With only 12,500 people vaccinated in France on Wednesday evening for 1 million doses delivered, it is difficult to imagine scraping the funds.
However, with more than 5 million people eligible at the end of January for 2.8 million vaccines available on that date, the situation promises to be much more tense very soon.
"The objective is not to waste any dose because it is true that we will be in short supply during the first three months of the year, with only two vaccines available (Pfizer-BioNTech and soon Moderna)" , explains Anne-Claude Crémieux, infectious disease specialist at Saint-Louis hospital in Paris.
This specialist rejects the alarmist forecasts of Matignon who mentioned a loss rate of up to 30% that she considers "delusional".
On the ground, the vaccination campaign began in a bumpy way but with the concern not to lose a drop of the precious Pfizer vaccine.
The first challenge is logistical and linked to the constraints of a vaccine that can be stored at -80 ° C that we have chosen to bring for this first phase as close as possible to patients, in nursing homes and hospitals.
Doses to be used within 6 hours
“The doses must be used within six hours after opening and are difficult to transport once reconstituted, recalls Rémi Parsy, hospital practitioner in Armentières (North), who participates in the vaccination in nursing homes attached to his hospital.
For the moment, in the geriatric sector, it's fine.
We adapt the number of doses ordered on demand and the public to be vaccinated is on site.
"
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Same strategy at AP-HP (Assistance publique Hôpitaux de Paris).
The huge Parisian network has set up a website so that caregivers eligible for vaccination can register.
But at the Hôtel-Dieu, for example, it has also set up a “walk-in” queue which allows the flow to be adjusted.
If some procrastination and the arrival of the first vaccines transported by bicycle by a doctor may have given a feeling of unpreparedness, the losses would be very limited at present.
“From 5.30 pm, we count the number of people we still have to vaccinate and we adapt the number of doses prepared, explains Aurélie, nurse on the site.
In the end, there may be a few doses left in the vial, but no more.
"
Non-priority people immunized with the bottoms of the bottle
In the absence of a priority audience, these few syringes are then allocated to other caregivers outside the age or co-morbidity criteria, according to a principle of common sense.
“The first day, I was vaccinated,” says Dr. Parsy, in theory too young for the first phase.
There was one dose left, nobody volunteered… What do we do?
It was really annoying, but it at least started the movement.
The next day, ten hesitant caregivers were vaccinated.
"
At the start of the campaign, candidates are not difficult to find to make the “bottoms of the bottle”, but the situation could be different when priority audiences have been immunized.
"In hospitals, we will manage, believes Anne-Claude Crémieux.
It could be more complicated outside.
The vaccines which arrive, in particular that of Moderna, are more easily preserved.
It is obvious that it would be better to allocate the doses of Moderna that we will receive to extra-hospital sites.
"
A sixth injection when possible
In addition to the “privileges” on the vaccination plan, useful not to spoil, the launch of the campaign highlighted another problem: should it be necessary to carry out five injections per vial of Comirnaty (the name of the vaccine from Pfizer / BioNTech) or six?
“Each 0.45 ml vial of product is diluted in 1.8 ml of sodium chloride, or 2.25 ml per vial, explains Rémi Parsy.
However, 0.3 ml per vaccine is injected.
There are dead volumes, between the needle and the amount that remains on the walls, but we can easily do a sixth dose
(Editor's note: 1.8 ml injected)
.
I asked the CHU and the Regional Health Agency, but for now, we are not allowed to give a sixth dose.
"
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Some centers did not have the same modesty and did not ask for a sixth injection when possible, which is not always the case, according to nurses.
"It should not be imposed, because it would be dangerous in the event of incomplete injection, but this possibility should be left to the vaccination teams," advises Professor Crémieux.
We cannot waste.
On the other hand, we do not especially mix different bottoms of bottles.
This would pose pharmacovigilance problems.
"
