"Extra Beds Won't Defeat COVID, Vaccination Will" - Ukraine’s Health Minister Viktor Lyashko

The number of patients with COVID-19 is growing sharply in Ukraine. 14 regions entered the "orange" quarantine zone, while 5 regions are "red". Some hospitals are already reporting overcrowding and lines of ambulances outside. A high percentage of the vaccinated population could save the medical system from future collapse, but so far in Ukraine, only about 20% of the population received the first dose of the drug.

hromadske spoke with Minister of Health Viktor Lyashko about a new wave of coronavirus in Ukraine, the pace of vaccination, and compliance with quarantine restrictions.

Unless we get vaccinated, triage is inevitable 

Currently, the incidence of coronavirus is growing rapidly in Ukraine, some hospitals are already short of places. Does the Ministry of Health have a plan to prevent collapse? 

The first thing everyone should do to help the health care system overcome the next wave is to come to the vaccination point and get jabbed.

Recently, I was on a business trip to Dnipro and Kherson, where I went to the intensive care unit and hospital wards in hospitals. In intensive care, people cannot talk because they are on artificial lung ventilation. But it is obvious that if people who are in the COVID department, wearing an oxygen mask had known how the disease would [affect them], they would have got vaccinated without hesitation.

In resuscitation, there were only the unvaccinated ones. Before criticizing the government, looking at the number of beds and ambulances, and asking how it will work out, we must first ponder: "What have I done to prevent this from happening?".

We have a plan, we are following it, but the main thing is to get jabbed. There is no other way out. The United Kingdom, Denmark and other countries have already shown results: 70% of the adult population has been vaccinated and the health care system has averted collapse. A vaccinated person can get sick, but such people rarely get hospitalized, and even less often require beds with oxygen therapy. Vaccination is the only chance to overcome the increase in incidence without problems.

Educator receives the second dose of vaccination from COVID-19 with AstraZeneca vaccine in Uzhhorod, August 4, 2021. Photo: UNIAN / János Nemes

People do not always listen to the recommendations of the Ministry of Health, bearing in mind that even family doctors often say that "not everything is so black and white, vaccination should be postponed". So what should we expect?

I will say some unpopular things. If today people fail to listen to the Ministry of Health or to the doctors who are guided by the evidence base, then, relatively speaking, triage will be introduced tomorrow.

Ambulances are calculated on the basis of the population, taking into account certain diseases: heart attacks, strokes, injuries, accidents - all this has not disappeared. As a result, the ambulance has to make a choice: where to go, who to bring and how to take to the hospital. We have oxygen beds. Today, the health care system has significantly more beds [as of October 12 in Ukraine, the total number of COVID beds stands at 79.8 thousand - ed.] than in 2020, even more than in the spring of 2021 [in April 2021, the total number of COVID beds was 72.1 thousand - ed.].

The new treatment protocols, in particular, already allow oxygen therapy during outpatient treatment, we have purchased almost 15,000 oxygen concentrators. But the health care system is not elastic, no matter what we do and no matter how many beds we deliver, it will not help if we do not get vaccinated.

Believe me, all the risks that may arise after vaccination are not equal to those that arise when an unvaccinated person becomes infected and if the health care system is overloaded.

According to your forecasts, the medical system will be more overloaded than in the spring of 2021? 

Forecasts about COVID are complex. We forecast and prepare for various scenarios, including the worst. The experience of EU countries has shown that as the number of vaccinated increases, the number of hospitalizations goes down. With the current rate of vaccination, we cannot afford to rest, so every day we re-equip hospitals for COVID treatment. Since October 1, about 10,000 COVID beds have been added and we will continue to increase them, but this also cannot go on indefinitely. We will have to introduce additional quarantine restrictions, close everything for a hard lockdown.

Minister of Health Viktor Lyashko during an interview with hromadske journalist. Photo: Oleksandr Khomenko / hromadske

Even for those vaccinated? 

During the introduction of the "red" level, we will allow only those who have been vaccinated twice to work.

As for the Kharkiv region, why has it not yet entered the "red" zone? Is it related to the mayoral election? 

Everyone is looking for a sensation. At the time of the meeting of the State Commission on Technogenic and Ecological Safety and Emergencies, we received a letter from the regional state administration that the situation is not critical yet. New hospitals have opened, they are coping. We are monitoring the situation, the Kharkiv region is still in the "orange" zone. This means that local authorities may impose certain additional restrictions there.

The local authorities are sending schools on vacation, although those were originally scheduled for October 25. We are keeping our fingers on the pulse. If the area again approaches the indicator of 65% of bed occupancy, we will consider this at the commission meeting and make appropriate decisions.

Regarding restrictions for unvaccinated people in the "red" zone, how will they be monitored? Kyiv is now in the "yellow" zone, 80% of staff and visitors to institutions must be vaccinated with either the first or second dose. But, for example, I was not asked for a vaccination certificate anywhere, except for the Ministry of Health. How will this be monitored in the future? 

Control bodies will monitor this. We are to have a conference call with the participation of the National Police, the State Consumer Service, the chief state sanitary doctors of the regions and the chief sanitary doctor. We have also recorded cases that in the "yellow" zone the rules are often ignored. This leads to the fact that we have from 10 to 16 areas in the "orange" zone. This does not work when the government is trying to fight somehow, and they do what they want.

If we relax the quarantine for the vaccinated, it is necessary for the entrepreneur who works under the new rules to understand that this step is the chance for the business to survive the lockdown period, and he must strictly control it [compliance with quarantine rules - ed.]. And control bodies must selectively identify violators.

MPs hold discussions during Iryna Herashchenko's speech from the rostrum. Only four deputies, as can be seen from the photo, have masks on their faces. Photo: UNIAN / Maksym Polishchuk

The MPs in the Verkhovna Rada allow themselves to walk around unmasked, why does this happen?

This is a question for the leadership of the Verkhovna Rada.

Have you tried to talk to them specifically, as they set an example for people?

We tried last year, but none of the law enforcement agencies can come in and fine a certain MP in the hall at all.

[However, when the then chief sanitary doctor Viktor Lyashko and President Volodymyr Zelenskyy violated quarantine measures in June 2020 and went to drink coffee in Khmelnytskyi without masks, the National Police post factum did draw up administrative reports on them. The head of the Office of President Andriy Yermak, his first deputy Serhiy Trofimov, the chairman of the Khmelnytskyi Regional State Administration Dmytro Habinet and Khmelnytskyi Mayor Oleksandr Symchyshyn also got reported. - ed.] 

The rate of vaccination should increase in waves

Recently, the head of the parliamentary committee on public health, Servant of the People MP Mykhailo Radutskyi stated that the Ministry of Health plans to expand the list of professions for which vaccination is mandatory. When will this happen?

From October 21, interregional transportation by air, road and rail is only possible with a vaccination certificate. In addition, an order was issued on the list of professions whose representatives must be jabbed against COVID - all educators, employees of central executive bodies, ministries and their structural units and local state administrations, district and city. In the next stage, we will carry out mandatory vaccination for all employees of government agencies and enterprises, social workers, postmen. The next one is utility companies.

The order enters into force one month after its official publication. We are making changes to increase the number of vaccinated people in such waves.

The European regulator recommended vaccinating people with weak immunity with the third dose. We started vaccinating people with concomitant diseases and doctors in the spring, half a year has passed. When will Ukraine have a decision on this?

So far, the number of people who have received the first and second dose does not allow us to develop strategies on how to strengthen the protection of those vaccinated. Our goal is to increase the number of jabbed people. When we reach it and there will be more than 50%, preferably 70% vaccinated, then we will consider other strategies for adolescent vaccination and using the booster doses.

In the summer there were statements that 70% of the population will be vaccinated by the end of the year. We currently have over 20%. Is this realistic?

We do our utmost for this to happen. Today we have 24 million vaccines. If all the media help, we will manage it.

In Portugal, the military was called in to help with the vaccination campaign. Is the Ministry of Health considering such steps? 

Unlike Portugal, we have a war, the military is on the front line. We are doing our best to support our military and they have had access to vaccination. They showed by their own example that people should get jabbed. Today, the Armed Forces of Ukraine have 94% of vaccinated people. We should look up to them. We may consider an option to engage them in a communication campaign.

Minister of Health Viktor Lyashko during an interview with hromadske journalist. Photo: Oleksandr Khomenko / hromadske

We will evaluate the results of the campaign after its completion

How successful do you think the vaccination campaign in Ukraine is - given the anti-vaccination sentiment and that some doctors talk out of vaccination, teachers do not want to be vaccinated. Isn't this a failed campaign for the Ministry of Health in terms of communication? 

We do not have many anti-vaxxers, more than half are people who said in the survey that they will not potentially be jabbed. Anti-vaccination sentiments did not arise only during COVID, it is a technology that is used in hybrid wars. We have been following such sentiments in Ukraine since 2008, when the immunization campaign against measles and rubella was disrupted. In 2018, the WHO included the anti-vaccination movement in the top ten threats to public health.

Generally, we have about 15-20% of anti-vaxxers - no more than 30%. Another 30% are people who are in favor of vaccination, whatever they are told. There are people who hesitate among anti-vaxxers and those who do not need to be persuaded. They may be exposed to certain information and then either get vaccinated or not. The communication campaign should be aimed at people who have doubts. We debunk myths, make explanations. The issue is that it was impossible to actively communicate when the number of vaccines was limited. Now the government has allocated funds for the Ministry of Culture to start buying advertising in prime time, which will help convince those in doubt.

But the rate of vaccination began to increase in the summer, and advertising appeared only in early fall.

Social advertising started in July. We also approached channels and media groups that own television channels. They didn't advertise in prime time, but it was shown, and we know how often. Besides, we talked to the channels, they began to spread information about it in the news. We will also purchase advertising blocks - with information about vaccination.

Minister of Health Viktor Lyashko explains an infographic showing the level of vaccination of the population against COVID-19 as of October 8, 2021. Photo: Oleksandr Khomenko / hromadske

So the campaign is not a failure? 

We will evaluate the results of the campaign upon its completion. I talked to the WHO Regional Office for Europe, where they say that we managed to do an incredible job over the summer: what we had four months before, and what we managed to achieve over the summer. We need to reach 70% of the vaccinated population, then there will live on. We have set ourselves such an ambitious goal. And if it is implemented, the quarantine restrictions in the spring will be completely different - minimal.

The former leadership of the ministry was often accused of lacking proper communication with the public. Do you think that has changed now? 

Hard to tell. The issue is that systemic communication is not easy to change in 3-4 months - so that everyone who wants to communicate with the ministry can do so. Is communication restored? Yes, we are doing it completely differently now: we have restored the board of the Ministry of Health, there were meetings of the board and the board of rectors of higher education institutions. Every Thursday once a month we have meetings with health departments. And once a month I ask that 7-8 chief doctors from some region come - the primary care, the regional institution and district hospitals to talk with them. Representatives of the National Health Insurance Fund also come to this meeting, we discuss problematic issues.

I mentioned communication, because in September there was a situation when a 19-year-old boy died [outside Kyiv, a 19-year-old student died shortly after being vaccinated against coronavirus with a drug from Pfizer. At noon he was vaccinated, and in the evening his body temperature rose, convulsions began. Then the boy's pulse and respiration disappeared, the medical staff of the institute gave him artificial respiration before the ambulance arrived]. At that time, all the media referred to the university's report, and the Ministry of Health did not issue a statement for a long time. How come? 

The fact is that the case happened on one day, and it became the hot topic only after a while. The message, announced by the Ministry of Health, was overlooked. Each case of adverse effects after immunization is entered into the database and investigated.

We are reporting that an investigation is underway. We have groups to respond to adverse events - national and regional. You can't just say what happened, because there is a medical ethic where certain things can't be communicated until the fact is confirmed.

But it could have been announced that an investigation was underway.

We said so, but no one heard. The number of vaccinated is increasing, respectively, the number of adverse events after immunization is increasing, this is already becoming a statistic. If we talk every time about a serious case that coincided in time, then the media will only talk about death all the time. When there is an adverse event, we record it and register how many of them occur.

New ambulances near the building of the Lviv center of emergency medical care, in Lviv, September 22, 2021. Photo: UNIAN / Mykola Tys

Now some questions from the hromadske community: 

What is happening with the reform of first aid?

The first aid reform has taken place. We now have emergency medical centers that work on an extraterritorial basis. They cover the entire region, we allow to work on a single call number between regions and with a dispatcher who sees through GPS where the vehicle is.

Now we are working in COVID times, on October 10 we registered a record number of ambulance calls - more than 40,000. We are updating the wheelbase, this year we bought more than 600 vehicles, this will allow us to get rid of old ambulances. We thus cover the critical need for cars, and then we have only a planned upgrade of cars, obsolete ones (over 10 years old) are written off. Previously, we had only category B, now there are also C, mobile intensive care units. There are also now all-wheel drive cars - so they can go on calls to hard-to-reach places.

In addition, we are launching air ambulance. Currently, it operates in only two regions: Lviv and Kyiv. We are potentially expanding the possibility of where you can fly. Aerospace, in particular, helps us in transplantation - to transport the donor to the patient.

The management of medical institutions forces doctors to prescribe as many services as possible during admission in order to receive more money from the National Health Insurance Fund, and use this number of prescribed services as KPI. How can this be dealt with? 

When I became Minister of Health, I decided to recalculate the services provided in July. After the recalculation, one of the problems was that not all institutions make entries in the electronic health care system. And then we can't identify that the patient was admitted and thus pay for the service.

We appreciate that there is such a problem. We have started writing a strategy for universal access to health services in Ukraine until 2030. It is about providing medical care to all who need it. That is, basic service packages must be covered if you live in Ukraine, regardless of your financial situation.

We understand where medical services or medicines are paid for out of the patient's pocket - during outpatient treatment, gifts to doctors, and in the hospital sector, where payments are also made. It is in the hospital sector that we plan to introduce the following system: if a person gets to the hospital, then after the service, when the budget period ends, approximately a month later, that person receives a text message - that they were in the hospital, received certain services and the state paid the hospital the specified amount. If the hospital provides services, claims that the patient received such a procedure, but in fact did not, the person will be able to follow up on it from the message. There will be a telephone number of the National Health Insurance Fund that people can call and say that they did not receive such a procedure.

Minister of Health Viktor Lyashko during an interview with hromadske journalist. Photo: Oleksandr Khomenko / hromadske

As a result of the reform, clinic directors have gained more autonomy, so managers often distribute themselves bonuses. What can be done about this?

It’s also painful for us. A decree in June 2021 instructed us to settle this issue. Clinics are considered non-profit communal institutions, so we have made a draft of changes. The salary of the chief physician may not exceed a certain amount of the minimum wage of an ordinary physician. So we want to reduce the gap between the administration and practitioners. If the chief physician wants to receive a higher salary, he must raise the doctor's salary. The chief physician in the contract must agree on the bonus with the owner - they can not just sign their own bonuses.

How is the SMA issue progressing?

The Cabinet of Ministers has approved a plan to combat orphan diseases. We are starting neonatal screening. There is a clear strategy for orphan diseases, we cannot grant one person [treatment assistance - ed.] and refuse someone else. There must be a register. We agreed with the president that he donated $11 million from the presidential fund so that we could start neonatal screening. That is, when a child is born, a drop of blood is taken from it and passed to check for orphan diseases. We have prescribed the 20 most common orphan diseases for which we will start the procedure. This will form a registry, and then we will understand the number of children who need treatment.

Managed access agreements have also been launched, and the Verkhovna Rada voted to amend the law on public procurement in the field of health care. We do not disclose the price, and this allows us to purchase innovative drugs for the treatment of orphan diseases at a lower price. Previously, negotiations were held with manufacturers, now the evaluation of medical technologies is being completed. Before purchasing, the drug must undergo an assessment of medical technology and prove its effectiveness. We have funds in the budget, this year we want to launch such a project.

Since the beginning of the coronavirus epidemic in Ukraine, hromadske has extensively covered this topic. We have written dozens of different materials about COVID and vaccination. It is important for us to show how doctors work during a pandemic, how patients receive care, and ask questions to the Ministry of Health. You can help us with this by joining the hromadske community of friends. We are funded exclusively by reader support, advertising and international donors.