The Pfizer-BioNTech COVID-19 vaccine. (Credit: Sebastien Bozon/AFP)
BEIRUT — The mid-February deadline for the first batch of COVID-19 vaccine arriving in Lebanon looked closer to reality Wednesday after a parliamentary committee approved a draft law for its emergency use.
Since November, caretaker Health Minister Hamad Hassan has repeated that Lebanon would begin importing 2.1 million doses of coronavirus vaccine “no later than February 2021” — thanks to an agreement to obtain the Pfizer-BioNTech vaccine, developed by a US pharmaceutical giant and a German biotech company.
A final deal looked set to be signed last week: a $4 million deposit had been paid and the president and caretaker prime minister had given their approval. But then a legal snag put a spanner in the works.
In order to sign a contract with the Lebanese government, Pfizer reportedly demanded that it not be held responsible for any adverse side effects. This is because its vaccine is administered under emergency use authorization, which requires less data than usual for approval.
A law permitting the use of emergency vaccines did not exist in Lebanon, so Parliament’s Public Health, Labor and Social Affairs Committee had to write one in just a couple of days.
The urgent draft law was approved by the body after a five hour session, committee member Fadi Alame (Amal/Baabda) told L’Orient Today.
It grants a two-year warrant for emergency use of all coronavirus vaccines, paving the way for the government to potentially sign contracts with other producers further down the line.
It is divided into three main parts, Alame explained: waiving liability for pharmaceutical companies, importers and health care staff who administer the vaccines; creating a committee to evaluate potential side effects and whether they merit compensation; and designating a fund that will pay out financial compensation in the case of serious side effects.
However, committee chair Assem Araji (Future/Zahle) stressed, “So far, the side effects have been found to be minimal — things like slight fever and aches.”
After two years, the responsibility for any adverse effects will lie squarely with the producing companies.
The full Parliament is set to meet in UNESCO Palace on Friday to vote on the draft law.
Alame said he expected it to be passed, as the health committee is made up of MPs, many of whom are themselves health professionals, from across the political spectrum.
“Each one of us will go to our respective parliamentary bloc to convince them that we have no other option but to pass this law,” he said, pointing to the surge in coronavirus cases and hospitals reaching capacity.
Assuming Parliament agrees on the emergency law and there are no obstructions, the final agreement with Pfizer can be signed and shipping can begin.
However, public health experts and MPs say a clear strategy for the distribution and administration of the vaccine is still missing.
“Everyone got distracted by the law,” Alame said, “but the strategy for who will get vaccinated first, and how, must be transparent.”
In a policy paper published last week, researchers at the American University of Beirut’s Knowledge to Policy Center warned that a coordinated strategy is paramount to a successful vaccination program.
“There is still so much uncertainty, while the vaccines are meant to be only a few weeks away,” said Nadeen Hilal, one of the paper’s co-authors. “We still don’t know what the plan is.”
For Thalia Arawi, a clinical bioethicist and the founding director of the Salim El-Hoss Bioethics and Professionalism Program at AUBMC, the vaccines should cover all front-liners, including delivery people, cleaning staff and others, “regardless of nationality, religion, race” or anything else.
“This is a public health crisis and the last thing our government needs is an additional individualistic, selfish attitude,” she said, while stressing that her opinions were her own.
Araji said that while the final strategy is still being developed by the Health Ministry’s specialized committee on COVID-19 vaccines, it is certain that health care workers and those over 65 will be prioritized.
As for rumors that politicians would be the first to receive the vaccine once it arrives, Alame dismissed them as “fake news.”
But even with a proper strategy, other factors could affect vaccine distribution. As Lebanon sinks further into economic crisis and its health care system is pushed to the point of collapse, its ability to effectively store and distribute the vaccine will be limited.
The Pfizer-BioNTech vaccine is perhaps the most challenging of all the vaccines currently being produced, as it requires super-cold storage at minus-70 degrees Celsius.
Lebanon has 12 specialized freezers, each with a storage capacity of 35,000 doses, the caretaker health minister told MTV’s Sar El Wa2et talk show last week.
However, “the logistics needed for the vaccine are by no means guaranteed in Lebanon,” Hilal said, pointing to the absence of a reliable, round-the-clock electricity supply to power the freezers.
This supply could become even more disjointed, she continued, as the state’s ability to maintain subsidies on fuel diminishes as its foreign currency reserves run out. In an interview last week, central bank Gov. Riad Salameh implied that there is only half a billion dollars in reserves left — enough to maintain the current subsidies for about one more month.
According to Araji, Lebanon has secured a price of $18 per dose, so vaccinations, which require two doses spaced at least 21 days apart, will cost the state $36 per person or $37.8 million in total.
Health officials have previously said they have asked the World Bank for a loan to cover the COVID-19 vaccines. A representative from the World Bank did not immediately respond to requests for comment.
Then there is the question of access. The initial 2.1 million doses that the government is buying from Pfizer would cover between 15 and 20 percent of the population, depending on which population estimate you take. (The World Bank puts the population at 6.9 million, while Lebanon’s Central Administration of Statistics puts it at 4.8 million.)
“But for the remaining 80 or 85 percent, we don’t know their fate at the moment,” Hilal said. “And there is no real plan.”
Lebanon is signed up to the World Health Organization’s COVID-19 vaccine scheme, COVAX, which aims to cover at least 20 percent of registered lower-income countries’ populations, with vaccines rolled out as they become available.
So far, COVAX has signed preliminary agreements to secure vaccines from Oxford-Astrazeneca and Johnson & Johnson. The former’s vaccine is being rolled out, while the latter’s is in final stage trials with no clear timeline for rollout.
Hilal warned that those not covered by the Health Ministry or COVAX plans may instead be forced to find their own vaccinations once they become available in the private sector.
“The most vulnerable people, such as the poorest, refugees and migrant workers, will be at a disadvantage,” she said.
In order to achieve herd immunity from COVID-19, scientists estimate that at least 70 percent of the population must be vaccinated.
“If the most vulnerable aren’t protected,” Hilal said, “then no one is.”