Protecting the most vulnerable first and those who care for them: this is the common thread of the five-phase vaccination strategy (read the benchmarks), presented Monday, November 30 by the High Authority of Health (HAS). The latter therefore recommends vaccinating first, with “The limited number of doses available at the start of the campaign”, the elderly, residing in nursing homes or in long-term care units, and older caregivers, suffering from comorbidity. A first phase which should concern “A million people” approximately and start in early January.
To make its choice, the HAS relied on two criteria: age and exposure to the virus. “A third of the deaths reported in France occurred in nursing homes”, deplores Professor Élisabeth Bouvet, infectious disease specialist and member of the HAS technical committee on vaccinations. “Residents are more vulnerable to Covid-19 because of their age, their different pathologies and their grouping in places where the virus can circulate. “
Community life thus justifies according to the HAS the priority given to nursing homes, even if some stress that the number of deaths from Covid among the elderly at home is also high. This is in particular the opinion of Pascal Champvert, the president of the Association of directors in the service of the elderly, who pleads so that the latter can go to be vaccinated in nursing homes.
It would indeed “Unreasonable to displace all residents of nursing homes, vaccination must take place on site” for Jacques Battistoni, the president of the Union of general practitioners. Pascal Champvert urges the government to call on logistics professionals, such as the army. “Capable of transporting doses from the airport tarmac to the 11,000 establishments which welcome the elderly”.
In addition to transport, the question of nursing home equipment will also arise. It is impossible to say for sure which vaccine will be available first in France. But that of Pfizer and BiONtech seems to be in the lead, which would suppose that the vaccine is stored at – 80 degrees. Finally, who will vaccinate? “Most elderly people in nursing homes have an attending physician, it is up to him or her to come and meet them and explain to them what are the advantages and disadvantages of vaccination”, insists Jacques Battistoni.
This “Transparency” will be essential to obtain the adhesion of the people, estimates the HAS which recognizes that there are still uncertainties on the effect of these vaccines. “We know that these vaccines prevent severe forms of the disease, and therefore from dying from Covid-19”, details Professor Daniel Floret, vice-president of the technical committee on vaccinations of the HAS. “But we don’t know if it prevents transmission of the disease. “
The HAS, which warned that its opinion would be evolving, further explains that the question of the benefits of vaccination for the elderly who have already had Covid has not yet been decided. “If we want the support of the population, we have to be honest to the end and say that people will potentially have serious side effects,” points out Pascal Champvert. It must be said and the government must immediately provide for a compensation fund. “
Once this information has been provided, the consent of the elderly will be essential. “People with all their cognitive faculty – or very minimal impairment – will be asked, it’s the law “, explains Odile Reynaud-Lévy, vice-president of nursing home coordinators. ” Ehpad are not places of lawlessness. ” For residents with cognitive impairment who have not written advance directives, “The main caregiver and the person of trust will be solicited”, ensures the geriatrician.
“But it is sometimes difficult to decide for someone”, pointe Claudette Brialix, president of the National Federation of associations and friends of the elderly and their families. ” It will therefore be necessary to explain the benefit-risk balance to families as well. “ Above all, she is worried about a possible chain vaccination. “There may be the temptation to want to go quickly to vaccinate everyone without bothering to talk. “