What can Canada learn from the most vaccinated country in the world? We asked the man behind Portugal’s vaccination effort

Last week, Vice Admiral Henrique Gouveia e Melo, co-ordinator of Portugal’s COVID-19 vaccine task force, said goodbye to most of his staff.

Then he went home and slept for 12 hours.

With more than 95 per cent of its eligible population vaccinated, Portugal says it no longer needs a vaccine task force.

As Canada and other wealthy nations experience some stagnation in vaccine uptake, many are looking to Portugal for lessons. About 12 per cent of eligible Canadians have yet to receive one dose of a COVID-19 vaccine, and 18 per cent have yet to receive their second.

When Gouveia e Melo, a Portuguese navy officer, took over the vaccine rollout from a political appointee in February, the program was in “shambles,” he says.

In the last week of January, Portugal was reporting more than 12,000 new COVID-19 cases and more than 200 deaths a day among its population of just over 10 million. Its health system was on the brink of collapse, ambulances carrying COVID patients had to line up outside of hospitals, waiting for beds, and nearly 2,000 people died from COVID-19 in the span of one week.

“I had the feeling that we had a huge mountain to climb, and I could not see the peak,” Gouveia e Melo told the Star in an interview this week.

In his 42-year military career, the 60-year-old officer has served as a submarine commander, captained a frigate, led the European Union’s Maritime Force and holds the record for most hours logged at sea out of any serving Portuguese naval officer, according to The Associated Press.

Gouveia e Melo credits much of Portugal’s vaccine success to military leadership over the rollout. Keeping politics out of public health helped build trust in vaccines, he contends.

In the beginning, about 40 per cent of the Portuguese population had doubts, he said, but by communicating clearly and calmly the benefits of vaccines, and employing wartime language to rally the population, he believes he was able to change their minds.

Portugal is now the most vaccinated country on earth, according to Our World in Data, with more than 85 per cent of its entire population vaccinated against COVID-19. On Friday, it dropped nearly all COVID-19 restrictions, reopening bars and nightclubs that had been shut since the dawn of the pandemic in March 2020. The country has been reporting about 600 new cases a day, just five per cent of its onetime peak, and hospitalizations have dropped dramatically. Portugal will start giving out third doses to seniors next week.

Gouveia e Melo used war-effort-framed notions of solidarity and personal responsibility to convince people to get the shots, he said.

“You are a warrior. You have to fight the war. Vaccinate yourself,” said the blue-eyed, salt and pepper stubbled admiral, dressed in his navy uniform during a conversation over Zoom.

Other countries, including Canada, have involved their military in vaccinations — until April, Ontario’s vaccine distribution task force was headed by retired general Rick Hillier — but perhaps not to the scale Portugal did.

There’s “no question” having non-political leadership as the face of the pandemic effort helps build trust, but it’s natural for politicians to be at the forefront because they are the ones funding and enacting policy, said Barry Pakes, public health specialist at the University of Toronto.

Politicians have largely led Canada’s vaccine rollout, with Liberal cabinet minister Anita Anand handling the procurement and distribution of shots, and premiers determining policy and encouraging people to get jabbed.

Vaccination strategy has also been a hot-button political issue, with Prime Minister Trudeau frequently criticizing Conservative leader Erin O’Toole throughout the recent election campaign for not requiring his candidates be fully vaccinated against COVID-19. The right-wing People’s Party of Canada, meanwhile, was able to rally the anti-vax crowd and nearly triple its vote share from 2019.

Still, politics and vaccines are much less intertwined in Canada than they are in other countries, such as the U.S., Pakes said. He added he’s not sure the militaristic messaging would go over so well here.

“That just isn’t something that resonates for many Canadians.”

Henrique Barros, epidemiologist at the University of Porto disagrees with Gouveia e Melo’s framing of the pandemic effort as a “war.” (With infectious diseases, there are no bad guys or good guys, he says, no winners or losers). He acknowledges the military is well-equipped to lead a vaccination campaign because they are trained to respond to emergencies, but attributes Portugal’s effective rollout to local governments.

Gouveia e Melo describes himself as the “tip of the iceberg” in a team of military strategists, mathematicians and doctors who co-ordinated with health ministry officials and local governments, overseeing a network of about 300 vaccination centres run by thousands of doctors, nurses and volunteers.

Underlying historical and social conditions have also propelled Portugal’s vaccine success, Barros said. People generally accept the safety and efficacy of vaccines in Portugal, and there is no history of anti-vaccine movements. Beyond the COVID-19 vaccine, Portugal has one of the highest rates of vaccine coverage in Europe.

“Vaccination was seen as something modern, something that would take you from a certain misery to a more hopeful situation,” Barros said. Public health measures during the height of the pandemic, like curfews and travel restrictions, also made people more eager to get the vaccine and see it as a “key to a more normal life.”

That said, Portugal is not immune to misinformation and vaccine opposition that has plagued other countries.

Gouveia e Melo described walking through an anti-vaccine demonstration in front of an inoculation centre in Lisbon in July, where he calmly explained “the killer is the virus” while protesters shouted “genocide” and “assassin” at him.

But most of the reception has been positive. Gouveia e Melo has become a household name in Portugal, and standing six-foot-three, he sometimes gets recognized on the street and thanked for his efforts.

Throughout his leadership, he’s frequently been put “on the spot” by the media to explain things, but he never avoids questioning, he said, “even in more difficult moments.”

“You must be very honest to the eyes of the public.”

His advice for Canada and other countries striving to boost vaccine uptake?

“Explain until exhaustion.”

Gouveia e Melo said he asks people to imagine they are at a fork in the road. If they go one way — refusing the vaccine — they have a one-in-500 chance of dying, according to Portuguese numbers. If they go the other way — and get the shot— they have a one-in-500,000 chance. “If you are smart or logical, what road do you want to take?” he asked.

He’s a fan of bluntness.

Pakes, meanwhile, isn’t sure it’s that easy.

“I think we’ve really done that already,” he said.

Now, the challenge is reaching out to specific communities that may have their own reasons for resisting vaccines, such as historical mistreatment by government and doctors.

While his tenure as head of Portugal’s vaccine task force is wrapping up, Gouveia e Melo said the war is far from over, so long as wealthy countries continue to hoard vaccines while poorer nations lack access. Closing that gap is a public health issue and a moral imperative, he said.

“We in the Western world speak a lot about ethics, but we also have to practise these ethics.”

Lex Harvey is a Toronto-based newsletter producer for the Star and author of the First Up newsletter. Follow her on Twitter: @lexharvs