RIVM program manager explains late vaccination start, "initial strategy not suitable for Pfizer vaccine"

Vaccination in the Netherlands is partly starting so late because, for a long time, a different strategy had been planned, said the public health agency RIVM in an interview with NU.nl on Wednesday. When the Pfizer / BioNTech vaccine, which is less suitable for distribution in nursing homes and GPs, suddenly turned out to be ready quickly, the strategy had to be changed.

“The AstraZeneca vaccine has been at the forefront for a long time,” says Hans van Vliet, program manager of the National Immunization Program. “From that perspective, it is very logical to say: we use the AstraZeneca vaccine via the infrastructure with which we already have a lot of experience in the Netherlands, for example, for flu shots, etc.”

The reality turned out to be different. It was not the AstraZeneca vaccine suitable for nursing homes and GPs that won the race, but the Pfizer vaccine, which must be stored at minus 70 degrees Celsius and is only delivered per thousand units. This makes it particularly suitable for large-scale vaccination campaigns in event venues, for example. And not for frail elderly people, but for healthy people who can easily travel to such locations.

“Nobody could say anything meaningful about the mRNA vaccines (including those from Pfizer and Moderna, ed.). They are used on a small-scale and experimental basis for cancer treatments, but have never been used against infectious diseases,” says van Vliet.

When it turned out that the mRNA vaccines were effective beyond expectations and could be delivered earlier than the vaccinations of AstraZeneca, the RIVM had to change its vaccination strategy.

“We then looked at how we could fit the Pfizer vaccine into the vaccination landscape. But we have to be sure whether something will work or not, and we sometimes really need more information,” says Jaap van Delden, program director of Covid-19 vaccinations at the RIVM.

“Almost every day, I receive varying information per pharmaceutical company about how much is coming and when. It is adjusting to the information that we receive. I would prefer to tell one story: this is how we are going to do it, and that’s it, but that is impossible to achieve. Because the world is not predictable,” he adds.

Yet, other EU countries, who were in the same situation, managed to get their vaccination programs up and running before the Netherlands. On Tuesday, Ireland was the penultimate EU country to start vaccinating. The Netherlands will close the row by beginning on January 8. Vaccines will only be distributed to all 25 local health institute (GGD) locations on January 18.

“I understand the turmoil, but it is a really complicated puzzle. It is also not a competition for us who started first in Europe,” says van Delden.

“What matters most is how quickly we reach which vaccination rate,” adds his colleague van Vliet. “In six to nine months, all European countries will have vaccinated a large part of their population. My expectation is that we will not see anything that we now put a magnifying glass on.”

According to RIVM experts, other European countries are also struggling with the vaccination process. “Perhaps there is an image in the Netherlands that other countries are rolling out the program at their leisure, but that is not the image we get from our international contacts,” explains van Delden.

There are even several Eastern European countries that will not use the Pfizer vaccine, says van Vliet. “They have bought it but say that other European countries can use it because they don’t see how to apply it.”

In Germany, the Pfizer vaccine can be given to nursing home residents because they use mobile vaccination units there.

According to van Vliet, the Germans turned a necessity into a virtue. “In Germany, they don’t have a national vaccination program like the Netherlands. They can pick up shots from the doctor, and the insurer reimburses them. Germany quickly saw that it had to build a separate organization. They did this with large sites, supplemented with mobile teams.”

According to van Delden, the Netherlands is also considering the use of mobile units, but he cannot yet say when this should happen.

Van Delden understands the criticism of the slow vaccination start, “but I think it is also good to keep seeing things in perspective.” “An operation that normally takes years, we have now managed to do it in a few months.” The criticism is sometimes a bit heavy, he finds.