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It will probably be a “V day”, a day of the vaccine, to inaugurate the anti-Covid vaccination campaign across Europe. Belgium, France, Germany, Italy, Luxembourg, the Netherlands, Spain and Switzerland have submitted a joint declaration to start the vaccination campaign together, although they do not indicate the start date. But times are shortening. The EMA, the European Medicines Agency, has announced that it will meet on December 21 to decide on the Pfizer-Biontech vaccine, anticipating the date initially scheduled for December 29. Then there will be a passage from the European Commission for final approval, which could take place within 48 hours after the green light from the EMA. “At that time, the vaccine could be used from the next day in EU countries,” said Guido Rasi, former executive director of the EMA. If the distribution machine and the logistics are ready, and with the immediate contextual validation of Aifa, “the vaccination campaign in Italy could therefore begin on December 28 and 29”.
But is Italy ready? Although Germany had already presented its national vaccination strategy in early November, the Italian plan still needs the final stamp. The final meeting between the Minister of Health Speranza, the Minister of Regional Affairs Francesco Boccia, the extraordinary commissioner Domenico Arcuri and the head of Civil Protection Angelo Borrelli is scheduled for December 16 to definitively launch the Italian vaccine plan.
After that, the car can theoretically start. Although at the beginning it will be a “symbolic action”, explained the Minister of Health, Roberto Speranza. The real vaccination campaign in Italy should start in mid-January.
Fasi
The vaccine plan presented by Speranza to Parliament in early December foresees the distribution of 202 million potential doses that will arrive in 2021 from Pfizer-Biontech, Moderna, AstraZeneca, Johnson & Johnson, Sanofi and Curevac. The first 10 million doses are expected to be available by March 2021 (8.7 million from Pfizer and 1.3 million from Moderna).
It will initially start with 1,874,323 million doses of Pfizer. Italians who fall into the “priority” categories to be vaccinated are almost 6.5 million: 1.4 million health and social health workers involved in the Covid emergency, more than 570 thousand employees and guests of the RSA, plus 4 , 4 million people over 80 years of age.
The first tranche will vaccinate 1.8 million people among health workers and the RSA population. The commissioner for the emergency Domenico Arcuri asked the regional presidents to be ready by January 10 and 15, when Pfizer should distribute these first doses in the nearly 300 hospitals and nursing homes identified by the Regions.
In the distribution of the first doses assigned to the Regions, the first three are Lazio with 356,824 doses, followed by Lombardy with 308,494 and Emilia Romagna with 177,186. Finally there is the Aosta Valley with 4,419 doses. The Regions must communicate the people to be vaccinated in the first phase. And by December 18, as there is no obligation to vaccinate, it will be necessary to know how many of these have given the go-ahead.
Phase two should begin in the spring, starting with 4.4 million people over the age of 80 and following the more than 13 million between 60 and 79 years.
Later it will pass to the younger population. But also in this case with priorities: at the top of the list will be the chronically ill and essential workers, in particular law enforcement officers, community and prison workers, but also teachers, school workers and perhaps even students (As he asked for a majority resolution on which Speranza gave a positive opinion).
The same priority scheme is the one followed in other European countries. In Germany, uA committee of experts presented the guidelines to the German Ministry of Health, recommending that older people and patients particularly at risk of other diseases be given priority, along with health professionals and other professionals crucial to public life.
Where will the vaccine be done?
If Germany has identified 60 distribution centers throughout the country, Italy has identified only one national storage center at the Pratica di Mare military airport, where the 202 million doses planned will transit from January to the first quarter of 2022. A From there, the vaccine will then reach 300 hospitals (public or private accredited) and then arrive at its destination, in the RSA, in the pavilions marked with primrose or in pharmacies.
This is where the Regions will take over the reins of the vaccine machine. Each one sent their plan to Commissioner Arcuri, also identifying an operational manager at the regional level. And each regional body is creating its own vaccination centers.
In a second phase, the vaccine should also be present at 1,500 administration points, while the mobile units will deliver it directly to the homes of the elderly or people with health problems and unable to travel.
Arcuri, together with the architect Stefano Boeri, presented on December 13 the symbol of the vaccination campaign – the primrose – and the project for the construction of 1,500 pavilions that will be located in several Italian cities, equipped with information points on vaccination and areas dedicated to vaccine administration. While in Germany, by contrast, old shopping malls, old airports, stadiums, concert halls, fairs and even churches have been identified as vaccination centers. Six of them are ready in Berlin.
It is not yet known when these 1,500 pavilions will arrive and how their activity will be coordinated with that of clinics, hospitals and other facilities that will administer the vaccine. In any case, in the first phase of vaccinations, it is known that the wards will be in limited number, since the vaccines will be administered to a limited segment of the population. Later, with the availability of a greater number of doses, more rooms should be installed with the launch of an online reservation system.
How to reserve it
The government plans to create a smartphone app to reserve and monitor any adverse reactions with a pharmacovigilance system. The software will send the alert on the withdrawal date. “Poste Italiane and Eni are helping us to implement an application,” Arcuri said on December 10. “It is a very complex system in which there will be many components: a call center, traceability elements, recognition and the possibility of feeding the information systems of the regions and the Ministry of Health in the implementation of a kind of vaccine registry equal to which there is for all vaccines administered to the Italian population. But nothing else is known.
Who will manage it
The Health Ministry has estimated that 20,000 doctors and nurses will be needed for the vaccination campaign. At least 16 thousand, of which about 3 thousand doctors, according to Arcuri’s calculations.
The public hiring notice, initially scheduled for December 10, was published on December 11. The text provides for the selection of a maximum of five employment agencies to which the selection will be entrusted with the hiring for 9 months of 3,000 doctors and 12,000 nurses and health assistants. Each of the winning agencies will be assigned a specific area. With a total value of the contract of 534.2 million euros. The monthly cost of work for doctors will be around 6,500 euros, 3,000 euros for nurses.
But Antonio De Palma, president of the Nurses Union, has already announced that finding 12,000 more nurses for the vaccination campaign, outside of public health and with temporary contracts, is almost entirely impossible. Simply because they are not there. After the first phase, it is expected to strengthen the workforce, also involving family doctors, pediatricians, police health personnel, pharmacies and mobile units.
Vaccination personnel will be divided into two categories. The first will take over the Pfizer vaccine, the first to arrive, which must be stored at nearly minus 80 degrees. Instead, a second will administer the doses that are maintained at normal vaccine temperatures. For the first category, it will be necessary to hire 2,629 people starting in January. From the second month, 7,771 people will also be needed, which will rise to 12,843 from the fourth to the fifth month.
The companies must submit their offers on December 28. Applications from healthcare professionals, also open to medical graduates and retired physicians, can only be submitted starting December 16, with no deadline, to create an open list to draw from. Then it will be necessary to select them and place them in the national territory. The road, assuming the required number is reached, is still long.
