Ahmed Al-Mandhari, World Health Organisation (WHO) regional director for the Eastern Mediterranean, was appointed in June 2018. Prior to taking the post Al-Mandhari, an Omani national, was director-general of the Quality Assurance Centre at the Omani Ministry of Health. His public health priorities include health emergencies including disease outbreaks, communicable and non-communicable diseases, health system strengthening and maternal, and child health. In this interview with Al-Ahram Weekly, Al-Mandhari warns of the dangers of coronavirus mutations, and the importance of a coordinated global framework to adapt vaccines, diagnostic tests, treatments, and prevention measures.
How do you evaluate health policy measures in Egypt to combat the pandemic? Egypt, like many other countries in the region, has made great efforts since the beginning of the pandemic. There are many challenges which health systems are working to overcome, not least societal laxity in dealing with the pandemic, a result of boredom and exhaustion engendered by the longevity of the pandemic, compounded by a false sense of security after the emergence of vaccines. The emergence of new strains of the virus has led to faster transmission. Some people are reluctant to take the vaccine, and rumour and misinformation has had a negative impact. We recommend that countries continue applying public health and preventive measures with the same degree of seriousness and commitment they did at the beginning of the pandemic. One very positive step Egypt has taken is to start manufacturing Covid-19 vaccines to cover the country's urgent needs.
How will you be able to vaccinate 20 per cent of the population of the Eastern Mediterranean region by the end of the year? COVAX is an initiative led by the WHO, together with the Global Alliance for Vaccines and Immunization (GAVI), the Coalition for Epidemic Preparedness Innovations (CEPI) and UNICEF. The COVAX Facility coordinates the availability of COVID-19 vaccines, and their equitable distribution in all countries and regions regardless of the economic situation of individual states. To date, more than 190 countries have joined the COVAX Facility. All countries in the region are members, either as self-financing states or within the framework of the pre-purchase commitment initiative launched by GAVI which provides financial support to eligible countries so that they can purchase the vaccine. The facility has so far provided 65 million doses to 124 countries. Most countries in the region have received vaccine shares, and the aim is to provide enough vaccines to meet 20 per cent of eligible states' needs. The region has so far received 50 million doses, with huge variations between countries. At least 300 million doses are needed to vaccinate the most vulnerable and at-risk groups, which represent 20 per cent of the population. Vaccine availability depends on countries and manufacturers fulfilling their obligations, and steadily increasing the speed and volume of deliveries. We also need to partner with high-income countries to make available any surplus vaccine supplies. We call on manufacturers to publicly commit to assisting any country that wants to share its vaccines with COVAX to lift contractual barriers within days, not months. The organisation welcomes recent news that several countries will donate vaccines to the COVAX Facility. We want to see speedy delivery of additional doses across the region.
In absence of a more equitable distribution of vaccines, what does the WHO recommend for less fortunate countries? Disparity in the distribution of vaccines is not specific to the region but a global problem. There are grave concerns over the consequence of depriving high-priority groups of vaccines while provision to lower priority groups is expanded. Disparities have reached unacceptable levels. Vaccination rates have reached 80 per cent of the population in some countries and less than one per cent of the population in others. One reason for this is the low level of vaccine supply to the COVAX Facility. The increase in case numbers has fed demand and there will be a shortfall of 190 million doses by the end of June. While we appreciate the work of some manufacturers to increase the speed and volume of deliveries we need other manufacturers to follow suit and make deliveries as soon as possible.
What are WHO's recommendations regarding Covid-19 mutations in India? Some of these mutations limit the ability to deactivate the virus, which may affect control measures, including vaccines. Virus mutations require a rapid and coordinated global response. The WHO is leading discussions to form a global decision network to adapt vaccines, diagnostic tests, treatments, prevention measures and other tools if needed. It is imperative to improve the ability of all countries to perform genome sequencing. What distinguishes Egypt and the 13 countries in the region is their ability to monitor genome sequences and detect pathogenic mutations.
What is your take on the varying efficacy of approved vaccines? All vaccines that have been authorised for use in emergencies by the Strategic Group on Vaccines at the WHO have proven safe and effective after careful and comprehensive evaluation and study. Comparisons between the vaccines in terms of efficacy do not indicate any large difference in the degree of effectiveness.
What is your take on re-vaccinating people periodically? Extensive studies are needed on the timeline of immunity that current vaccines give. There is, too, the possibility Covid-19 could turn into a seasonal virus the characteristics of which change from one season to another, in which case re-vaccination will be needed.
When will there be more effective treatments for the coronavirus? Some countries have announced promising new treatments but we do not have sufficient evidence/information. Until we do we will continue to develop palliative treatment protocols that deal with the symptoms of the disease, reduce its complications, improve the general condition of patients and thus aid recovery.
What is your assessment of the precautionary measures taken across the region in recent months? We still have a long way to go. Many countries have yet to receive sufficient doses to vaccinate most at-risk groups. As of 23 May, the region had reported more than 9.8 million cases and 198,000 deaths. While some countries are reporting a decrease in cases and deaths, the virus continues to infect and kill people every day across the region and there are worrisome new mutations in many countries.
Given the political instability in some countries in the region, what actions can be taken to limit the spread of viral infections and increase vaccine provision? In our fight against this pandemic, we either win together, or we all lose. And there have been positive aspects in terms of strengthening health systems, supplementing capabilities that were lacking, and activating preparedness plans. We believe that health systems now have a better chance to respond to the pandemic than they did, and they must take advantage of the global momentum and the spirit of solidarity. There is a growing conviction that success in ending the pandemic rests on providing low-income countries, countries in conflict and vulnerable groups with the required healthcare.
After more than a year of intense focus on the pandemic, have other health programmes suffered from a diversion of funds? Among the major repercussions of the Covid-19 pandemic is its negative impact on health programmes and efforts to provide basic health services, especially in countries where the health sector was already weak. The economic fallout from the pandemic affected many countries' ability to meet their health financing needs. In an early stage of the pandemic WHO stressed the importance of balancing efforts between responding to the pandemic and continuing basic health programmes. Among the programmes that have been neglected are vital vaccination campaigns against other diseases, including polio, and this is something that must be remedied as soon as possible.
*A version of this article appears in print in the 27 May, 2021 edition of Al-Ahram Weekly
