WHAT’S THE ISSUE AT HAND?
On 14 February 2021, almost one year after it detected the first imported case of COVID-19, Lebanon launched its national vaccination campaign. The campaign came shortly after a surge in confirmed cases that followed the 2020 holiday season, raising the total number of cases to 301,052 infections detected and 3,082 registered deaths by the end of January 2021.[1] As the vaccination campaign progresses, the number of confirmed cases is averaging 160 a day, a sharp decrease from the approximately 5,800 cases that were reported daily at the height of the outbreak.
 
Institutional setup
Following the first COVID-19 case detected in Lebanon on 21 February 2020, an inter-ministerial emergency COVID-19 response committee headed by the prime minister was established, including all the relevant ministers and other high-level officials.[2] Concurrently, a national emergency task force was formed to conduct weekly assessments of the epidemiological situation and support overall preparedness and response by improving “whole-of-society” coordination. A national communicable disease committee was also put in place as an advisory body of experts and relevant Ministry of Public Health (MoPH) staff to provide technical support on the spread of the virus.
 
On 6 November 2020, a COVID-19 Vaccine National Coordination Committee (NCC) was established to carry out the vaccination plan. The NCC includes senior-level MoPH officials, UN agencies and World Bank representatives, academic experts, and private sector partners. Its main role is to review and incorporate global-level guidelines related to COVID-19 vaccines into the vaccination plan, identify target populations for COVID-19 vaccines, and establish an operations room to coordinate, inform, and communicate with partners and the press. In accordance with the World Health Organization (WHO)/UNICEF/World Bank vaccine readiness assessments under VIRAT/VRAF 2.0,[3] seven national technical working groups were appointed to focus on one of the seven pillars of the preparedness tool: 1) prioritization, 2) targeting and population calculation, 3) service delivery, vaccine supply chain and logistics, 4) regulatory pathways, 5) training, supervision, and communication, 6) resources and funding, and 7) safety surveillance, monitoring, and evaluation.
 
Necessary regulations and policies
A legislative process paved the way for the deployment of vaccines. The Lebanese Parliament passed Law No. 211 on “Regulating the Emergency Use of Medical Products to Combat the COVID-19 Pandemic,” which sought to “shield healthcare providers, pharmacists, manufacturers, marketing certificate holders, and distributors of COVID-19 vaccines from [legal] liability for injuries associated with the development, management, or use of the vaccines (except in cases of serious injuries or death caused by intentional misconduct).”
 
Furthermore, the vaccines were exempted from customs and taxes under Decree No. 7445. Customs and port authorities, as well as all relevant entities, were directed to work together to facilitate customs clearance in order to speed up the importation of COVID-19-related medical products.

Vaccine procurement
At the start of the vaccination campaign, the Lebanese government was set to immunize 35% of its 6.8[4] million residents by the end of 2021, which would require the deployment of 4.83 million doses at a cost of USD 16.1 million. The ultimate goal of the national COVID-19 vaccination plan is to achieve high immunization levels in the community (equal to, or greater than, 80%).
 
Given the Lebanese government’s fiscal and operational constraints, the MoPH decided to involve the private sector in its vaccine initiative by authorizing 18 companies to negotiate directly for the Sinopharm, Sputnik V, and Oxford-AstraZeneca vaccines. By May 2021, 9.94 million doses had been reserved, enough to inoculate 73% of the population (MoPH: 6.19 M, COVAX: 2.73 M, private sector: 1.0 M, and 15,000 from the Indian government).
 
Funding
Using the budget allocated by UNICEF for routine vaccinations, as well as funds from its budget, the Lebanese government was able to make its first down payment to the COVAX platform.[5] On 21 January 2021, the World Bank approved Lebanon’s request to reallocate financial resources under the Lebanese Health Resilience Project[6] to support vaccine procurement and deployment. In doing so, the government secured USD 34 million for its vaccination campaign.
 
The MoPH will also rely on the contributions of some of its development partners, as well as readily available resources, to bring down operational costs.
 
Deployment
Through the help of a targeted media campaign aimed at mitigating vaccine hesitancy, residents of all eligible ages were encouraged to register on an online platform operated by the MoPH. A clear prioritization process was put in place based on the risk of exposure and developing severe disease.
 
As of 19 June 2021, 763,871 people (16% of the adult population) were vaccinated, 396,507 (8.3% of the adult population) of whom received their second dose, out of a total of 1,714,833 (25.1% of the adult population) registered residents on the MoPH platform. It is estimated that employer-based platforms (army, security forces, syndicates) will register an additional 15% of the total population.
 
In an attempt to speed up the deployment process, the ministry of health initiated a series of walk-in “marathons” (i.e., all day long). As of mid-June, the MoPH had organized three such events, the first of which lowered the eligibility age to 30 years and did not require pre-registration on the platform. These relaxed measures resulted in a high turnout, especially among non-Lebanese, who constituted 36% of the total 10,385 people vaccinated. The second marathon took place in rural areas in Akkar, Hermel, Bekaa, and Baalbek, targeting residents over 60, with lower than anticipated participation. The latest nationwide (two-day) marathon was designated for residents over 53, registering a total of 46,286 people who received the jab.


WHY IS IT IMPORTANT?
The COVID-19 outbreak has hit Lebanon hard at a time when the country is facing its most dire economic crisis in decades. The multiple lockdowns not only put an additional strain on most sectors of the economy, they also undermined public trust in national public health policies, as they were not initially successful in curbing the spread of the virus. Inoculating a large segment of the population (60-85%) to reach herd immunity[7] is a necessary pre-requisite for both reviving the economy and allowing society to return to some semblance of normality.

 
BACKGROUND
On 31 December 2020, the Pfizer-BioNTech COVID-19 vaccine was the first to be given emergency validation by the World Health Organization, approximately one year after the beginning of the outbreak. In the following months, a number of additional vaccines were also authorized, ushering in the start of a global vaccination campaign that is the largest in history. To date, about 2.4 billion doses of COVID-19 vaccines have been administered worldwide. Lebanon was one of the early recipients of the Pfizer-BioNTech vaccine, receiving its first shipment of 28,500 doses on 13 February 2021.


[1] According to the MoPH, the number of confirmed cases of COVID-19 as of 12 June 2021 has reached 543,371 cases and 7,819 related deaths. For updated data, you can visit the website of the ministry.
[2] It involved the Ministry of Public Health, the Ministry of Foreign Affairs, the Ministry of Social Affairs, the Ministry of Education and Higher Education, the Ministry of Public Works and Transport, the Ministry of Defense, the Ministry of Interior and Municipalities, the Ministry of Information, and the Disaster Risk Management Unit at the Prime Minister’s Office.
[3] The VIRAT/VRAF 2.0 are assessment tools developed by the WHO, World Bank, and partners to provide countries with an integrated roadmap of milestones and a framework for self-monitoring progress in preparing for vaccine introduction.
[4] According to Lebanon’s National Deployment and Vaccination Plan, the total population is estimated at 6,800,000, this includes 5,999,958 Lebanese citizens and registered refugees, and approximately 800,042 unregistered refugees and migrants.
[5] The COVAX program was launched in April 2020 by the WHO, the European Commission, and France in response to the COVID-19 pandemic, and is one of the three pillars of the “Access to COVID-19 Tools Accelerator.” It is designed to ensure rapid, fair, and equitable access to COVID-19 vaccines worldwide.
[6] The Lebanese Health Resilience Project is an initiative by the MoPH, in cooperation with the World Bank, to increase access for poor Lebanese and displaced Syrians in Lebanon to quality healthcare services and to support the COVID-19 response.
[7] According to the WHO, the exact percentage of people that must be vaccinated to reach herd immunity is still not known and could vary according to the community, the vaccine, the populations prioritized for vaccination, and other factors. For more information about the COVID-19 vaccination.