INTERVIEW: Egyptian health expert Alaa Ghannam talks vaccination 'ahead of the third wave'

Dina Ezzat , Sunday 14 Feb 2021

Health policies prominent Expert Alaa Ghannam says that the world has shown its most 'ferocious economic face' when it came to the distribution of the COVID-19 vaccine

Alaa Ghannam
Dr. Alaa Ghannam

“Any vaccine is better than no vaccine, all vaccines should be provided for free even if the government decides to launch a donation campaign to raise funds for a free-for-all project” and “we should get ready for the third wave even if we expect and hope it would be less aggressive and less fatal than the previous two”."

These are three main points that Alaa Ghannam - a long time expert on health policies -  had shared in an interview with Al-Ahram Online, where he also shared an assessment on the performance of the government along with the medical system in navigating through the pandemic throughout the year.

“To start with we need to remember that the whole world is learning on the job; we don’t know enough about the virus, its behaviour and its patterns or its side effects and consequently we don’t know enough on how to best treat it or to avoid its possible complications. So with all [of this] taken into consideration, I think the [Egyptian] doctors have been trying very hard  and at times under really unfavourable working conditions,” said Ghannam.

It has been a very hard year with this novel virus and nobody knows for certain when the nightmare will come to an end.

“For sure there will be a third wave – sometime around September this year. If we judge by the history of pandemics and the pattern on performance of viruses we hope that the third wave would be less aggressive and less fatal than the previous two,” he said.

So far, Ghannam argued that the most ferocious and lethal was the second wave of COVID-19, which started in Egypt during around September, about eight weeks after the end of the first wave, sometime towards the end of July.

With the third wave, he said, “we should be prepared to avoid some of the mistakes we made during navigating our way through the first and second waves when we really knew very little - just like the rest of the world - on this pandemic”.

One thing that Ghannam is determined to underline is “the need to act seriously on a serious process of vaccination”.

“Vaccinations are essential to reduce the cases in general and the tough cases and mortality caused by COVID-19 in particular,” he said.

“It is true that there have been some studies that indicated that maybe close to 40 million Egyptians have somehow caught the virus with either no symptoms or very mild symptoms. However, these same studies also propose that the number of Egyptians who were infected with COVID-19 are around seven millions only. So the argument of counting on an assumingly secured herd immunity rather than vaccination is not at all founded,” Ghannam argued.

“The price of herd immunity in terms of lives and also in terms of [the]economy is just too high to tolerate; we need to have a clear and serious vaccination plan and we need to start on with it promptly,” he added.

Missing out on signing contracts with the pharmaceuticals that produce vaccines sometime before the beginning of the second wave  - “yes, before the vaccines were actually produced” – was one of the worst mistakes of managing the pandemic during the past 12 months according to the analysis of Ghannam.

“We all know that the vaccines for COVID-19 would have been passed for emergency use and we all knew that countries who would pay first would get the vaccine first,” Ghannam said.

That being said, Ghannam hastens to add that the world “has shown its most ferocious economic face” in dealing with the vaccines for COVID-19.

“Around ten countries or so of the richest world states have consumed close to two-thirds of the vaccines that have so far been produced; this is so unfair,” Ghannam said.

He added that “the world should have shown some solidarity in facing up to this pandemic by prioritising vaccines for medical teams, senior citizens and those with chronic illnesses world-wide instead of securing vaccines for segments of populations that are not technically in a rush to get and who are just getting it because they happen to be living in the countries who produce the vaccine or who have the money to buy it first”.

“Now as we see the second wave nearing its final phases we should be working to secure vaccines, especially for those who need it the most before we get into the third wave with hopes that it would be less aggressive and less fatal,” he argued.

In Ghannam's assessment , the medical teams of Egypt could count for quarter million women and men – plus or minus. Citizens above the age of 60 are around 7 per cent of the population and those with chronic medical cases, “especially those who suffer from the most dominant cases in Egypt of high blood pressure and diabetes” are around 20 million people.

“All in all I think we are talking about around 30 million people who should be on the priority list of vaccination. This means we are talking about 60 shots. I don’t think it is beyond the financial means of the government to secure this amount in due time,” he argued.

Ghannam is so unequivocal about the need to provide the vaccines for free for all those on the priority list and others. In times of pandemics, in line with the constitution of Egypt and the guidelines of both WHO and the World Bank, vaccines should be provided free of cost.

“The government might decide to start a campaign to raise funds to help secure the vaccines but this does not mean that anyone should be paying EGP 100, EGP200 or any other amount as they get the vaccine,” he stressed.

Ghannam is not willing to worry much about which vaccine will be made available. He argues that the debate about the Chinese versus the Russian vaccine or the European versus the American vaccines “is just commercial talk”.

“It is typical that each producer will try to secure a bigger share of the market; we should not get obsessed with this debate. We should not lose focus of what we need,” he argued.

Ghannam is not willing to immediately subscribe to the medical debate about the efficacy of particular vaccines in providing immunity against particular strains of COVID-19.

“We don’t have enough scientific evidence to support this argument; again, the world is still in a learning process,” he said. “Any vaccine is better than no vaccine and the faster we move with the vaccination plan the better off we will be – not just in terms of health but also in terms of economy,” he argued.

“Economy has been a concern right from the beginning and this is why the measures of curfew and partial lockdowns that were adopted in the first wave were not introduced with the second wave,” Ghannam said.

“Again, the world is worried about economy – not just Egypt. Obviously rich countries are better off but still,” he argued.

“Then again, if we want to avoid compromising public health to try and save economy – and I am not even sure that this would work because when public health declines the economy is adversely affected – we need to move more promptly with a serious and efficient vaccination plan,” he argued.

A drop in the vaccination plan, he added, would be comparable to the drop in PCRs in the first wave and the drop in the quality of medical service in the second wave.  “When we could not do enough PCRs – and that was also in part an issue of availability – we failed to keep track of the real figures which might be ten times the announced figures or maybe even more, as officials have said,” Ghannam argued.

Then he added, “when we failed to provide adequate services at public isolation facilities at a time when the private facilities were much more expensive and not significantly better, if at all, we allowed a trend of preferred home isolation in the absence of adequate medical supervision, which meant that in some cases complications occurred unmonitored, this in turn led to more cases of deaths”.

In short, Ghannam is convinced that the most important lesson learned from the first and second waves of COVID-19 is that “we have to be ahead in terms of planning and in terms of acquiring the necessary tools to face up to this aggressive and treacherous virus.”

“For example, we now know that the mortalities among doctors and medical teams in general – which are really high in Egypt – have [appeared] more in hospitals that do not cater to COVID-19 patients. The reason is that neither the government nor private hospitals were strict enough with the precautionary measures at these hospitals,” Ghannam added.

The bill of COVID-19 in Egypt - during the past year - goes way beyond the regrettable cases of mortality and those of infection,“in view of the fact that nobody knows for sure the nature of possible complications of the infection on the short or long term,” and beyond the economic slow-down.

“There is the very significant cost that the health system has paid when it got so strained. It has been too much pressure,” he said.

Luckily, Ghannam argued, Egypt has an established history in dealing with pandemics and in preventive medicine. “Traditionally, preventive medicine is one of the strongest sides to the Egyptian medical system,” he said.

Today, he argued that the medical system needs to get an emergency support scheme. He argued that the government has to be very mindful of the fact that many of the smart and young doctors who saw their colleagues die while fighting COVID-19, or who lost patients to the virus, at times due to lack of resources, would be quite inclined to reach out to any of the many openings that the Western world now has as other countries act to expand their medical services in the wake of the crisis the whole world lived with the pandemic.

“We need to worry about having better-equipped hospitals and more accessible medical services for sure but we also need to worry about the human resources that we could be losing,” he said.

Meanwhile, Ghannam acknowledged that one direct negative side effect of the pandemic on the health system, in addition to the potential increase in doctors’ migration, relates to the Comprehensive National Health Insurance System.

Himself a leading architect of the original blueprint of the NHIS, Ghannam regrets the inevitable delay that came with the pandemic in incorporating more citizens into the system.

According to the original plan, seven out of Egypt’s 29 governorates should have been covered by the NHIS by the end of this year. Ghannam thinks that this is “highly unlikely, we will have to double our work to catch up but still I don’t think we can meet the original deadline,” he said.

In his opinion, if there was only one thing that everyone should learn from this devastating pandemic it should be the big difference in the chances of better surviving unexpected tough medical crisises when the health system is strong and readily accessible to as many people as possible.

“Investment in public health is always worthwhile, the time is now to act upon this lesson and to act promptly to provide vaccines for free for all who need it urgently,” Ghannam said.

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