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
Update 5th April 2021
From available data, only 0.9 per cent of all those who received the Pfizer or the Moderna vaccine were infected with COVID-19 more than 14 days after the first dose and only 0.6 per cent who received a second dose of Pfizer vaccine tested positive for COVID-19. None of those who received both doses of the Moderna vaccine are known to have contracted the virus. Only 0.4 per cent of persons who received the first dose of the Astra Zeneca vaccine got infected after 14 days of taking it. Details on the impact of the second AstraZeneca dose will be available once the booster shots begin to be administered after 8-12 weeks of the first dose.
Update 1st April 2021
As of 31st March 2021, Malta had administered 191,716 vaccine doses, of which 53,540 were 2nd doses (Ministry for Health Social Media Update 31st March 2021). One third of the Maltese population has now received at least one dose of a vaccine.
The vaccination rollout in Malta has generally run smoothly so far and is ahead of the planned rollout as outlined in the national strategy. Malta is one of the leading countries in Europe and globally in terms of the percentage of the population vaccinated. The supply of vaccines has been the limiting factor influencing the speed of roll out so far. It is expected that once supplies increase, the daily rate of vaccination can match the supply.
As of 31st March 2021, four COVID-19 vaccines have been authorised for use in EU countries by the European Medicines Agency. These include the Pfizer/BioNTech vaccine (authorised 21st December 2020), the Moderna vaccine (6th January 2021), the AstraZeneca vaccine (29th January 2021) and the Johnson & Johnson vaccine (11th March 2021).
All Maltese citizens and all residents of Malta with a valid residency card are eligible to receive a COVID-19 vaccine, free of charge.
A priority list has been established detailing the order in which population groups will receive the vaccine, starting with people who are most at risk from the complications of COVID-19 infection. No major changes have been made to the initial plans, although there was revision of the priority age groups by Advisory Committee on Immunisation Policy (ACIP) to include over 60s, in view of emerging evidence. Educators were also prioritized to the top of the third group for vaccination in an agreement between government and the teachers’ union. Additionally, the Astra Zeneca vaccine was initially only earmarked for use in persons up to the age of 55 years of age and was being administered to essential workers within this group. However, when evidence of efficacy in older age groups emerged, this age was increased to 70 years upon recommendation of the ACIP.
Priority groups to receive the vaccine are:
• Health and long-term care workers
• Persons living in long-term care facilities
• Persons 85 years and over
• Other “frontliners” (e.g. police)
• Persons 80-85 years
• Persons with a chronic disease that places them at risk of COVID-19 complications
• Persons 70-80 years of age
• Staff at schools and child-care centres
• Persons 55 years and over
• Rest of the population
A second dose has been/is reserved for every person receiving a first dose.
Vaccinations (as of 31st March 2021) have now started in persons aged 60 and over. The current aim is to vaccinate 70% of Malta’s population by September.
40 vaccination centres have been established at a number of locations, including the national immunisation centre, health centres, health clinics, council offices, armed forces headquarters and academy, police headquarters, university campuses and the Malta College of Arts, Science and Technology (MCAST). These facilities were set up to speed-up the vaccination process, especially once supplies of vaccines not requiring very low temperatures for storage became available, with large vaccination centres also opened to facilitate physical distancing between attenders. Older people in institutions have been vaccinated on site and a home service is being provided to individuals receiving treatment at home, through their usual health care service provider.
Governance, procurement and storage:
The roll out of the vaccination strategy and its operational governance falls under the responsibility of the Office of the Chief Operations Officer of Mater Dei Hospital, in conjunction with the Primary Health Care Department and its component National Immunisation Service and Pharmacy Services.
Co-ordination for acquisition of vaccines is being done through the Joint Procurement Mechanism of the EU Commission, since Malta forms part of the European Union Joint Procurement initiatives for COVID-19 vaccinations and medical supplies. The supply, transport, storage and cold chain and distribution is being led and coordinated by the Central Procurement and Supplies Unit of the Ministry for Health. Orders for vaccines were placed from a number of suppliers to ensure coverage for the whole population.
The Central Procurement and Supplies Unit has ensured that the requirements for maintaining the vaccines at the required storage conditions, as recommended by each manufacturer, were met. Continuous temperature mapping and alarm facilities for constant monitoring of each cold store and procedures for ensuring cold chain is maintained are in place.
Administration of vaccines (health professionals):
Vaccines are being administered by nurses and other healthcare workers, including students. Private family practitioners have been invited to join the national vaccination system on a voluntary basis, allowing them to administer vaccines privately to their patients. This will be implemented in the near future.
Appropriate medical equipment and medical treatment for anaphylaxis are available at all vaccination centres with planned supervision of medical staff according to vaccine manufacturer instructions.
In light of the spread of the pandemic, health services have been significantly altered and reconfigured. In the primary care setting, as mentioned previously (see section 2.1) many private GPs have shifted towards using telemedicine and providing telephone consultations and they have been supported in their decisions by the professional council. Electronic prescriptions and electronic submission of sickness certification have supported these practices. Primary care within state health centres has reorganised to also carry out a medical triage assessment of possible cases of COVID-19 over the telephone. Where possible, suspected cases are swabbed if the medical condition permits, otherwise house visits take place with full PPEs. The acute hospital has duplicated its emergency room to cater for COVID-19 and non-COVID-19 persons with the aim of decreasing contagion between patients. Temperature measurement of staff and patients entering all health facilities takes place rigorously in an attempt to identify those at potential risk.
Government of Malta. COVID-19 information page. (13/03/20). https://www.gov.mt/en/Government/DOI/Press%20Releases/Documents/ISSUE03_ENG_14032020.pdf
Government of Malta. COVID-19 information page. (14/03/20). https://www.gov.mt/en/Government/DOI/Press%20Releases/Documents/ISSUE03_ENG_14032020.pdf