French vaccine deployment slowed down by paperwork, focus on the elderly

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

The director of the house, Samuel Robbe, first had to work his way through a dense 61-page vaccination protocol, one of the French government’s many voluminous guides that exhaustively detail how to proceed, right down to number of times (10) that each vaccine vial must be inverted to mix its contents.

“Delicately,” the booklet states. “Don’t shake.”

As France tries to figure out why its vaccination campaign was launched so slowly, part of the answer lies in forests of bureaucracy and the decision to prioritize vulnerable elderly people in retirement homes. This is perhaps the most difficult group to start with, due to the need for informed consent and the difficulty in explaining the complex science of accelerated vaccines.

Claude Fouet, still full of vim and good humor at 89 but with memory problems, was among the first of his Parisian residence to accept a vaccination. But in conversation, it quickly becomes apparent that his understanding of the pandemic is uneven. Eve Guillaume, the director of the house, had to remind Fouet that in April, he survived his own contact with the virus which killed more than 66,000 people in France.

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

Guillaume says getting consent from his 64 residents – or their guardians and families when they’re not fit enough to agree on their own – is proving to be the most labor-intensive part of his preparations for start vaccinations later this month. Some families have said no, and some want to wait a few months to see how the vaccinations go before making a decision.

“You can’t rely on nursing homes to go fast,” she says. “It means, every time, starting a conversation with the families, talking with the guardians, taking collegial action to make the right decision. And that takes time.”

At the Jean XXIII house, between the fortified city of Besançon and the birthplace of Pasteur in Dole, Robbe had a similar experience.

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

Getting consent was the biggest hurdle for a doctor and psychologist going from room to room discussing vaccinations, he says. The residents’ families were given a week during the December vacation to approve or deny, a decision that had to be unanimous among immediate family members.

When a woman’s daughter said yes but her son said no, a shot was not given because “they can turn on us and say, ‘I never accepted that'” , explained Robbe. “No consensus, we are not vaccinating.”

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

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“My friends say, ‘What is this circus? The Germans have already vaccinated 80,000 people and we haven’t vaccinated anyone, “he says.” But we don’t share the same stories. When you offer a vaccine to the Germans, they all want to be vaccinated. In France, there is a lot of hesitation about the history of vaccinations. People are more skeptical. They need to understand. . They need explanations and to be reassured. “

France has given priority to nursing homes because they have seen nearly a third of his deaths. But her first vaccination, on Dec. 27, of a 78-year-old woman in a long-term care facility, quickly turned out to have been just the token launch of a deployment the government never planned. to set up properly before this week.

It was not until Monday, as expected, that authorities launched an online platform where health workers must record all vaccinations and show that vaccinated people have obtained a mandatory consultation with a doctor, adding to the paperwork.

In some countries that move faster than France, the bureaucracy is lighter. In Britain, where nearly 1.5 million people have been vaccinated and plan to offer jabs to all nursing home residents by the end of January, those able to consent need only to sign a one-page form giving basic information about the benefits and possible side effects. .

No medical interview is necessary in Spain. She started vaccinating the same day as France but administered 82,000 doses in the first nine days, while France only managed a few thousand.

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Germany, like France, also imposes a meeting with a doctor and gives priority to injections for residents of health centers, but it reaches them more quickly thanks to mobile teams. At the current rate of nearly 30,000 vaccinations per day, Germany would need at least six years to vaccinate its 69 million adults. But while the German government is criticized for the slow deployment, France has taken an even quieter start, at least in numerical terms, but has pledged to reach 1 million people by the end of January.

Other countries have racked up more people by offering shots to larger sections of people who are easier to reach and who can get to appointments. The vast majority of the more than 400,000 doses administered in Italy went to health workers.

Lucile Grillon, who manages three nursing homes in eastern France, says the many hours invested in preparing the vaccinations of 50 residents and staff who were beaten on Friday were time well spent. She worked during the holidays to prepare.

“We can’t 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 that.’ , she adds. “The doses are too precious.”

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