“The Pandemic Will Last for Several More Years,” says Jarno Habicht, the Head of the WHO Country Office in Ukraine

The World Health Organization declared the outbreak of the COVID-19 pandemic in March 2020. More than a year has passed since then. Countries have adapted to the new reality: people keep social distance, wear face masks and limit their social interactions or ‘migrate’ online. According to the WHO estimates, it is only through herd immunity achieved with the help of mass vaccination that we could overcome COVID-19.

Six months ago, Jarno Habicht, the Head of the WHO Country Office in Ukraine, predicted the third wave of the pandemic and commented on COVID-19 cure in his interview for Suspilne. Suspilne has recently had another interview with Dr. Habicht and found out when exactly is the expected time for the humankind to exit the pandemic and whether Ukraine will have enough vaccines under international aid programmes.

The vaccination level in Ukraine is one of the lowest in Europe. How do you assess the country’s preparedness for vaccine supply under the COVAX agreement?

— We should look to the vaccination campaign not only in Ukraine but across the world as well. It is a good thing that we are talking about this during the European Immunization Week. We should also consider the availability of the vaccines. Now health care workers are being vaccinated, as well as people from risk groups, including the elderly. As of the end of April, a half of the vaccines supplied under the COVAX agreement had already been administered. We are expecting a new batch in the nearest time. Ukraine has been scaling up vaccination since the end of February within the framework of the National Plan. It all started with mobile teams going to hospitals. Now we can see fixed vaccination sites open in all oblasts, there are 1,900 of them — people can visit those sites, get their vaccine and primary health care, etc. The goal for the summer is to have more than 3,000 vaccination sites.

Thus, to succeed, we need a combination of quantity and availability of vaccines, trained staff and vaccination sites in place. So, I am optimistic and I expect the vaccination to expand in the nearest months.

Taking this into account, do you find the Ministry of Health’s public outreach efficient?

— I think people should be well informed, especially the priority groups. There are different outreach mechanisms: from health care professionals to information channels and telephone hotlines. We have been building so many different dashboards in Europe and globally to see how many vaccines are administered daily, what are the groups who are covered. Now we can track it quite well. We can also see that more than 50 percent of the citizens would like to get a COVID-19 vaccine, and I think that is very positive dynamics. The most important thing is that the vaccines will help us to exit the pandemic in 2021–2022.

What are the predictions for the achievement of herd immunity in Ukraine?

— As for herd immunity, this term implies that a critical mass of people should develop immunity against a disease. We are dealing with a new disease. We are still studying the duration of immunity for the administered vaccines. These criteria are not clear. That is why nobody knows when the herd immunity will be achieved. The second aspect which is extremely important in terms of vaccination is that the vaccines prevent serious disease to the serious condition through COVID.

Vaccination will protect health care workers, who help us all. The reason is, you cannot abolish all the other health care services as many people have chronic diseases and no possibility to visit their doctor on time. Maybe some of them have to postpone their care because of cancer treatment. Thus, health care workers, the elderly and the ones in the risk groups come first. Then we can move on and collect data on herd immunity.

How was the pace of vaccination affected by the decision of several countries to stop using particular vaccines? What can be done about that now?

— When you stop vaccination, it surely does slow down the pace. Many countries did so. They temporarily suspended vaccination to evaluate the risks. And some countries stopped vaccinating altogether. Some countries are doing research on which age group they should stop vaccinating. The reason is, safety is important for everyone. And we want to find out what is going on.

Maybe it has something to do with the side effects?

— That is true. There were many discussions about certain vaccine products and the information we have on thrombocytopenia syndrome, for example, which is very rare. It is listed as a rare side effect for some vaccines. And we know the incidence is very low. So, we are talking about one case in 250 thousand according to the United Kingdom statistics, or one case in 100 thousand according to the data collected across the EU.

Every medicine, every vaccine can have certain side effects. It is crucial that we should manage them and inform the public accordingly. That is why thrombosis and thrombocytopenia syndrome are something that we as doctors have to monitor in people for 4–20 days and provide them with support and aid in case they have any side effects.

How prepared is the world to fight new COVID-19 strains? Can vaccination protect against them?

— The current vaccine products we now have mostly help to fight the already existing strains. They are gradually spreading from different parts of the world.

And, of course, we should see how the vaccines and the platforms used in their development might help us achieve immunity. So, the current vaccine helps. But this is an area where research should be carried on. A year ago we could only dream of having vaccines. Now we have them. So, in these circumstances we should study the interaction between the new strains and vaccines.

Are vaccines equitably distributed across the world? What is your advice for the poor countries that are considerably falling behind in vaccination, thus having less possibilities than the developed countries? How can the inequity be tackled?

— 92 countries are going to get free vaccines for their citizens to cover up to 20% of the risk groups. Part of the vaccines delivered to Ukraine. No one is safe until everyone is safe. Research shows that we could efficiently fight COVID-19 and prevent 6 deaths out of 10 if we had 2 billion vaccines for simultaneous distribution across the world. With no equitable distribution, say, if 50 countries get more than the others, we will prevent only 3 deaths out of 10. So, that means that many lives will not be saved.

That is why Covid-19 vaccines, as well as solidarity and equitable distribution, are really important. Otherwise we will not be able to exit this global pandemic. And, as we can see today, the reality is that most vaccines, that is, 4 out of 5, are currently concentrated in high-income or upper-middle income countries. If we take a look at the low-income countries, we will see that they have less than one percent of all COVID-19 vaccines available. Thus, we can see inequality. We need more solidarity. Otherwise we will see some countries exit the pandemic, but on a global scale the pandemic will last for several more years.

The psychological consequences of the disease turned out to be as stunning as the physical ones. Is there any research on this?

— We see that 8 million people in Ukraine need different kinds of mental health support. Now, in the times of COVID-19, this issue is more acute than ever. Mental health needs are on a continuous rise in all countries affected by the virus. Thus, we understand that we should provide more assistance to families and people within the next 5 to 10 years. But the effects are very high. We have children that lost dozens of academic days last year. We have families that lost their income. We have many families that do not know what will happen to their job in the future. So, this pandemic has many consequences that we should look into before we take action.

Are there any WHO studies on the impact of vaccination on pregnant women?

— This issue is being studied at the moment. And it is the responsibility of not the WHO, but, as a rule, of the national regulatory authorities and the pharmaceutical companies that produce the vaccines. We know that pregnant

women may be more vulnerable to COVID-19, so we have to evaluate every case of administering a vaccine to a pregnant woman.

How many more vaccines can Ukraine get and what companies will they come from?

Ukraine received over 1.1 million vaccine doses by now, and half of them have already been administered. COVAX currently aims to vaccinate up to 20 percent of the population. Moreover, there is a possibility that the Ukrainian government could use COVAX to cover even more than 20% of Ukrainians. Ukraine has also reached additional agreements with different manufacturers. Pfizer, for example. But I also know about the Serum Institute of India’s AstraZeneca vaccine that helped Ukraine to launch its vaccination campaign in February 2021.

So, I hope we will have enough vaccines due to these different mechanisms. As for the coming supplies, COVAX will provide additional vaccines in May. Thus, under the current commitments, 1.7 million AstraZeneca vaccines will be available through COVAX. Furthermore, Ukraine will receive more than a million Phizer vaccines. And still, COVAX continuously monitors the vaccine supply rates, vaccination capabilities and the equity of distribution of vaccines on a global scale. So, there will be more available vaccines. It is crucial that we follow the National Vaccine Distribution Plan and the National Vaccination Plan. We protect the vulnerable populations.

How did the WHO adapt its work amid the pandemic and what programmes did it have to cut down or curb altogether?

— At the beginning of the pandemic, huge part of our work was focused on COVID-19. And we had to start with studying what we knew about the virus and what to do next. But in hindsight, I would say that our work in Ukraine was never altogether curbed in any other area. Our team keeps on working with HIV and tuberculosis. These are also important directions of aid for the country. We have to provide access to antiretroviral therapy and testing for people with HIV.

The same with mental health. As we go through the pandemic it cause a need for mental health support.

But our work is still largely focused on COVID-19 and response to it. My colleagues are currently visiting hospitals. We are checking oxygen availability. While the situation in western oblasts is improving, some eastern oblasts still have hospitals with more than 80% occupancy. We need to provide oxygen for those areas. We have to take all precautionary measures and sustain high vaccination rates. Then we can move out of the outbreak. I am very optimistic 2022 will be much better. But we need to join our efforts to make it better.