Policy responses for Switzerland - HSRM


Policy responses for Switzerland

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

On March 13, the Federal Council took measures to ensure the efficient use of healthcare infrastructure across cantons and to prevent overloading in individual cantons. It obliged the cantons to provide the Confederation with up-to-date information on the total number and utilisation of hospital beds and ventilation equipment, stocks of personal protective equipment and the availability of medical staff. However, in general, Cantons are free to organise the cantonal response to COVID-19, which means that the organisation of testing and treatment varies widely across cantons (see section 1.5).

On March 20, the Federal Council imposed a more detailed ban on non-urgent medical procedures in hospitals. Healthcare facilities, in particular hospitals and clinics, medical practices and dental surgeries, were prohibited from carrying out medical examinations, treatments and therapies (interventions) that were not urgently indicated (see section 3.3).

The FOPH is encouraging doctors and hospitals to offer teleconsultations and provided information on the existing tariff structure that allowed reimbursement of teleconsultations. However, hospitals and doctors’ offices were free to decide whether or not to offer teleconsultation services.

In order to free acute care hospital capacities, patients could be discharged to rehabilitation facilities without obtaining prior approval from their health insurer (see section 4.1).

Planning for vaccination
On August 7, it was communicated that the federal government has concluded an agreement for the procurement of vaccine doses from the biotech firm Moderna, which is already at an advanced stage with its vaccine project. If the vaccine successfully passes the clinical trial phase and can be approved for the Swiss market, Switzerland will receive 4.5 million vaccine doses. It is expected that two vaccine doses will be necessary for one person, meaning that it will be possible to vaccinate 2.25 million people. Besides the conclusion of the agreement with Moderna, the federal government is still holding further talks with other companies working on vaccines in order to increase chances of rapid and secure access to vaccines. The Federal Council has allocated a total of CHF 300 million for the procurement of the vaccine. On November 11, 2020, the Federal Council decided to increase this amount by 100 million francs in order to have sufficient leeway for further procurements.

Additionally, on October 16, 2020 the Swiss federal government concluded an agreement with AstraZeneca and the Swedish government for the delivery of up to 5.3 million doses of vaccine. The Swiss public will therefore gain access to a further Covid-19 vaccine – provided it successfully passes the clinical trial phase and is approved by Swissmedic.

In September 2020, Switzerland confirmed its participation in the COVAX programme (COVID-19 Vaccine Global Access Facility). This is intended to secure vaccines for 20 percent of its population. Switzerland is contributing CHF 20 million.

By 11 February 2021, the federal government had signed agreements with five vaccine manufacturers:
• Novavax: 6 million doses of vaccine
• Curevac: 5 million doses of vaccine
• Pfizer/BioNTech: 3 million doses of vaccine
• AstraZeneca: 5.3 million doses of vaccine
• Moderna: 13.5 million doses of vaccine

On December 19, 2020 Swissmedic, the Swiss Agency for Therapeutic Products,  granted authorization for the Pfizer/BioNTech vaccine and on January 12, 2021 the vaccine from Moderna was approved. Approval for other vaccines is still outstanding.

The first doses of the vaccine were delivered in December 2020 to Switzerland, stored by the army pharmacy, and then distributed to the cantons. After that the cantons were able to start vaccinating vulnerable groups in targeted and supervised settings.

this website provides information on received vaccine doses, doses distributed to the cantons and administered vaccine doses in Switzerland: https://www.covid19.admin.ch/en/overview  

Organization of registration for vaccines differs between cantons (for information, please see: https://foph-coronavirus.ch/vaccination/when-can-i-be-vaccinated/#cantons) 

From 4 January 2021, the vaccination of vulnerable groups and other priority groups was planned to start all over Switzerland. The canton of Lucerne was the first to start vaccinating, on December 23, 2020.

Coming into force on Janaury 1, 2021, the Federal Department of Home Affairs (FDHA) made an amendment to the Health Insurance Benefits Ordinance (KLV), according to which vaccination against COVID-19 will be covered by the mandatory health insurance. The costs that are not covered by health insurance are borne by the federal government and the cantons.

If someone does not have health insurance in Switzerland the COVID-19 vaccination is also free of charge if the person:
 lives in Switzerland and, for example, works for a diplomatic or consular representation or an international organization.
 lives in Switzerland as an employee on secondment, a student or pensioner.
 is a cross-border commuter and is exposed to a risk of infection at work (e.g., healthcare personnel with patient contact or care staff in retirement and care homes).

For these groups the costs of the COVID-19 vaccination will be covered by the Swiss federal government.

Mid-December 2020, the Federal Office of Public Health (FOPH) and the Federal Vaccination Commission (EKIF) defined the vaccination strategy that will apply to COVID-19 vaccinations.

Priority for vaccination is to be given to the following target groups:

Target group 1: especially vulnerable people

The following people are being given access to vaccinations first:
• people aged 75 and over
• people with chronic diseases of the highest risk, regardless of their age
• people who live in a retirement or care home. Staff who are in contact with residents of retirement and care homes also have the option of being vaccinated at the same time.

After that come:
• people aged between 65 and 74
• people under 65 with chronic diseases who have not yet been vaccinated

After vaccination of high risk groups (vulnerable people), the vaccination will also be offered to the following target groups in the corresponding order:

• Target group 2: Healthcare professionals with patient contact/carers for people at especially high risk,
• Target group 3: Close contacts (household members or relatives providing care) of people at especially high risk,
• Target group 4: People in communal facilities with an increased risk of infection and outbreaks (for example homes for the handicapped).

These priorities are being put into practice differently from canton to canton. In particular there are differences in the vaccination of healthcare professionals. For this reason the Federal Vaccination Commission and the FOPH have drawn up guidelines specifying which groups of healthcare professionals are to be vaccinated at the same time as especially vulnerable people (target group 1). Given that vaccine volumes are stil limited, the goal is to assure the provision of healthcare in areas that are particularly affected while making sufficient vaccine available for especially vulnerable people at the highest risk.

Once sufficient vaccine is available, adults who are not in target groups 1 to 4 as described above will also be able to have the vaccination.

Currently there are no plans to vaccinate children or to make COVID-19 vaccination compulsory.

Every person who has been vaccinated receives a written, signed proof of vaccination in paper form, which can be transferred to a paper vaccination record (“Impfbüchlein”) by a health professional at a later date upon presentation of the signed proof. The proof contains information on the vaccine administered (for example trade name, manufacturer and lot number).

COVID-19 vaccinations can also be documented electronically, which is voluntary. Vaccination data will be recorded at www.myvaccines.ch in the Swiss electronic vaccination record (e-vaccination record).

Sources and links:

• March 13 announcement of federal measures against coronavirus: https://www.admin.ch/gov/de/start/dokumentation/medienmitteilungen.msg-id-78437.html
• March 20 announcement of federal measures against coronavirus: https://www.admin.ch/gov/en/start/documentation/media-releases.msg-id-78513.html
• Ordinance on Measures to Combat the Coronavirus (COVID-19): https://www.admin.ch/opc/en/classified-compilation/20200744/index.html#a10a 
• August 8 FOPH new release on vaccination procurement: https://www.bag.admin.ch/bag/en/home/das-bag/aktuell/medienmitteilungen.msg-id-80005.html
• Coronavirus Vaccination: https://www.bag.admin.ch/bag/en/home/krankheiten/ausbrueche-epidemien-pandemien/aktuelle-ausbrueche-epidemien/novel-cov/impfen.html
• Coronavirus: Federal Council increases credit for Covid-19 vaccine procurement: https://www.bag.admin.ch/bag/de/home/das-bag/aktuell/medienmitteilungen.msg-id-81070.html
• COVID-19 vaccine: federal government signs contract with Pfizer: https://www.bag.admin.ch/bag/en/home/das-bag/aktuell/medienmitteilungen.msg-id-81495.html 
• COVID-19 vaccine: federal government secures additional doses of vaccine from Moderna: https://www.bag.admin.ch/bag/en/home/das-bag/aktuell/medienmitteilungen.msg-id-81515.html 
• Swissmedic grants authorisation for the first COVID-19 vaccine in Switzerland: https://www.bag.admin.ch/bag/en/home/das-bag/aktuell/medienmitteilungen.msg-id-81761.html 
• Die Impfung gegen COVID-19 wird für die Bevölkerung kostenlos sein: https://www.bag.admin.ch/bag/de/home/das-bag/aktuell/medienmitteilungen.msg-id-81514.html 
• Coronavirus: Vaccination: https://www.bag.admin.ch/bag/en/home/krankheiten/ausbrueche-epidemien-pandemien/aktuelle-ausbrueche-epidemien/novel-cov/impfen.html#-368996953
Covid-19-Impfstrategie: Besonders gefährdete Personen sollen zuerst geimpft warden: https://www.bag.admin.ch/bag/de/home/das-bag/aktuell/medienmitteilungen.msg-id-81667.html