Interview with Paulette Lenert in Delano "Have scenarios ready to be deployed when it gets tough"

Delano: Are you starting 2021 with renewed optimism, now that the vaccine roll-out has begun?

Paulette Lenert: Maybe a hint of optimism in so far that we have managed, with a partial lockdown, to get our figures really consistently down. At one moment in October, they went completely up, and we just succeeded in achieving a certain stabilisation. And thats what keeps me optimistic, the sense that you can see we can do it. And people certainly did understand what it was about, otherwise, it couldn't have worked. Its not just about policy if people don't respect the rules. As for the vaccine, yes... but the vaccine won't be of any help at this very critical moment. January and February are really the worst months to come regarding the pandemic, combined with the new UK variant. We have had it here in Luxembourg but we don't know, and none of the countries around us really know, how quickly it will start to spread. I mean, if you see what's happened in Ireland and in the UK, it is quite scary, because the rapidity is doubling. So, I'm really worried about that. We have to stay really strict on everything that's unprotected contact. That's why we still remain really severe on visits at home, which are limited to an absolute minimum. That's why the hospitality sector stays closed, because you are in close contact by definition when you are eating. I'm quite happy that we didn't give in to setting exceptions during the Christmas holidays as some countries did. It was really hard to resist because there was such pressure...but just a few days can be too much. There's some optimism because you can see vaccines are being produced and have started to arrive. We didn't know about that six months ago and now everybody takes it for granted. But my greatest anxiety is about the psychological effects of the vaccines. After the state of emergency, when numbers were really low, everyone thought everything is going to be fine. That's why it is a really critical time for the pandemic, because there's a fatigue.

Delano: Were you happy with the way procurement and now distribution of the vaccine within the EU have been coordinated?

Paulette Lenert: I must say I don't share this criticism right now. I think the EU did a good job. It's the first time we really succeeded in acting together. And they just made this choice to split... to have like five or six producers in line, which, personally, I think was really a good decision. It was like a 'bon père de famille'. Because you just didn't know. Everybody says, `well, you should have bought more Pfizer, but who knew that Pfizer would be the first? These messenger RNA vaccines are new, and nobody knew if they would be admitted or not. So, it was a wise decision just not to put all our eggs in one basket. Now, I have no reason to doubt that we will receive our 0.14% of the allocation from every single contract that has been signed. It's also a matter of production not being quick enough to deliver and logistics in getting this stuff to every single country. I mean the Moderna vaccine arrived just two days after it was allowed on the market. And we shouldn't complain about that...

Delano: Is there any indication of what percentage of the population in Luxembourg is willing to take the vaccine?

Paulette Lenert: We are currently conducting a survey, with results coming 20th of January. We put a lot of energy into informing people, we have had question and answer events on Facebook once a week. We have the dedicated covid interne site, we've been hosting webinars for professionals, which is a different audience from the general public. So, I am quite confident. I mean the vaccines have been turned around in record time, so obviously people have questions. And I think when they receive the answers they will feel comfortable enough to decide for themselves. It's very successful in retirement homes, with 90% saying they will take it up, which is already very good. It's just a little bit early to tell.

Delano: You have been at the forefront of the government's fight against the pandemic, and you have received praise and also been subject to some criticism. How has that affected you personally?

Paulette Lenert: It was like 14 days after I started [that the pandemic hit Luxembourg]. It's a weird feeling, especially because it's not over. Some people say, 'oh it will be done by summer', but that's another six months! It's tiring. Front line workers are really stressed. But those of us in the back office have also really been on it all the time since the beginning. There was no single break, and, at the end of the year, when people usually relax, we were in the middle of planning the start of the vaccination. There's no expectation to return to any kind of a routine.

Delano: Obviously, the pandemic has taken away resources from other health services?

Paulette Lenert: Exactly. We try to handle emergencies, but its not been normal. Clearly, you have the same challenges in bigger countries, but here its always the same lawyers, the same doctors here at the direction de la santé. Its the same people in the comité de pilotage...

Delano: Was it also a challenge coordinating with the other government ministries?

Paulette Lenert: I think that's probably easier here in Luxembourg, because we are small. So, you can easily get in touch, make a phone call. We have fewer hierarchies. If you have local authorities, and so on, or municipalities... that makes it even more complicated, like in France now. We have these centralised vaccination centres, for example, which is easier to organise than having to work and coordinate with a whole panoply of different actors.

Delano: One particular area of concern was schools. Parents were worried, teachers expressed concern...

Paulette Lenert: It's very important. If you think about the collateral damage for the youth, you cannot imagine. They had to just cut off their social contacts. It's not only the educational aspect, but it's also just building their social competencies... that's really hard for them. And it's a very difficult decision. From a society point of view, I think it really should be the priority to give them the education they are entitled to. And that's really a challenge. And there was never a routine because at the beginning we were told there were studies saying children don't transmit the virus that much, then new studies saying they do. So, it was really difficult to navigate on this fluctuating knowledge. People were saying, 'you don't have a scientific basis for your decision, but where would we get it? Nobody had it. It takes time to conclude studies. So, during the emergency, it's really difficult to have this reliable scientific evidence. If you wait for that... I mean the virus is a natural thing, it spreads, it doesn't care if we have evidence or not. It's just there and you have to act. And then it's very difficult to take this criticism...

Delano:...because everyone's an expert, right?

Paulette Lenert: Yes, and it touches the whole of society. So, it's really a political subject. And the image I have is that I spent like two-thirds, or even more, of my time justifying what I do, explaining what I do rather than taking decisions. And that, that's not normal. In a crisis, you should be on the bridge leading and taking action and not spend time on justification and explanation.

Delano: What lessons have been learned from the pandemic that can be applied to future crises?

Paulette Lenert: Preparedness. Have scenarios ready to be deployed when it gets tough. Because it was really a challenge all of a sudden to find the right people, to address them, to get the contracts done. I think we could have a reflection for the future to assist in identifying tempore non-suspect people who could be really thinking or detached for such tasks. That's really something that we could work on. Even now, there are more people from other administrations working for me than I have staff here. And they will eventually have to go back to their work. So, it's very fluctuating from a human resources point of view, it's not a solid team that's used to working together.

Delano: The health sector in Luxembourg is facing its own challenges away from the pandemic. What is the latest status of the proposed Observatoire de la santé?

Paulette Lenert: It still has to be passed in parliament. It would certainly have been a big advantage to have it in place. They could have handled the whole thing, because there was so much missing. We had to develop IT programmes for the monitoring, to have a view on levels of ICU occupation.... Digital health is one of my priorities anyhow, but all the data collection, the tracing... there was nothing. We were still working with faxes when I started. I thought it was a joke. In Germany, they still do. Within one or two months, we put up the whole IT system with databases to have this completely changed and modernised. And I think now they see how good it is to have good data management in place.

Delano: The Association luxembourgeoise des étudiants en médecine has reported that up to 30% of medical students don't return to Luxembourg to practise. What measures can be taken to encourage more graduates to come back to Luxembourg?

Paulette Lenert: Yes, that's one of the main points of the Gesondheetsdësch [a health system working group that includes actors from across the sector] which was launched on 14 February last year. Studies in the medical field are very much linked to practice. So, because people study abroad, they are already connected, when they start their working life, not just to their university, but to hospitals and medical centres, and so on. I think very naturally they just put down an anchor to their social life, probably more in this field than other fields of study. It's very important to develop complete medical studies here in Luxembourg as well, not only for our nationals, but also to attract people from wherever. So, we will end up doing the same, because if you have attractive studies with attractive practices and internships, then that would be the challenge for the country to convince people to stay here. Because the problem is not specific to Luxembourg, every country is probably making efforts to make it attractive for people to stay.

Delano: A European Council opinion reported in May that between 59% and 69% of current medical staff in Luxembourg are expected to retire over the next 15 years. Is this going to pose a staffing crisis?

Paulette Lenert: It's pretty challenging. If we start with studies, develop a medical school, it won't bring in people who are trained within a year or two. That's why I also strongly believe in innovation and technology. We really have to push everything we can that makes the job easier, relying more on remote monitoring or teleconsultations. To be efficient without needing the same amount of human resources. Another strategic approach could also be to invest much more money in prevention, to keep people healthy for longer. And, as I said, in digital health, there are some really good practices over in other countries that we still haven't implemented here.

Delano: Is the local medical professional on board with this strategy?

Paulette Lenert: Yes, at the Gesondheetsdësch, all the actors are with us. But it's difficult in pandemic times to advance at the rhythm you expect, because of the dynamic. And one of the things is that you just can't meet really naturally... It's easier to handle physical presence meetings, especially dealing with such huge subjects. I find it easy to work on WebEx with my team or people you know, it's been fantastic. It doesn't make much of a difference, in fact, it's even more efficient than driving around to meet. But for the Gesondheetsdësch, somethings missing, because it's really a very broad spectrum of actors and we just need this room to socialise, to communicate.