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
The patient isolated at home can stay at home after their case is confirmed with a positive laboratory test result. If a patient treated in an inpatient facility is confirmed to have COVID-19, if possible, the patient will be isolated in the care setting. If not, the patient should be isolated in an infectious ward with territorial supply obligation. If the infectious ward does not have enough capacity for the confirmed case, the patients will be transported to one of the five designated isolation hospitals .
Most of the hospitals nationwide are deferring elective procedures, including surgeries and examinations, and only perform emergency procedures. Diagnostic test results and other medical documents can be downloaded from the National eHealth Cloud, which also manages the ePrescriptions .
One hospital from the private sector offered its capacity for coronavirus treatment. There are offers also from the hotel industry , and an initiative has been launched by Airbnb hosts to offer accommodation free of charge to health workers, who would like to isolate themselves from their families .
The leading exhibition and conference organizing company in Hungary has offered (if necessary) one of its exhibition hall to be organized to a heath care facility .
Primary health care providers (GPs) play an important role in detecting COVID-19 cases as people with symptoms are asked to call them first, instead of going to a health care facility. The GPs do a health check by phone and use a short checklist to decide whether it is a suspected case or not. If it is, the GPs notify the National Emergency Ambulance Service and ask to take a sample for laboratory testing. The National Emergency Ambulance Service goes to the location of the patient, takes the sample and deliver the sample to the lab.
From the 7th of November, the National Ambulance Service is responsible for coordinating the patient pathway for suspected and confirmed COVID-19-cases. 
Vaccine services and delivery
COVID-19 vaccinations in Hungary is voluntary and free for the population. Anyone who wants to get vaccinated should register at vakcinainfo.gov.hu. For the pensioners the registration forms will be delivered by post. The first doses of vaccines are expected to reach Hungary at the end of 2020 or early 2021, and frontline workers and the elderly will be the first to be inoculated. .
According to Pfizer’s local unit, Hungary will receive a total of 4.4 million doses of the Pfizer-BioNTech COVID-19 vaccine in the 2020-2021 period, including 80,000 doses scheduled to arrive before the end of 2020 .
On the 23rd of December, Dr. János Szlávik, Chief Physician of the Central Hospital of Southern Pest National Institute of Hematology and Infectious Diseases, conducted the first COVID-19 vaccination in Hungary .
Péter Szijjártó, Minister of Foreign Affairs and Trade, has reported that Hungary has received 6,000 doses of Russia’s COVID-19 vaccine on the 28th of December. 
On the 30th of December, a second shipment of the Pfizer-BioNTech COVID-19 vaccine containing 70,000 doses arrived in Liszt Ferenc International Airport. According to the Hungarian News Agency, 2,500 healthcare workers have received the first dose of this vaccination. This shipment will be sufficient to inoculate 35,000 Hungarian healthcare staff.
The vaccine has been distributed to hospitals in Budapest, Győr, Kecskemét, Tatabánya, Kaposvár, Miskolc, Székesfehérvár and Balassagyarmat. Distribution of the vaccine continued on the 30th of December to another 11 hospitals both in Budapest and in the counties. 
From the 7th of January, the coronavirus vaccination has started in Hungary’s four largest elderly care homes. Two of the four facilities are in Budapest, one is in Pécs and one is in Miskolc .
The vaccination order is the following in Hungary :
1. Healthcare workers
2. Social care workers and people receiving social care (residents in nursing homes)
3. Elderly over the age of 60
4. Law enforcement officers who come into direct contact with the public during their work
5. 18-59 year olds who have comorbidities that put them in a higher risk group
6. Critical infrastructure workers
7. All 18-59 year olds who do not fall into the above risk groups
On the 22nd of January, Chief Medical Officer Cecília Müller announced the approval of the AstraZeneca and Sputnik V vaccines by Hungary's health authorities. 
On the 29th of January, the National Institute of Pharmacy and Nutrition (OGYEI) approved the Chinese Sinopharm vaccine. 
On the 29th of January, a new government decree was adopted, which allows the Minister of Foreign Affairs to authorize a new vaccine, provided that:
• it has been authorized in three countries, including a member of the European Economic Area or a member or candidate country of the European Union
• it has been used to inoculate over one million people worldwide [14, 15]
At the end of January, the vaccination campaign for healthcare workers, nursing homes and residential social institutions was completed. The second doses of the vaccine and any missed first vaccinations are still given (Pfizer and Moderna vaccines).
During the first week of February, the vaccination of elderly people who registered for the vaccine by mail or online has begun. All GPs have received and will receive a weekly update with the list of the elderly people registered in their practice. Those who are most at risk based on their age and health are at the top of the list, the GP should start the vaccination with them. The elderly will be notified by their GP about the date and place (hospital vaccination point, GP’s office, home of the elderly) of the vaccination .
Each GP (which means more than 5,000 practices) should have selected 6 people from the list to vaccinate at a hospital vaccination point between February 4-8. Now the hospital vaccinations points are using Pfizer vaccine. In addition, 1,080 GPs received 1 ampoule of Moderna vaccine. From an ampoule, 10 elderly people could be vaccinated by the GP in the office or at the elderly person’s home .
From the second week of February, vaccination of registered chronic patients under the age of 60 has started with the AstraZeneca vaccine. The GPs will also receive a list of chronic patients under the age of 60 in their practice. They will be notified by their GP about the date of the vaccination. It is up to the GP to decide which of their chronic patients they consider appropriate to vaccinate first .
From the 1st of March, the timing of the 2nd dose of Pfizer and AstraZeneca was changed. The second dose of Pfizer should be given after 35 days of the 1st shot (previously it was 21 days). When using AstraZeneca, the time interval between the first and second dose changes from 4 to 12 weeks. The aim of the modification is vaccinate as many people as possible with at least one shot .
On the 23rd of March, Hungary's medicines authority granted licences for use to the Chinese CanSino coronavirus vaccine and Covishield, AstraZeneca's vaccine produced in India .
On the 24th of March, the Chief Medical Officer announced that the next category to be inoculated will be people working in essential services, including electricity distribution companies and public transport .
From the 27th of March, the vaccination of pregnant women became possible with Pfizer and Moderna (first dose in the 2nd or 3rd trimester, second dose after childbirth). Pregnant women are prioritized to get vaccinated, but they should register and consult with their GP/ gynaecologist .
From the week of 1st of April, the vaccination of the teachers and kindergarten workers has started in order to make the reopening of schools possible.
Vaccine coverage and access
The vaccine is free of charge, including for those who did not properly pay the public charges necessary to obtain social security benefits (from the 12th of February, people who have more than a six-month debt of social security contributions cannot get health care services free of charge but they can get the COVID-19 vaccine) .
According to Gergely Gulyás, Head of the Prime Minister's Office, a certificate will be introduced without request for those:
• who have received two vaccines for an unlimited time
• who have recovered the disease after a negative PCR test, or ten days after the positive PCR test for six months
• who are able to confirm the presence of antibodies by a blood test in a certified laboratory, for four months- with reimbursement possible upon request.
The certificates will be sent in case of recovery from the infection before 1st of March, until the 15th of March, in case of recovery after the 1st of March within eight days by post. 
The following personal information will be written on the certificate:
• passport or ID number
• the number of the certificate
• if the certificate holder was vaccinated, the date of vaccination
• if the certificate holder has recovered from COVID-19, the validity date of the certificate.
• On the 27th of February the relevant government decree changed to delete a line that had shown the type of vaccination received by the certificate holder 
 https://index.hu/belfold/2020/03/17/koronavirus_felajanlas_hotel_karantenkorhaz_nagy_elek/; https://www.sonline.hu/kozelet/helyi-kozelet/szallodai-karanten-a-siofokiaknak-2175003/;
 Government decree 488/2020 (XI. 11) http://njt.hu/cgi_bin/njt_doc.cgi?docid=222662.419599
 https://koronavirus.gov.hu/cikkek/kormanyinfo-vedettseget-igazolo-okmany-bevezeteserol-dontott-kormany, http://njt.hu/cgi_bin/njt_doc.cgi?docid=247540.420315