Opinion: The Political Factor Hampers the Vaccination Process in Moldova

Vladimir ROTAR The grave internal political crisis in the country, characterized by an acute phase of confrontation between the president and parliament, affects even the fight against COVID-19, delaying the start of a full-scale vaccination process of the Moldovan people Yesterday, a vaccination campaign was launched in Moldova, the last of the European countries. The first person to get vaccination was the head of the intensive care unit of the Republican Clinical Hospital Alexandru Botezatu. In general, three stages of the vaccination are planned. At first, 70,000 medical and social workers will receive a jab. During the next four months, people over 60, people with chronic diseases, teachers, law enforcement officials, the military and prison officials will be vaccinated. The third stage will cover the rest of the population until herd immunity is achieved. The immunization process was finally started thanks to the help of neighboring Romania. Last weekend, the first shipment of 21.6 thousand doses, out of the 200 thousand promised by President Klaus Johannis, was delivered to the country. It should be noted that this is not the first time Bucharest has provided humanitarian support to our country during a pandemic. True, the Romanian aid used to cause scandals: either it was received not in the central square but somewhere under the bridge, or the quality of the delivered goods would turn out to be doubtful. The received vaccine is likewise never that simple. So far, the Moldovan Medicines Agency has registered three vaccines against coronavirus - the German-American Pfizer/BioNTech, the Russian Sputnik V and the British-Swedish AstraZeneca. The latter was delivered to Chisinau from Romania. 's global reputation is rather controversial, and there are several reasons for this. First, the relatively low efficiency, inferior to the main competitors, which is 60-70%. Secondly, it has not completed all the necessary clinical studies yet, especially when older people are concerned. For example, in a number of other EU countries, as well as, for example, in South Korea and Canada, AstraZeneca vaccination is allowed only for adults under 65 (in Spain and Italy - under 55). Much distrust of this vaccine in Europe and over the globe is also fueled by reports of severe side effects after the dose, ineffectiveness against mild disease forms, as well as instability to new strains. For example, South Africa returned 1 million doses of AstraZeneca vaccine delivered in early February to the manufacturer, suspending it in the national vaccination program. The decision was made after the vaccine turned out to provide only minimal protection against diseases caused by the country's dominant coronavirus variant 501Y.V2. The main competitive advantage of AstraZeneca is the sparing (in comparison with Pfizer, for example) delivery and storage terms and, most importantly, the price - only 2.5 euros per dose. For comparison, the price for today's most expensive vaccine of the American corporation Moderna ranges from $ 25 to 37, BioNTech/Pfizer - about $ 20. Be that as it may, with all the shortcomings of the Swedish-British drug, Moldova can hardly receive today any other vaccine in large volumes. According to the COVAX vaccines distribution mechanism for low- and middle-income countries, 156,000 of AstraZeneca doses (the first batch is about to arrive) and only 24,570 of Pfizer doses are to be delivered to the republic in the first half of the year. As already mentioned, the disadvantage of AstraZeneca is that it is not recommended for people over 65 (and everyone knows how large the proportion of the elderly population in Moldova is). In our country, it will also not be used for those who have had a severe form of a coronavirus disease, was transfused a blood plasma, or took cytotoxic drugs. In addition, our specialists  are also well-aware of the ambiguous reputation of this vaccine: two local hospitals are reported to have refused to be vaccinated with this drug. Ideally, Moldova will need about 7 million doses (2 doses per 3.5 million citizens), but in practice, it can get by with a bit smaller amount given that immunization of about 70% of the population is required to develop herd immunity. This means that humanitarian aid and COVAX alone will not be enough. Moreover, the latter is already problematic in terms of delivery deadlines (previously, WHO promised Moldova a vaccine by mid-February). The current situation, in fact, leaves no choice but to organize mass public procurement of vaccines. And it is very strange that the government, given the obvious global shortage of vaccine, took no care of this in advance. Russia's Sputnik V could be one of the options for such procurement. This vaccine is gradually recovering from the world's initially cautious attitude towards it (30 countries have already opened the supply line), and is currently receiving positive feedbacks even in the West. Its well-known advantages are high efficiency (91.4%, and 100% against severe cases), easy storage conditions and low price - only $10 per dose. Sputnik supplies to Moldova have been negotiated for a long time, but things are not moving. As in the case of the Russian loan, the vaccine delivery faced certain bureaucratic and, most importantly, political difficulties. In fact, the country was witnessing a kind of a political competition over the geopolitical direction from which the first vaccine was to arrive. As is known today, the winner is the West, since the first vaccine received by Moldova is a British-Swedish drug from Romania. Perhaps, this silent competition was the reason why the Russian medicine delivery was delayed. At least, PSRM leader Igor Dodon has already accused the presidency of hindering the Russian vaccine registration in the republic. Whether this is true or not is not entirely clear, but Maia Sandu is known to have repeatedly stated that the vaccine should be used in Moldova only following its registration at WHO or the European Medicines Agency (Sputnik does not have it so far). On the one hand, the position is logical, but there is an opinion that less bureaucracy amid the impending new wave of the pandemic would do well to save the population. After all, even the European Union has countries that have already authorized Sputnik V supplies despite the lack of EU's regulatory approval - namely, Hungary and Slovakia. Moreover, the Prime Minister of the latter, Igor Matovic, commenting on the situation, noted that “It is right to buy the Russian vaccine as COVID-19 does not know anything about geopolitics.” In addition, Austrian Chancellor Sebastian Kurz announced recently his intention to start production of Sputnik V in the country and stated the ongoing talks with Russia on possible supplies of the vaccine. The Czech Republic is also showing interest in it. It is difficult to disagree with the fact that COVID-19 really does not know anything about geopolitics, but, unfortunately, Moldovan politicians and officials know geopolitics very well. This is probably why our Ministry of Health, when asked about Sputnik, again reiterated that the immunization program will use only those vaccines that have been registered in the EU, the USA or approved by the WHO - and this is despite the fact that Moldova itself has registered the Russian vaccine. Nevertheless, the PSRM Igor Dodon still believes that the Russian vaccine may soon reach Moldova, and in three ways: through humanitarian aid and though public or private purchases. The last option brings us back again to the issue of purchases and the logical question about the republic's financial resources to that end. Maia Sandu has regularly criticized the previous government for not allocating funds in the budget to buy the vaccine. Her opponents, in turn, point at the situation with the government appointment, saying its absence makes funds allocation impossible. At the same time, experts note that the money have yet been allocated, but in a very small amount - about 15 million lei, which will not be enough to purchase even a cheap AstraZeneca in the needed volumes. However, former Prime Minister Ion Chicu recently denied the president's accusations, stating that the 2021 budget law has reserved 277.82 million lei in state intervention funds to finance urgent and emergency expenses, primarily taking into account the pandemic situation and vaccinations. In general, it is as usual difficult to understand who is right and who is cunning. It is unclear, however, why the president is rather passive given the sharply deteriorating pandemic situation (the example of Dodon who took responsibility for the fight against the pandemic and eventually “paid the price” for it is not yet forgotten, but now it is definitely not time to count political losses and dividends). Even the tools available to the head of state are not being used, such as the Supreme Security Council, which could deal with this vital topic. In the meantime, the parliament has decided to tackle the situation. Speaker Zinaida Greceanîi held a meeting with members of the government the day before, urging to “find promptly the ways for purchasing a batch of 1 million doses to vaccinate citizens”. Acting Prime Minister Aureliu Ciocoi said that the public vaccines procurement process will be initiated from sources of the Compulsory Health Insurance Funds and the Government Reserve Fund. Taking into account the already demonstrated “quickness” of the authorities, thanks to which Moldova was the last on the continent to begin the immunization process, there are not so many hopes for an early start of vaccines purchasing in large volumes. Especially considering that good vaccines (Moderna, Pfizer, etc.) are expensive and scarce, the affordable AstraZeneca does not inspire confidence, and the Russian Sputnik V, seemingly optimal in terms of price/quality, used to hit several political barriers in a row on its way. Perhaps a new round of the pandemic in Moldova will make us forget about political turmoil at least for a while and join forces for a common and good cause - otherwise, yesterday's sad mark of 4,000 deaths from COVID-19 will not be the last “milestone” of this pandemic.