Dr. Jarno Habicht, WHO representative, Head of Country Office in Ukraine
27 September 2021
Author: Anna Levchenko
Head of WHO Office in Ukraine: It is really possible to vaccinate more than 70% of population in Ukraine In an exclusive interview with the Interfax-Ukraine agency, the WHO Representative, the Head of the WHO Office in Ukraine, Dr. Jarno Habicht, spoke about the global goals of vaccination against COVID-19 and whether Ukraine can achieve these goals.
How does the WHO assess the current situation with the spread of coronavirus infection?
We are approaching the end of the second year of the epidemic, and this is a third school year our children will study in a pandemic. In the coming months we expect the next wave of COVID-19 in Ukraine, and it is too early to say when we will be able to get out of it. In many countries we still see community transmission of Covid - in the country or in the organized groups. Meanwhile, at the global level, we can say that in September the number of cases of the disease got somewhat stabilized. Though, it stabilized at a very high level.
That is, the number of cases is not growing?
It is stable but at a very high level. If you look into the European region, it accounts for about 30% of the total number of global cases of COVID-19. We are now monitoring variants and mutations of concern and interest. Speaking of mutations of concern, we have the Delta variant, and the evolution of that variant will determine how we get through this autumn. We know that this variant also circulates in Ukraine. This mutation, in comparison to the "Alpha" variant spreads much faster, and that means the number of hospitalizations will increase.
I want to say right away that vaccination will play a very important role in overcoming the spread of this mutation of the coronavirus, in particular for the elderly, since vaccination will help to avoid a serious course of the disease.
In addition to this mutation, which we already know about and prepare for, there are variants that are classified as of interest. These are, in particular, Lambda and Mu variants. They are being watched because they will determine how COVID-19 evolves Globally and in the European region.
In other words, we are now in the middle of another outbreak and we need to stay careful.
According to our forecasts, which are confirmed by statistics, in September we will see increase in the number of cases of disease in Ukraine. We see that the rate of positiveness of the tests performed has almost doubled over the past month, which means that more people are sick now. In addition, we see that the number of Ukrainians who end up in a serious condition in hospitals and intensive care units is growing.
At the same time, the vaccination coverage in Ukraine has reached ̶a̶l̶m̶o̶s̶t̶ over 10% of the population. This is not at all the level that we see in other European countries, where vaccination coverage reaches over 60%. Now in Ukraine, the number of fully vaccinated citizens is about 5 million (today 4 959 086) people but our goal, of course, is to achieve a higher figure.
In this respect, the following facts are very significant: in high-income European countries the vaccination coverage is about 58% of the population, in middle-income countries it is about 28% of the population, and in low-income countries the vaccination coverage is about 8%. If we compare Ukraine to similar countries, we can say that in these countries the vaccination coverage is at the level of 8-10%.
Though, if we talk about Europe on average, then Ukraine needs to catch up with the European countries because today in Europe as a whole we have about 410 million people vaccinated or about 55% of the total population.
The main task now is to provide vaccination for everyone with one or two doses of vaccine, and later, in a year or two, if necessary, it will be possible to talk, perhaps, about some additional vaccination.
To what extent do you think this task is being fulfilled?
Globally the goal was to have 10% coverage by the end of September. In other words, Ukraine has already reached this figure.
The next goal is to vaccinate at least 40% of the population by the end of the year, and I think Ukraine will be able to achieve even higher rates by the end of this year. But we need also take to consideration that national vaccination plan targets are higher in Ukraine.
How many people can actually be vaccinated in Ukraine - 50%, 70%, 100%?
This question is very difficult, and I hope that more than 70% can actually be vaccinated. According to the survey results from August we now see that every second Ukrainian is interested in being vaccinated. The most important thing is that you need to vaccinate the elderly and those who are at risk. The main critical issue is to help people who may have severe illness and even die in intensive care units. Therefore, now we should not chase the indicators but rather aim at certain target groups.
When we look at the European region we see that almost 55% of the total population have been vaccinated (with first dose and fully vaccinated). And if we look at the data from 36 countries that provide data on the age of vaccinated patients, we see that in the 60+ group they have more than 70% vaccinated. It is very important to use this approach and focus specifically on older people who have high risks. I hope that this is exactly what Ukraine will do in the coming months.
At the same time, in almost all countries we see a situation when the first 50% of population were vaccinated easier than the remaining citizens to reach coverage targets as 60, 70 or more.
Will COVID-19 vaccination become an annual mandatory procedure?
We don't know that yet. Now all efforts are aimed at ensuring that everyone gets a full course of vaccination.
What is the most difficult population group that does not want to get vaccinated?
I would say that the question is not whether certain groups of people want to be vaccinated or not, it is more important how the vaccination programs are organized, if they can effectively reach 100% of people. For example, in Ukraine there is an issue with vaccinating the elderly people who live somewhere in the countryside, in remote settlements. Such people are unlikely to be able to come to a large vaccination center in Lviv, Kharkiv or Kyiv.
In addition, there is a problem with information about immunization, vaccines and their benefits. We see that more information materials need to be distributed to people so that they understand what vaccines are and what are the benefits of immunization. It is very important that the medical community, academia get united around the idea of immunization. And for all groups of people, you need to think how to organize the process in such a way that it becomes easy to get vaccinated.
We started immunization at the end of February, we used mobile teams for this, later stationary immunization sites were added, and only at the beginning of summer the immunization centers began to appear, which are now available almost in all regions of Ukraine.
Now we see that people use services of these immunization centers. For example, studies show that 23% of vaccines were administered in these large centers, 46% - in stationary sites, and 31% - by mobile teams.
By the way, we found out another interesting fact: not all Ukrainians, even those interested in vaccination, know exactly where they need to go to get vaccinated. The problem in the early months of the immunization campaign was that we lacked the vaccine itself. But now starting from August, there should be enough vaccines in Ukraine. Now in Ukraine there are more than 10 million doses in stock; by the end of this year about 15-20 million doses of the vaccine should be delivered to Ukraine. And now it will be very important to accelerate the pace of vaccination in order to achieve both global and Ukrainian goals.
For many Ukrainians, one of the incentives to vaccinate was the opportunity to travel to Europe but Europe did not recognize the Coronavac vaccine, which currently was used to vaccinate about 1.657 mln Ukrainians. What is the WHO’s position on the approval of Coronavac vaccine, which is currently recognized by the WHO but not approved by a number of European countries?
A lot has already been done in this regard. This topic, the recognition of the Coronavac vaccine, was discussed by the representatives of the WHO and the leaders of European countries. We can say that these are actually not problems of the European region only but also a problem of a global level. In addition, this issue was discussed by the COVID-19 International Health Regulation Emergency Committee in July 2021.
The position of the WHO is that we recommend that all countries, including EU member states approve all vaccines that have been listed for emergency use.
It is important to note that the EU is not adopting a decision as a single authority regarding the vaccines; such a decision is made by each individual country. Let me note that after meetings of the WHO representatives with representatives of regulators of individual countries, many countries approved the Coronavac vaccine. From my perspective, I would like to say that the situation looks rather confusing when there is a list of about 10 vaccines, and for each one you need to verify separately which countries recognize it and which don't. Nevertheless, it is very important to understand that from the public health perspective vaccines were not created so that people could travel freely, although for this too, but the main purpose of vaccination against COVID-19 is to protect against severe disease and death. It is also very important that now vaccination helps us to gradually return to normal life.
Will the WHO recognize the Russian Sputnik V vaccine?
The process that could allow the inclusion of the Sputnik V vaccine into the list of those approved for emergency use has not been completed. In order for this vaccine to be included in the WHO list of recommended vaccines, our experts have to examine certain materials that the manufacturer must submit, inspections and audits must be carried out by the WHO team at the manufacturing facility. Let me put it that way: this process has not been completed, moreover, the WHO has not even received a full package of documents for this vaccine. Therefore, it will be possible to speak about any kind of recognition only when we receive a full package of documents.
What is the WHO's point of view to the fact that some countries suggest to restrict certain rights of unvaccinated people, for example, to attend certain events?
We say that vaccination is not a mandatory measure but we do recommend to use vaccination as a very effective way to deal with epidemic outbreaks.
Why not mandatory?
We always recommend evidence-based approach and decision made based on balance of risk and benefits. Under National Deployment and Vaccination Plan each country has identified priority groups who should get access to vaccine first, and it is because of their risks due to COVID-19 or their functions. We do not have the same level of risks and benefits for everyone, and we therefore we do not recommend mandatory vaccination enforced by law, unless lack of vaccination harms others. Another important point that for mandatory we should have sufficient vaccine supply to cover everyone upon request, and it is not there yet globally and in many countries. Therefore, as of today in Ukraine, we cannot say that COVID-19 vaccines should be mandatory for use. At the same time, we realize that we have overwhelming evidence that the course of COVID-19 in vaccinated people is much lighter and priority groups, those with high risks for COVID-19 complications and severe outcomes, as well as those with essential functions should be vaccinated as soon as possible, and vaccination is the only strong tool we have to protect them.
There is a lot of discussion around the mandatory vaccination in the beginning of the school year - if it is necessary to vaccinate all teachers and university professors. What is the WHO's position?
Such a discussion is under way in almost all countries. The same questions arise regarding the vaccination of staff in covid and non-covid hospitals.
In many countries, the vaccination coverage among the teaching staff is very high. If we talk about the health of each individual teacher and professor, then I would certainly recommend each of them to be vaccinated.
Usually, if countries decide that vaccination should be mandatory, they often fail to enforce it fully. This is a complex issue, both from the legal point of view and from the point of view of ensuring the right to education and work. Nevertheless, I am sure that in Ukraine our teachers could be protected much better. In fact, there are many older teachers in Ukraine and their health requires protection, i.e. vaccination.
At the same time, it must be remembered that in addition to vaccination in those communities and communities where the virus transmission continues, other protective and preventive measures should be used including distancing, wearing a mask and washing hands.
Does the WHO have any leverage to stimulate vaccination or wearing masks, in a word, to contain the spread of the virus?
Our influence and, at the same time, our task will be to provide support. This is, for example, what we are doing now in Ukraine: Ukraine gained access to the vaccine through the COVAX mechanism. From the beginning of February to the present day, it is the COVAX mechanism that made available almost 20-25% of vaccines by now.
Will the COVAX continue to operate in 2022?
In 2022, it's operation will continue for sure, and later we will see, if there will be need for it. Many countries are now organizing their ways to obtain and purchase vaccines, including Ukraine. For example, on the basis of bilateral agreements Ukraine has purchased 15-20 million doses of vaccine.
In fact, it is important to make sure that you have sufficient amount of vaccine. For example, now the situation is such that, in a sense, it is even easier to get a vaccine in Ukraine than in the high income countries.
Is there enough vaccine manufacturing capacity in the world today or is it still necessary to look for new production sites?
Now the number of manufacturers is constantly growing, the number of production sites is increasing, and they are located in different countries. Just in August, a new manufacturing hub was launched in South Africa, to which the mRNA vaccine technologies were transferred with the help of the COVAX mechanism and support from the WHO.
Of course, there is and there remains a need for rapid production and rapid development but on the other hand one should not forget that it is necessary to ensure access to vaccination, etc. Globally, we can see that vaccine use is very disproportionate - about 52% of the world's population lives in low- and middle-income countries but only 18% of vaccines have been used in these countries. So, unfortunately, we see inequalities in accessing the vaccines.
I really hope to see fewer ICU patients next year than I saw in the past. In recent months, I have spent a lot of time in visiting Oblasts and hospitals and I can say that hospitals are now in better condition, better prepared than they were last year, and nevertheless, I would like to see fewer Ukrainians in intensive care.