Last week, Vice Admiral Enrique Gouveia e Melo, coordinator of Portugal's vaccination task force, said goodbye to most of his staff and then went home and slept for 12 hours. With more than 95 percent of its eligible population vaccinated, Portugal says it no longer needs the vaccination task force.

As Canada and other wealthy countries suffer from declining numbers of vaccine recipients, many look to Portugal to learn from its experience, as about 12 percent of eligible Canadians remain unvaccinated after one dose of the COVID vaccine, and 18 percent have not yet received a second dose.

When politicians assigned Gouveia e Melo, a Portuguese naval officer, to the vaccine distribution operation among the Portuguese in February, the program was in a "state of chaos," he said.

In the last week of January, Portugal reported more than 12,000 new COVID cases and more than 200 deaths daily among its slightly more than 10 million population. Its healthcare system was on the verge of collapse, and ambulances carrying COVID patients lined up outside hospitals waiting for beds, with nearly 2,000 deaths due to COVID within one week.

Gouveia e Melo credits Portugal's success to military leadership in the vaccination process and insists that keeping politics out of public health helped build trust in vaccines. Initially, about 40 percent of the Portuguese population had doubts, he said, but he believes he was able to change their minds through clear and calm communication about the benefits of vaccines, using wartime language to rally the population.

Portugal is now the most vaccinated country on Earth according to Our World in Data, with more than 85 percent of its total population vaccinated against COVID-19, having lifted almost all COVID restrictions last Friday, and reopening bars and nightclubs that had been closed since the dawn of the pandemic in March 2020. The daily COVID case count was about 600, only five percent of its earlier peak, and hospital cases have dropped significantly. Now Portugal will start administering the third dose to seniors next week.

Many countries have assigned their militaries to vaccine deployment efforts, including Canada. Until last April, the vaccine distribution team in Ontario was headed by retired General Rick Hillier, but perhaps not on the scale that Portugal did.

Barry Pakes, a public health specialist at the University of Toronto, said, "There is no doubt that having a non-political leadership as the face of vaccination efforts against the pandemic helps build trust, but it is natural for politicians to be at the forefront because they fund and implement policy."

Politicians have largely led vaccine rollout in Canada, with Liberal Minister Anita Anand responsible for purchasing and distributing vaccines, and premiers setting vaccination policies and encouraging people to get vaccinated.

Vaccination strategy was also a hot political issue, with Prime Minister Trudeau repeatedly criticizing Conservative leader Erin O'Toole during the last election campaign for not requiring his candidates to be fully vaccinated against COVID. Meanwhile, the right-wing People's Party of Canada was able to mobilize anti-vaccine crowds and nearly tripled its vote share compared to 2019.

However, Pakes said politics and vaccines are less intertwined in Canada than in other countries like the United States. He added he is not sure military messaging would be well received by Canadians.

Henrique Barros, an epidemiologist at the University of Porto, does not agree with Gouveia e Melo's framing of pandemic efforts as a "war." He says: with infectious diseases, there are no villains or heroes, no winners or losers. He acknowledges the military was well equipped to lead the vaccination campaign as they are trained to respond to emergencies, but attributes Portugal’s success to effective local governments.

Gouveia e Melo describes himself as the "tip of the iceberg" in a team of military strategists, mathematicians, and doctors who coordinated with Ministry of Health officials and local governments, overseeing a network of about 300 vaccination centers run by thousands of doctors, nurses, and volunteers.

Barros said underlying historical and social conditions contributed to Portugal's vaccine success, where people generally value vaccine safety and efficacy, and there is no strong history of anti-vaccine movements. Portugal has one of the highest overall vaccination rates in Europe.

Barros said: "Vaccination was seen as something modern, something that would take you from a certain misery to a more optimistic situation." Public health measures during the pandemic peak, such as curfews and travel restrictions, also made people more eager to get vaccinated and view it as "the key to a more normal life."

Nevertheless, Portugal is not immune to misinformation and anti-vaccine opponents that have plagued other countries.

Gouveia e Melo described facing an anti-vaccine protest in front of a vaccination center in Lisbon in July, where he calmly explained to people that "the killer is the virus," while protesters shouted at him "genocide" and "murderer."

But most reactions were positive, and Gouveia became a familiar figure in Portugal and sometimes is recognized on the street and thanked for his efforts.

Throughout his leadership, he was often called "immediately" by the media to explain matters, and he said he never avoids questioning even in the most difficult moments, adding, "You must be very honest in the eyes of the public."

His advice to Canada and other countries struggling to enhance vaccine uptake was "Explain until exhaustion."

Gouveia e Melo said he asks people to imagine they are at a crossroads. If they go one way, which is rejecting the vaccine, they have a one in 500 chance of dying, according to Portuguese figures. If they go the other way and get vaccinated, they have a one in 500,000 chance. "If you are smart or logical, which path would you want to take?"

On the other hand, Pakes is not certain people are convinced that easily. The challenge now is reaching specific communities that may have their own reasons for vaccine resistance, such as historical mistreatment by the government and doctors.

Gouveia Melo said as his tenure as head of Portugal's vaccine task force ends, the war is not over as long as wealthy countries continue hoarding vaccines while poor countries lack access. He said bridging this gap is a public health issue and a moral necessity. "We in the Western world talk a lot about ethics, but we must also practice these ethics."

Reported by Toronto Star