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How Malta Became a COVID-19 Overachiever: Episode 16

The tiny island of Malta is an overachiever in curbing the COVID-19 pandemic, according to Politico.

Eva & Daiva @ The Inoculation

The tiny island of Malta is an overachiever in curbing the COVID-19 pandemic, according to Politico. Before the end of August, the Maltese government announced that 90% of the population over 12 years of age is fully vaccinated. This meant that the first phase of the vaccination programme was largely complete before rolling out boosters to vulnerable populations from mid-September.

But it’s not enough to say that vaccinating the population was easy because Malta is so small. Data from Eurobarometer surveys and the WHO show that vaccine hesitancy was not that uncommon before the pandemic. In the Eurobarometer survey, over a third said they believed in the conspiracy that viruses were produced in government labs in order to control the population - that’s above the EU average. So how did Malta manage such a successful vaccination campaign?

To find out, Daiva talked to public health and infodemic expert Prof. Neville Calleja and the vaccination programme’s coordinator Steve Agius. In this episode, Eva and Daiva discuss what they learned.

Our reporting is supported by IJ4EU and Alfred Toepfer Stiftung. Please subscribe to our newsletter, and this show on Apple Podcasts, Audible, Google Podcasts, Spotify or another platform of your choice. Follow us on Facebook as @theinoculation, on Twitter as @TInoculation, and on Instagram as @the_inoculation


Eva Schaper  0:00
Hello and welcome to the Inoculation. Today we're gonna talk about Malta. So why are we going to talk about Malta? Because of all the countries in the world tiny Malta has some of the highest vaccination rates. Today we're going to look at how Malta did it and if there's something that other countries can learn from them.

Before the end of August, the Maltese government announced that over 90% of the population over 12 years of age were fully vaccinated and Malta was able to roll out boosters starting from mid September, the Politico news site grouped Malta with Portugal and Spain as vaccine overachievers.

Welcome to today's episode of the Inoculation. And welcome to all our new listeners. And welcome to all our listeners who live in Malta. Today's episode is going to be about Malta and how they were able to get almost all their population vaccinated against COVID.

Daiva Repeckaite  0:58
If you know anybody who would be interested in hearing this story, send them the link right now, you know that your telephone is right next to you somewhere.

Eva Schaper  1:10
Luckily, Daiva lives in Malta, and she can tell us a bit more about the situation there. She talked to a few experts for us to learn more about the situation or the general vaccination strategy and the rollout. Hello, Daiva. Hi. Who did you talk to? Who are those people?

Daiva Repeckaite  1:24
So first of all, I talked to Neville Calleja who lectures at the University of Malta, but he's also head of health information and research at the Ministry of Health. Then I also met Steve Agius, who is the Chief Operating Officer at the Mater Dei hospital and he is in charge of Malta's vaccination campaign.

Eva Schaper  1:41
Okay, so you really found two experts who are going to be able to tell us a lot, I think, um, first, I just want to ask you a couple of things about Malta because we have listeners all over the world. And maybe some of them aren't really even sure where Malta is.

Daiva Repeckaite  1:58
Yeah, doesn't even show on some maps. It's so tiny. It is next to Sicily. And to the south it's close to Tunisia and Libya.

Eva Schaper  2:07
I would belong to the UK for a long time, didn't it?

Daiva Repeckaite  2:11
Yes, exactly. It was a British colony for a very long time. English is still one of the main languages and one of the two official languages next to Maltese.

Eva Schaper  2:19
This is interesting. And that's something that I think will come up later in our talk to why everybody speaking English might be a factor.

Daiva Repeckaite  2:28
Yes. So people have easy access to information and misinformation from all around the world. Thanks to their fluency in English.

Eva Schaper  2:35
How long have you lived on Malta?

Daiva Repeckaite  2:37
Just over four years.

Eva Schaper  2:38
Is it a large island? How many people live there?

Daiva Repeckaite  2:41
So approximately half a million. But you know, it's difficult to say because the island depends on tourism. And especially before the pandemic, people used to come and go and maybe get a summer job. But yeah, that's the estimate.

Eva Schaper  2:55
Okay. And is it a wealthy Island?

Daiva Repeckaite  2:58
It's actually quite wealthy. It has boomed over the past decade or so. Malta enjoyed a lot of advantages of being in the eurozone and people coming and going easily, lots of companies. So the standard of living has been growing.

Eva Schaper  3:15
Is it a very religious Island? I would imagine, of course, I might be wrong on this side. It might be very Catholic.

Daiva Repeckaite  3:20
Yes, you're totally right about that. The population identifies as Catholic and also the religion is even inscribed in the constitution of Malta. Actually, the density of churches is just astounding, okay.

Eva Schaper  3:34
And this is also I think, in Malta is where a number of the Crusades set off.

Daiva Repeckaite  3:39
Now, that's true that there's a very famous battle from the 16th century that between the Crusaders and the Ottoman Empire, and it's celebrated by the country because the Crusaders won.

Eva Schaper  3:51
Are people very educated. What kind of work do people do?

Daiva Repeckaite  3:There's not a lot of manufacturing here. The population of farmers and fisherfolk is dwindling. So a lot of people actually work in the public sector in different government jobs. A lot of people work in the finance industry, a lot of people work in tourism related jobs. So hospitality and driving things around the island driving people around the island, and the level of education is lower than the EU average. Malta has more early school leavers, people who don't obtain secondary school qualifications. It's not among the most educated countries in the EU.

Eva Schaper  4:30
Okay, that's interesting. And I think that's also really interesting to know. When we look at misinformation later on. Absolutely. Just out of curiosity, I kind of remember that you were able to get vaccinated a lot earlier than I was in Germany. So can you tell us a bit about your own experience getting vaccinated?

Daiva Repeckaite  4:49
Yeah. I was actually hoping that journalists will somehow have some kind of priority access to the vaccine multistatic as most countries from healthcare workers from people living in Large institutions. So for example, homes for the elderly or prisons, and then eventually, in spring, it was rolled out to teachers. And I got my vaccine in early May, this was pretty good, I guess, for my age group. But you know, I didn't enjoy any, any priority. So I just got it when it's opened for people between 30 and 40.

Eva Schaper  5:25
Okay, so let's take a look at the things you found out in your reporting. Was there one big thing that stood out?

Daiva Repeckaite  5:33
I think it's important to note that also in the conversations that were not on the record, and the that only informed my understanding of Maltese vaccination campaign people say, and the experts I interviewed, here, say that trust in doctors is very important and a huge factor in Maltese vaccination success. So people often have very strong relationships with their family doctors, and they ask them all sorts of questions, they go with their grievances. And it was very interesting that Neville Calleja when I talked to him, so that in terms of public health, people are not, not really, you know, of the kind that would want to take health into their own hands. And this is very different. For example, comparing to where I come from, which is Lithuania, where people have this tradition that is passed on, in families usually that you first try all kinds of herbs, and you try all kinds of domestic remedies. And then you go to the doctor, when it's really, really bad in Malta, people take disease very, very seriously. And they seem to have a fear of disease, and they go to their doctor right away.

Eva Schaper  6:42
Well, that's interesting. Is there a general belief in science? Or is it just doctors?

Daiva Repeckaite  6:47
Actually, I looked up the Euro barometer survey in trust and science, I think it was quite quite a popular survey in that survey, Malta, I would say, didn't really stand out in the trust in science. And it's interesting that it had the very low trust in journalists' ability to explain scientists, so I don't know what it means for us. And then in earlier surveys, there's a very high trust in doctors however.

Eva Schaper  7:15
Okay, that's interesting that that seems like an important point. Okay, so starting from the beginning, how did Malta go about vaccinating its population?

Daiva Repeckaite  7:24
the process was very similar to other countries. So they started preparing early in advance. Steve Agius is in charge of multos vaccination campaign

Steve Agius  7:34
for our planning, we started off by ensuring that the most vulnerable and the elderly are captured in our first cohort. And in less than two months, we covered the entire health care sector, and elderly and vulnerable.

Daiva Repeckaite  7:52
And then they started sending people notices.

Eva Schaper  7:55
Basically, in the beginning, the rollout was just like in a lot of other countries, but in other countries, for example, in Germany, where I live, there was just a point when where the number of people who are willing to get vaccinated, you know, is going close to zero. So, where I live in Bavaria, we're just at 60% of the population that's vaccinated. So did Malta run up against any of these problems? Why was everybody willing to get vaccinated in Malta?

Daiva Repeckaite  8:24
They said that, yes, we planned this in advance, and we made it very easy for people to get vaccinated. And here we have Steve, who manage the vaccination campaign, telling us about how they made it easy. For example, for young people who didn't consider themselves like in other countries to be high risk group. They went to the places where youth hang out, they didn't require any kind of complicated registration.

Steve Agius  8:53
We organised a number of mobile clinics, and we had our mobile clinic in St. George's Bay in Valletta, you know, when much of it was extremely popular with the woods. And also, I think one of the benefits was that we were administrating due to obviously the cold chain. We were administering the Johnson and Johnson one dose vaccine there. So it was very convenient for them to just come for one dose.

Eva Schaper  9:17
Well, that was very interesting. What else did you find out?

Daiva Repeckaite  9:19
there was also a media campaign. And I think it's very important that you remember, there was a time when a lot of media were discussing the role of women's leadership, encouraging vaccination in controlling the pandemic in different countries, right, you know, examples were New Zealand and Slovakia and so Malta had the superintendent for public health, Charmaine Gauci, who used to go on TV to announce the news of the pandemic every day and people trusted her very much these days. She has a column in the times of multiple the largest newspaper in English, where she answers people's questions and people ask her all kinds of things and they say First, some vaccine hesitant concerns such as Will this affect my fertility? Will this affect my children's health in the years to come? What is the risk benefits, you know, ratio and so on.

Eva Schaper  10:12
Okay. Yeah, that makes sense. You know, what I was thinking about is multi just as good. Are they just as fast in vaccinating their population, because it's so tiny?

Daiva Repeckaite  10:23
So something that stood out for me in the interview with Steve, something that kind of confirmed the view that a lot of people actually went out and volunteered for the vaccination campaign, I talked to my dentist about vaccination as well. And he told me that he was volunteering for the vaccination campaign. And Steve told me as well that it was very impressive how people from different walks of life, whoever was qualified to do that volunteered for the vaccination campaign, let's listen in.

Steve Agius  10:54
What was impressive was the collaboration and the contribution that we found from volunteers, just dental students, such as medical students, you know, our forces of Malta. So it was a joint effort. And that enabled us obviously, to scale up, don't forget that it wasn't a case of taking resources from the hospital, because the hospital was still in operating mode. So I wanted to make sure that we managed to upscale our programme without hampering the work on in the hospital.

Daiva Repeckaite  11:25
So I think what this helps is that not only did it keep medical resources available for other things, but it's also increased the number of people who were personally telling others so their relatives and their friends that oh, look, I'm back, I'm volunteering for this campaign. And this is so good. And we're vaccinating so and so many people. So I think it felt more personal to a lot more people to know that, for example, their cousin is volunteering for this campaign.

Eva Schaper  11:52
Okay, so it's not size loan, because I think before we started recording, we just tried to find a country that's about as small as Malta. And I think what we found was Liechtenstein, and the vaccination rate is hovering in the middle 64 65%. So it actually can't be size alone.

Daiva Repeckaite  12:12
So I think it helped in a way because people are very tightly connected. And I think it's difficult to be completely surrounded by your own echo chamber, even during the pandemic, I think you'll still bump into people who are very different, you know, in your neighbourhood, religious community or in your family, people were exposed to all kinds of ideas and, and opinions. Again, Malta is historically not the most vaccine trusting society, if I may say so. And remember when we were just preparing for our investigation into vaccine hesitancy, and we looked up some surveys about people's attitudes towards the measles vaccine. So those surveys from Malta were actually quite troubling. And over two in five people told in an in a survey two years ago that they believe that vaccines overload and weaken the immune system, but they were also very concerned about side effects.

Eva Schaper  13:10
Oh, interesting. Well, let's just listen in to what Neville told you.

Neville Calleja  13:14
So we have misinformation about other stuff, of course. So effect of other vaccines, for example. So we did have a dip when the Wakefield paper came out originally. I'm not sure if I'm allowed to say this. But following also the populist government in the US, we saw a resurgence of Wakefield related posts on our social media, like everywhere else in the world. Okay. Was it intentional or not? I guess it might have been, because otherwise, I don't know why it's researched in the first place. But we did see a resurgence and that hit us possibly, even worse, then it hit us with the first time it happened. So the first time it happened was, you know, mid 2000s, roughly.

Daiva Repeckaite  14:01
So it's not that people have this automatic trust in all vaccines. I think it's more that on a small island like this. It's very easy to know someone who suffered from COVID or maybe even to know someone who died of COVID. I think it's more than fear of COVID and its impact.

Eva Schaper  14:19
Did either Neville or Steve tell you anything about vaccine misinformation?

Daiva Repeckaite  14:24
Oh, yes, absolutely. This question had to come up because if you look at the websites of the off the main national media, you will find a lot of comments underneath each article about vaccination, with people spreading all kinds of conspiracies. You find a lot of conspiracies on Facebook as well in different natural health and natural lifestyle groups. Neville who is involved in monitoring the pandemic misinformation with the who told me that there are different Facebook, telegram and WhatsApp groups spreading misinformation do we want it Take a listen to what Neville said, yes, let's hear it in his own words

Neville Calleja  15:03
To be honest with you, we realise that there is a much higher proportion of anti Vax sentiment amongst foreign resident or people resident here, born elsewhere. And we attribute that primarily to their belonging to social media groups from their, from their original country. Okay. So we do see certain sort of proportions within certain ethnic groups living in Malta that correspond nicely, so I have to say, to their hesitancy in their home country. So, you know, unfortunately, social media creates echo chambers, right, where you sort of keep hearing the same thing from your circle of friends, who obviously have certain commonalities with you. So we've seen that, definitely, then there were some sectors that seemed to be more prone to misinformation, much as I, you know, I'm unhappy about it. But we noticed misinformation to be particularly prevalent amongst certain natural remedies groups, who are usually, you know, really into healthy stuff, they somehow gravitated a lot towards anti vaccine sentiment, some of those who might have been more hard hit by restrictions were a bit more prone for anti Vaxxer people involved in the hospitality industry, or tourism or events, especially in the events sector, were more prone to misinformation, again, describing this concept of echo chambers and what your friends feel like, again, level of education, you get some highly educated individuals who were pushing a lot of misinformation. On the other hand, we did find that those with lower levels of education were more prone to believe it when they read it online.

Daiva Repeckaite  16:57
And what I found very interesting is that they're trying to use social networks against the perils of social network.

Neville Calleja  17:05
I don't want people to believe that infodemic management needs to be a high tech exercise, okay? It's not I mean, here in Malta, we've been doing infodemic management from the beginning, but not high tech at all. In actual fact, it's been a bit of a voluntary effort by several healthcare professionals, many of whom are also public health professionals who have been actively monitoring. I mean, the beauty of being in a small country is that there are few groups on social media with very large memberships. So monitoring those public large groups gave us a very good grasp of what misinformation was circulating. And we could go in and debunk in the comments.

Daiva Repeckaite  17:50
And they also promote correct information in the different specialist groups. So for example, groups for doctors.

Eva Schaper  17:59
Okay, that's interesting. So this is a forum. I think, also, what we've heard a lot about prebunking, getting the right information out before the misinformation comes in. Do you think that would be correct to say that this is a form of prebunking, or is it corrective?

Daiva Repeckaite  18:15
It is pre banking, but Neville also mentioned the importance of debunking.

Neville Calleja  18:19
So I've learned with time that if you post something, which is good information, it's good. But it doesn't get as much traction, as a misinformation post, with debunking information in the comments, because the silent majority is there reading through the comments and not commenting.

Daiva Repeckaite  18:39
So going forward, I think that's Malta so far doesn't have any major concerns. But this doesn't mean that Malta is free of misinformation and free of these concerns that other countries have there have been a number of protests against the vaccination and against other pandemic containment measures.

Eva Schaper  18:59
Do you think what you told me was that in contrast to a lot of other countries, I think Malta kept a lot of restrictions in place and kept a lot of restrictions to have tourists fully vaccinated, which is, which is quite difficult for a country that's so dependent on tourism. So I think the question here is, do you think that just having these restrictions also made people more willing to get vaccinated

Daiva Repeckaite  19:24
This seemed to be the case. When people wanted to travel, they went and, and got their vaccinations. This was a bit of a gamble because many countries were promoting their tourism products to attract the few travellers who are still going around despite the pandemic, but in the end, it paid off because it seems that Malta had a pretty good recovery compared to last year. And I remember when I was flying into Malta in July, there were still a few people who at the airport, they were informed that they would have to spend two weeks in a hotel before they can in enjoy their stay in Malta, this is very expensive. And this is a huge disincentive. So whoever wanted to enjoy just a holiday in Malta would have had to get vaccinated. And case numbers remain quite low in some.

Eva Schaper  20:15
So if I sum up what you just told me, what really sets Malta apart from other countries was basically, people trust their doctors, they were scared of COVID. I think they believed in the reality of COVID. The government made it really easy to get vaccinated, the government seemed to be approachable.

Neville Calleja  20:36
The superintendent of public health herself, maintaining a presence or constant presence on the media. Originally, it was actually every day, then it went down to per week, she also has a slot, as you're aware with one of the newspapers now, the communication with the public through social media on a daily basis. Sometimes even the minister himself engages. So I know this population, if I need the message to be disseminated, inhaled, I usually ask the Minister to give me a few minutes. And that would be covered in the evening news. And especially with certain like the older half of the population, what gets disseminated in the evening news spreads really fast. So that is very effective.

Eva Schaper  21:21
And also the presence of a number of restrictions that are sort of like a push mechanism to get the people who might be a bit hesitant to still get vaccinated if they wanted to travel. And I think also combating misinformation actively.

Daiva Repeckaite  21:38
Exactly. And I would also add that usually people identify very strongly with one political party or another and these two parties will do anything to sort of undermine each other's policy and each other's efforts, but on vaccination, they didn't voice any major contradictions. And they were showing an example to the public into their voters that vaccination is the way out of this pandemic.

Eva Schaper  22:07
Okay. So there was also political unity across parties, which is something that many countries don't have a did anyone didn't level or Steve, tell you anything about the outlook for the future, or maybe for future pandemics, because we really can't rule out that will not have another pandemic.

Daiva Repeckaite  22:25
So they said that it's very important to prepare in advance to have evidence to have planning to have the data, for example, people's contacts, and this helped them when the time came to, to actually go and send people these nudges to get vaccinated.

Eva Schaper  22:42
Okay, is there anything else that we need to talk about?

Daiva Repeckaite  22:44
So I think let's not discount Malta as just a small country where it would have been easy, obviously, logistically, it was easier to deliver vaccines all over the islands. But it is more important to say that trust in the healthcare system was built up over the years and making doctors and volunteers kind of ambassadors of the vaccination campaign has really paid off.

Eva Schaper  23:10
Okay, Daiva that was really fascinating. Do you want to tell our listeners about another show that we're producing right now?

Daiva Repeckaite  23:18
Yes, exactly. So we've been watching trends in Bulgaria and Romania, which are the EU's most under vaccinated countries. Luckily, we have a reporter who is very knowledgeable about Romania, and she's currently working on our brand new episodes about what happens in this country and why vaccination rates remain so low.

Eva Schaper  23:41
Everything we talked about all the links will be in the show notes so that you can find them. If you want to take a look at all the background information that we have in this show. We are also going to add a transcript of the show to our website www the inoculation comm if you prefer to read about all of these things

Daiva Repeckaite  23:58
If you want to hear more stories about vaccine hesitancy, you can look up the inoculation wherever you like to listen to podcasts.

Eva Schaper  24:05
And don't forget to subscribe to our newsletter inoculated, and the link is also in the show notes.

Daiva Repeckaite  24:11
You can follow us on Facebook, YouTube, Instagram and Twitter. Our reporting is supported by ij4eu and Alfred Toepfer Stiftung. bye for now

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