", said Firass Abiad, head of the government-run Rafic Hariri Hospital.

Plasma is also used, but to a lesser extent, as "studies revealed it is only efficient in the early stages of the virus". As for chloroquine and remdesivir, very few hospitals still use them, he added.


Lebanon signed an $18 million deal with Pfizer-BioNTech for the delivery of 1.5 million vaccines expected in February, according to the health minister's adviser, Mahmoud Zalzali.

Under the agreement, vaccines will also be delivered for free to refugees. Although the exact number is not yet known, there are estimates it may amount to about 700,000 vaccines.

Lebanon has also joined COVAX. According to Zalzali, the agreement stipulates the delivery of 2.2 million vaccines to Lebanon, but they will not be delivered before the third quarter of 2021.

- Libya -


Blood plasma has been one of the main methods of treating Covid-19 patients in the North African country.



Libya has bought 2.7 million doses of the British-Swedish AstraZeneca vaccine for about $10 million, Badreddine al-Najjar, head of the country's national disease control centre, told AFP.

That would allow it to vaccinate about 1.25 million people, about 20 percent of the population. It is hoped supplies will begin arriving in March.

"This was a purely technical choice for Libya. It is stored and transported at temperatures between two to eight degrees Celsius, which makes it suitable for the weather conditions in Libya," he said.

- Morocco -


Since March, Morocco has opted to use hydroxychloroquine to treat Covid-19 patients as well as doses of azithromycin, an antibiotic used against bacterial infections, including pneumonia.

Health Minister Khaled Ait Taleb defended the use of the controversial hydroxychloroquine, saying results had shown "it had a certain efficacity in preventing the virus from the entering the cells".

"This allowed us right from the start of the infection, and not in serious cases, to decrease the viral load and reduce contagion," he said, quoted by the website Media24.


Vaccinations have not yet started in Morocco, but authorities say 10 million doses of the Sinopharm vaccine should arrive by the end of the year.

- Oman -


Some private hospitals are using plasma therapy to treat Covid-19 patients, which had shown some "positive results", according to a statement by Burjeel Hospital Al Khuwair earlier this year.


Oman announced this month that it had approved and will import the Pfizer-BioNTech vaccine for use on those older than 16.

- Qatar -


Hospitals are using a number of different treatments tailored to each patient. Limited use is made of plasma treatments.


Qatar has contracts with several of the pharmaceutical companies with promising vaccines, with Pfizer-BioNTech likely to be the first to become available, AFP understands.

The first jabs could become available by the end of the year. It has also entered into procurement agreements with other vaccine suppliers, including the US company Moderna.

- Saudi Arabia -


Saudi health authorities have prescribed a cocktail of drugs, including hydroxychloroquine for moderate or mild cases. Dexamethasone has been prescribed for patients requiring ventilation.

Remdesivir was initially recommended for very critical patients, but state media said the drug has "little or no effect" on severe cases.


Saudi Arabia, which has recorded the highest number of deaths among the Gulf Arab states, has approved the Pfizer-BioNTech vaccine after successful trials. Health Minister Tawfiq Al-Rabiah was among the first to take the jab on Thursday.

- Sudan -


Various treatments have been used on Covid-19 patients, including antibiotics such as azithromycin, amoxicillin and doxycycline, as well as steroids like dexamethasone and anticoagulants.


The health ministry has announced that 8.4 million doses of a Covid-19 vaccine will be provided for specific groups, mainly the vulnerable and frontline workers, with the first distribution planned in the first quarter of 2021. But no further details were given.

- Syria -


For the most serious cases, "physicians are using dexamethasone injection to improve patients' survival and reduce the hospitalisation period", as well as using oxygen and ventilators, the WHO regional office in Syria told AFP.

The Syrian health ministry has said the government treatment protocol was based on three main medicines: chloroquine (Syria has around six laboratories that produce it), azithromycin and interferon, used to treat viruses and certain cancers.


"There are no vaccines determined yet," the WHO regional office in Syria said. But the WHO, together with the UN children's agency UNICEF and Gavi, were supporting Syria to acquire "vaccines to cover at least three percent of the population to start with and aiming for 20 percent in 2021".

- Tunisia -


Several treatments are being used, including azithromycin, paracetamol and anticoagulants, as well as oxygen.


Tunisia has contracted to buy vaccines from Pfizer and is working through the COVAX initiative. One million people will be vaccinated in the first stage, said Hechmi Louzir, director of the Tunis Pasteur Institute. The vaccine should arrive in the second quarter of 2021, and health services are preparing a vaccination campaign.

- United Arab Emirates -


The UAE has used hydroxychloroquine to treat simple and moderate cases, but is continually monitoring its use. The Abu Dhabi Health Services said in June it had also used blood plasma on at least 240 patients.


The rollout of the Sinopharm vaccine has already begun, with UAE authorities saying it was 86 percent effective. The health ministry said there were "no serious safety concerns".

Two vaccines have undergone third-phase trials in the UAE, the Sinopharm project and Russia's Sputnik V.

- Yemen -


The pandemic has exacerbated the already dire humanitarian situation in Yemen, where the health system has all but collapsed amid the ongoing civil war.

A string of field clinics run by international agencies have opened in some places, but according to the UN humanitarian agency OCHA in October, the response is focused on testing, surveillance and case management.


There is still no word on the procurement of Covid-19 vaccines.

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