Former MoH Guntis Belēvičs: Latvian officials must set an example as Catherine II and Netanyahu did!

The second conversation with Guntis Belēvičs, Doctor of Biology, doctor-biophysicist, pharmacist, entrepreneur, former Minister of Health.
19.01.2021. MKMāris Krautmanis
Guntis Belēvičs demonstrates how to perform the rapid Covid test correctly ©Neatkarīgā

In the previous issue of Neatkarīgā, we started with the topic of how much our country needs a smart strategy for using rapid Covid tests. Because rapid tests can make a significant contribution to limiting the spread of infection. In this interview, we continue to talk about what is important for the Covid crisis to pass as soon as possible and for the Latvian economy to suffer as little as possible.

In a small settlement, there may not be a clinic, but there is a pharmacy, which usually doubles as a health center where people come for both medicine and advice. But how to solve the vaccination issue purely technically? Not everywhere will have suitable premises.

The solution seems quite obvious. Mass testing took place in Austria, tents were built, and "testing streets" were set up for this purpose. Those who had previously applied online could do a rapid test.

Then should tents be set up for tests and vaccinations in Latvia as well?

Definitely. There are pharmacies where there may not be enough space for vaccinations and tests. Then you can place a tent in front of the pharmacy. You can see on the Internet what the rapid test points at German airports look like. You can see how people in China are being tested. The municipality can also come to the rescue and provide additional premises. There are many different options. It must be intelligent, well thought out, it needs attentiveness and it needs everyone to be involved.

But a large part of the population is not ready to be vaccinated.

This is currently the case. The Prime Minister may be outraged at the slow pace of vaccination, but the readiness to vaccinate is what it is today. We can analyze the reasons why. Take, for example, Daugavpils Regional Hospital, which is a very good, large hospital. 10% of the medical staff there are now ready to be vaccinated. Readiness has doubled in a short time, from 5% to 10%. But the rest of the nation? After all, people ask for advice from their medical acquaintances.

If a person is an authority, then he is trusted; if not - then no…

If we are talking about vaccination against Covid, a good example these days is Israel, where more than 20% of the population has already been vaccinated. A positive role model is of paramount importance. Israeli Prime Minister Benjamin Netanyahu and the Minister of Health were the first to be vaccinated, and both have been vaccinated for the second time in front of television cameras.

I can tell you where such examples come from. In 1768, Catherine II risked her life and was the first to be vaccinated against smallpox in the whole empire. She called a doctor from England, who took material from a boy with smallpox and vaccinated the Empress with it. Catherine II prepared a postal horse with a carriage so that if she died, the doctor could escape. Because it was clear that the doctor would then be killed. When the Empress did not die after vaccination, 140 courtiers got vaccinated after her. Catherine II had a medal engraved with a portrait of her on it and the text "She has set an example." Netanyahu is not the first in history to think that he should set an example!

The Pfizer vaccines, which were the first to be sent to Latvia, are very good, but they are made according to new principles - ones that have not been used in mass vaccination so far. I think that the readiness of doctors and other people to be vaccinated will increase significantly when other vaccines appear. Now there is also a vaccine from the company Moderna available in Latvia, and now there will be an opportunity to choose. In the future, with each new vaccine, the choice will be even greater.

The first one sent to us - the Pfizer vaccine - should be stored at minus 80 degrees, while the Moderna vaccine - at minus 20. This is already much more convenient - it can be stored in the freezers of many refrigerators. Pfizer vaccine can be stored in large quantities in Latvia in only one place - the Blood Donor Center. You can imagine what it is like for logistics, how difficult it is to distribute a vaccine that needs to be kept at minus 80 degrees! This vaccine can also be stored in a normal refrigerator for a few days, but can no longer be used after that.

The vaccine is a special medicine and all medicines have an expiry date. All Covid vaccines have just been developed. This means that the Covid vaccine manufacturers currently have no evidence of long-term stability of this medicine.

We are talking about speeding up the vaccination rate, but the first vaccine that has arrived has not yet been 50% used. But it expires in April. Pfizer has honestly stated that the shelf life is six months. But the company had already produced the vaccine earlier, waiting for it to be registered in the European Union. When the vaccine came to us, the first months of its expiration date had passed. This means that we also have to take into account that we may have to throw away a lot. I am very concerned about the large quantities of vaccines with such short shelf life and the degree of readiness to vaccinate that people currently have.

We first vaccinate medical staff. Other countries, such as Germany, started differently, first vaccinating the most vulnerable groups, namely those who live in elderly care homes. Then everyone over 80 years.

I understand those arguments - we are told that the capacity of our hospitals is running out, so we need to vaccinate doctors first. But one could first conduct a survey on the readiness of doctors to be vaccinated. We have started from the wrong end. We should have started with the government, with the parliament - they were able to set an example for us. Managing the country remotely, the way it is currently done, is nonsense. It was one thing in the beginning when the pandemic started, but it is nonsense in a situation when vaccines and tests are available in Latvia.

Monitoring is carried out at all times to see if vaccines have immediate side effects. Only a few people out of a million have them. Why, then, have ministers and parliament not been vaccinated?

The Minister of Health can issue an order to vaccinate all doctors, but this does not increase the readiness to vaccinate.

It is not possible to steer a ship remotely, especially during a storm.

Other health services can be denied and extra beds can be placed in hospitals. Then we will have more beds. But we are running out of capacity in intensive care units. There the number of beds cannot be increased so easily.

Have there been any drugs for Covid, any new treatments?

I still don't understand why convalescent plasma is not used?! This method has been used for a century. It is used very successfully for the treatment of Covid in Germany and Switzerland. It is the plasma of people who have recovered from Covid and have high enough antibody titers. At our Blood Donor Center, convalescent plasma is also collected - not on a national basis, but on the initiative of the employees themselves. Plasma is collected from donors who have recovered from Covid. But there is no nationally established and paid system to offer all who have recovered from Covid with high enough antibody titers to become plasma donors. There is no such initiative from the Ministry of Health. Such a system would require a little additional funding, but here again we have to quote Krišjānis Kariņš that there is more money than ever before.

This medicine - the convalescent plasma of people who have recovered from Covid - is an effective medicine. It can be used to help advance a struggling patient who is in a serious condition and in intensive care to a less severe condition, thus relieving the need for intensive care.

This could have been predicted from day one, as this method is known from many diseases of the past, and it also works for Covid. But we do not use it. But in Germany, Austria, Switzerland it is used.

Was it justified to decide to focus on vaccines that are not authorized in the EU (AstraZeneca) and not to buy those that were available, Pfizer?

AstraZeneca's registration has been delayed, but 1.2 million people have already been vaccinated in the UK. I am convinced that the AstraZeneca vaccine will soon be available throughout the European Union. Latvia has agreed that AstraZeneca will be the largest part of our vaccine portfolio, but this happened when the portfolio was divided, when the European Union allocated funds for research and supported the development of these vaccines, that one was closest to registration at that time. As soon as the AstraZeneca vaccine is registered in the EU and available in Latvia, the readiness of our doctors to vaccinate will also increase. Because this and many other vaccines are made according to principles that are understandable to doctors. In addition, AstraZeneca will be able to be stored in a normal refrigerator throughout its shelf life. This will not put additional pressure on logistics. Vaccines will also differ from each other on one really important criterion - how long they will create immunity. However, all vaccines still need to gather evidence on this.

At the moment, we need to save the country's economy, we need to get people back to work, we need to stop the spread of Covid. And vaccination is not the only possible measure. Early diagnosis is also needed, especially in asymptomatic patients. Detecting these patients and recording their contacts is very important. It also needs to be addressed nationwide.

What have you heard about the Sputnik vaccine made in Russia?

This vaccine will not be available for us because it is not going to be registered in the European Union. The initiative to register a medicine in the European Union must come from the manufacturer of that medicine. I think that Russian vaccine manufacturers have enough countries where they can register their vaccines - this vaccine is already used in Russia, and there is still Latin America, Asia. The vaccine was developed at the Gamaleya Institute in Moscow. I myself studied medicine in Moscow and I think that a large part of the graduates of my faculty still work at the Gamaleya Institute. I think the Sputnik vaccine is a good vaccine, just like every other. Russia has its own procedure, which is slightly different from the European Union registration procedure, but the procedure is definitely there. I have no reason to think that the Sputnik vaccine is bad just because it is made in Russia.

The Sputnik vaccine does not need to be at minus 80 degrees and can be stored in the refrigerator.

AstraZeneca also does not need to be stored frozen, nor does Johnson & Johnson, and there are other vaccines that do not. There will be even more different vaccines - it won't be long before we have five different ones available in Latvia as well. The unavailability of vaccines is no longer a slowing factor. Vaccines are already available in Latvia. A new consignment of Pfizer vaccines has arrived. But where are those who want to be vaccinated?

Managers of large health facilities are forcing their employees to be vaccinated with the only one currently available, but this can have the opposite effect. I think that when other vaccines become available, the desire to get vaccinated will increase several times. I will also get vaccinated when I have the opportunity.

It is possible that a situation will arise in which it will be necessary to invite all those who want to be vaccinated in order not to destroy vaccines due to expiration dates. The idea that many will want to bypass the line, in my opinion, does not correspond to the reality of life. Our leaders - the President, the MPs, the Prime Minister and the Ministers - can make a significant contribution to vaccination. They must set an example with their actions as Catherine II and Netanyahu!

But a large proportion of people firmly believe that vaccines will be used to inject chips to control humanity, and they believe in even crazier theories…

Now that's nonsense. I am convinced that the vaccines that are already here and those that are yet to come are all of good quality. At the same time, many doctors will be waiting for vaccines based on long-known and understandable principles to be available.

It's hard to understand. If all vaccines are good, how will they differ - will one candy be tastier than another? A strong rejection of any vaccine can be seen.

But doctors understand. They will also get vaccinated. But there should be a choice between vaccines.

When the doctors have vaccinated and I think that such a day will come in a few months, then the rest of the nation will follow.

It is extremely important to get the country out of the curfew. We can, of course, be glad that there is more money than ever before, and it is lent to us at a very low interest rate, but we will have to return it. Not us, but our grandchildren. Germany will also have to return it, but it will be returned by the grandchildren of the migrants. Given the birth rate that is in immigrant families, there will be a lot of people in Germany, they will work, and there will be people who repay the Covid loan. But we have another problem. If we want Latvia to exist, we must promote the birth of our own people.

Our remaining citizens will flee if the economy is ruined. We are now taking on a huge debt burden, which must be done now, but it should be done in moderation and prudence. The international rating agency Moody's has already ranked Latvia among those countries that are not quite safe. This means that if our country will not be able to repay its debts on time, and we certainly will not be able to do so, Latvia will have to re-credit. We will re-credit, but already at a high interest rate. Paying back this Covid debt will form a significant part of the state budget in the future. This may lead to no development in Latvia and people fleeing.

As far as medicine is concerned, all the issues are getting out of the bag. We need to increase the number of doctors and nurses by all possible means, we need to increase the number of state budget places in medical schools and colleges. There will be a situation soon where the foreigners who studied medicine in large numbers in our universities will not be able to come here at all. There is a capacity to train doctors in Latvia. In the place of foreigners who have not arrived, we need to recruit locals so that they come to study medicine in larger numbers. But the state has to pay for it. If foreigners who pay out of their own pockets do not arrive, the place must not be left empty. Therefore, from that money, for which Mr. Kariņš is happy that there is more than ever before, the number of budget places for medical studies could be significantly increased. There should also be easier conditions for attracting nurses and doctors from the former Soviet republics - from Belarus, Ukraine and others. It would be possible to add orderlies to the list of specialists we accept as migrant workers and to hire them to work as orderlies while learning the national language, after which they can certify in their main profession. We should do everything we can to ensure that medical staff does not dwindle out but rather increases.