THE WORLD BANK (L " I VJ I WORLD BANKGROUP Lilia Burunciuc Director, Caribbean Latin America and the Caribbean Region August 19, 2022 The Honourable Colm Imbert Minister of Finance Ministry of Finance Level 8 Eric Williams Finance Building Independence Square Port of Spain Republic of Trinidad and Tobago Dear Minister Imbert: Trinidad and Tobago: COVID-19 Emergency Response Project (Pl73989) First Amendment to the Loan Agreement We refer to the Agreement ("Loan Agreement") between the Republic of Trinidad and Tobago ("Borrower") and the International Bank for Reconstruction and Development (the "Bank") dated February 22, 2021, for the above-mentioned project ("Project"). We also refer to your letter dated March 9, 2021, requesting the Bank to amend the Loan Agreement to include the procurement of COVID-19 vaccines to the Project. The capitalized terms used in this amendment letter ("Amendment Letter") and not defined herein have the meanings ascribed to them in the Loan Agreement. Additionally, the Borrower's Minister of Finance, by letter dated June 14, 2021, requested an extension from the Bank, for the Borrower to deliver to the Bank the following documents: (i) Stakeholder Engagement Plan; (ii) Labor Management Procedures and (iii) Environmental and Social Management Framework. We are happy to inform you that the Bank has agreed to your request and hereby proposes to amend the Loan Agreement as follows: 1. Schedule 1 is hereby amended and replaced in its entirety to read as in Annex 1 to this Amendment Letter. 2. Section I.A. of Schedule 2 is hereby amended to read in its entirety as follows: "A. Institutional Arrangements. The Borrower, through MoH, shall: (a) operate and maintain, throughout Project implementation, a PIU within MoH, with functions, staffing and resources acceptable to the Bank, as described in the Project Operations Manual. 3rd Floor, Courtleigh Corporate Center, 6 St. Lucia Avenue, Kingston 5, Jamaica 1 Phone 1 (876) 960-0459 Email: lburunciuc@worldbank.org The Honourable Colm Imbert -2- August 19, 2022 (b) no later than thirty (30) days after the Effective Date, hire the following additional staff as part of the PIU: (i) a Project manager; (ii) a financial management specialist; and (iii) a procurement specialist; all with qualifications and functions acceptable to the Bank, as described in the Project Operations Manual. (c) no later than May 31, 2022, hire an environmental and social specialist with qualifications and functions acceptable to the Bank, as described in the Project Operations Manual. (d) no later than thirty (30) days after the Effective Date, establish and thereafter operate and maintain, throughout Project implementation, a committee (the Committee) with functions, responsibilities and composition acceptable to the Bank, including the Project oversight responsibility, as further described in the Project Operations Manual. (e) coordinate with the pertinent RHA with respect to: (i) the supervision of the proper use of the goods and services procured under Part 1 of the Project; and (ii) the provision of information for purposes of Project monitoring and evaluation under Part 3 of the Project." 3. Section I.B of Schedule 2 is hereby amended to read as follows: "B. Project Operations Manual 1 . No later than thirty (30) days after the Effective Date, the Borrower, through MoH, shall adopt a manual (the Project Operations Manual) satisfactory to the Bank, and thereafter carry out the Project in accordance with said manual, containing, inter- alia: (i) specific provisions on detailed arrangements for the carrying out of the Project; (ii) the composition, qualifications, and responsibilities of the PIU and the Committee; (iii) the procurement, financial management and disbursement requirements; (iv) the coordination mechanisms with RHAs; (v) the Personal Data collection and processing requirements in accordance with good international practices; (vi) the performance indicators; and (vii) the Anti-Corruption Guidelines. 2. Notwithstanding the preceeding paragraph, and in order to ensure adequate implementation of Part 2 of the Project, the Borrower shall, incorporate as part of the revised Project Operations Manual, a manual for COVID-19 Vaccine delivery and distribution plan ("Vaccine Delivery and Distribution Manual" or "VDDM"), in form and substance satisfactory to the Bank, which shall include: (i) rules and procedures for prioritizing intra-country vaccine allocation following principles established in the WHO Fair Allocation Framework, including an action plan setting out the timeline and steps for implementing such rules; (ii) rules and procedures establishing minimum standards for vaccine management and monitoring, including medical and technical criteria, communications and outreach plan, cold chain infrastructure, infection, prevention and control and other related logistics infrastructure; The Honourable Colm Imbert -3- August 19, 2022 (iii) rules and procedures for processing and collection of Personal Data in accordance with good international practice; and (iv) vaccine distribution plan, including action plan setting out timeline and steps for immunization. 3. The Borrower shall carry out the Project in accordance with this Loan Agreement, the Project Operations Manual, and the Vaccine Delivery and Distribution Manual. 4. The Borrower, through MoH, shall ensure that the collection, use and processing (including transfers to third parties) of any Personal Data collected under this Project shall be done in accordance with best international practices, ensuring legitimate, appropriate and proportionate treatment of such data. 5. Except as the Bank shall otherwise agree, the Borrower, through MoH, shall not assign, amend, abrogate, or waive the provisions of the Project Operations Manual without prior approval of the Bank. 6. In the event of any conflict between the provisions of the Project Operations Manual and the provisions of this Loan Agreement, the provisions of this Loan Agreement shall prevail." 4. Section I.C of Schedule 2 is hereby amended to add the following new paragraph 6: "6. In case the Borrower's Trinidad and Tobago Defence Force and/or any other security personnel are used for the transport and storage of Project COVID-19 Vaccines or to provide security to any Project sites or assets, the Borrower shall, through MoH, in coordination with other government authorities, ensure that such personnel are deployed in accordance with the relevant requirements of ESSs and the ESCP." 5. A new Section I.D is added to Schedule 2, as follows: "D. Use of Military and Security Personnel 1. All activities that shall be carried out by the Trinidad and Tobago Defence Force and/or any other security personnel, such as the transport and storage of Project COVID-19 Vaccines shall be carried out under the direction of MoH and shall be undertaken exclusively for the purposes related to the Project. The activities financed by the Loan proceeds under the direction of the MoH and supported by security arrangements for the transport and storage of Project COVID- 19 Vaccines using state agencies such as the Trinidad and Tobago Defence Force and/or any other security personnel, shall be strictly in accordance with the Project Operations Manual and any other arrangements or protocols that the Bank may require for carrying out these activities. 2. Except as the Bank may otherwise agree, the Borrower, through the MoH, shall ensure that that the ownership of any assets acquired out of the Loan proceeds shall be transferred to, or shall vest, with MoH or any equivalent or appropriate line ministry or agency agreed with the Bank." The Honourable Colm Imbert -4- August 19, 2022 6. A new Section I.E is added to Schedule 2, as follows: "E. Standards for COVID-19 Vaccine Approval All Project COVID-19 Vaccines shall satisfy the Vaccine Approval Criteria." 7. The table in Section III.A of Schedule 2 is hereby amended and replaced in its entirety to read as follows: Category Amount of the Loan Percentage of Expenditures to Allocated be financed expressed in USD (exclusive of Taxes) (1) Goods, non-consulting 11,900,000 100% services, consulting services, Operating Cost, and Training under Parts 1 and 3 of Project (2) Goods, non-consulting8,050,000 100% services, consulting services, Operating Cost, and Training under Part 2 of the Project (3) Front-end Fee 50,000 Amount payable pursuant to Section 2.03 of this Agreement in accordance with Section 2.07 (b) of the General Conditions TOTAL AMOUNT 20,000,000 8. The following disbursement conditions are hereby included, respectively as Section III.B.2.i. and III.B.2.ii of Schedule 2 to the Loan Agreement, and the current Section III.B.2 is renumbered to Section III.B.3. "2. No withdrawals shall be made from Category 2 until: i. evidence satisfactory to the Bank has been furnished to the Bank confirming that the Borrower, through MoH, has updated, consulted upon, disclosed and adopted the ESMF (including the LMP) and the SEP both in form and substance satisfactory to the Bank. ii. Evidence satisfactory to the Bank has been furnished to the Bank confirming that an environmental and social specialist has been hired as part of the PIU, with terms of reference acceptable to the Bank." 9. The Appendix to the Agreement is amended by adding, and placing in alphabetical order the following terms and definitions (and, as a result, the remaining terms and definitions are renumbers to maintain alphabetical order): The Honourable Colm Imbert -5- August 19, 2022 * "COVAX Facility" means the COVID-19 Vaccine Global Access Facility, a mechanism through which demand and resources are pooled to support the availability of, and equitable access to, COVID-19 vaccines for all economies, and which is coordinated by Gavi, the Vaccine Alliance, the Coalition for Epidemic Preparedness Innovations ("CEPI"), and the WHO. * "ESMF" or "Environmental and Social Management Framework" means the framework referred to in Section III B.2. of Schedule 2 to this Agreement, to be updated, disclosed, consulted upon, and adopted for the Project, as set out in the ESCP, in accordance with the Environmental and Social Standards. * "LMP" or "Labor Management Procedures" means the procedures referred to in Section III B.2. of Schedule 2 to this Agreement, to be prepared or updated, disclosed, consulted upon, and adopted for the Project, as part of the ESMF, and as set out in the ESCP, in accordance with the Environmental and Social Standards. * "Project COVID-19 Vaccine" means a vaccine for the prevention of COVID-19, authorized by the Borrower's national regulatory authority for distribution, marketing and administration within the territory of the Borrower, and acquired or deployed under the Project; "Project COVID-19 Vaccines" means the plural thereof." * "SEP" or "Stakeholder Engagement Plan" means the plan referred to in Section III.B.2 of Schedule 2 to this Agreement, to be updated, disclosed, consulted upon and adopted for the Project, as set out in the ESCP, in accordance with the Environmental and Social Standards. * "Stringent Regulatory Authority" means a National Regulatory Authority ("NRA") that is classified by WHO as a Stringent Regulatory Authority. * "Vaccine Approval Criteria" or "VAC" means that the Project COVID-19 Vaccine: (a) has received regular or emergency licensure or authorization from at least one of the Stringent Regulatory Authorities identified by WHO for vaccines procured and/or supplied under the COVAX Facility, as may be amended from time to time by WHO; (b) has received the WHO Prequalification or WHO Emergency Use Listing; or (c) has met such other criteria as may be agreed in writing between the Recipient and the Bank. * "Vaccine Delivery and Distribution Manual" or "VDDM" means the Borrower's manual referred to in Section I.B.2of Schedule 2 to this Agreement, as the same may be amended from time to time with the Bank's prior written approval. * "WHO" means World Health Organization. * "WHO Fair Allocation Framework" means the rules which govern the allocation of vaccines to participants in the COVAX Facility, as developed by WHO, subject to periodic review by the COVAX Facility. * "WHO Emergency Use Listing" means a risk-based procedure for assessing and listing by WHO of unlicensed vaccines, therapeutics, and in vitro diagnostics with the aim of expediting the availability of these products to people affected by a declared public health emergency. The Honourable Colm Imbert -6- August 19, 2022 * "WHO Prequalification" means a service provided by WHO to assess the quality, safety, and efficacy of medical products for priority diseases, and which are intended for United Nations and international procurement to developing countries. 10. The following definition in the Appendix to the Agreement is hereby amended in its entirety as follow: * "Committee" means the committee to be established by the Borrower, referred to in Section I.A.(d) of Schedule 2 to this Agreement. 11. A revised Environmental and Social Commitment Plan ("ESCP") dated May 24, 2022 is attached as an annex to this Amendment Letter and replaces in its entirety the ESCP dated June 26, 2020. All the terms and conditions of the Loan Agreement that have not been amended hereby shall remain unchanged and in full force and effect. Please confirm your agreement with the foregoing, on behalf of the Borrower, by signing, dating and returning to the Bank the enclosed copy of this Amendment Letter. This Amendment Letter shall be executed in two (2) counterparts each of which shall be an original. This Amendment Letter will become effective upon: (i) receipt by the Bank of evidence satisfactory to the Bank, confirming that the Project Operations Manual has been updated; (ii) receipt by the Bank of one fully executed original of this Amendment Letter; and (iii) the Bank's dispatch of the notice declaring effectiveness of this Amendment Letter. Sincerely, Pp p Lilia Burunciuc REPUBLIC OF TRINIDAD AND TOBAGO By: I Authorized Representative Name: Ct___tA___: Title: Date:_______ The Honourable Cohn Imbert -7- August 19, 2022 cc: Ms. Suzette Taylor-Lee Chee, Permanent Secretary, Ministry of Finance Ms. Michelle Durham-Kissoon, Ag Permanent Secretary, Ministry of Finance Mr. Erivaldo Gomes, Executive Director, The World Bank Group Mr. Santiago Pastrana, Alternate Executive Director, The World Bank Group Ms. Tashay Francis, Advisor to Executive Director, The World Bank Group -8- Annex 1 Project Description The objectives of the Project are to detect and respond to the threat posed by COVID-19 and strengthen the national health system for the emergency response to the COVID- 19 pandemic. The Project constitutes the second phase of the MPA Program, and consists of the following parts: Part 1: Emergency response to COVID-19 Providing immediate support to respond to the COVID- 19 pandemic through, inter alia: 1. strengthening case detection and recording through, inter-alia: the acquisition of laboratory equipment, medical supplies, including test kits and reagents for the diagnosis of COVID-19 during the outbreak, and the provision of training on the correct use of said equipment and supplies; and 2. strengthening the health care system capacity to provide a comprehensive range of services for the treatment and care of COVID- 19 patients through, inter-alia: (i) the acquisition of essential disinfection and sterilization equipment, including medical supplies, and supplies to ensure safe hospital waste management practices; (ii) the acquisition of key health care delivery inputs, including personal protective equipment and additional medical supplies for frontline health workers; (iii) the provision of training of health staff on appropriate clinical care for COVID-19 patients and the safe disposal of medical waste; (iv) the acquisition of medicines and vaccines (if they become available); and (v) the acquisition of equipment for the treatment of COVID- 19 patients. Part 2: Support to COVID-19 Vaccination Campaign 1. Supporting MoH in the purchasing of Project COVID-19 Vaccine. 2. Provision of technical assistance on vaccine demand generation and the design of a communications campaign which shall include, inter-alia: (i) the establishment of mechanisms to communicate more effectively and reach out to the most vulnerable populations, (ii) engage citizens and target beneficiaries in providing feedback on program delivery and identification of gaps, and (iii) transparency and reporting on the implementation of the National Vaccine Deployment Plan. Part 3: Implementation Management and Monitoring and Evaluation Carrying out Project management activities including: (i) carrying out of financial management (including Project audits), procurement, environmental and social requirements of the Project; and (ii) monitoring and evaluation of the Project.