Covid-19. Mandatory ? Really effective? Seven questions you ask yourself about vaccination

The first ones vaccines against the Covid-19 will be administered from Sunday, December 27 in France, announced the Minister of Health Olivier Véran on Monday. Last step before the official launch, the High Authority for Health (HAS) announced that it would make Thursday, December 24 his opinion on this vaccine developed by laboratories Pfizer and BioNTech.

Questions still remain about this vaccine strategy: who is concerned? What follow-up? Does the vaccine prevent transmission of the virus? We take stock of all these questions.

1. Will vaccination be compulsory?

Emmanuel Macron clearly stated in his speech on November 24: vaccination will not be compulsory in France. “I want to be clear, I will not make vaccination compulsory”, he said, hoping that this new step in the fight against the coronavirus pandemic will take place “In a transparent manner, by sharing at each step, all the information, what we know, like what we don’t know”.

But a new bill combining vaccine and freedom of movement elicited fiery reactions from the opposition on Tuesday, who feared a restriction of freedoms. After this outcry, the government postponed this text. In the viewfinder of the opposition, an article “Establishing a sustainable management system for health emergencies” in the event of a future pandemic.

This bill provides that, in territories where a state of emergency has been declared, the Prime Minister may “Subordinate the movements of people” at “The presentation of the results of a screening test” negative or “The follow-up of a preventive treatment, including the administration of a vaccine”.

“This text is not at all intended to consider compulsory vaccination against the coronavirus”, assured Olivier Véran Tuesday evening. But, “Because it takes confidence for the French to be freely vaccinated, […] the government will not propose this text to parliament for several months, before being out of the crisis ”.

A very sensitive subject when we know that 59% of French people do not intend to be vaccinated against the coronavirus, according to a poll published in late November.

2. How will the delivery of the vaccine take place?

Regarding the delivery of the vaccine, the ” Supply Chain […] is operational to start vaccination at the end of this week ”, government spokesman Gabriel Attal said on Monday.

More its transport is complicated by the storage conditions of this product, which should be stored at “ultra-low temperature” (approximately – 70 ° C). “The vaccine will be supplied to Europe from the production sites of Pfizer in Belgium and BioNTech in Germany. […] The doses will arrive by road for hexagonal France and by plane for the overseas territories ”, Pfizer said.

For ease of transport, the two manufacturers designed an insulated shipping container that “Can maintain temperature for 10 days without being opened” and “Up to 30 days” by renewing the dry ice which fills it, specifies the American laboratory.

“Once thawed, the vaccine vial can be stored safely for up to 5 days under refrigerated conditions”adds Pfizer.

The doses will be transported to “Around a hundred sites with dedicated freezers, which will most of the time be hospital sites, at a rate of about one per department, in order to be able to vaccinate all establishments [pour personnes âgées] who are linked to these hospitals ”, detailed Tuesday the Minister of Health Olivier Véran.

There will also be “Six logistics platforms distributed evenly over the territory”, warehouses “Authorized for the storage of health products” whose list is not “Not made public at this stage”, specifies the Ministry of Health.

Particular attention will be paid to the safety of the convoys transporting the precious doses, also underlined the Ministry of Health, evoking a follow-up ” narrow “ by the police.

Read also: Covid-19. Like gold bars, vaccines transported and stored under very close surveillance

3. Who has priority for vaccination?

On November 30, the High Authority for Health (HAS) presented its recommendations on the prioritization of populations to be vaccinated against Covid-19. This strategy has been established by phase and in order of priority. Two main criteria were taken into account: the existence of a risk factor for developing a severe form of the disease and increased exposure to the virus.

The two most important risk factors for severe forms are, above all, age and the presence of co-morbidities. Regarding the risk of exposure, HAS clarified that “The professionals most at risk are medical health professionals, paramedics and medical auxiliaries, stretcher bearers as well as social workers and personnel in the personal services sector likely to welcome and be in contact with patients infected with SARS-CoV-2 ”.

The HAS has developed a vaccine strategy in five phases. The first three cover the start of the vaccination campaign. They aim to allow vaccination of all people at risk. The following two phases should allow vaccination to be opened to adults without comorbidities and will be specified as the objectives of the previous phases are achieved.

Read also: Covid-19. How is vaccination in nursing homes organized? Three-step response

4. Does the vaccine prevent transmission of the virus?

During the presentation of its vaccine strategy on November 30, the High Authority for Health clarified that it had not decided the question of the contagiousness of a vaccinated person. It’s missing “More data on this subject”, said Dominique Le Guludec, president of the HAS, adding that “The idea is not easy to understand”.

While the injections will prevent severe forms of the disease, it is still unclear whether they will affect the transmission of the virus. “The vaccine stops the disease in the lungs but not necessarily the entry of the virus into the body, that is the problem. In order for it to prevent transmission, it must block the penetration of the virus into these airways “, specifies Pr Daniel Floret, vice-president of the technical committee on vaccinations.

Asked by The Parisian , Bruno Pitard, research director at the CNRS (National Center for Scientific Research) and expert in vaccine strategy, the issue of transmission depends on the effectiveness of the vaccine. “To give you a picture, if you have 100 virus particles and [le vaccin] blocks 80, there are 20 left, so you may have some symptoms “, he explains.

It would therefore be possible to infect a nearby person while being immune. But according to Jean-Michel Pawlotsky, virologist at the CHU Henri-Mondor in Créteil, “It is possible in theory […] But in fact, it’s unlikely ”.

5. Is it useful to be vaccinated if you have had Covid-19?

For the High Authority for Health, there is no need in France to systematically vaccinate people already infected with the coronavirus, but nothing is against it if they wish.

According to a press release from the HAS released on December 19, the scientific finding is “ that to date, the data do not allow us to know whether there is any benefit in vaccinating people who have already been infected with SARS-CoV-2 “.

Consequently, the HAS “Considers at this stage that there is no need to systematically vaccinate people who have already developed a symptomatic form of Covid-19”.

The High Authority for Health notices the absence “Specific serious adverse reaction”, when a person who has had Covid-19 is vaccinated. It therefore concludes that there is nothing to prevent such a vaccination, if an infected person wishes, “Following a decision shared with the doctor”.

6. What will be the follow-up of the vaccinated people?

After the start of the vaccination campaign, a report on reported side effects will be published weekly and one “Reinforced device” will be set up to facilitate their declaration, explained the Medicines Agency (ANSM) on December 11.

“The major stake is […] to identify undesirable effects which would not have been observed during clinical trials “, explained Céline Mounier, director of surveillance at ANSM.

The regional pharmacovigilance centers (CRPV) will be responsible for analyzing the declared side effects and “Will take into account not only cases reported by health professionals and patients, but also cases reported by laboratories”, detailed Céline Mounier. “We will put online every week” these analytical reports, she added.

To facilitate the reporting of these cases, the Adverse Reaction Reporting Portal will be “Modified”, to be “Accessible as quickly as possible” and collect the relevant information from the outset.

Read also: Vaccines and Covid. In the event of adverse reactions, who can patients turn against?

7. How much will these vaccines cost?

Vaccination against Covid-19 will be free for all, Jean Castex said on December 3. To ensure free access, the government has earmarked 1.5 billion euros for this purpose in the social security budget for 2021.

“Our first objective is to ensure that France has enough vaccines for its population. And obviously, and this is another advantage of the negotiations conducted at European level, in the end we will only pay what is actually delivered to us ”, underlined the Prime Minister. Vaccine prices negotiated at European level were disseminated in error by the Belgian Secretary of State for the Budget, on December 17. On this document, the unit price varies from 1.78 € for the vaccine of the Swedish-British group AstraZeneca, to 18 dollars (14.70 €) for that of the American Moderna.

The European Union has signed provisional contracts to procure vaccines from several pharmaceutical laboratories. She could for example pay over $ 10 billion (8.4 billion euros) to procure hundreds of millions of doses of Pfizer-BioNTech and CureVac vaccines.

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