The Pandemic of SARS-2 coronavirus with its associated disease (COVID-19) could not have hit the ailing health System in Libya in worse times;[[1]],[[2]] Close to 100,000 cases of COVID-19 were confirmed in Libya by the end of 2020.[[2]] This represents the highest number (1405 cases in every 100,000 inhabitants) in North Africa. The reported mortality rate of (20 deaths per 100,000 inhabitants) is also among the worst in the WHO's East Mediterranean region.[[2]] All that despite a relatively small number (total 535,108) of polymerase chain reaction tests performed in the whole country since the beginning of the pandemic, with 17.9% cumulative positivity rate[[2]] which is far higher than the 5% target threshold in testing for COVID-19, i.e., the actual number of infections and COVID19-related mortality in Libya could be 3–4 times higher than the figures reported above particularly among vulnerable groups including the internally displaced, residents of nursing homes, illegal immigrants, etc.
The projected rise in the number of new cases and fatality rate[[3]],[[4]] may be averted if the pandemic is managed through unified protocols across the country to prevent the spread of the disease by adequate testing and tracing of suspected cases as well as isolating and treating confirmed cases. However, we have two rival governments; the Government of “disputed” National Accord in the West and a 6-year-old “Interim” Government in the East while many Southern authorities remain selectively incognito to one or both governments. Neither Governments nor related institutions will acknowledge the work or the need of the other! UN organizations, Members of the International Community, and many Libyan Health Care Workers (HCWs) have repeatedly called for a unified approach to COVID-19 since the beginning of the Pandemic.[[2]],[[3]],[[5]]
A group of Libyan Doctors and other HCWs from East, South, and West of Libya have met virtually and through face-to-face meeting in Benghazi, Sabah, and Tripoli on September 12 in a Libyan-lead initiative called “We Are All Responsible” to combat the spread of the disease and issued a unified statement[[6]] calling for the unification of all efforts directed to combat COVID-19 in Libya. The meeting was the first of its kind since the Civil War broke out in 2014. Over and above ongoing efforts, the initiative identified 11 Goals [[Table 1]] that need to be achieved to minimize the risk death from COVID-19 and other life-threatening conditions including noncommunicable diseases (NCDs). UNSMIL, UNDP, Ministries, Municipalities, and members of the House of Representatives have rendered their support to the initiative.[[7]] These efforts have led directly to the first Virtual meeting between Heads of Administrations of the both Ministries, National Centre for Disease Control, and the Mayor of the Capital of the South “Sabha” on September 24 as mediated by the Initiative. Working principles were agreed under the umbrella of Health Diplomacy as the Bridge-to-Peace, a second meeting was held on December 28, 2020, more meetings are expected to follow.
Table 1: Goals identified to support the control of transmission and death from-COVID-19
The initiative became a media magnet with more than 12 TV and Radio Interviews conducted in the first 12 weeks since the joint statement was released; the aim has always been to call for unification of efforts to combat COVID-19, educate the public, and support the Health System in the East, South, and West alike. Five scientific meetings were held on alternate Saturdays starting in November with 30–50 professionals participating in each session. These meetings are often attended by heads of administrations from both sides and members of NCDC – in their own capacity – as well as by members of the Scientific Committee on COVID-19 who played a major role in the process of negotiations with COVAX. It's no secret that COVAX negotiations and agreement(s) are not for public disclosure particularly regarding the price agreed and the funds transferred to COVAX from the 156 COVAX-members-states.[[8]] The fifth scientific meeting was dedicated to the process adopted to render COVID19-Vaccine available and fairly distributed to all Libyans. In Phase I, just over 2.8 million doses of Vaccine were granted for Libya which is expected to cover up to 20% of the population, i.e., the vaccine will be offered free-of-charge to 1.4 million of the high-risk groups by the spring of 2021. Further negotiations are underway to guarantee adequate supply of Vaccine for rest of the population as soon as possible.
The type of vaccine will be defined not only by its availability but also by current Health System's capability, for example, Pfizer BioNTech COVID-19 vaccine may not be the ideal choice for Libya due to the need for −80°C for its storage and transportation which is not easily available on the ground. Moderna COVID-19 Vaccine, Oxford AstraZeneca and/or other Vaccines may prove to be more suitable for the transportation, storage, and redistribution to one of the largest countries in Africa by land area. It was also agreed for UNICEF to act as a facilitator between the Libyan authorities and COVAX, and their role will mainly focus on procurement, transportation, storage, and distribution. Furthermore, it was agreed with UNICEF to establish four cold chain facility across the Country (Tripoli, Misurata, Sebha, and Benghazi). Now all efforts are being made to implement and achieve the objectives of the vaccination plan, which was drafted by a group of experts from the Supreme Committee for Vaccinations and the Scientific Committee for combating the Pandemic, together with an active participation from most of the relevant stakeholders in the Country.
COVID-19 has challenged each and every Health System Worldwide, few if any have risen to the challenge without failing, the Libyan Health System is no exception. The bigger challenge to the Libyan authorities and Health Care professionals today is how to find ways to work together putting their differences aside while facing this common and unforgiving major threat to all residents regardless of location, political affiliation, ethnicity, or ideology. Unifying our efforts is needed now – more than ever before – in order to combat this major public health crisis and to mitigate its potentially devastating impact on the people and the economy of Libya.
