Implementation of the French vaccine delayed by bureaucracy, focus on the elderly

The few hours it took to deliver the first coronavirus vaccines to 14 residents of the John XXIII nursing home – in honor of a pope and not far from the birthplace in eastern France of the vaccine pioneer Louis Pasteur – took weeks of preparation.

The house’s director, Samuel Robbe, first had to chew a dense 61-page vaccination protocol, one of several robust French government guides that exhaustively detail how to proceed, up to the number of times (10) that each vial of the vaccine must be. turned upside down to mix its contents.

“Gently” stipulates the booklet. “Don’t shake.”

While France tries to find out why its vaccination campaign was launched so slowly, the answer lies partly in the forests of bureaucracy and in the decision to prioritize vulnerable elderly people in nursing homes. They are perhaps the most difficult group to start with, due to the need for informed consent and the difficulties in explaining the complex science of accelerated vaccines.

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

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“I was in the hospital,” recalled Fouet slowly, “with a dead person at my side.”

Guillaume says that obtaining the consent of his 64 residents – or their guardians and families when they are unable to agree – is proving to be the most laborious part of his preparations to start vaccines later this month. Some families said no and others want to wait a few months to see how the vaccines will unfold before deciding.

“You can’t count on medical homes to go quickly,” she says. “It means, every time, to start a conversation with the families, talk to those responsible, take collegial steps to reach the right decision. And it takes time ”.

At John XXIII’s house, between the fortified city of Besançon and Pasteur’s hometown in Dole, Robbe had a similar experience.

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After the European Union gave the green light to the use of the BioNTech-Pfizer vaccine in December, Robbe says it took two weeks to put all the pieces together to vaccinate 14 residents this week, just a fraction of its more than 100.

Obtaining consent was the biggest obstacle for a doctor and a psychologist who went from room to room to discuss vaccines, he says. Residents’ families had a week during the December vacation to approve or refuse, a decision that had to be unanimous with immediate family members.

When a woman’s daughter said yes, but her son said no, the injection was not given because “they can turn on us and say, ‘I never agreed to that,'” explained Robbe. “Without consensus, we don’t vaccinate.”

Only by cutting shortcuts and getting residents to agree superficially could the process go faster, he says.

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“My friends are saying, ‘What is this circus? The Germans have already vaccinated 80,000 people and we have not vaccinated anyone,'” he says. “But we don’t share the same story. When you propose a vaccine to the Germans, everyone wants to get vaccinated. In France, there is a lot of reticence about the history of vaccines. People are more skeptical. They need to understand. They need explanations and to be reassured. “

France prioritized nursing homes because it saw almost a third of their deaths. But her first vaccination on December 27, of a 78-year-old woman at a long-term care facility, quickly proved to be just the symbolic launch of an implementation that the government never intended to start properly before this week.

Only on Monday, as scheduled, did the authorities launch an online platform where healthcare professionals must register all vaccines and show that the vaccinees had mandatory consultation with a doctor, increasing bureaucracy.

In some countries that are moving faster than France, the bureaucracy is leaner. In Britain, where nearly 1.5 million have been inoculated and plans are to offer jabs to all nursing home residents by the end of January, those who can consent need only sign a one-page form that provides basic information about benefits and possible side effects.

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

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Germany, like France, also requires a meeting with a doctor and is prioritizing injections for nursing home residents, but is reaching them faster, using mobile teams. At its current rate of nearly 30,000 vaccinations a day, Germany would need at least six years to inoculate its 69 million adults. But while the German government is facing criticism for its perceived slow implementation, France started out even more smoothly, at least in numerical terms, but promised to reach 1 million people by the end of January.

Other countries have accumulated larger numbers by offering photos to larger groups of people who are easier to reach and can go to appointments. The vast majority of the more than 400,000 doses administered in Italy were for healthcare professionals.

Lucile Grillon, who runs three nursing homes in eastern France, says the many hours invested in preparing the vaccination for 50 residents and employees who received the vaccine on Friday were time well spent. She worked over the holidays to prepare.

“We cannot wait until we have the doses in our refrigerator to realize that we are not ready to vaccinate and then we have to throw the doses away and say, ‘Rats! I didn’t think about it, ‘”she adds. “The doses are too precious.”

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“It took us two months to prepare for flu shots. Here, we were asked to set records, to vaccinate against COVID in less than 15 days, ”she says. “I don’t see how we could have gone any faster.”