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Egyptian Health Minister Hala Zayed at a press conference on January 24, 2021, speaking about the government's plans for Covid-19 vaccinations. © 2021 Fadel Dawod/NurPhoto via AP

(Beirut) – The Egyptian government should bolster measures to provide equitable access to Covid-19 vaccines for everyone in Egypt, Human Rights Watch said today. The government should allocate vaccines transparently, based on sound medical and public policy criteria, including World Health Organization guidance.

By early March, 2021, the Egyptian government had made vaccines available only to some health workers, as well as limited numbers of older people and people with chronic illnesses and had not provided a clear plan for its rollout. Official statements, mostly verbal, have been contradictory and suggest that the government plans to charge for the vaccine or require millions of low-income people to apply for a fee waiver, exacerbating inequitable access.

“Charging impoverished Egyptians for a critical vaccine goes against the fundamental human right to health and reflects the government’s distorted priorities,” said Amr Magdi, Middle East and North Africa researcher at Human Rights Watch. “To effectively fight the pandemic, Egypt should expand vaccine access by making it affordable and accessible for all, including making it freely available where needed.”

High-income countries, which have pre-booked the vast majority of the world’s Covid-19 vaccine supply, have not adopted suggestions, such as waiving intellectual property rules, that would enhance vaccine access for lower-income countries.

Health Minister Hala Zayed said in a news conference on January 24 that medical teams will receive the vaccine for free, along with people supported by Solidarity and Dignity (Takaful wa Karama), a government cash transfer program launched in 2015 as part of structural economic reforms tied to International Monetary Fund (IMF) loan agreements, that includes less than half of the poorest Egyptians. Everyone else will apparently be required to pay.

In late 2020, the program was supporting 3.6 million families, with 14 million people. The proportion of Egyptians who officially live under the national poverty line, currently EGP 857 per month (US$54.6), was 29.7 percent out of a population of 100 million people in 2019-2020, before the onset of the pandemic.

Zayed said in a TV interview on January 24 that the required vaccine payment will be up to EGP 100 ($6.38) per dose and that people who cannot afford the vaccine but are not registered under Solidarity and Dignity can request waivers. Her ministry has yet to make clear how, where, or when people could request those waivers.

In her news conference, Zayed refused to answer a journalist’s question about how many people are among the medical professionals and other critical categories to be prioritized for vaccination. She appeared to exclude health workers other than doctors and nurses. The government plans also do not appear to prioritize vaccinating workers in high-risk jobs such as supermarkets, senior care homes, and education.

In January, the government created a website that on March 1 began accepting registrations for the vaccine but only from medical professionals, the elderly, and people with immunity-compromising health conditions. On March 4, the health ministry offered the vaccine for the first time to registered people who are not medical professionals. Zayed said that only about 153,000 people had registered on the website by March 4. On March 7, pro-government media reports said that less than 2,500 people received the vaccine. A health ministry official told Sky News Arabia that the vaccine was being offered for free. But the government issued no clarification about whether this will be the case for all people.

Zayed said that those who cannot use the website can register at a local hospital. This is a positive step, but the authorities should ensure it does not result in unequal access for people with less internet access, including women, older people, and people living in poverty.

The online system requires a mobile phone number and national ID number, or passport number or refugee document number for non-Egyptians.

A Cairo resident who registered his parents with the system told Human Rights Watch that they received registration numbers via text messages, but not appointments for vaccinations. An Egyptian social media influencer tweeted that he had the same experience.

Finance Minister Mohamed Mo’eit claimed on January 14 that there was “no crisis” in allocating funds for vaccines, but that the government needs EGP 20 billion ($1.27 billion) to provide vaccines for 100 million Egyptians. At the time of his statement, the government had allocated only EGP 1 billion ($63,750). Pro-government media viewed his statements as implying that the vaccine would not be free for all.

Official statements have been vague about how many doses the government has received. As of early March, Egypt had apparently received 400,000 vaccine doses, of which 350,000 were the Chinese-made Sinopharm received as gifts from the UAE and China. Egypt also received 50,000 doses of the British AstraZeneca vaccine on January 31 as part of a deal to deliver 20 million doses.

Zayed said that the government will also receive 40 million doses of vaccines via COVAX, a global Covid-19 procurement facility. Her statement apparently refers to the broader COVAX goal, which is that each participant country will obtain doses sufficient for 20 percent of its population “in the longer term.” The COVAX facility projected in early February that it would provide Egypt with 5.1 million doses in 2021, but an early March estimate lowered the projected number to 4.4 million.

Media reports say the government is soliciting private sector firms and wealthy business owners to donate money to cover vaccine costs through the non-transparent Tahya Masr Fund controlled directly by President Abdel Fattah al-Sisi outside of the state budget. The health minister said this is the source for funding vaccinations, contradicting a statement by the finance minister that the funding will come from the government’s budget.

Egyptian authorities usually do not make public information about donations to the fund, although President al-Sisi has directly on many occasions requested donations from business owners. The government has targeted journalists and rights groups following critical coverage of Covid-19 equity and other issues. These factors and the lack of a clear plan for the vaccine roll-out make it hard to assess the government’s efforts to provide the vaccine.

Egypt has signed loan agreements worth $8 billion with the IMF to support addressing Covid-19’s health and economic consequences, as well as several World Bank health projects worth hundreds of millions of dollars. Many requirements in these agreements do not appear to have been met, including transparency about contracts.

The Egyptian government should publish its vaccine contracts, Human Rights Watch said. Transparency about the terms and conditions is critical for accountability for companies and the government. Pharmaceutical companies have human rights responsibilities aligned with the UN Guiding Principles on Business and Human Rights and the Human Rights Guidelines for Pharmaceutical Companies in Relation to Access to Medicines. Companies should avoid the overbroad use of “commercial confidentiality” and should not block the government from disclosing vaccine procurement prices.

Egypt confronts external challenges facing many lower income countries in obtaining Covid-19 vaccines. Out of concern that vaccine pricing could be a significant barrier to universal and equitable access, Human Rights Watch has said that companies and governments should support India’s and South Africa’s proposal at the World Trade Organization to waive aspects of global intellectual property rules (TRIPS) to enable local, large-scale manufacturing and make vaccines affordable for all. Egypt is a cosponsor of the proposal. The Office of the United Nations High Commissioner for Human Rights said that Covid-19 vaccines should be treated as “global public goods, rather than as marketplace commodities available only to those countries and people who can afford to pay the asking price.”

International law asserts that everyone has the right to “the highest attainable standard of physical and mental health.” Countries have a duty “to make available and accessible to everyone, without discrimination, especially to the most vulnerable, all the best available applications of scientific progress necessary to enjoy the highest attainable standard of health.” The Egyptian government needs to allocate a meaningful budget for purchasing and distributing sufficient vaccines to meet this obligation, Human Rights Watch said.

The 2014 constitution requires the government to allocate at least 3 percent of GDP to health but the government in 2019-2020 allocated only 1.19 percent and following the pandemic only 1.37 percent of the 2020-2021 GDP, according to a study by the Egyptian Initiative for Personal Rights. Khaled Ali, a prominent human rights lawyer, filed a lawsuit in late January asking an administrative court to order the government to provide the vaccines for all Egyptians free of charge. On February 13, the court adjourned the hearing in the case to March 27.

“The Egyptian government’s lack of transparency in dealing with this life-threatening public health emergency is unacceptable,” Magdi said. “It’s also a reminder that health and other social and economic rights are greatly strengthened by free speech and a vibrant civil society.”


Correction 3/10/2021: This news release was updated to reflect that the online vaccine registration systems can also accept foreign nationals with passport numbers or a refugee document number. The registration website is inaccessible outside Egypt. Human Rights Watch confirmed the information with two Cairo residents.

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