Anti-Vax Hospital Workers, Line Jumpers Complicate Vaccine Rollout

A photo of a vaccination shared by Tunisia's Ministry of Health on March 21, 2021 on its @covid19tunisia Facebook page.

As a new wave of Covid-19 infections hits Tunisia, health workers say that the vaccine roll out is beginning to overcome some initial hesitancy and skepticism. Some of this skepticism has been of the vaccine itself–even among health workers–but also of governing institutions and their communication.

“I have no trust in anything that this State brings us. Since these vaccines were brought by the state, then I do not trust it,” Ali (not his real name), a 36-year-old health worker at the La Rabta hospital in downtown Tunis told Meshkal/Nawaat.

Ali is not the only health worker who is skeptical of the vaccine. Only about 20,000 to 25,000 out of Tunisia’s 40,000 frontline health workers registered for a vaccination as of the beginning of April, according to Ines Ayadi, an advisor to the Minister of Health and a member of Tunisia’s official Vaccination Committee, speaking on the Carthage+ TV channel. Ayadi added that about 40 to 60 percent of doctors don’t want to be vaccinated, and authorities made a political decision not to obligate health workers to receive vaccinations.

Ali, who is likely among those counted as frontline workers by the Health Ministry, confirmed to Meshkal/Nawaat that, so far, the La Rabta Hospital administration has not pushed health workers like him who are wary about the vaccine to receive their inoculations, and Ali has not registered to get the vaccine using the State’s online Evax platform.

“The only case I might consider getting my vaccine is if it is proven to be safe with the majority of people who got it,” he said. “Now I don’t have trust in what might happen to me.”

This distrust is something that officials are aware of, but they believe it is progressively waning as more people receive vaccinations without any negative side effect.

“There is still some hesitation and fear… some are waiting to see their friends do it and then when they see things going well and there are no complaints or side effects, they say: ‘Why not?!’” Dr. Tarek Ben Naceur, the Ministry of Health’s Director in Tunis told Meshkal/Nawaat.

Non-Frontline Health Workers Get Vaccines

As of April 7, Tunisia has administered 116,242 vaccines according to officials. Health officials have said that the priority for vaccinations starts with frontline health workers, followed by people over 75 with chronic health issues.

On April 2, Health minister, Dr. Faouzi Mahdi, stated that 42 percent of health workers and 36 percent of people aged over 75 have received their vaccine so far.

However, there have been reports that anyone with national ID cards indicating they are health workers were among the first to be vaccinated, even if they were not technically working in a frontline setting. The regional director of a vaccination center was reportedly fired after reports of such a case happened.

These cases of fraud have prompted civil society watchdog group IWatch, the Tunisian branch of Transparency International, to launch the “Vaxmeter” project to track how well authorities implement the national Covid-19 vaccination strategy that they themselves have set.

In a statement released on March 28, IWatch noted that non-frontline healthcare professionals, such as plastic surgeons, veterinarians and medical students residing abroad, had received the vaccine. These individuals had shared on social media pictures of themselves receiving the jab.

Ahmed Bedoui, the project manager of IWatch’s Vaxmeter project, told Meshkal/Nawaat that letting medical students and doctors who are not in direct contact with Covid patients receive the vaccine could be harmful to the credibility of the entire process.

“This sidesteps priorities and the rights of patients themselves,” Bedoui told Meshkal/Nawaat.

Bedoui said that IWatch is working to try and have its own observers in vaccination centers to report on any potential violations of the national strategy.

“Ultimately our goal is to make the process transparent and boost the citizen’s trust in the vaccine because we are having a trust crisis,” Bedoui said.

Dr. Tarek Ben Naceur, the Tunis Regional Health Director, hsaid some of these cases were due to what he called “fraud” of the online system. He said authorities have now put in place new checks to minimize such fraud.

“It’s a bad [ethical] choice from Tunisians who are not part of the healthcare workers system, who signed up on the platform and identified as healthcare workers. It is honestly fraud,” he told Meshkal/Nawaat.

Ben Naceur said that after they realized such violations were taking place, it became compulsory for healthcare workers showing up for the vaccine to present their unique social security number (CNRPS number) to verify their healthcare worker status, and not just the SMS they received through the online Evax platform.

While IWatch have pointed to some problems, they have also been clear to point to the positive aspects of the State’s vaccine rollout, with IWatch co-founder and member of its steering committee Mouhab Garoui thanking health officials for their work during an appearance on the Carthage+ TV channel.

Official Communication Problems

There may be another explanation for why some non-frontline health workers have received vaccines already. Doctors at the Menzah vaccination center, speaking off the record to Meshkal/Nawaat, explained that Tunisia initially received more vaccines than it has frontline health workers, creating a need to expand the vaccination priority.

As of March, Tunisia had received 30,000 doses of the Russian Sputnik V vaccine–delivered first–followed by 93,300 doses of the Pfizer-BioNTech vaccine and then 200,000 doses of the Sinovac vaccine, donated by China. This was more than enough to cover the 20,000 to 25,000 frontline health workers Health Minister advisor Ayadi noted had registered for the vaccine.

To receive the vaccine, Tunisians need to register on an online platform called Evax, which currently has about 900,000 people registered on it.

However, doctors at the Menzah vaccination center said that this mismatch between the number of frontline healthcare workers and total vaccines was not properly and promptly communicated by the Health Ministry. One doctor told Meshkal/Nawaat that the official communication strategy has been “zero.”

“If you as a Ministry of Health choose to change your priorities…the most important and simplest thing to do is to notify everyone that you have changed your priority, because you have published a certain priority but in application we see that that priority was sidestepped,” Bedoui of IWatch said.

Alongside apparent communications issues has been a lack of adequate planning and organizing in the vaccine roll out. Again, speaking off the record, a doctor at the Menzah vaccination center said that the daily routine of workers at the center is disorganized. Workers do not know how many patients they will be vaccinating in a day or what resources are available on a given day.

“You just don’t know” what will be available on a given day, the doctor told Meshkal/Nawaat.

On March 13, Meshkal/Nawaat was among the media that covered the first public and official vaccinations administered in Tunisia at the Menzah center. Journalists were not informed of what time vaccinations would begin so just turned up as early as 6 a.m. to ensure they could cover the event. Details about the first people to receive the vaccinations such as their age, title, and names were not announced to the press in advance.

Decreasing Hesitancy as New Wave Rises

While concerns about the official vaccination rollout and communications have coincided with hesitancy about the vaccine, it appears that this is changing as a new, deadly wave is hitting the country.

In March, 2021, Tunisia recorded 253,175 infections compared to 210,252 infections and in February, itself up from 175,607 infections in January. In contrast to rising infection numbers, the number of deaths has been decreased over these three months, however death rates often lag behind increasing infection rates. The Health Ministry itself is aware of the rising danger, and on April 4 issued a statement classified 17 Tunisian governorates and 95 districts as areas with “a high to a very high” risk level for virus spread and on April 7 the government announced new lockdown measures.

At the vaccination center for the Tunis region at the Menzah stadium, health workers on April 6 said that the number of people showing up each day to receive their vaccinations has increased in recent days.

“At the beginning there was a fear from everyone and statistics were not pleasing. We would only have five percent of people registered [show up]. But thankfully we are starting to progress…some numbers indicate 70 percent [of those registered show up],” Dr. Nafissa Sghaier, regional coordinator of the vaccine campaign in Tunis told Meshkal/Nawaat at the Menzah regional vaccine center.

According to the Tunis Regional Health Director Dr. Ben Naceur, the Menzah stadium with its staff of about 30 people has the capacity to administer up to 1400 vaccinations per day. But so far, the most it has achieved is 800 in one day.

At the same center, Meshkal/Nawaat spoke to people who received their vaccinations.

“I had no issue convincing my mother… these are precautions one must do… we have faith in our doctors” Najib Bakari, whose 87 year-old mother was receiving the vaccine told Meshkal/Nawaat.

Despite the new wave of infections hitting the country, Dr. Ben Naceur said that some people have been waiting to register for vaccination only when the vaccination brand they believe is the best will be available.

“Some people want this, others want that…There are people who want Sputnik, others want Pfizer and there are also those who are waiting for the Chinese one,” Ben Naceur said.

Dying While Waiting for ICU Bed

The urgency of a successful and quick vaccination rollout has been highlighted by the lack of other basic health resources to deal with rising numbers of Covid-19 infections.

In a two-day period in early April, 14 people died in La Rabta Hospital’s Emergency Room and Covid-19 unit because all available ICU beds were already full of other Covid-19 patients, according to a statement by infectious diseases specialist Dr. Rim Abdelmalek on the official National State TV channel Wataniya 1.

Abdelmalek said that in that case, ambulances kept going around to other hospitals looking for empty ICU beds, but their efforts were unsuccessful.

There is some confusion over how many ICU beds Tunisia has in total, and Meshkal and Nawaat have previously reported on the delays and issues related to financing and public procurement of Covid-19 supplies.

The Health Ministry has pointed to this lack of resources in recent days. In a statement on Sunday, April 4, 2021, the Health Ministry’s Scientific Committee for Countering the Coronavirus raised an alarm about “difficulties in the provision of basic health services linked to some degree of human necessities not being available [such as] human resources and materials.”

On April 4, the state news agency TAP reported that the occupancy rate of ICU beds at the Covid-19 unit in Manouba and El Kassab Hospital had reached 75 percent, with 22 out of 30 beds occupied due to a rise in cases.

The rate at which vaccines have been distributed has increased over time and officials have announced several days in April when over 9000 vaccines were distributed, while the average since the first vaccination on March 13 has been over 4000. The Health Ministry’s Scientific Committee has pointed to the “need to take measures for a faster pace in the vaccination operation.”

Dr. Tarek Ben Naceur, the Tunis regional Health Director told Meshkal/Nawaat that Tunisia is expecting to receive about 3 million vaccine doses by June 2021.

This article was produced as part of a reporting partnership between Meshkal and Nawaat.