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Malta, Hungary and Denmark topping EU vaccine tables - what can we learn from them?

Different approaches to the roll-out have been taken across the EU.

IRELAND’S VACCINE ROLL-OUT has slowed down, with continued delivery shortfalls hampering the health service’s progress.

During the week HSE chief Paul Reid expressed his frustration in particular with AstraZeneca, stating that repeated and sometimes last-minute reductions to deliveries had “rocked” confidence in the company.

Officials have stressed that Ireland is, by European Union standards, working its way through the population at a decent pace, ahead of some of the bloc’s big players like France and Germany. 

But a small number of countries in the EU have steamed ahead, despite the fact that they are part of the same vaccine pool, with an entitlement to doses proportionate to their population.

Malta

Although there have been criticisms in some countries of the European Union vaccine strategy, Malta’s health minister Chris Fearne has said the pooled purchasing of vaccine doses prevented competition that would have left Malta out in the cold.

“Imagine the situation had we not done this together,” he said in an interview last month. “Had member states gone their own way… there would have been a race between member states, so the larger member states would have probably had access to the vaccines, while the smaller member states would have lagged behind, possibly not even having had access at all.”

At that point the country had given at least one jab to 10% of the population of 515,000 people – now around 20% of the population have received a first dose.

The country had ordered two million doses in total through the EU procurement scheme – enough to immunise its population twice over. The government in Malta also ordered any additional doses that the European Commission put up for availability.

Some countries opted not to take up their full population-based allocation and officials in Malta have said their decision to order as many doses as they possibly could has helped them with the steady progress they have been making. 

Malta has also used a network of community health centres to dispense doses as quickly as they arrived.

Hungary

In Hungary, around 1.5 million people – around 11.9%  of the 9.8 million-population have received at least a first jab so far. All those who have registered on the government’s website can be vaccinated by early April, officials have said.

The only EU member to be administering both the Chinese Sinopharm and Russian Sputnik V jabs, Hungary has blamed Brussels for slow deliveries of western-developed vaccines.

Prime Minister Viktor Orban’s chief-of-staff Gergely Gulyas this week said Hungary’s vaccine success is “thanks to the Chinese vaccines”. He was speaking as he announced the arrival in Budapest of a new batch of 450,000 Sinopharm doses from China.

Along with Hungary, the United Arab Emirates, Cambodia, Peru and Zimbabwe have all started administering the Sinopharm vaccine, which its makers say is 79% effective. It has not been approved by the European Medicines Agency.

Hungary is one of just three countries in the EU to begin administering doses of Russia’s Sputnik V vaccine ahead of approval by the European Medicines Agency. 

This vaccine works in a similar way to the AstraZeneca/Oxford jab, but has a 91.6% efficacy, according to trial results.

More than a dozen nations have authorised its use, including Belarus, Armenia, Iran, Algeria, Argentina, South Korea and Venezuela.

In the midst of its steady vaccine progress, Hungary is still dealing with record numbers of Covid-19 cases and patients requiring hospitalisation.

Officials said coronavirus hospital patient numbers reached a record high of 8,329, while a record 8,312 new infection cases was also posted.

Around 16,500 Hungarians have died in total due to the coronavirus since the pandemic began. A strict lockdown, including school closures, began Monday.

Denmark

Denmark has been a leader in Europe since the start of the year. By 15 January it had given vaccines to 2.2% of its population of 5.8 million.

Early on in the roll-out this was, in part, due to a decision not to set aside half the vaccine allotment to ensure patients got their second dose. The country’s officials decided to delay the second dose of the Pfizer vaccine by up to six weeks, rather than the recommended three.

In a similar strategy to the one taken in the UK, as soon as the vaccines came into the country, as many people as possible were given their first doses.

The country has been credited with well-oiled logistics and a swift campaign in nursing homes, where almost everyone who wanted a vaccine had received one by the middle of January.

The country also attributes the strong start to its universal healthcare system, governed by easily-mobilised local regions.

Denmark has a centralised national register which assigns each resident a personal identification number linking them to government services.

Health records are linked to a person’s ID number and this has helped the health service to categorise residents into different priority groups, with an accompanying app that allows health officials to communicate with people.

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How does Ireland’s approach compare?

Ireland does not have an integrated and centralised system such as the one in Denmark.

The absence of a database for the various cohorts in society has been a clear problem throughout the roll-out, with the health service relying on GPs to compile names and contact details from their own records when vaccination of the over-70s began recently.

Now that the programme includes people at very high risk of severe disease, the HSE is depending on hospital groups – and again GPs in some cases – to identify patients who fall into this category and to contact them. 

An entirely new IT system had to be built in order to manage and track the roll-out. This is currently being used, with further updates to be added as the health system moves through the various cohorts. 

In terms of orders, the Irish government, like Malta’s, has not held back, ordering the full allocation (1% of the EU’s total pool of vaccines) of each vaccine approved for use in the EU. 

When it comes to the accessing of further stocks of vaccines, the government has said it will take surplus doses from other countries if they are offered – but only if they are EMA- approved vaccines.

Officials have been wary of commenting on vaccines such as the Sputnik V one before the regulator has given them the green light. It is unlikely they would follow the Hungarian government’s lead and source vaccines that have not been approved by the EMA. 

The EMA recently launched a rolling review of the Russian vaccine, but there is no indication of when this will progress to a formal marketing authorisation application. 

Unlike Denmark, Ireland has been focusing on following the two-dose schedule with vaccines. As of 9 March 396,089 first doses had been administered and 157,072 people were fully vaccinated.

Just over 8% of the population has received a first dose and 3% are fully vaccinated.

More than 66,000 residents of long term care facilities are fully vaccinated and over 87,000 frontline healthcare workers have received both doses. 

The health service has said Ireland has the infrastructure in place; vaccinators are trained, mass vaccination centres are opening up and expanding, additional staff are being recruited. The sticking point, it says, is the unreliable supply of vaccine doses. 

Despite this uncertainty, the government is still confident it will be able to deliver almost one million vaccines in April, 1.2 million in May and 1.68 million in June. 

- With reporting from AFP.

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