24-Sep-2021 ______________________, 2021 H.E. Neil Rijkenberg Minister of Finance Ministry of Finance Mbabane, Eswatini Re: Kingdom of Eswatini: IBRD Loan No. 9098-SZ (Eswatini Covid-19 Emergency Response Project) Amendment to the Original Loan Agreement Excellency: We refer to the Loan Agreement (“Original Loan Agreement”) for the above-referenced Project, between the Kingdom of Eswatini (“Borrower”) and the International Bank for Reconstruction and Development (“Bank”), dated April 29, 2020. We also refer to the Additional Loan Agreement negotiated between the Borrower and the Bank on March 17, 2021, for the purpose of providing an additional financing to the Project. In order to align the provisions of the Original Loan Agreement with the ones of the Additional Loan Agreement, the Bank proposes to amend the Original Loan Agreement as follows: 1. Schedule 1 is amended to read as the Annex attached to this amendment. 2. The following paragraphs are amended and/or added into Section I.A of Schedule 2 as follows: (a) Paragraph (c) is added to Section I.A2 to read as follows: “(c) the DPP and the Expanded Program on Immunization under the Public Health Unit, which shall be responsible for rolling out the Project Covid- 19 vaccines.” (b) The following sentence is added to Section I.A.3 to read as follows: “Notwithstanding the above-mentioned, the Borrower shall appoint and/or hire one (1) logistics specialist, one (1) procurement specialist, one (1) vaccine specialist and one (1) communications specialist, all with experience and terms of reference satisfactory to the Bank, who shall be assigned to work within the Core Implementation Team and be responsible for supporting the rolling out the deployment and distribution of Project Covid-19 Vaccines.” (c) The following paragraphs are added to Section I.B to read as follows: -2- “3. Without limitation to Section B.1 above, in order to ensure adequate implementation of Part 1.4 of the Project, the Borrower shall prepare and adopt a manual for COVID-19 Vaccine delivery and distribution (“Vaccine Delivery and Distribution Manual”), as part of the Project Implementation Manual, in form and substance satisfactory to the Bank, which shall include: (a) 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; (b) rules and procedures establishing minimum standards for vaccine management and monitoring, including medical and technical criteria, communications and outreach plan, cold chain infrastructure, and other related logistics infrastructure; (c) rules and procedures for processing and collection of Personal Data in accordance with national law on Personal Data protection and good international practice; and (d) vaccine distribution plan, including action plan setting out timeline and steps for immunization. 4. The Borrower shall carry out the Project in accordance with the Vaccine Delivery and Distribution Manual. Except as the Bank shall otherwise agree, the Borrower shall not assign, amend, abrogate, or waive the provisions of the Vaccine Delivery and Distribution Manual without prior approval of the Bank. In the event of any conflict between the provisions of the Vaccine Delivery and Distribution Manual and this Agreement, the provisions of this Agreement shall prevail.” 3. Section I.G of Schedule 2 is added into to read as follows: “G. Standards for COVID-19 Vaccine Approval All Project COVID-19 Vaccines shall satisfy the Vaccine Approval Criteria.” 4. Section I.H of Schedule 2 is added into to read as follows: “H. Use of Military and Security Actors 1. Without limitations to the provisions of Section D.2 of this Schedule and if during Project implementation, the Borrower decides to use its military or security forces, the Borrower shall: (a) prior to any involvement of its military and/or security forces in the carrying out of Project activities, send a written notice to the Bank communicating such decision, including the name of the military or security unit; and (b) all activities carried out by said military or security unit under the Project shall be under the control of MOH and shall be undertaken exclusively for the purposes related to the Project. All goods, services, Operating Costs, and Training Costs financed by the Loan proceeds may be used by said military or security unit under the direction and control of MOH and strictly in accordance -3- with the Project Implementation Manual and other arrangements or protocols that the Bank may require for carrying out these activities. 2. Except as the Bank may otherwise agree, the Borrower shall ensure that the ownership of any assets generated, goods procured, and works constructed by the military or security unit referred to in paragraph 1 of this Section 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.” 5. The table set forth in Section III.A of Schedule 2 is amended to read as follows: Category Amount of the Loan Percentage of Expenditures Allocated to be financed (expressed in USD) (inclusive of Taxes) (1) Goods, works, non-consulting 5,985,000 services, consulting services, Incremental Operating Costs, 100% Training Costs for the Project (except for Part 2) (2) Front-end Fee 15,000 (3) Interest Rate Cap or Interest 0 Amount due pursuant to Rate Collar premium Section 4.05 (c) of the General Conditions TOTAL AMOUNT 6,000,000 6. Section III.B.2 of Schedule 2 is amended to read as follows: “2. The Closing Date is March 31, 2024.” 7. The following definitions are added to the Appendix: “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. “DPP” means the Borrower’s Deputy Directorate of Pharmaceuticals. “Expanded Program on Immunization” means the Borrower’s current immunization program within MOH, which provides services aimed to reduce morbidity, disability and mortality due to vaccine preventable diseases amongst children under five years – this is in line with the national health policy. “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 purchased or deployed under the Project; “Project COVID-19 Vaccines” means the plural thereof. -4- “Regions” mean the regional areas of the North America, South America, Europe, Asia, Asia Pacific, and Africa. “Stringent Regulatory Authority” means a National Regulatory Authority (“NRA”) that is classified by WHO as a Stringent Regulatory Authority. “Vaccine Approval Criteria” means that the Project COVID -19 Vaccine: (a) has been 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 Borrower and the Bank. “Vaccine Delivery and Distribution Manual” means the Borrower’s manual referred to in Section I.B.3 of Schedule 2 to this Agreement, as the same may be amended from time to time with the Bank’s prior written approval. “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. “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 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. All other provisions of the Original Loan Agreement, except as herein amended, shall remain in full force and effect. Please indicate agreement to the foregoing, on behalf of the Borrower, by countersigning and dating the form of confirmation on the two original copies of this letter provided and returning one original, as countersigned, to us. This amendment shall become effective as of the date of effectiveness of the Additional Loan Agreement. -5- Yours sincerely, INTERNATIONAL BANK FOR RECONSTRUCTION DEVELOPMENT __________________________ Marie Francoise Marie-Nelly Country Director for Eswatini CONFIRMED: KINGDOM OF ESWATINI By: ________________________ Authorized Representative Hon. Minister Neal Rijkenberg Name: ______________________ Minister Finance Eswatini Title: _______________________ 26-Sep-2021 Date: _______________________ -6- ANNEX SCHEDULE 1 Project Description The objectives of the Project are to prevent, detect and respond to the threat posed by COVID-19 and strengthen national systems for public health preparedness in Eswatini. The Project is part of the MPA Program, and consists of the Original Project and the additional activities set forth below: Part 1: Emergency COVID-19 Response 1. Strengthening COVID-19 case detection, confirmation, contact tracing, recording and reporting through inter alia: (a) strengthening disease surveillance systems and in-country testing capacity through scaling up rapid near patient molecular testing and other testing technologies, including strengthening health facilities, the National Reference Laboratory (NRL), and other public health laboratories in specimen collection, packaging, storage, shipment and epidemiological capacity for early detection and confirmation of cases; (b) combining detection of new cases with active contact tracing; (c) supporting epidemiological investigation; (d) strengthening risk assessment; (e) strengthening screening, isolation and follow up of travelers at point of entry; and (f) providing on-time data and information for guiding decision-making, response and mitigation activities. 2. Strengthening the health system for COVID-19 preparedness planning through; inter alia: (a) assisting the health care system for preparedness planning to provide optimal medical care, maintain essential community services and minimize risks for patients and health personnel by, inter alia: (i) providing training on risk for health facilities’ staff and front-line workers on risk mitigation measures; and (ii) providing health facilities’ staff with appropriate protective equipment , water supply, sanitation, hygiene materials and health care waste management services; (b) strengthening clinical capacity through, inter alia: (i) developing financing plans for the establishment of specialized units in selected hospitals; (ii) developing treatment guidelines and hospital infection control guidelines; (iii) establishing local isolation units in selected hospitals; and (iv) providing clinical training to health workers on widespread infection control; and (c) relieving the burden on inpatient and outpatient health care services through inter alia: (i) recruit temporary surge capacity for service delivery; (ii) reorganizing, repurposing and equipping selected health facilities (including the Lubombo referral hospital and the Raleigh Fitkin Memorial hospital) for the delivery of critical medical services and increased demand of services due to the outbreak; (iii) developing intra-hospital infection control measures; and (iv) procuring fully equipped ambulances for highly infectious diseases. 3. Improving the implementation of social distancing measures and strengthening communications preparedness through inter alia: (a) developing well-design communication strategy targeting parents, traditional and religious leaders and general -7- public; (b) developing guidelines for managing at risk groups, including elderly isolation, pension pick-up situations and people with HIV and other chronic conditions; (c) carrying out behavior change communication activities that (i) support cost-effective and sustainable methods including promoting handwashing, food hygiene, and safe water practices through various communication channels (e.g. via mass media, counseling, schools, workplace), and (ii) are integrated into specific ongoing outreach activities of Borrower’s ministries and sectors, especially ministries of health, education, agriculture, and transport; (d) carrying out two-way communication activities to raise awareness, knowledge and understanding among the general population on the risk and potential impact of the pandemic; (e) supporting community mobilization through trained community health workers, religious leaders and traditional healers; and (f) developing and distributing basic communication materials on COVID-19 including: (i) question and answers sheets and fact sheets in Siswati; and (ii) general preventative measures for the general public such as “dos” and “don’ts”; (iii) information and guidelines for health care providers; (iv) training modules (web-based and printed); (v) presentations, slide sets, videos and documentaries; and (vi) symposia on surveillance, treatment and prophylaxis. 4. Providing assistance in the urgent efforts to respond to the Covid-19 pandemic through: (a) supporting the Borrower’s health sector in accessing vaccine purchase mechanisms, purchasing and deploying Project Covid-19 Vaccines; (b) strengthening the Borrower’s institutional framework to enable safe and effective deployment of Project Covid-19 Vaccines, including: (i) developing and/or upgrading regulatory standards at the national level (i.e. pharmacovigilance, authorization mechanisms); (ii) preparing appropriate minimum standards for vaccine management (i.e. cold chain infrastructure); and (iii) setting up accountability, grievances and citizen and community engagement mechanisms; and (c) supporting the development of the Borrower’s infrastructure, immunization systems, and service delivery capacity for the deployment of Project Covid-19 Vaccines, including: (i) strengthening the planning and management of vaccination plans, regulations and standards, monitoring and evaluation and budgeting; (ii) strengthening procurement, supply and distribution of vaccines and energy efficient cold storage technologies for safe immunization service delivery; and (iii) supporting vaccine-related delivery, risks communication and advocacy, health personnel training, supervisory, transport and logistics, medical waste management and enhancement information management systems and activities. Part 2: Strengthening Capacity in Preparedness for Health Emergencies Strengthening the Borrower’s capacity in preparedness for health emergencies, including: (a) strengthening the surveillance system and enhancing analytical capacity for real-time rapid reporting and analysis of surveillance data; (b) supporting simulations to regularly evaluate and enhance health emergency preparedness; (c) preparing and equipping the health system and facilities to respond to future health emergencies; (d) strengthening capacity for national health emergency rapid procurements; and (e) strengthening capacity of frontline health workers to respond effectively to victims of violence. Part 3: Implementation Management and Monitoring and Evaluation 1. Carrying out Project management activities, including: (a) strengthening public structures for the coordination and management of the Project, including central and local (decentralized) arrangements for the coordination of Project activities; (b) carrying out -8- financial management and procurement requirements of the Project; (c) strengthening existing structures through the recruitment of additional staff/consultants responsible for overall administration, procurement, and financial management; (d) carrying out Project coordination activities; and (e) strengthening existing data and monitoring systems for vaccine deployment, data collection, analysis and reporting for action and decision- making 2. Carrying out monitoring and evaluation of the Project, including: (a) monitoring and evaluating prevention and preparedness; (b) building capacity for clinical and public health research, including veterinary, and joint-learning across and within countries; and (c) providing training in participatory monitoring and evaluation at all administrative levels.