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 first shipment of Pfizer-BioNTech vaccine containing 4,800 doses arrived in Serbia on 22 December. The Serbian Agency for Medicines and Medical Devices approved the use and import of this vaccine on 18 December, after the two companies applied for the registration of the vaccine on 2 December. The first contingent of the Russian vaccine Sputnik V of 2,400 doses arrived in Serbia on 30 December and another 19,500 doses of vaccines produced by Pfizer-BioNTech arrived on 5 January 2021. The vaccination of health workers began on 30 December for staff working in infectious diseases clinics and emergency centres.
The president of the National Coordination Team for Immunization, State Secretary of the Ministry of Health Mirsad Djerlek explained on 4 January that in the first phase of vaccination against COVID-19, it is planned to vaccinate about 720,000 people. In addition to health workers, there are also users of gerontology centres and institutions of social care, then the elderly over 75, citizens aged 64 to 74 who have associated diseases (https://www.srbija.gov.rs/vest/en/165825/vaccination-of-11000-people-planned-until-end-of-week.php).
As of 7 January 2021, approximately 20 vaccination points in Belgrade have been established with the plan to set up the 110 vaccination points in general hospitals throughout Serbia in early January and to gradually increase the pace of vaccination in order to complete the first phase, within which are those older than 75. Within the second phase, it is planned to vaccinate from 11 to 21 percent of people, i.e., 740,000 new citizens: those older than 65 who are not included in the first phase, as well as employees in state administration, local self-government and educators and members of the Army and Police.
In the third phase, almost 1.7 million people will be vaccinated, citizens aged 50 to 64, regardless of the risk factors, and those younger than 50 who have risk factors.
The president of the National Coordination Team for Immunization said that in the second half of January, 500,000 doses of the Russian Sputnik V vaccine would arrive in Serbia, as well as large quantities of the Chinese vaccine (https://www.srbija.gov.rs/vest/en/165954/more-than-110-vaccination-points-throughout-serbia-from-tomorrow.php).
Prime Minister Ana Brnabic said on 10 January 2021 that Serbia has agreements with various manufacturers for eight million doses, which is enough for four million people. As of 11 January, citizens are able to apply to the electronic system through which they are able to express their desire to be vaccinated and as of 14 January, citizens will be able to apply through the contact centre. They have the option to say whether they want to be vaccinated with any vaccine that is approved or whether they want to be vaccinated with a certain vaccine. The Prime Minister informed on 10 January 2021 that the relevant Chinese institutions have approved the export licence for Sinofarm vaccines, and that an additional half a million doses of the Sputnik V vaccine are expected in Serbia.
The first shipment of one million doses of Chinese Sinopharm COVID-19 vaccine arrived in Serbia on 16 January and mass vaccination campaign started on 19 January with presentation of the a state-of-the-art system for application, scheduling and tracking of vaccines and the immunisation of the population of Serbia (https://www.srbija.gov.rs/vest/en/166398/mass-vaccination-in-serbia-starts-today.php).
By 25 of January many vaccination posts have been established throught the country with the biggest ones in Belgrade and Novi Sad Fair grounds.
As of 8 February, mass revaccination with the second dose of vaccines started at more than 200 checkpoints in Serbia.
On 9 February additional 50,000 Sputnik V vaccines and on 10 February, additional 500,000 Sinofarm vaccines arrived in Serbia, with arrivals of 88,000 doses of Pfizer vaccines arrived on 15 and 22 February.
On 14 February, the president of Serbia Aleksandar Vucic delivered to Prime Minister of Northern Macedonia Zoran Zaev the first consignment of coronavirus vaccines that Serbia donated to that country. In total 8,190 doses of Pfizer vaccines were delivered to Northern Macedonia from Serbia.
On 21 February 150,000 doses of AstraZeneca vaccines arrived to Serbia, making it one of the few countries in the world where citizens are able to choose between four different vaccines against the corona virus – the American-German Pfizer-BionTech, the Russian Sputnik V, the Chinese Sinofarm and the British-Swedish AstraZeneca. Prime Minister Ana Brnabic stated that Serbia had signed contracts for the purchase of 12,332,200 vaccines, and that around two million arrived in the country by 22 February.
On 28 February, in total 2.62 millions of vaccine doses arrived to the country, enough for vaccination of 1.3 million of people.
On 2 March Serbia donated 5,000 AstraZeneca vaccines to Bosnia and Herzegovina.
On 18 March, Serbia signed the Agreement on the supply of two more million doses of Sinopharm's vaccine from the Chinise company.
On 25 March, the Russian Direct Investment Fund (RDIF, Russia’s sovereign wealth fund) and Institute of Virology, Vaccines and Serums Torlak announced that they reached an agreement on the production of Sputnik V vaccine against coronavirus, in Serbia. According to a statement from the Office of the Minister without portfolio in charge of innovation and technological development, Serbia will become the first country in Southern Europe to produce Sputnik V. The vaccine could be exported to other countries of the region at a later stage. The production of Sputnik V is due to start by May 2021 at facilities of Institute Torlak. Torlak is Serbia’s national vaccine producer supplying healthcare institutions in the country with vaccines for the compulsory immunisation programme. The first batch of Sputnik V was delivered to Serbia on December 30, 2020 and the vaccination against coronavirus with the Russian vaccine started in Serbia on 6 January 2021.
The first 57,600 doses of Astra Zeneca vaccines through the COVAX program arrived in Serbia on 2 April 2021.
The Minister for European Integration Jadranka Joksimovic, Minister of Health Zlatibor Loncar, Head of the EU Delegation to Serbia Sem Fabrizi and Director of the UNOPS Office in Serbia Michela Telatin signed on 29 December the Agreement on strengthening the health system for vaccination against COVID-19 and of the capacity for the delivery and provision of the cold storage chain.
The agreement redirected the use of €3.2 million from two programmes whose beneficiary is the Ministry of European Integration, whose purpose has been the strengthening of the local economic development.
The funds will be used to meet all the prerequisites for safe vaccination, such as providing a cold chain for vaccines, and therefore 20 ambulances, 26 special vans, refrigerators and devices for deep cooling will be procured. The second part will be invested in strengthening the capacity of the health system, in the procurement of 40 triage containers, as well as for 200 health workers, whose contracts will be extended for another three months. Part of the money will be set aside for 3,600 hygienic sets for the Roma community, and for disinfection of approximately 5,000 schools and kindergartens.
In February the government designated 4 hospitals as points of treatment for COVID-19 cases (the Clinic for Infectious and Tropical Diseases of the Clinical Centre of Serbia in Belgrade and the Clinics for Infectious Diseases in the Clinical Centres of Vojvodina, Nis and Kragujevac). With an increase in the number of cases on 16 March, five more hospitals were designated to deal exclusively with COVID-19 patients (three in Belgrade, one in Nis and one in Novi Sad) (https://www.srbija.gov.rs/vest/451398/zdravstvene-ustanove-zbrinjavaju-samo-hitne-slucajeve.php).
According to the current initial algorithm, the patient must have had to have direct access to a general practitioner in primary care, preferably their “chosen doctor”, over the phone. During the initial phone call, the primary care physician would takes epidemiological data and assess the severity of symptoms. For persons suspected to have COVID-19 who werare older than 60 years and for persons with an underlying condition or comorbidity, the first examination hads to be conducted. In all other persons, if the physician, according to the patient's statement obtained by telephone, estimateds that it is a mild clinical presentation (temperature lower than 38° C and a cough without difficulty breathing), no clinical examination wasis necessary.
In case the doctor during the examination of the patient or during the monitoring period of the patient suspecteds a deteriorating health condition or if there wasis a risk of severe acute respiratory illness, they would refer the patient to the relevant infectious dieasedisease department for further examination and treatment. Testing and treatment of cases wereare performed only in designated hospitals.
On 10 March, the Ministry of Health published the list of phone numbers in all district Institutes of Public Health in Serbia as the first point of contact for patients with respiratory infections symptoms who had a history of travel to COVID-19 affected areas (https://covid19.rs/). On 18 March, the Ministry of Health established designated examination rooms for patients with symptoms of respiratory infections in all Primary Care Centres in Serbia. Phone numbers of designated examinations rooms are available to patients 24/7. On 25 March, the national COVID-19 info line has been established where patients can get all relevant information and directions related to COVID-19 (https://covid19.rs/%).