3. Providing health services effectively
The section on PROVIDING HEALTH SERVICES EFFECTIVELY describes approaches for service delivery planning and patient pathways for suspected COVID-19 cases. It also considers efforts by countries to maintain other essential services during periods of excessive demand for health services.
3.1 Planning services
There are currently 9 designated health facilities to treat COVID-19 patients (see Section 2.1). Primary care is responsible for detecting suspected cases and referral for testing (see Section 1.5). There has been an increase in the availability and use of telephone consultations.
On 10 July the Government approved the proposed amendments to the Law on the Legal Regime of the State of Emergency, which allows the centralized management of the healthcare system once a State of Emergency has been declared. The amendments authorise the government to transfer the management of all medical facilities in Armenia to the Ministry of Health, regardless of their affiliation and ownership.
On 17 August, the MoH announced that the first morgue in Armenia designated for autopsies of cases of highly dangerous infections in accordance with international standards has been fully renovated and put into operation. The Ministry’s “Scientific-practical center of forensic medicine” branch operating in Kotayk region is now equipped with modern equipment and has two autopsy rooms, one of which is designated for autopsies of cases of highly dangerous infections, including COVID-19.
On 20 January 2021, the Ministry of Health published the priorities for COVID-19 vaccine risk groups. The priorities were agreed at a regular sitting of the Republican Advisory Committee on Immunization and the possibilities of obtaining COVID-19 vaccines during the second window of COVAX were also discussed. The Committee has proposed that vaccinations against COVID-19 should be carried out in stages, setting the following priorities for at-risk groups:
- In the first stage, the residents in elderly care centres will be vaccinated, as well as the employees and medical workers in care centre, people aged 65+, and people aged 16-64 years who have chronic conditions.
- Taking into account the epidemiological situation and vaccine availability, lecturers, teachers, employees of the Ministry of Emergency Situations, servicemen, justice workers, public transport workers, civil servants will be vaccinated at the second stage.
Armenia plans to purchase 10,000 doses of the Russian vaccine Sputnik V, depending on its availability, and the country has made advance payments to COVAX to procure vaccines for 300,000 people (about 10 percent of the population) (https://eurasianet.org/caucasus-vaccine-effort-infected-with-geopolitics). If it becomes available in March 2021, the possibility of buying enough of the AstraZenica vaccine to cover 3% of the population has also been discussed. The Ministry of Health is trying to cover the remaining gap through bilateral requests. Armenia will not be using the Pfizer vaccine due to its storage requirements (at below -70C). The first vaccine doses procured through COVAX (24,000 doses of the AstraZenica vaccine) arrived on 28 March 2021. Armenia is also seeking a deal to acquire the Novavax vaccine.
Vaccination for citizens will be free-of-charge and voluntary. People vaccinated against COVID-19 will be given a vaccination card, but for international travel, people are advised to check the vaccination card requirements for the country of entry in advance.
The national vaccine roll out strategy was adjusted to reflect the available two types of vaccines (Sputnik V/15,000 doses and AstraZeneca/24,000 doses). The high-risk groups of the population will be prioritized under the following categories will receive the AstraZenica vaccine:
- People aged 65 and over
- People with chronic medical conditions aged 55 and over
- Healthcare workers aged 55 and over
- Workers and residents in long-term care facilities of age 55 and over
The Sputnik V vaccine will be used for the following groups:
- People with chronic medical conditions aged 18-54
- Healthcare workers aged 18-54
- Workers and residents in long-term care facilities aged 18-54
Vaccinations will start in Yerevan on 13 April and in the regions on 14 April.
As of 21 April 2021, according to official sources, 248doses of the AstraZeneca and 850 doses of the Sputnik V vaccines have been administered in Armenia since the beginning of the vaccination programme on 14 April. This is a slower start than had been anticipated, and health officials acknowledged that even people from risk groups are in no rush to take free vaccines despite a high COVID-19 infection rates. Recent surveys have found high levels of vaccine hesitancy, with 56% of those surveyed saying that they would not voluntarily take the vaccine.
As of 27 April, the Ministry of Health approved all adults for vaccination with AstraZeneca. The MoH launched its vaccination campaign on 13 April, with only frontline workers, seniors and chronically ill people aged 55 and older eligible for the AstraZenica vaccine initially. The campaign was extended a week later to younger people deemed most at risk from COVID-19. They were offered Sputnik V vaccine. According to health authorities, only about 2,200 Armenians were vaccinated against COVID-19 as of Monday despite an ongoing third wave of COVID-19 in the country, and only 400 doses were administered in the previous week. The Minister of Health decided to expand eligibility for AstraZeneca vaccine to all people aged 18 and older. She said that 31 May is the use-by date of the first 24,000 doses of the vaccine imported to Armenia on 28 March. According to the Deputy director of NCDC, the reason for that decision are many phone calls received from people who want to be vaccinated but are not included in any high-risk group. The authorities are maintaining their restrictions on the use of Sputnik V. It is still restricted to vulnerable people aged between 18 and 54.
From 23 April 2021, the programme also changed so that COVID-19 vaccines in primary health care organizations are free of charge for both for Armenian citizens, and for foreign nationals and stateless persons in Armenia. Vaccination is carried out by primarily healthcare facilities every working day, and, starting 24 April, also on weekends from 10 am to 4 pm. This has been accompanied by an awareness campaign that has included high-level politicians and ambassadors getting vaccinated on television to try and help alleviate vaccine hesitancy in the country.
In May 2020 nine mobile COVID-19 vaccination units began operating in shopping centres and other busy parts of Yerevan as well as central squares in Gyumri Vanadzor and Dilijan. Vaccines are available free-of-charge to all – including non-citizens. The mobile units are open from 15:00-20:00.
As of 29 June 2021, vaccines are available through primary healthcare facilities and mobile vaccination points throughout the country for all population 18 and older including foreign citizens and refugees. There are 3 types of vaccine with difference for eligibility including Astra Zeneca, Sputnik V and Sinovac. However, by the autumn the Ministry of Health will purchase new COVID-19 vaccines from Johnson & Johnson and Novavax. There is serious vaccine hesitancy in Armenia and consequently vaccination rates remain very low. As of 29 June 2021, 58,717 people had received their first dose of vaccine and 17,158 people had received two doses – around 2.6% of the total population had received either first or the second dose. Vaccinated individuals are provided a QR code that is accessible through Armed e-health application. The goal is to have about 700 thousand residents vaccinated by the end of 2021.