Supply Isn’t the Only Thing Stymying Europe’s Vaccine Rollout

https://www.nytimes.com/2021/03/25/world/europe/italy-vaccine-astrazeneca-coronavirus.html

Version 0 of 1.

ROME — The mayor of Cremona, one of the northern Italian towns first hammered by the coronavirus during the pandemic’s initial explosion in Europe, received a call over the weekend that the local vaccination center was empty. The region’s booking system had failed to set up appointments with older residents, leaving more than 500 doses of vaccine at risk of going to waste.

“There was staff, there were also vaccines, but there were no people,” said the mayor, Gianluca Galimberti, adding that the situation had been bad for weeks. Similar scenarios are playing out throughout the country, as the authorities struggle to get vaccines to older and vulnerable Italians who most need them.

Europe’s vaccination efforts are moving at a maddeningly slow pace compared with those in United States and Britain. The temporary suspension last week by multiple countries of AstraZeneca, the vaccine that the European Union has bet on, was only one indication of how Europe’s rollouts have been plagued by an overabundance of caution, bad deals and flouted obligations by pharmaceutical companies that have created a supply shortage.

The situation remains dire enough that the European Union unveiled emergency restrictions Wednesday to curb exports of Covid-19 vaccines for six weeks. But that drastic step is unlikely to solve many of the problems that have plagued Europe’s vaccine rollouts.

Even when supply is not the issue, bureaucratic inertia, strategic errors, a diffusion of responsibility and logistical problems in booking appointments have seriously undercut vaccination efforts.

In Italy, those missteps have especially affected the older, and most vulnerable, population. A full year after the country became the first Western nation to confront the virus, it now has the dubious distinction of having the highest rate of daily deaths from Covid-19 among Europe’s major powers. About one in five people over 80 have received both doses of a vaccine, and about 5 percent of septuagenarians have received their first shot.

When it comes to distributing vaccines, Italy is on par with France and Germany and a little behind Spain, but its difficulties in vaccinating older citizens have constituted a lethal failure in a country that has the oldest population in Europe.

Prime Minister Mario Draghi recognized the problem in a speech to the Italian Senate on Wednesday, saying that while the pace of vaccinations was beginning to increase, it was “crucial to first vaccinate our elderly and fragile citizens who have more to fear for the consequences of the virus.”

To speed things up, his new government has sought to centralize the response, putting a general in charge and mobilizing the military and an army of new vaccinators — a departure in a country where much authority has been given to regional leaders over time.

Such steps underscore Europe’s rising desperation in the midst of a brutal third wave.

Italy’s infection fatality rate reduced only slightly during the first two months of its vaccination campaign, forcing the government to try to protect its unvaccinated citizens with a nearly national lockdown that began on March 15.

Italians, who have been through so much, are searching for reasons for their latest affliction.

In its initial rollout in late December, Italy gave the Pfizer vaccine to health care workers, giving it an early lead in Europe. But its plan was then to make large use of the cheaper and easier-to-store AstraZeneca vaccine, which has since been dogged by supply shortages and various concerns about its safety and efficacy.

Last week, Italy and other major European countries briefly suspended the vaccine’s use over worries that it possibly caused blood clots in a handful of cases. This week, American regulators raised concerns that the company may have skewed data to make the vaccine look more effective than it is.

Even before the recent chaos, Italy’s version of the Food and Drug Administration recommended that the vaccine’s use be limited to “individuals between 18 and 55 years” because of questions about how well the vaccine worked for older people.

As a result, Italy moved early on to vaccinate teachers within the age range, but also lawyers, prosecutors and hospital administrative staff. Older people, vulnerable and frustrated, went unvaccinated, while Italy’s death rates remained high. On Tuesday, 551 people died of the virus, the most since January.

On Wednesday, Mr. Draghi said that differing approaches by the regions to vaccinating people over the age of 80 was unacceptable, adding that some “neglect their elderly to favor groups who claim priority based probably on some contractual power.”

In Tuscany, a region usually admired for its health care system, only about 6 percent of people over the age of 80 have been fully vaccinated, prompting a public letter from leading citizens.

“Inefficiency,” they wrote, “produces deaths.”

Matteo Villa, a researcher at the Italian Institute for International Political Studies who has studied the coronavirus pandemic, said that Italy’s strategy of first vaccinating only health care workers had resulted in a bottleneck that made the virus more deadly.

“When the delays came,” he said, “we still had a lot of elderly people to vaccinate.”

Guido Bertolaso, the former head of Italy’s civil protection agency who is now in charge of the vaccine campaign in Lombardy, said the country had failed to act on emergency footing.

He blamed pharmaceutical companies not making good on their promised deliveries for Italy’s problems. “When you plan, you must know where you get the vaccine, at what time, which amount, on a weekly basis,” he said. In any case, he added, “In Italy with planning, we are not very good.”

Avoidable organizational and logistical problems have slowed the rollout and infuriated Italians. In Lombardy, a wealthy northern region at the center of Italy’s outbreak, intensive care wards are still packed with older and dying Italians, making it an emblem of Italy’s missteps.

“Every time the phone rings, I hope it’s them,” said Ester Bucco, 84, from Castiglione Olona, in the Lombardy region, who registered two months ago to get vaccinated but has yet to get an appointment. She walks around the house carrying her home phone and said she had started taking anti-anxiety pills to cope. “I really want to see my grandchildren.”

Lombardy’s top health care official resigned in January after being criticized for not calling back doctors and nurses from their holidays to distribute the vaccine. Bugs in the region’s internet platform overbooked certain times for vaccination appointments while leaving others unfilled. People received appointments in faraway towns.

The slow pace of Italy’s vaccinations contributed to the collapse of the last government and the arrival in February of Mr. Draghi, who has a reputation for competence, as prime minister.

He immediately replaced the official leading the vaccine response with an army general, Francesco Figliuolo, who on Thursday sent medical task forces into southern regions. Mr. Draghi’s new plan promises to increase inoculations from about 170,000 a day to up to 500,000. As of Wednesday, Italy had administered 85 percent of its available doses.

Perhaps most important, he has used his influence in the European Union, where he was once head of the central bank, to drive the bloc’s punishment of pharmaceutical companies that failed to meet contractual obligations by freezing vaccine exports from being flown to Australia.

“In Europe, we need to exact full respect for contractual obligations from the pharmaceutical companies,” Mr. Draghi said Wednesday, calling for more domestic vaccine production. “The European Union needs to fully use all the tools available, including the E.U. regulation on vaccines export.”

In the meantime, Mr. Draghi, who called for “less formal requirements and more pragmatism,” has struck deals that mobilized dentists and thousands of pharmacists to administer vaccines.

The government says that new vaccine supplies will make up for lost time and that 80 percent of Italians will be vaccinated by September.

But the question remains whether the vaccines are getting to the right people.

Mr. Galimberti, the Cremona mayor, said some of the doses in his town had been salvaged by volunteers and city officials combing the area for people to vaccinate. One nearby mayor loaded buses with older people and brought them to the vaccinations centers.

Mr. Bertolaso blamed “the algorithm” of the region’s booking platform for the problem and said that given the supply of vaccines available, things were going fine.

“It’s a problem that we are trying to overcome,” he said. “And by the end of the month I think that it will be OK.”

Gaia Pianigiani contributed reporting from Siena, Italy.