COVID-19 vaccines reduce morbidity and mortality, but mass vaccination faces multiple challenges leading to different vaccination rates in different countries.
Malta, a small European country with a total population of more than 500,000, has achieved a very rapid vaccination rollout.
The Coronavirus outbreak presented a major challenge to the entire European Union. National, regional, and local communities were on the frontline in countering the disease and its consequences. The Maltese Government acted promptly to put in place measures to minimize the impact of the COVID-19 pandemic, thus ensuring that the economy returns as quickly as possible to the path of economic growth.
To assist with the significant weight on national health systems, the EU intervened with different measures aiming at making ESI Funds more flexible and easier to use in order to tackle the Covid-19 pandemic. In April 2020, the Commission launched two packages of measures: the Coronavirus Response Investment Initiative (CRII)
and the Coronavirus Response Investment Initiative Plus (CRII+), which were swiftly endorsed by the European Parliament and the European Council. By means of these
measures the Commission agreed to make money available for fighting the crisis, by quickly mobilizing cash reserves from the European Structural and Investment Funds
(ESIF) – the EU;s cohesion money to provide immediate liquidity to Member States’ budgets. The CRII and CRII+ initiatives also resulted in greater flexibility for countries
to reallocate financial resources from the Cohesion Policy budget, making sure the money is spent in the areas of greatest need i.e. the health sector, support for SMEs, and the labour market. These funds could be deployed and used according to already existing Cohesion Policy rules.
This was further supplemented on 27th May 2020 with the presentation of the REACT-EU package. Existing funds have been re-oriented and new funds made available in all EU countries and regions to tackle the crisis.
The Maltese Government has promptly responded and used the CRII and CRII+ flexibilities to tackle the COVID-19 epidemic. In fact, in December 2020 an agreement was reached with the Commission to make eligible for support under ERDF COVID-19 adopted measures and particularly, to support the health expenditure incurred in connection with actions implemented as crisis-response measures to the COVID-19 outbreak, including vaccines. This decision aimed at making the best use of unspent funds and facilitating the acceleration of program implementation by resulting in a frontloading of payment appropriations.
With the launch of Call 12 under Operational Program I, assisting the Ministry for Health to mitigate the health impacts brought about by the COVID-19 pandemic, Malta was able to benefit from a grant of €13,810,622.00 in the form of a reimbursement under ERDF 08.990/1 for expenditure incurred on the number of vaccines procured up to the 15th November 2021. This amount has been verified
and certified by Malta’s Managing Authority for EU Funds.
Early in 2020, Malta was -one of the countries that pushed for European Commission joint procurement including funding for the eventual development of COVID-19
vaccine/s. As vaccines become available in the last quarter of 2020, and later approved by the EMA, Malta was able to acquire sufficient vaccines to cover the entire population. The Maltese authorities obtained the maximum vaccines doses that were eligible from all manufacturers through the European Commission joint procurement processes led by the European Union on behalf of Member States.
The European Commission’s strategy enabled Malta to secure enough vaccines for the entire eligible population from various sources and overcome any logistic vaccination problems that might have arisen due to production or shipment delays from any single manufacturer.
Malta follows the objectives of vaccination strategies against COVID-19 as directed by the European Centre for Disease Prevention and Control (ECDC). By beginning of August 2021, 398,128 of the population were fully vaccinated and 405,073 received the first dose of the Pfizer, Moderna, Johnson & Johnson or AstraZeneca vaccine, with both morbidity and mortality declining progressively as vaccination coverage progressed.
As a result, Malta adopted a just-in-time rollout strategy ensuring the best possible use of vaccination throughput and vaccine-brand mix. This strategy resulted in a
flexible and agile approach towards the administration of the vaccines. Various designated vaccination sites, selected within strategic locations across Malta and Gozo, were transformed, alongside hospitals and general practices, in a relatively short time.
To prepare and administer the vaccines, various multidisciplinary teams, comprised of medical and non-medical staff, were trained to participate in this mass vaccination roll-out.
Among these teams, one could find members of the disciplinary forces, medical students, active and retired healthcare workers as well as many volunteers.
A very robust and real-time inventory distribution system ensured that enough stock of equipment, necessary for vaccination, was always available. This included dead-
space syringes and needles to extract the doses from vaccine vials during the just-in-time preparation of the vials designed to ensure that the exact number of vials are
removed from freezers for thawing to be used the following day. Malta’s consistent objective was always to retain the current momentum and vaccinate as many people as possible, in the shortest possible timeframe.
The positivity and mortality rates were substantially high during the end of the year 2020 and the first three months of the subsequent year 2021. However, with the institution of a partial lockdown on the 10th March 2021 and rapid vaccination rates, a drop in morbidity, mortality and hospital admissions were observed within two weeks. Indeed, as vaccination coverage increased and the elderly population was inoculated, both positivity and the mortality rates declined.
As at today, Malta has administered at least 1,233,948 doses of COVID-19 vaccines.
Assuming every person needs 2 doses, that’s enough to have vaccinated about 122.7% of the country’s population.
The strategy adopted by Malta, together with the financial support recovered from the EU under this project, has enabled this small European country, to be one of the
initial countries with the highest vaccination rollout. Malta has successfully implemented a COVID-19 strategy covering a substantial proportion of the population over a short period of time, with herd immunity (70% of the population inoculated with at least a single dose) through a single dose on the 19th May 2021. Low population vaccination hesitancy and high vaccine doses availability were two major factors in
this success.
