Malta as a primer for rapid and effective COVID-19 vaccination strategy

By Dr. Tomislav Meštrović, MD, Ph.D.Jan 6 2022Reviewed by Aimee Molineux

A research paper recently published in the journal Health Sciences Review shows how high vaccine availability and low population vaccination hesitancy were two pivotal factors for the successful control of coronavirus disease 2019 (COVID-19) in Malta, Europe.

Study: The fastest national COVID vaccination in Europe - Malta's strategies. Image Credit: MyNewImages / Shutterstock

Since the start of the COVID-19 pandemic that is still raging across the world, the small European country of Malta (with a total population of fewer than 500 thousand people) has experienced extraordinary COVID-19 containment during the first wave; however, the scenario was somewhat different when the second wave hit their shores.

One of the few countries around the world with a fast and stringent vaccination program is Malta. There are a myriad of challenges ranging from structural capacities, logistical obstacles, and vaccine hesitancy, which has resulted in very different vaccination rates among European countries.

More specifically, high vaccine hesitancy is frequently observed in many countries among younger individuals. Even healthcare workers can be quite vaccine-hesitant, which was most notable in countries such as France and Belgium.

This is why a research group, led by Dr. Sarah Cuschieri from the Faculty of Medicine & Surgery at the University of Malta, aimed to present a narrative review of Malta's vaccination strategy and its influence on the COVID-19 situation in this country.

A deep view into meticulous vaccine logistics

With the use of a Google Search Engine, all relevant Maltese newspapers (such as MaltaToday, Times of Malta and Malta Independent) were reviewed. Furthermore, the data on daily vaccination roll-out has been obtained from the COVID-19 platform of Malta's Ministry of Health.

Furthermore, a meticulous summary of the vaccination strategy has been provided by the 'COVID-19 Vaccination Logistics' officer, especially in terms of securing the vaccines, their distribution, targeting any priority groups, as well as the outcome summary.

And indeed, Malta made use of the European Commission joint procurement and received a maximum amount of eligible vaccines, regardless of the manufacturer. In addition, four priority population groups were immediately identified, with vaccine doses allocated and adequately stored for each individual.

Several facets of a success story

Different factors have played a significant part in the success of Malta's COVID-19 vaccination approach. First and foremost, a small population opened the door for efficient planning, which was observed in other small islands such as the Cayman Islands or the Falkland Islands.

Furthermore, new vaccination hubs were continuously open in order to preserve postulated rapid vaccination strategy (even when second doses were introduced). At the same time, another successful approach was the maximization of vaccine orders from all manufacturers.

Even the worrying news of the rare clotting events after the AstraZeneca vaccine did not stop or slow down the vaccination drive in Malta, as was the case in many other countries. There was also a swift order of booster doses in case of the emergence of new variants.

Lessons learned

This study has shown how the Island of Malta has implemented a successful COVID-19 strategy with a rapid coverage of a substantial amount of population, resulting in herd immunity by mid-May 2021 already. Two significant factors linked to this success are low population vaccination hesitancy and the availability of a large number of vaccine doses.

"Although Malta has a rapid and high vaccination coverage, with the achievement of herd immunity on the horizon, this does not preclude another COVID-19 wave", caution study authors. "Increased population mobility decreased adherence to mitigations measures such as social distancing and mask-wearing as well as waning of vaccination protection are all potential contributors to such an occurrence," they add.

This is in line with various modeling studies that show a rise in contact rates may counteract all the benefits of a successful vaccine program, emphasizes this paper published in the journal Health Sciences Review. Thus, it is crucial to insist on population vigilance and adequate public health surveillance to implement timely measures should the need arise.