France at the time of choosing its vaccine strategy

Time is accelerating in the race for the vaccine. On Thursday 19 November, the President of the European Commission, Ursula von der Leyen, indicated that the European Medicines Agency could “Give the vaccines of Pfizer-BioNTech and Moderna their conditional marketing authorization from the second half of December”. What to start the vaccination campaign against Covid-19 in the wake of or at the beginning of 2021?

“Logistics is really not a pitfall”

For the time being, the French government has not yet unveiled its strategy, unlike Germany for example, which already has a precise roadmap, defining priority groups, and providing logistical resources, including the requisition of convention centers and halls from December.

→ READ. Covid-19: vaccines at the heart of G20 discussions

“Logistics is really not a pitfall, assures Bruno Lina, virologist and member of the scientific council. We are used to receiving millions of flu shots, and the country has many strategic storage areas, even if the state does not like to communicate too much about it. “

“We did not anticipate such rapid data on the effectiveness of vaccines, but I do not think we are late”, affirms Élisabeth Bouvet, president of the technical commission of the vaccinations of the High Authority of health (HAS), which must give two opinions to the government at the beginning of December: one on the priority groups; the other on the organization and modalities of the vaccination campaign. The government said it ordered 50 “Super-freezers”, in order to store the Pfizer vaccine, which requires storage at – 70 ºC.

Priority audiences

While knowledge of vaccine candidates is becoming more precise every day, there are still many unknowns, “In particular on the effectiveness of each vaccine on a particular type of population”, underlines Nathalie Ernoult, head of advocacy at Médecins sans frontières. This makes defining an overall strategy still difficult.

Scenarios are emerging all the same. In addition to this, you need to know more about it.“Two populations should be vaccinated as a priority: the oldest people, in particular those living in nursing homes and those in follow-up and rehabilitation care : this represents 1.5 million people. And health workers (estimated at 1.8 million people, Editor’s note). Then, we will decline according to the number of available doses “, details Élisabeth Bouvet. People at risk for comorbidities should also be given priority.

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Friday, November 20, the Paris town hall assured to be ready to vaccinate 30 to 40% of the population from January, targeting “The over 65s and the most vulnerable”, according to public health assistant Anne Souyris. Should follow “A second phase of vaccination” for the general population. To conduct this campaign, five sites in the city will be requisitioned, she added, without specifying them. “It is possible that the first dose will be administered in the first quarter of 2021, but the vaccination of the general public will not be able to start before the second half of 2021”, tranche Bruno Lina.

Focus on the field

Another puzzle: defining who will vaccinate and where. At the beginning of November, the HAS underlined the important role of treating physicians and pleaded for the involvement of nurses and pharmacists, which would require “Regulatory changes”. “We should no longer do dehumanized vaccination in large centers, we need a doctor-patient relationship”, supports Bruno Lina.

“The ministry told us that there was no question of remaking what we had experienced in 2009 with the H1N1 flu: an organization led by the State, disconnected from professionals in the field”, notes Jacques Battistoni, president of the union of general practitioners MG France. “The goal is to leave it to liberal doctors to organize themselves, but the constraints of dose conservation (at low temperature for some, and in multidose vials, editor’s note) means that vaccination cannot be done in a doctor’s office alone. We have to organize ourselves locally. In my town of Calvados, we have already asked the mayor for a municipal hall. “.

As for the compulsory nature of vaccination, the HAS considers it “Inconvenient”. “I think the government is in the same perspective”, says Élisabeth Bouvet. The issue of acceptance by the population is essential, while various polls conclude that half of the French are suspicious. “Mass vaccination is necessary to obtain collective immunity, pleads Bruno Lina. We must go through a vaccination strategy and messages that are as reassuring as possible. “

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