Policy responses for Cyprus - HSRM


Policy responses for Cyprus

2.2 Workforce

Update 18th May 2021

A new measure has been introduced via Decree, stating the mandatory use of a Safepass, in order to visit crowded places such as restaurants, malls, etc. In order to possess a Safepass citizens should have either a) negative test (PCR /rapid), carried out within the last 72 hours, b) have been vaccinated with at least one dose at least 3 weeks prior or (c) were infected with coronavirus during past six months (see Section 1.2 for more details).

Update 16th May 2021

On May 5th the Pharmaceutical Services published the frequently asked questions and answers about Covid-19 vaccines (https://www.pio.gov.cy/coronavirus/uploads/pdf). Due to the strong misinformation, especially on social media, on May 13th the Blood Centre informed blood donors that the Covid-19 vaccine does not adversely affect the safety and quality of blood products and does not pose any threat to the health of the blood donor and the transfused patient (https://www.pio.gov.cy/coronavirus/uploads/13052021-pdf). In addition, the MoH announced that workers who have been vaccinated with the first dose of a licensed vaccine, are exempted from the obligation for weekly testing with rapid antigen test, after the third week of vaccination (https://www.pio.gov.cy/coronavirus/uploads/07052021-pdf).

As part of the effort to improve the quality of service provided to citizens through the Covid-19 Vaccination Portal and to avoid system overload, the Deputy Ministry of Research, Innovation and Digital Policy announced that from May 5thonly one person will have the right and access to make an appointment for each person. Note here that before there was no limit to the number of persons who could log in to the portal and at try to book an appointment for the same individual hoping in this way to secure the vaccine type of their choice (https://www.pio.gov.cy/coronavirus/uploads/04052021_allagesstarantebouembolia.pdf)

Vaccine coverage and access:

On April 15th, following negative reports about the AstraZeneca vaccine, all members of the Council of Ministers were vaccinated with this vaccine, while the President of the Republic stated that it is the vaccination that matters, not the vaccine, and the minimal side-effects observed, cannot be an obstacle to mass vaccination which will create the prospects of herb immunity and will allow the restarting of the economy and the return to normal life (https://www.pio.gov.cy/coronavirus/uploads/15042021_proedrosdiloseisembolia.pdf). After evaluating data from international studies and the recommendation concerning the AstraZeneca vaccine, the MoH decided to reduce the period between the 1st and 2nd dose of this vaccine by four weeks; from 12 to 8 weeks. (https://www.pio.gov.cy/coronavirus/uploads/27042021-pdf).

Aiming to accelerate the vaccination process and coverage of a satisfactory percentage of the population, on April 22nd the MoH invited all personal doctors to express interest in carrying out vaccinations in their clinics for people over 30 years old (beneficiaries of the National Health System) with the AstraZeneca vaccine (https://www.pio.gov.cy/coronavirus/uploads/22042021-pdf). On May 13th the MoH announced that personal doctors could now vaccinate people aged 20 and above with the AstraZeneca vaccine. So far, 254 personal doctors have joined this process (https://www.pio.gov.cy/coronavirus/uploads/13052021-pdf).

As of May 13th, 42.5% (314,163 people) of the population had been vaccinated with the first dose of the vaccine and 13.3% (98,605 people) had completed their vaccination regime. At present Cyprus ranks third in the EU for the number of vaccinations per 100 inhabitants (412,768 vaccinations i.e. 46.9 doses per 100 inhabitants). Having achieved the initial target of scheduling appointments and vaccinating people aged 45 or older by the beginning of May, the process of offering at least once the possibility to people aged 18 or older to arrange appointments has been completed on May 15th. Consequently, in the period to follow, people of older age groups, who have not yet scheduled an appointment will be offered the opportunity to do so again. Moreover, the vaccination portal will be available to university students studying abroad at some point in June 2021. Therefore, overseas students are requested to wait until the portal is made available for them exclusively in June 2021 and then book their appointment to avoid cancelations and rescheduling. (https://www.pio.gov.cy/coronavirus/uploads/14052021_vaccinationsEN.pdf).

Update 9th April 2021

On April 7th there was a new announcement by the MoH, that the EMA has concluded that there is a possible linkage of AstraZeneca’s COVID-19 vaccine to very rare cases of unusual blood clots with low blood platelets, nevertheless confirms that overall benefit vs risk remains positive (https://www.pio.gov.cy/coronavirus/uploads/07042021--AstraZeneca%E2%80%99s%20COVID-19%20vaccine%20-%20EMA%20finds%20poss%20blood%20platelets.pdf).

Vaccine coverage & access

The National Vaccination Plan is based on the planning and availability of vaccines, with priority currently give to the vaccination coverage of patients with an increased risk of serious illness (https://www.pio.gov.cy/coronavirus/uploads/28032021_vaccinationappts_specialgroups.pdf).

With a simplified appointment process, the Vaccination Portal opened on March 29th offering 19,000 vaccination appointments to people with Diabetes Mellitus and Severe Obesity (https://www.pio.gov.cy/coronavirus/uploads/31032021_vaccinationfordiabeticsobeseEN.pdf).

On April 4th the Vaccination Portal opened for individuals who use biological agents or other immunosuppressive medicines and on April 9th for persons of 59 and 60 years old (https://www.pio.gov.cy/coronavirus/uploads/04042021_vaccinationsforvulnerableEN.pdf).

On April 8th, while there were 19,378 vaccination appointments available for all three vaccines, for persons of over 61, 10,000 appointments for the AstraZeneca vaccine remained unwanted, indicating that the public was negatively affected by the events. Despite the reassurances that have been given, the population was not convinced about the safety of this vaccine (https://www.philenews.com/koinonia/eidiseis/article/1166165/grizoyn-plati-sto-astrazeneca-sta-azitita-10-000-doseis?fbclid=IwAR3tVA9iIu_KCuUoTvSkj1FNCo5o8dxE7WBq36G0mP8hFVHlV8tmwhg97o8).

By the end of March 2021, Cyprus ranked 5th in the EU with the vaccination of more than 14.78% (at least one dose) of the population (https://www.pio.gov.cy/coronavirus/uploads/22032021--%CE%A3%CF%84%CE% 9%CE%BA%CE%AE%20%CE%BA%CE%AC%CE%BB%CF%85%CF%88%CE%B7.pdf).

On April 9th, 183,225 vaccinations were administered (130,937 with the first dose and 52,288 with the 2nd dose of the vaccine, 10,318 with an increased risk of serious illness) and at least 81.65% of people aged 80 years and over and 76.34% of people aged 70-79 years were vaccinated with the 1st dose (https://www.pio.gov.cy/coronavirus/uploads/10042021_vaccinationsvulnerableEN.pdf).

Update 20th March 2021

Following the scientific opinion of the EMA, on March 18th the MoH announced that there is no evidence linking the AstraZeneca vaccine with the thromboembolic incidents reported, and that the vaccine was considered safe and effective, and consequently all postponed appointments could be rescheduled (https://www.pio.gov.cy/coronavirus/uploads/18032021_astrazenecavaccinations.pdf).

Update 13th March 2021

On March 11th, the EMA recommended granting a conditional marketing authorisation for the use of the COVID-19 Janssen vaccine (Johnson & Johnson) for people above 18 years of age (https://www.pio.gov.cy/coronavirus/uploads/11032021--EMA%20recommends%20COVID-19%20Vaccine%20Janssen%20for%20authorisation%20in%20the%20EU.pdf). This is the fourth vaccine that the Cyprus government will receive, after those by BioNTech/Pfizer (on December 27th 2020), Moderna (on January 19th 2021), and AstraZeneca (on February 17th 2021).

Update 11th March 2021

The designated authority for vaccinations in Cyprus is the Medical & Public Health Services of the MoH. A formal Committee was set in order to organise, coordinate and implement the National Vaccination Plan COVID-19. This is an ad hoc committee which was established following a ministerial decision and consists of the deputy director of Medical Services & Public Health Services and representatives from the Cyprus Medical Association, the Federation of Patient Organizations of Cyprus and the Advisory Scientific Committee on Coronavirus (https://www.unic.ac.cy/el/anakoinothenta-arthro-pio-1643/). A primary objective of the committee was the elaboration of a vaccination prioritisation plan among the various population groups based on the current mortality and morbidity and other relevant epidemiological data.

Vaccines in Cyprus are secured through the EU centralised procedure which is applies to all Member States. The receipt of vaccines following licensing by the EMA, the monitoring of the vaccination process and the monitoring of the stocks, are all done centrally by the MoH, using a software that enables to control the number of vaccines used and in stock (https://www.pio.gov.cy/%CE%B1%CE%BD%CE%B1%CE%BA%CE%BF%CE%B9%CE%BD%CF%89%CE%B8%CE%AD%CE%BD%CF%84%CE%B1-%CE%AC%CF%81%CE%B8%CF%81%CE%BF.html?id=17453#flat,

The MoH has taken the necessary steps to abide to the necessary requirements for appropriate and safe storage of the different vaccines, with the purchase of special refrigerators where necessary, transportation containers, as well as a cold chain monitoring system. Their storage is centralised as they are transported to the pharmaceutical depositaries of the State Health Services Organisation, and then on channeled to all vaccination centres in Cyprus, as well as to other designated facilities where vaccinations take place (https://www.pio.gov.cy/en/press-releases-article.html?id=17457#flat). The process of supply and distribution of the relevant consumables is the joint responsibility of the ad hoc committee and the Procurement Department of the MoH.

Vaccinations are carried out at Vaccination Centres by trained health professionals (Health Visitors/Nursing Officers). Health Visitor Services (under the Nursing Directory of the MoH), have the responsibility to carry out safe vaccinations in accordance to the national and international protocols (https://www.moh.gov.cy/Moh/MOH.nsf/All/B9FCF33823572354C2257A1E0027363A?OpenDocument, https://www.moh.gov.cy/moh/moh.nsf/All/4CB9F1DBDA97AB24C22585B4003CB942/$file/%CE%9A%C%BD.pdf) (https://www.ema.europa.eu/en/news/extra-dose-vials-comirnaty-covid-19-vaccine). At each Vaccination Centre there is a doctor and nurse present with necessary equipment to address any adverse events caused by the vaccine. The time schedule of the vaccination centres has been extended with all health professionals working overtime in order to increase the vaccination rate and coverage. The services of nursing and medical students have also been south to support this initiative (https://www.pio.gov.cy/%CE%B1%%CE%B8%CF%81%CE%BF.html?id=18265#flat).

The vaccination is administered by personal appointment, which can be booked by the individual or their representative through the General Health Service beneficiary portal (https://www.pio.gov.cy/coronavirus/uploads/4012021_manualVaccinesPortalEN.pdf). Each person receives a text message on his/her phone with the details of the appointment, and there is also the possibility to send a reminder. Proof of the administration of the 1st dose is provided either electronically or in paper form (vaccination card). At the time of the first dose administration, an appointment for the 2nd dose is arranged within the recommended time frame (https://www.pio.gov.cy/en/press-releases-article.html?id=17457#flat).

Based on the findings of clinical trials carried out for each vaccine, the ad hoc committee in collaboration with the Scientific Advisory Committee on coronavirus has produced a priority list of population groups. The hierarchy prepared is as follows:
  1. Residents and staff of nursing homes and long-term care facilities as well as health professionals working at the designated reference hospitals for covid-19, ICUs, Accident and Emergency Departments and the national ambulance service). These groups commenced vaccination on December 27th 2020
  2. Persons >80 years old (priority to persons in vulnerable groups as per MoH guidelines)
  3. People >75 years old (priority in vulnerable groups) (until February 16th 2021)
  4. Individuals >=16 years of high risk for severe disease (since the end of February 2021)
  5. People working in Primary Health Care Centres, followed by other health professionals/personnel, and residents in other closed structures, such as prisons and reception centres for refugees and migrants (since the end of February 2021).
  6. The rest of the population

The main goal for Cyprus, is to reach a vaccination coverage of over 40% by the end of the first half of 2021, provided that deadlines are kept and vaccines are received as planned. This coverage will include the elderly and people working in closed structures, as well as healthcare professionals and people with serious underlying conditions. It is anticipated that in this way, the protection of these people from possible infection will be achieved, while hospitalisations and deaths will decrease and consequently the Healthcare System will be protected (https://www.pio.gov.cy/en/press-releases-article.html?id=17457#flat).

In the past three months, the Minister of Health together with government officials and members of the ad hoc and scientific advisory committees have been holding daily briefings informing the public about the vaccination coverage, the strategy and the new vaccines.

Early in the commencement of vaccinations in Cyprus, both the President of the Republic and the Archbishop were administered the vaccine live on TV and spoke by setting an example and speaking of the vaccine’s merits
(https://www.euronews.com/2020/12/28/covid-vaccine-cyprus-president-has-jab-live-on-television, https://www.pio.gov.cy/coronavirus/uploads/29122020--%CE% E%BF%CF%85%20COVID-19.pdf). Lastly, all information and answers to frequently asked questions about vaccines/vaccination against the COVID-19 are on the government’s website (https://www.pio.gov.cy/coronavirus/eng/categories/vaccines-en,

In a written statement on March 6th, the Minister of Health announced that Cyprus had reached 100,000 vaccinations or about 11.5% of the total population (https://www.pio.gov.cy/%CE%B1%CE%BD%CE%B1%CE%BA%CE%BF%CE%B9%CE%BD%CF%89%CE%B8%CE%AD%CE%BD%CF%84%CE%B1-%CE%AC%CF%81%CE%B8%CF%81%CE%BF.html?id=18854#flat).

Vaccine coverage & access

The Government’s intention is to reach a full vaccination coverage of the population, as this is viewed as the most effective means to end this pandemic. The vaccine is provided free of charge to all citizens who so wish (https://www.pio.gov.cy/en/press-releases-article.html?id=17457#flat), even to those that they are not covered by the NHS (https://www.pio.gov.cy/coronavirus/uploads/Application%20process%20for%20registration%20to%20Covid%20vaccinations%20portal%20for%20non-ghs%20beneficiaries.pdf). COVID-19 vaccination is however not mandatory in Cyprus.

The National Vaccination Plan provides for 38 Vaccination Centres in Primary Healthcare Centers and other designated facilities in all districts where vaccinations are taken place. Mobile units contribute to the onsite vaccination of health professionals (private and public), to remote areas and closed structures. Depending on the number of vaccines available, there is a potential to operate simultaneously up to 100 different units. Most of the Vaccination Centres operate from 08:00 until 15:00 with some extending to 18:00 (https://www.pio.gov.cy/coronavirus/uploads/NationalVaccinationPlan.pdf). In mid-February, the procedure for vaccination of patients who are bedridden also began (upon request) under the responsibility of the Homecare nursing services of the State Health Services Organization (https://www.pio.gov.cy/coronavirus/uploads/19022021--%CE%9B5%CE%B9%CF%82.pdf, https://www.pio.gov.cy/coronavirus/uploads/%CE%95% E%91%20COVID-19.pdf).

The government has included the Turkish Cypriot community in its vaccination plan and therefore the Turkish Cypriots will be gradually receiving vaccines to meet their needs. (https://gr.euronews.com/2021/01/18/kypros-covid-19-to-proi-paralamvanoun-tourkokyprioi-protes-doseis-emvolio-pfizer).

Update 31st December 2020

On December 15th the MoH presented the National Vaccination Plan for COVID-19, with vaccines from six companies. At the same time answers to frequently asked questions about vaccines/vaccination against COVID-19 were published by the MoH (https://www.pio.gov.cy/coronavirus/uploads/15122020_answers.pdf).

The first batch of the Pfizer-BioNTech vaccine was delivered on December 26th, and according to the plan, vaccinations began on December 27th with priority given to healthcare personnel and residents in nursing homes as well as health professionals working at the reference hospital and other designated facilities and services including emergency departments and ambulance service personnel (https://www.pio.gov.cy/coronavirus/uploads/22122020_vaccinespfitzer_engl.pdf).

On December 17th the MoH issued new guidelines regarding the management of confirmed cases (Isolation guidelines for confirm COVID-19 cases.pdf (pio.gov.cy)) and their close contacts (https://www.pio.gov.cy/coronavirus/uploads/Isolation Guidelines for Suspected Cases of COVID-19.pdf). Based on these the isolation period is determined at 14 days. The person identified as a close contact may be released from isolation earlier than the 14 days, provided that a negative PCR result is found on the 10th day from the last day of first contact.

Update 7th December 2020

On December 1st the MoH informed the public that BioNTech/Pfizer and Moderna have applied for a marketing authorization of their COVID-19 vaccines, through the European Medicines Agency (https://www.pio.gov.cy/coronavirus/uploads/01122020--Moderna.pdf, https://www.pio.gov.cy/coronavirus/uploads/01122020--20mRNA%20BNT162b2.pdf).

On December 1st, the Scientific Advisory Committee announced at a press conference, that the Republic of Cyprus has joined the central procedures of the European Commission for the pre-purchasing of COVID-19 vaccines. At the same time, it was reported that preparations are being made for the distribution and delivery plan, the storage, the order of prioritization for vaccination, the provision of structures and infrastructure, as well as the recording and monitoring of vaccines https://www.pio.gov.cy/coronavirus/uploads/%CE%93%CE%B5%BD%20COVID19.pdf).

Update 16th November 2020

According to the Minister of Health and members of the Scientific Advisory Committee the revised plan of the Public Health Services for the pandemic, provides that the reference hospital will become a hospital exclusively for coronavirus and in case full capacity is reached the State Health Services Organisation will activate wards firstly in the Limassol General Hospital and secondly in the Nicosia General Hospital (https://www.pio.gov.cy/coronavirus/uploads/04112020_YpYgeiasquestionsandanswers.pdf and https://www.pio.gov.cy/coronavirus/uploads/06112020_sinentefxitypouepistimonikiomada.pdf).

Cyprus, through the mechanisms of the European Union, has already pre-purchased vaccines that will cover the whole population (https://www.pio.gov.cy/coronavirus/uploads/04112020_YpYgeiasquestionsandanswers.pdf and https://www.pio.gov.cy/coronavirus/uploads/4112020_TelevisedaddressbyPoR.pdf).

Update 16th November 2020

Due to the increase number of COVID-19 patients at the reference hospital, three pulmonologists and three physicians from the private sector were commissioned to support the existing staff. The Cyprus Respiratory Society announced that all its members are ready to support the efforts of the MoH for the control of the pandemic.

The public hospitals entered the COVID-19 crisis with a pre-existing shortage of doctors, caused by the mass movement of health care personnel from the public to the private sector because of the implementation of the new National Health System. It is expected that the current staff shortages will be further exacerbated due to staff isolation, sickness or even potential fatalities that are likely to occur during this pandemic. It is worth noting that from a recent analysis of 267 confirmed cases, 73 concerned health professionals (15 doctors, 35 nurses), although a large proportion of the health care personnel have undergone special training regarding COVID-19. A special platform has also been created where health care professionals can receive training online.

To increase or maintain the availability of health workers, the Council of Ministers has decided to support the health sector with €100 million to combat the pandemic where necessary, including:
• Employment of additional medical and nursing personnel, and support staff for a more efficient and direct response to the work they are required to carry out
• Purchase of necessary equipment and consumables
• Support the Institute of Neurology and Genetics, both in human resources and in infrastructure
• Support of the National Ambulance Service.

In addition, according to the Quarantine Bill issued on March 10th, the Minister of Health is authorised to:
a) Enlist and call medical and nursing personnel from the private sector to work at the public hospitals.
b) Enlist and call any volunteering medical or nursing school final year students in Cypriot Universities, when necessary

The MoH has also recruited volunteers to assist with contact tracing and phone call answering inquiries. There have also been calls to industry to support the effort, by expanding laboratory capacity, and using hotels as quarantine places.

Update 18th April 2020

An important factor in the health system's effort to meet rsing demand due to COVID-19 is the significant number of infected health care workers in Cyprus. An analysis from the University of Cyprus of the first 493 laboratory-confirmed cases of coronavirus disease, showed 25.4% were health care workers (n=125), of which 5.7% physicians (n=28), 13.2% nurses (n=65), 2.2% other health occupations (n=11), and 4.3% auxiliary staff (n=21). This reduces the capacity of the healthcare sector to effectively deal with the pandemic.

Update 6th June 2020

The number of infected health workers by the virus continues to be high in Cyprus. According to the latest National Surveillance Report, as of 02/06/2020, out of all 952 confirmed cases until June 2nd, 20% are health-care workers (n = 190) - 4.1% physicians (n = 39), 10.1% nurses (n = 96), 1.4% other health occupations (n = 13), and 4.4% auxiliary staff (n = 42) (https://www.pio.gov.cy/coronavirus/en/pdf/ep206ien.pdf).

Update 2nd November 2020

In the context of the wider effort to reduce the spread of the pandemic, the MoH has hired additional health inspectors in order to better monitor the catering facilities for compliance with the preventive measures (https://www.moh.gov.cy/Moh/MOH.nsf/All/55C9E1CE44212363C225860800277C53?OpenDocument).

In addition, the Epidemiological Monitoring Unit is staffed with fifteen more officers who were employed as temporary employees. (https://www.moh.gov.cy/Moh/MOH.nsf/All/61272DE8419F9AD6C2258603003CE089?OpenDocument. Furthermore, due to the increase in the number of Covid patients treated in the reference hospital, a decision was taken to strengthen it with additional nursing staff.