French vaccine explosion delayed by red tape, focus on elderly

The few hours it took to give the first coronavirus vaccine shots to 14 residents of the John XXIII nursing home – named after a pope and not far from the birthplace in eastern France of vaccine pioneer Louis Pasteur, prepared weeks .

The director of the house, Samuel Robbe, first had to chew his way through a dense vaccination protocol of 61 pages, one of several solid guides from the French government that fully set out how to work, to the number of times (10) that each vial of the vaccine should be turned upside down to mix its contents.

“Delicate,” the booklet states. “Do not shake.”

While France is trying to find out why its vaccination campaign was launched so slowly, the answer lies partly in forests of red tape and the decision to prioritize vulnerable older people in nursing homes. They are perhaps the most difficult group to start with, due to the need for informed consent and difficulty in explaining the complex science of fast vaccines.

Claude Fouet, at the age of 89, but with memory problems, still full of wit and good humor, was one of the first in his care home in Paris to agree to a vaccination. But in a conversation, it quickly becomes clear that his understanding of the pandemic is dire. Eve Guillaume, the director of the house, had to remind Fouet that he survived his own brush in April with the virus that killed more than 66,000 people in France.

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“I was in the hospital,” Fouet remembered slowly, “with a dead person next to me.”

Guillaume says the consent of her 64 residents – or their guardians and families if they are not fit to agree themselves – is the most labor-intensive part of her preparations to start vaccinations later this month. Some families have said no, and others want to wait a few months to see vaccinations unfold before deciding.

“You can’t count on medical care homes going fast,” she says. “It means I start a conversation with families every time, talk to guardians, take collegial steps to make the right decision. And it takes time.”

In the John XXIII house, between the fortified city of Besancon and Pasteur’s birthplace in Dole, Robbe had a similar experience.

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After using the BioNTech-Pfizer vaccine by the European Union in December, Robbe said it took two weeks to put all the pieces together to vaccinate 14 residents this week, just a fraction of its total of more than 100.

Consent was the biggest obstacle for a doctor and a psychologist who went from room to room to discuss vaccinations, he says. The families of residents were given a week to approve or refuse it during the December holidays, a decision that had to be unanimous from immediate family members.

When one woman’s daughter said yes but her son said no, no shot was given because ‘they can turn against us and say,’ I never agreed to that ‘, Robbe explained. “No consensus, we do not vaccinate.”

The process can only go faster by cutting residents and making it easy for residents to agree, he says.

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“My friends say, ‘What is this circus? The Germans have already vaccinated 80,000 people and we have not vaccinated anyone,'” he says. “But we do not have the same history. If you Germans suggest a vaccine, they all want to be vaccinated. In France, there is a lot of reluctance about the history of vaccinations. People are more skeptical. They need to understand. They need explanations and need be reassured. ‘

France put nursing homes first because they saw nearly one-third of its deaths. But the first vaccination of a 78-year-old woman in a long-term care facility on Dec. 27 was quickly just the symbolic launch of a rollout the government had never before this week planned to get properly underway.

Only on Monday, as scheduled, did authorities launch an online platform where health workers must report all vaccinations, indicating that the vaccinated had received a mandatory consultation with a doctor, which added to the red tape.

In some countries moving faster than France, the bureaucracy is slimmer. In Britain, where nearly 1.5 million have been vaccinated and the plan is to offer it to all residents of old age homes by the end of January, those who agree to it need to sign only a one-page form that provides basic information about the benefits and possible side effects.

No doctor interviews are required in Spain. It started vaccinating on the same day as France, but administered 82,000 doses in the first nine days, while France managed only a few thousand.

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Germany, like France, also recommends a meeting with a doctor and prefers shots for residents of nursing homes, but it gets faster with mobile teams. At its current rate of nearly 30,000 vaccinations per day, Germany would need at least six years to vaccinate its 69 million adults. But although the German government is facing criticism for the alleged slow implementation, France has had an even calmer start, at least in numerical terms, but has promised to reach 1 million people by the end of January.

Other countries have picked up larger numbers by offering shots to wider cross-sections of people who can be more easily reached and bring themselves to appointments. The vast majority of the more than 400,000 doses administered in Italy are to health workers.

Lucile Grillon, who runs three nursing homes in eastern France, says the many hours invested in preparing vaccinations for 50 residents and staff who went on strike on Friday were very well spent. She worked through the holidays to get ready.

“We can not wait until we have the doses in our fridge to realize that we are not ready to vaccinate and then have to throw away doses and say, ‘Rats! I did not think of that,'” she adds. “The doses are too precious.”

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“It takes us two months to prepare for flu shots. Here we are asked to set records to vaccinate against COVID in less than 15 days,” she says. “I do not see how we could have gone faster.”