Professor Salim Adib is a medically-trained epidemiologist who obtained a doctorate of public health in 1991 from the University of Michigan, Ann Arbor. Between 2010 and 2012, he was manager of the Public Health Department of the Emirate of Abu Dhabi. In 2013, he served as a Professional International Expert for the Non-Communicable Diseases Department of the World Health Organization East Mediterranean Regional Office in Cairo. Adib was the International Epidemiological Association’s council member for the Middle East and North Africa from 2014 to 2021, and has been on the executive council of the Association of Francophone Epidemiologists since 2017. He is now a professor of public health practice at the American University of Beirut. In 2017, he cofounded the Lebanese social democratic reformist party Sabaa (www.sabaa.org), in which he currently serves as shadow cabinet Prime Minister. Diwan interviewed Adib in late January to get his perspective on the Covid-19 crisis in Lebanon.
Michael Young: How would you assess Lebanon’s national strategy to combat Covid-19?
Salim Adib: The strategy Lebanon has adopted has gone through two distinct periods. The first one started with the first report of a confirmed Covid-19 case in late February 2020, and the second began in May 2020 and is still ongoing.
During the first phase, the magnitude of the epidemic was still relatively limited, characterized by dissemination in well-defined clusters centered around cases brought by travelers to the country. The government responded through a series of radical measures that included the total closure of all land and air travel into Lebanon. This first phase was crowned with relative success.
Thereafter, a triumphal attitude overtook the government, and the airport was reopened in a chaotic way around the end of May 2020. From that point on, the response became erratic, incoherent, emotion-led, and marked by largely unjustifiable measures. Risk areas such as the healthcare system’s response or the fragile surveillance system were not addressed, allowing the situation to spiral out of control. Lebanon’s financial bankruptcy and the explosion at Beirut Port last August 4 made things worse. It is by sheer luck that the epidemic has remained within relatively moderate dimensions and seems to be slowly moving toward a favorable outcome.
MY: Lebanese hospitals are being overwhelmed by people suffering from the virus, which many say justifies a tight lockdown. Yet there are growing protests in the country, particularly among the poorer segments of the population, against the latest lockdown that prevents them from earning a living. What would be a solution to this dilemma?
SA: Even under normal circumstances, no government can enforce a global lockdown without preparing a social safety net as a contingency for those who will find themselves in great distress. This has simply not happened. It may be argued that social protection is not possible given Lebanon’s dire financial circumstances. An alternative would have been to work with the various economic sectors to define safety conditions under which some businesses could continue to function and to maintain a modicum of economic activity. That too did not happen. The government suspended annual taxes that nobody would have paid anyway, but did not attempt to limit inflation by reducing extravagant public spending. Children are forced into online home schooling, but no help has been provided to poorer families to ensure online access for their children. Social deprivation is a clear and present danger that the vulnerable population understands better than it does a hypothetical threat from a virus. Not addressing this sense of deprivation is a recipe for unrest.
MY: Does Lebanon have any body that collects and analyzes data on Covid-19?
SA: The body that is supposed to collect data about the epidemic is the Epidemiological Surveillance Unit at the Ministry of Public Health. However, from the very beginning of the epidemic, data have also been collected by the World Health Organization’s office in Lebanon, the Emergency Coordination Department under the Office of the Prime Minister, and the Lebanese Red Cross. The datasets collected have often overlapped and contradicted each other on some items, while completing each other on others. The validity of all these datasets, or their finality, was never seriously checked. None of these governmental agencies runs meaningful analyses of the data. Stakeholders using the data for epidemiological analysis and projections noticed an erosion of quality as the number of cases increased and the epidemic persisted. As of today, all the analyses are estimations based on educated opinions.
MY: Has it been a good decision to close schools, given that studies have shown that children are unlikely to be severely affected by Covid-19, and actually can serve as a barrier to the virus in society if they catch it?
SA: Closing schools would have been justified while schools were being refurbished and staff trained to ensure a minimal probability of viral transmission in class. Instead, schools were closed with no further steps taken. The educational inequity resulting from this situation was never discussed. Closing schools simply meant that poorer schoolchildren were going to miss years of studies, while those from richer families had all the means available to follow online courses, while also being able to afford private tutoring at home.
MY: Lebanon is planning to distribute the Pfizer vaccine and has taken measures that include setting up a website to register those who want to take it. How would you characterize this vaccine selection process?
SA: The Ministry of Public Health has set up a commission to oversee the vaccine procurement process. This commission has presented a vaccination plan that reads like a list of subtitles drawn from a World Health Organization template. The whole document does not attempt to estimate the number of persons expected to be prioritized for vaccination. It has no set timetable based on secured contracts. The budget needed to run the process—from buying vaccines to importing and distributing them—has not been secured. The issues of cold preservation of vaccines, their safe storage, the agreements passed with vaccination centers, the special considerations concerning the elderly are all discussed vaguely and evasively.
If past behavior can help predict the future, the first batches secured through public funds will eventually reach Beirut, only to be distributed rapidly to members of the political class and their henchmen. The rest of the population will be left to its own devices, to buy privately imported vaccines at market prices rigged by the big drug importers. Fortunately, by then herd immunity would have reached the needed threshold to stop the circulation of the virus.
MY: How do you see the progression of the disease in the coming months?
SA: Following the viral dissemination generated by a chaotic summer season, the aftermath of the port disaster, and the festive Christmas season, a new peak of cases was reached in the first half of January 2021. The crest seemed to have been reached at around the end of January. A major effort by all private hospitals is slowly but surely absorbing the surge in cases requiring in-patient care. The case-fatality rate is still less than 1 per 1,000, despite the rising number of deaths. It is estimated that by now 30 percent of the Lebanese population has been exposed and has recovered from Covid-19, thus gaining a more or less important level of immunity.
With more stringent restrictions on international flights, the slow but still growing rate of persons obtaining vaccination through personal means, and the increasing rate of naturally immunized persons, it is very likely that a 50–60 percent threshold needed to stop the infection in Lebanon will be reached by the end of March. Only renewed blunders from the amateurs in the government, which is supposed to be managing the crisis, can prolong this ordeal to the summer of 2021.
