Naeema Al-Gasseer, a Bahraini national, was appointed to the position of World Health Organisation (WHO) representative in Egypt in August 2020 at a critical time in the fight against the coronavirus. A year later, she says there is a lot to be learnt from the Egyptian experience. According to Al-Gasseer, the WHO has included Egypt as one of the world's success stories in handling Covid-19 due to the top-level political commitment to the country's healthcare sector led by Minister of Health and Population Hala Zayed. All sectors of the government worked together, she said. The whole community was also engaged in combating Covid-19, she added, citing the example of contributions by businesses to the Tahia Masr Fund, for example. Another success story was how Egypt had worked closely with neighbouring countries and with the international community to combat the pandemic. "Very early on, Egypt positioned itself to be part of the global solidarity in addressing the pandemic," Al-Gasseer said. Egypt joined the clinical trials for the vaccines against Covid-19, since these could not be approved until their safety, efficacy, and quality had been shown. Al-Gasseer herself chose to take part in one clinical trial as an act of solidarity in the fight against Covid-19. She lamented that vaccine availability was still an issue, however, not only for Egypt, but also for 140 other countries where there is a shortage of vaccines. "We were expecting 20 per cent of Egypt's population to be vaccinated by the end of the year. Today, we are only talking about around four million people having been vaccinated because promises to Egypt in terms of vaccine delivery were not met," she said. Nonetheless, Egypt had done well in managing its resources. "We really commend Egypt because when the national vaccine campaign began it included everyone —refugees, migrants, everyone living in Egypt had access to the vaccine," she said. Globally, two billion doses were supposed to be distributed through the COVAX facility established to deliver the vaccine worldwide, especially to low and middle-income countries. However, these doses did not materialise in the promised numbers because production is lower than demand, Al-Gasseer said. COVAX, co-led by Gavi (the Vaccine Alliance,) the Coalition for Epidemic Preparedness Innovations ( CEPI) and WHO, is one of the three pillars of the Access to Covid-19 Tools (ACT) Accelerator, launched in April 2020 in response to the pandemic with the aim of providing equitable access to Covid-19 diagnostics, treatments, and vaccines. The goal was that by the end of September 2021 at least 10 per cent of the world's population would be vaccinated, 40 per cent by the end of December 2021, and 70 per cent by next year, Al-Gasseer said, adding that today these goals have not been attained. In Africa for example, less than one per cent of the continent's population has been vaccinated. One factor that should help improve the availability of the vaccines is the announcement by the G7 countries that they will contribute quantities of them. During their meeting in June this year, leaders of the G7 group of the world's major industrial nations pledged one billion Covid-19 vaccine doses to poorer countries. While the move was seen as a step in the right direction, observers believe is it still not enough, however. Another factor is increased local production, and Egypt has taken steps towards the production of the vaccines on its own territory, not only through the transfer of technology, but also by developing its own vaccine through the National Research Institute. This is now in phase 2 clinical trials, Al-Gasseer noted. "Egypt can be a hub for the production of the vaccines given its capacity and expertise," she said, adding that the more production there was, the more the world can meet demand, especially as there may be a need for annual vaccinations. She stressed that the WHO advocates for a transitional period in which intellectual property rights will be lifted in order to enable the expansion of vaccine production worldwide. The Egyptian government announced in early July that it has produced one million Sinovac doses through the state-owned Egyptian Holding Company for Biological Products and Vaccines (VACSERA). The manufacture of Sinovac vaccine doses is part of an agreement between VACSERA and the Chinese biopharmaceutical company Sinovac.
SUCCESS STORY: Al-Gasseer said that Egypt has been a success story because it has not only managed the pandemic, but has also managed other health issues as well. In the midst of the Covid-19 pandemic, a task force for essential health services had been formed for maternal healthcare, people with diseases like hypertension and heart disease, and people with diabetes or cancer. The digitised system initiated under the 100 Million Health Campaign had also been useful. The campaign, which aimed initially at eliminating the Hepatitis C virus in Egypt, has been expanded to include screening for diabetes, hypertension, and heart and respiratory diseases, and has involved putting patient data into a national digitised system. Information can easily be retrieved from the system about those who have non-communicable diseases, allowing them to be given their medicine at home instead of coming to health centres during the pandemic, noted Al-Gasseer. "This is a success story that could be scaled up, including in many other countries that do not have such digital systems," she said. The campaign is a good example of the universal healthcare that Egypt is currently rolling out, she added, ensuring everyone is covered by health insurance. Universal health coverage is something Al-Gasseer worked on in Egypt in 2010 when she was assistant regional director of the WHO and focused on strengthening the health system based on research and evidence. Back then, she said, such strengthening was not yet part of the UN Sustainable Development Goals (SDGs). "Transforming it from an idea to positioning it strategically was possible thanks to the political commitment at the time," she said, noting that Egypt's constitution makes health coverage a right for all. Healthcare, she said, is not only about hospitals and administering medication, but is also about a combination of promoting people's health and prevention through early detection and vaccination, providing care and ensuring rehabilitation services if needed. By providing healthcare coverage on the widest possible basis, Egypt is also tackling poverty, Al-Gasseer noted. A WHO study in 2010 found that many people still pay out of their own pockets for healthcare, and that it can be a major expense, adding to poverty rates in some countries. In order to reduce poverty, it is important that people pay less out of their own pockets for healthcare and have their sicknesses detected earlier to minimise consequences, she said. Through the universal health insurance system Egypt aims to protect people from poverty "through giving people better healthcare, not sick care", she stressed. Al-Gasseer also praised Egypt's efforts to put an end to Hepatitis C. In 2010, Hepatitis C was identified as one of the major public health threats draining Egypt's health system and finances. "Now, we are being asked to evaluate whether Egypt has succeeded in eradicating the virus. There is a good deal of pride in what Egypt has done," she said. This had been possible through investing in early detection, health education, and the improvement of blood safety and infection control, including access to safe water and sanitation. "Today, Egypt is one of the first countries maybe in the world in this regard. In 2010, it had one of the highest numbers in terms of prevalence of Hepatitis C, but it is now eliminating it," she said. Egypt is not only protecting itself, but its neighbours as well, noted Al-Gasseer. It has reached out to Africa by promising to treat one million Africans for Hepatitis C. It did the same thing with Covid-19 when it supported many countries with donations. Another initiative Al-Gasseer believes will help in the provision of better healthcare is the Decent Life initiative, a presidential initiative which aims at improving quality of life in the poorest rural communities where it is aligned with the WHO's constitution that aims at the "attainment by all people of the highest possible level of health", where health is defined as "a state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity". The initiative involves improving primary healthcare centres and access to health facilities and improving working conditions for healthcare providers. It seeks to provide a healthy environment, access to safe water, and access to areas where individuals with disabilities, women, children, youth, and the elderly can exercise and spend time. Al-Gasseer noted that part of Egypt's universal health insurance law aims to improve the working conditions of healthcare workers and to improve their renumerations, incentives, and salaries. This "caring for the carers" is key, she said, adding that it is also timely, given that this year is also the International Year of Health and Care Workers. "We should all express our thanks to them for keeping everyone safe," Al-Gasseer concluded.
*A version of this article appears in print in the 29 July, 2021 edition of Al-Ahram Weekly.
