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
MOH is responsible for planning of the rollout of COVID-19 vaccine. The Centre for Health Emergencies (ESSC) is responsible for the first stage of the vaccine rollout. Main functions involve receiving and storing vaccines delivered to Lithuania, monitoring stocks and ensuring timely distribution to vaccination centres. A procedure for the purchase of appropriate freezers that ensure extra-low temperature has been launched, and in March 2021 Lithuania has 8 locations suitable for storing Pfizer vaccines, to enable distribution to vaccination centres. The ESSC also organizes the purchase of equipment and safety products needed for vaccination (syringes, disposable masks, gloves, disinfectant wipes, etc.), costing around 570 thousand euros. As of March 2021, there is an adequate amount of necessary equipment to match the current vaccine supply, however scaling up may be difficult to do global demand for more equipment. Every vaccination centre needs to be equipped with the necessary medication to provide first aid in the event of anaphylactic shock.
Lithuania purchases vaccines jointly as part of the EC procurement mechanism. By November 2020, pre-contracts have already been signed with four pharmaceutical companies that are completing clinical trials and can submit their vaccines for registration in the coming months. Lithuania aims to acquire enough vaccines to immunise 70 percent population, while diversifying vaccine purchases among several manufacturers. (2)
On 2nd December, the Cabinet of Ministers approved the European Commission's proposal to participate in the conclusion of the sixth preliminary agreement with the manufacturers of the COVID-19 vaccine - this time with the pharmaceutical company Moderna. According to the agreement with Moderna, Lithuania would receive nearly 500,000 doses. Lithuania will purchase 10,000 additional doses of COVID-19 vaccine from Moderna (5). The government decided to purchase more than 16 thousand additional doses of the vaccine from the pharmaceutical company Novavax. Lithuania will receive a total of 633,000 doses of vaccine from this manufacturer, and their supply should begin as early as the second quarter of this year. (6)
The pharmaceutical companies with agreement to provide vaccines for Lithuania included (3):
• AstraZeneca (1.86 million doses);
• Janssen Pharmaceutica NV (purchase of 1.24 million doses of vaccine was approved, but this number was reduced to 700,000, transferring the surplus to other EU countries);
• Sanofi Pasteur & GSK (1.5 million doses);
• BioNTech & Pfizer (1.24 million doses);
• Moderna (0.5 million doses);
• Novovax (0.6 million doses);
• CureVac (1.4 million doses).
Import of COVID-19 vaccine doses, approximate numbers by 31st March 2021:
BioNTech / Pfizer: 301,525
On 1st April vaccination programme statistics are as follows (19):
Total number of vaccine doses received: 642,365
Number of doses of vaccine used: 568,777
Number of people who received one dose: 392,316 (14.0%)
Number of people who received two doses: 176,461 (6.3%)
On 7th December, the Head of Operations of the State Operations, acting Minister of Health, issued an order which tasked the Directors of Municipal Administrations with appointing a coordinator (municipal medical doctor or other administrative staff) to manage COVID-19 immunisation process in each municipality.(4)
Each municipality has a vaccination coordinator - a municipal doctor or other administrative employee who will coordinate the vaccination process in a particular municipality and the personal health care institutions that will organize the vaccination of priority groups. Designated coordinators will organize coronavirus vaccination in treatment facilities in their municipalities. To ensure a smooth vaccination of the population, MOH experts will work closely with the coordinators. On 7th December, the Head of Operations of the State Operations, acting Minister of Health, issued an order which tasked the Directors of Municipal Administrations with appointing a coordinator (municipal medical doctor or other administrative staff) to manage COVID-19 immunisation process in each municipality. (4) (as we stated earlier in the text). They are becoming responsible for vaccine administration (e.g. some vaccines require special syringes to ensure complete use) as well as supplies to address adverse events due to vaccination (e.g. epi-pens for anaphylactic shock).
On 23 March 2021, during a remote meeting of the Ministry of Health with mayors of cities and districts, municipal coordinators and representatives of health care institutions organizing vaccination, it was agreed that vaccination of the population should also take place on weekends, seeking to increase immunisation rate. (20)
Vaccination roll out and priority groups
Vaccination programme in Lithuania has started on 27th December with BioNTech/Pfizer vaccine in 5 vaccination centres which are located in designated hospitals treating COVID-19 patients. On 8th of January 2021, once EMA approved the use the sixth dose of BioNTech and Pfizer vaccine, health professionals in Lithuania were also able to use the additional doze contained in a package. (8)
Vaccination is available to eligible residents, including foreigners who are permanent residents of Lithuania and / or who are insured with compulsory health insurance. Vaccination is given free of charge and, as of March 2021, only available through public providers. There are plans to allow pharmacists to vaccinate people at later stages (upon completing additional training) to speed up the programme implementation.
The priority list is based on the recommendations of the Council of Experts formed in December 2020 and adopted by the MOH (7). On 15th February, MOH has updated the COVID-19 vaccination plan in line with the vaccine delivery plans submitted by pharmaceutical companies AstraZeneca, BioNTech and Pfizer and Moderna. If manufacturers ensure a stable supply of vaccines, the updated vaccination plan aims to vaccinate people over the age of 65 in the first quarter of 2021, and mass vaccination to begin in May 2021. Following the recommendations made by the WHO, the State Medicines Control Service and the Advisory Council of Independent Experts, a decision has been taken to vaccinate individuals over the age of 18 with the AstraZeneca vaccine (including those over 65) allowing 12 weeks between the first and second vaccinations. (9) The length of the programme is planned on 60% uptake in eligible groups, and immunising people who had COVID-19 three months after the diagnosis.
The order of prioritization and implementation (March 2021) (10):
Group Timeline (2 doses) Status
1. Health professionals involved in treatment of COVID-19 January 2021 Completed
2. highest-risk patients January – February 2021 Completed
3. volunteers involved in treatment of Covid-19 January – February 2021 Completed
4. employees of mobile units and fever clinics; health care and municipal vehicle drivers who have contact with COVID-19 patients.
January – February 2021 Completed
5. Long-term care residents, staff and volunteers January – February 2021 Completed
6. Social care staff, volunteers, carers and residents of social care institutions; child services staff; assistants of disabled persons; sign language translators Completed
7. staff in laboratories performing COVID-19 testing; January – February 2021 Completed
8. experts working on COVID-19 outbreak investigations January – February 2021 Completed
9. Other health care workers and students not working directly with COVID-19 patients January – February 2021 Ongoing
10. pharmacy staff; January – February 2021 Ongoing
11. Military and intelligence personnel participating in military and international operations January – February 2021 Ongoing
12. Members of the Tokyo Olympic and Paralympic teams February – March 2021 Ongoing
13. Cancer and HIV patients February – March 2021 Ongoing
14. Teachers in kindergarten, pre-school, primary school and special needs education teachers; February – March 2021 Ongoing
15. People aged 80+ February – June 2021 Ongoing
16. People aged 75-79 February – June 2021 Ongoing
17. People aged 70-74 March – June 2021 Ongoing
18. People aged 65-69 March – July 2021 Ongoing
19. People with chronic diseases April – July 2021 Ongoing
20. Patients of specialized inpatient psychiatric clinics undergoing compulsory treatment; April – June 2021 Ongoing
21. Key workers performing essential functions; April – July 2021 Ongoing
22. Remaining residents May onwards Ongoing
From 13th of January, due to issues with adhering to priority groups and managing the lists of those eligible for vaccination, heads of municipal administrations are responsible for the vaccination programmes in all health care establishments in their municipality. (11) In order to ensure a smooth process, vaccination centres will now have to draw up lists of not only people to be offered vaccination, but also reserve lists of individuals who could be vaccinated in cases where for objective reasons it would not be possible to vaccinate people on the main list. (12) Residents who fall into priority groups but were not invited to be vaccinated can enquire with their GP or through municipality.
Around 20th January, Lithuania has 5th highest vaccination rate among the EU countries. (13)
By early February it was reported that 90% of residents of social care institutions and 80% of staff working there have been immunised. (14) However, an outbreak was recorded in February at one of the care homes, with 14 out of 15 testing positive using PCT test thought to have been immunized with two doses of Pfizer vaccine, with two weeks passing from the 2nd vaccination. The NVSC is investigating the causes of the outbreak, including looking into vaccination process. So far the serological tests showed that all newly infected people had COVID-19 antibodies, including a person who was not immunized. (15)
On 4th of February, the Ministry of Education, Science and Sport announced that vaccinations for teachers are not compulsory, and those who refuse to receive vaccination cannot be dismissed, but they would have to undergo testing every 10 days. (16)
By 25th of February 2021, vaccination of the first priority group, healthcare workers, with 2 doses has been completed, with vaccinating more than 60,000 people (over 75% coverage). (17)
MOH constantly monitors vaccination process across the EU. On 9th March 2021, the State Medicines Control Service received information on suspension of AstraZeneca batch ABV5300 in Austria. By that time Lithuania received 9600 doses from the same batch, with 1932 doses remaining unutilised. Vaccination with those has been suspended.(21) Vaccination with AstraZeneca vaccine, other than suspended batch, was briefly suspended between 17th and 18th March, pending EMA decision on the vaccine safety (22). This move resulted further increased vaccine hesitancy among the priority groups (23). Following low uptake among groups allowed to be vaccinated, calls were made, including by the Minister of Interior, as well as the mayor of Vilnius, to expand vaccination programme to other groups, or allow mass vaccination.(24) Thus, programme was expanded at the end of March to teachers and pupils taking final school exams.(25)
On 10th March 2021, the Ministers of Health of Estonia, Latvia and Lithuania invited the European Commission to establish a transparent temporary mechanism for the redistribution of vaccines between the Member States of the European Union, taking into account the exceptional epidemiological situation and circumstances in which surplus vaccines may remain unused after the expiry of the vaccines.
Issues have been raised in the media regarding access to vaccination for cancer patients. The process for them is organised through their cancer treatment providers, meaning that for many vaccination is not available locally and they need to travel to a specialised centre. There is also variation across providers on how patients are selected and notified. (18)
Relevant information on vaccination: https://koronastop.lrv.lt/lt/vakcinavimas
COVID-19 vaccine deliveries to Lithuania (constantly updated): https://sam.lrv.lt/lt/naujienos/sam-informuoja-apie-covid-19-vakcinos-pristatymus-i-lietuva-nuolat-atnaujinama
On 29th January it was planned that the suspected 2019-nCoV would be isolated in the six health facilities across the country, which were designated to see COVID-19 patients, and which were considered to be equipped to deal with the infection risk and high dependency (also see section 2.1). As the number of cases has increased in March this was adapted, and patients diagnosed with a mild form of coronavirus infection remained at home if the isolation requirements were met. In hospitals, there are plans to have designated wards and intensive care departments allocated to deal specifically with COVID-19 patients.
Routine consultations with GPs and nurses can be conducted remotely. Medical prescriptions and supplies can also be extended remotely. Disability certificates for quarantine, trauma or illness can also be issued remotely. All decisions on disability, level of working capacity and special needs that expire during quarantine will be automatically renewed throughout the quarantine period and for a further 3 months after the end of quarantine. The same would apply if the decision expires shortly after the quarantine, which means that a decision on disability has been made for 3 months from the date of the end of the quarantine.(1) MEDO platform, run by volunteer medical doctors, was created to answer questions people may have regarding their health.