Monkey pox: the reasons for the bad start of vaccination in France

It is 8:15 a.m., Tuesday July 12, when Maxime takes the metro. The 28-year-old young man takes advantage of the journey that takes him from his home to his work to strum and learn about vaccination against monkeypox. Since the opinion issued by the High Authority for Health (HAS) on July 8 aimed at extending vaccination to “the most exposed groups” – homosexuals, multi-partner trans people or people in a situation of prostitution -, he is thinking of make an appointment. While France had adopted more of a reactive vaccination philosophy – by offering an injection only to adults, including caregivers, who had had risky contact with a patient -, it has broadened its approach, joining the United Kingdom in this approach. , the United States or Canada, as demanded by LGBTQ + associations, health professionals and left-wing parties.

But health authorities are facing a growing number of critics reporting difficulties in getting an appointment. “I am told that there are too many requests and not enough availability, so I am simply told to call back later and wait,” he is surprised.

And Maxime is not the only one in this case. “Given the high demand, delays for making appointments and injections may be observed during the first days of the campaign,” agreed the Directorate General of Health (DGS) in a press release. In Ile-de-France, a dozen centers are open, but they still only offer a handful of appointments: 100 per week in the Bichat and La Pitié-Salpêtrière hospitals; or around forty in Lariboisière. In this last center, the doctor Willy Rozenbaum, honorary professor of infectious diseases, regrets a crying lack of anticipation: “This morning [NDLR : mardi 12 juillet], we received a hundred calls while we only have 40 doses per week with priority for established contact cases. And just this morning, we counted seven new cases in patients who came without an appointment!” ), also notes “a sharp rise in cases” and a “strong demand for vaccination” while his establishment has so far received “60 doses”. The situation is similar in other regions, such as in Lyon where no center has will be able to perform injections before July 18, reports Lyon Capital.

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A question arises: does France have enough doses? The state of monkeypox vaccine stocks is classified as a defense secret and cannot be disclosed to the general public because the use of the smallpox virus, eradicated but kept in military laboratories, particularly in Russia, represents a risk. identified as bioterrorism. But the Directorate General of Health (DGS) ensures that “all people concerned by the indications of the HAS can be vaccinated in the weeks to come”. As of July 13, just over 700 contact cases have received an injection in France, or around fifty per day. “There is nothing to worry about: we have sufficient doses, these are destocked as and when the needs are expressed and restocking is planned as needed”, assures the DGS to L’ Express, specifying that “additional orders from the Danish laboratory Bavarian Nordic have been placed, and others are under study”.

Lack of staff

Beyond the number of doses available, professionals have noted problems with the delivery of vaccines to the centres. “The main limitation so far came from the mode of transport, reveals Willy Rozenbaum. Vaccines were initially supposed to travel at -20°C, but the health authorities have obtained that they are now transported between 0 and -6°C. is easier”. Two vaccines, Imvanex and Jynneos, are available in France. These are third-generation smallpox vaccines, produced by the Danish biotechnology company Bavarian Nordicet. They have a protocol for use established by the National Agency for the Safety of Medicines and Health Products (ANSM). The HAS claims to have taken into consideration the efficacy data of the available vaccines in deciding to extend vaccination. She says she also relied on the ANSM’s opinion on the favorable risk-benefit of third-generation vaccines in pre-exposure to the virus.

Another limitation: the vaccine can only be dispensed by hospital pharmacies because there has been no marketing. But, above all, there is a crying lack of personnel in French hospitals. “For the time being, we are mainly faced with a lack of personnel, in the middle of summer, in the midst of the seventh wave of Covid, with in particular a lack of nurses yet authorized to vaccinate against Monkeypox”, regrets for his part Professor Gilles Piaux. “The staff are exhausted or absent, but this is not the first time that a public policy decision has been taken without evaluating the means necessary to carry it out. The reduced teams are struggling in pain. For the moment”, he continues.

An observation widely shared by Willy Rozenbaum: “To operate a vaccination center, you don’t just need doses, you also need staff! Doctors to examine people because we don’t vaccinate those who have already contracted the disease in principle. , nurses, people to answer phone calls and organize appointments… It’s a whole organization. However, are we currently able to do for Monkeypox what we did for Covid? The answer is no”.

“Lack of foresight”

While 912 cases have been confirmed in France, including 569 in Ile-de-France, some, like Willy Rozenbaum, regret a “lack of anticipation”. “We could have planned certain measures from May. The result is that all the people concerned will certainly not be able to be vaccinated before the end of the summer, and that the virus will continue to circulate massively”, continues the doctor. For Professor Gilles Pialoux, it would be better “to get out of the precautionary principle to excess to spread the care between the city, the private centers and the hospital, laboratories included”; but also “make public the information on the benefit-risk ratio of this vaccination against smallpox in the context of vaccinoscepticism that we know”.

The next few weeks will tell us if the logistical problems have been resolved. Looking at what is happening across the Atlantic, there is however reason to be worried. While the United States has ordered nearly 4 million doses in total, New York City is also experiencing hiccups in its vaccination policy. The municipality had, Tuesday, July 12, opened a few slots to be vaccinated, but the system did not hold up in the face of the influx of requests. The incidents come as the city now has 267 cases, an increase of 141% in one week. “We received 14% of the nationally allocated doses, yet we had much more than 14% of the cases nationally,” said New York Governor Kathy Hochul.

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In France, as in the United States, the demand could be much higher than the doses available. Not to mention a multiplication of cases which does not seem to be slowing down. Which makes Professor Gilles Pialoux say that “the extent of viral circulation and, therefore, of the demand for vaccination is still poorly estimated”. In question, unreliable epidemiological data, under-reporting of cases, and a classification of Monkeypox as MOT (Highly Transmissible Microorganism) which restricts diagnoses.