CORONA­VIRUS – the FAQs 8

This is the eighth of a series of Covid-19 newsletters from FDIME (Foundation for the Development of Internal Medicine in Europe). The aim of the newsletters is to present qualified answers to the public, specifically on issues in which internists have a saying.
In this newsletter (FAQ) you may read about the acceptance of vaccination and how to convince those who are hesitant.
FDIME is a non-profit organizations, which aims to improve medical care for patients in Europe and has several activities promoting medical research and medical education of young European specialists in internal medicine. FDIME supports young internists to attend the European School of Internal Medicine, participate in the European Exchange program and also provide grants for research in Internal Medicine.

You are also invited to pose additional questions, which we can try to answer in one of our next newsletters.

Theme:
Acceptance of vaccination, convince those who are hesitant

Why is vaccination against Covid 19 so important?

At the end of the hectic year 2020, marked by the Covid 19 (Corona) pandemic, light from the end of the tunnel is finally visible! In many European countries vaccination started just before Newyears Eve with a few countries following a little later. At least two vaccine brands are available after extensive (but quickly processed) investigations and more will be available very soon.

In our FDIME FAQs vaccination has been discussed a couple of times previously and in this newsletter (FAQ 8) we aim to report about the acceptance of vaccination in various European countries. We provide arguments from both individual and societal perspectives to convince those who are still hesitant to take the vaccin. It is a responsiblilty also for the medical profession to support the efforts to open up our societies and counteract the multiple negative effects of severe restrictions on individuals, interactions, economies, internationalisation and education. In addition, we must reduce the burden on health care to avoid collaps.

For this reason we asked colleagues from 11 countries to answer a couple of questions regarding this subject. A summary of the replies is presented in the Table. It appears that less than 50 % (Switzerland and Estonia) up to 75 % (Spain, Italy and Iceland) of the population intend to be vaccinated. For herd immunity a vaccination coverage of 60 -80 % is probably necessary, but largely unknown.

Acceptance of vaccination; Table of questions and answers

Questions	Answers
% intend to vaccinate	≤ 50 50 – 75 ≥75 unknown 4 2 3 2
Why reluctant	1. Risk of side effects 2. Evaluation too short 3. No proven efficacy 4. Fear of the vaccin
Vaccine for free	Yes (all)
Vaccination ruled by national authority	Yes (all)
Vaccination mandatory	No (all), but very much recommended
Who first	– Nursing homes and caregivers – Health care professionals – Public services(teachers, public transport) – Old/sick people
Choice of vaccine free	No (all)
Start of vaccination	Most last week of December 2020, Russia and UK first week of December 2020, some countries first week of January 2021.
Time needed for vaccination of the whole population	probably ± 6 months, largely unknown
Duration of protection	6-12 months, but largely unknown

Comments and discussion

The most important reasons for people to be reluctant or hesitant to receive vaccination are: evaluation time too short, fear of adverse effects, no proven efficacy and fear for vaccination in general. Negative communities, reluctance to accept Covid 19 and fear for a specific vaccine are less important reasons to be hesitant.

In relation to these doubts, it should be underlined that the studies behind approval of the vaccines are carefully designed, very big and continously followed-up. Thus, they meet all the requirements of the regulatory authorities. The documented protective effect is very high, in comparison with any other vaccin or medication. In addition, the development process utilize new sophisticated molecular methods to select effective and safe antigen targets for the immune repsonse of the vaccinated individual. The reasons behind the uniquely short development of Covid 19 vaccins are scientific developments, close collaboration between countries, researchers and the scientific community and the industry. And, most important, the extremely short lead times for decisions from regulatory authorities related to all steps in the development process.

The vaccine will be provided for free in every country included in this FAQ and the vaccination program usually is ruled by a national (or regional/municipal) authority.

Vaccination will not be mandatory, but highly recommended in most countries. It will not be possible for people to choose their vaccine ( a specific brand).

The highest priority for vaccination is usually asigned to residents in nursing homes and their caregivers, followed by health care workers and other elderly (or vulnerable) people. Also mentioned: immunosuppressed patients, public service staff, including teachers and public transport drivers. In some countries it is being considered to provide those who are vaccinated more privileges/possibilities, such as access to theaters, festivals, sports etc. than those who are not. It is obvious that most countries lack a strategic and beforehand agreed plan to reassure that groups of professionals with high and unique competence related to vital societal functions are vaccinated with the highest priority. In health care such competencies are particularly related to intensive and emergency care.

As stated before, vaccination has just started or will start shortly, with the exception of the UK where vaccination already started December 7 2020.

The time to complete the entire vaccination program is largely unknown, but will probably be around 6 – (12) months. Also the period during which the vaccine will provide protection is uncertain; most answerers predict 4 – 12 months. It should be stressed however, that although this question of course is important from an individual perspective, also a duration of immunity limited to 4-6 months will probably prove to be enough to break the chain of virus transmission and end the pandemic. Thus, the responsibility of the indivudual is dual; towards themselves but also towards the return to a normal society and the risk of severe illness and death of others.

It is clear that European internists are strong proponents for vaccination without hesitations. The risks of vaccination seem limited and are certainly less drastic than those associated with being ill with Covid 19. We should therefore all accept the vaccine as soon as it is offered.

January 7, 2021

Writing group: Stefan Lindgren, Ramon Pujol, Daniel Sereni and Jan Willem Elte

Appendix, individual answers per country:

Answers from France, author Daniel Sereni:

Questions	Answers
What is the percentage of people declaring they intend to be vaccinated?	40 %
Rank the reasons why some people are reluctant or hesitant to vaccination?	The evaluation has been too short 3 No proven efficacy 4 High risk of side effects 1 Fear for the vaccin in general 2 or for a specific vaccine and if so which one unknown Other reasons
Will the vaccine be provided for free?	Yes
Is the vaccination program ruled by a national authority?	Yes
Will vaccination be mandatory – for the whole population? – for some categories? Which? – who will go first?	No No No Elderly people living in nursing homes
Will people be able to choose their vaccine (if different brands are available)?	Unknown
When is vaccination planned to start?	27 December 2020
How much time will be needed to complete the entire vaccination program?	Probably more than six months
For how long will the vaccine give protection in your opinion?	At least six months - probably more- but decreasing with time, which would necessitate to repeat the shots every year like what is done with the Flu vaccine.

Answers from Sweden, author Stefan Lindgren:

Questions	Answers
What is the percentage of people declaring they intend to be vaccinated?	70% (minimum needed 60%)
Rank the reasons why some people are reluctant or hesitant to vaccination?	The evaluation has been too short 2 No proven efficacy High risk of side effects 1 Fear for the vaccin in general or for a specific vaccine and if so which one Other reasons
Will the vaccine be provided for free?	Yes
Is the vaccination program ruled by a national authority?	There is a national coordinator working directly under the Government. Vaccination is supervised by the regulatory body “National Board of Health and Welfare”. The vaccinations are organised by the 21 county councils which already have a routine for this from vaccination of seasonal influenza.
Will vaccination be mandatory – for the whole population? – for some categories? Which? – who will go first?	No, not mandatory, but strongly advised. There might be consequences for those who choose not to be vaccinated but that is not clear yet. First priority is elderly living in nursing homes and the personel working there, together with those receiving home care. Second priority is all other health care personel.
Will people be able to choose their vaccine (if different brands are available)?	No
When is vaccination planned to start?	It starts on small scale today (December 27) and will be rapidly accelerated over the next weeks/months.
How much time will be needed to complete the entire vaccination program?	The whole Swedish population is expected to have received two doses of vaccine by the end of June 2021.
For how long will the vaccine give protection in your opinion?	At least 4-6 months. But nobody knows for sure yet.

Answers from The Netherlands, author Jan Willem Elte:

Questions	Answers
What is the percentage of people declaring they intend to be vaccinated?	About 75%, the number has recently increased considerably.
Rank the reasons why some people are reluctant or hesitant to vaccination?	The evaluation has been too short 2 No proven efficacy 3 High risk of side effects 1 Fear for the vaccin in general 4 or for a specific vaccine and if so which one 5 Other reasons 6
Will the vaccine be provided for free?	Yes
Is the vaccination program ruled by a national authority?	Yes, the government and municipal health services.
Will vaccination be mandatory – for the whole population? – for some categories? Which? – who will go first?	No No No Health personnel, caring for the elderly and for Covid-19 patients (also in the hospitals) and after that the vulnerable elderly (nursing homes).
Will people be able to choose their vaccine (if different brands are available)?	No, not at present.
When is vaccination planned to start?	January 8, 2021
How much time will be needed to complete the entire vaccination program?	At least half a year, probably longer.
For how long will the vaccine give protection in your opinion?	Uncertain, perhaps only half a year, but possibly longer.

Answers from Italy, author: Nica Cappellini:

Questions	Answers
What is the percentage of people declaring they intend to be vaccinated?	Not based on a survey but a guess based on interviews and taking into account the negativists: Approximately 75% are in favour of vaccination.
Rank the reasons why some people are reluctant or hesitant to vaccination?	The evaluation has been too short 1 No proven efficacy 5 High risk of side effects 2 Fear for the vaccin in general 3 or for a specific vaccine and if so which one 4 Other reasons 6
Will the vaccine be provided for free?	Yes there is a national health plan.
Is the vaccination program ruled by a national authority?	Yes
Will vaccination be mandatory – for the whole population? – for some categories? Which? – who will go first?	Non mandatory but very much recommended. 1. health care providers 2. public services providers (Public transportation drivers, teachers) 3. Residents in elderly care residencies 4. over > 65yrs 5. the whole population
Will people be able to choose their vaccine (if different brands are available)?	So far there is no possibility to make any choice.
When is vaccination planned to start?	27 of December (as for Europe vaccination day) than from January 3rd.
How much time will be needed to complete the entire vaccination program?	I presume until summer time.
For how long will the vaccine give protection in your opinion?	First 2 injections have to be performed. There are no sufficient data, but at least 6 to 12 months.

Anwers from Iceland, author Runolfur Palsson:

Questions	Answers
What is the percentage of people declaring they intend to be vaccinated?	This has not been explored. Generally, the participation in vaccination programs is very high in Iceland.
Rank the reasons why some people are reluctant or hesitant to vaccination?	The evaluation has been too short 1 No proven efficacy High risk of side effects 2 Fear for the vaccin in general or for a specific vaccine and if so which one Other reasons
Will the vaccine be provided for free?	Yes
Is the vaccination program ruled by a national authority?	Yes, the National Health Service.
Will vaccination be mandatory – for the whole population? – for some categories? Which? – who will go first?	No
Will people be able to choose their vaccine (if different brands are available)?	No
When is vaccination planned to start?	29 December 2020
How much time will be needed to complete the entire vaccination program?	Unknown. Depends on availability of vaccine. It may take 6 months or more to complete the vaccination of the nation.
For how long will the vaccine give protection in your opinion?	This is not known. My prediction is that the vaccine will provide a long-lasting immunity, at least against current strains of SARS-CoV-2.

Answers from Switzerland, author Vreny Briner:

Questions	Answers
What is the percentage of people declaring they intend to be vaccinated?	In Switzerland less than 50% want to be vaccinated.
Rank the reasons why some people are reluctant or hesitant to vaccination?	Many people are sceptical because of the new method of the vaccine, no long-term results. Every year, flu vaccine is little done in the group of nurses, although they are more exposed than the average population. The evaluation has been too short 2 No proven efficacy 3 High risk of side effects 1 Fear for the vaccin in general 4 or for a specific vaccine and if so which one 5 Other reasons 6: reluctance to accept Covid 19
Will the vaccine be provided for free?	Yes
Is the vaccination program ruled by a national authority?	Yes, the government/military and counties are organizing vaccination with special ‘vaccination teams’.
Will vaccination be mandatory – for the whole population? – for some categories? Which? – who will go first?	No No In Switzerland high risk people and old people (>75 – 85 y) incl. nursing homes, health personnel, caring for the elderly.
Will people be able to choose their vaccine (if different brands are available)?	No
When is vaccination planned to start?	In some counties (e.g. Luzern, Appenzell) it started this week (last week of December).
How much time will be needed to complete the entire vaccination program?	It is not so clear.
For how long will the vaccine give protection in your opinion?	Unclear. We hope for more than one season. But because of the new mutation, it is not known if the new strain is covered by the vaccine. Maybe there are mutations as with the flu virus.

Answers from Spain, author Ramon Pujol:

Questions	Answers
What is the percentage of people declaring they intend to be vaccinated?	In Spain about 75%.
Rank the reasons why some people are reluctant or hesitant to vaccination?	The evaluation has been too short No proven efficacy High risk of side effects 2 Fear for the vaccin in general or for a specific vaccine and if so which one Other reasons 1: Negativist communities 3: Ignorance
Will the vaccine be provided for free?	Yes, without exceptions.
Is the vaccination program ruled by a national authority?	The central government authorities distribute the vaccines to the regional autonomous communities and then “vaccination teams” administer the vaccine to selected groups.
Will vaccination be mandatory – for the whole population? – for some categories? Which? – who will go first?	In Spain it is voluntary for everybody. Firstly: Residents in nursing homes and their caregivers Secondly: Health care professionals Thirdly: General population according to individual risk.
Will people be able to choose their vaccine (if different brands are available)?	In Spain the only vaccine available now is Pfizer-BioNTech.
When is vaccination planned to start?	On Sunday 27th December 2020.
How much time will be needed to complete the entire vaccination program?	Probably more than six months.
For how long will the vaccine give protection in your opinion?	There is no clear answer to this question.

Answers from UK, author Mark Cranston:

Questions	Answers
What is the percentage of people declaring they intend to be vaccinated?	I am not aware of any percentage of people declaring they intend to be vaccinated.
Rank the reasons why some people are reluctant or hesitant to vaccination?	The evaluation has been too short No proven efficacy High risk of side effects 1 Fear for the vaccin in general 1 or for a specific vaccine and if so which one Other reasons 3: Misunderstanding of the ‘herd immunity’ required for immunization of the population.
Will the vaccine be provided for free?	YES only the NHS.
Is the vaccination program ruled by a national authority?	YES. NHS.
Will vaccination be mandatory – for the whole population? – for some categories? Which? – who will go first?	Vaccine will be provided for elderly, at risk groups such as immunosuppressed or transplant population and healthcare workers. Each hospital will decide themselves who will be vaccinated.
Will people be able to choose their vaccine (if different brands are available)?	Not that I am aware of.
When is vaccination planned to start?	It started already 7/12/20.
How much time will be needed to complete the entire vaccination program?	Difficult to answer – that will depend on the logistics and the NHS operation to get the whole population vaccinated – perhaps 6 months.
For how long will the vaccine give protection in your opinion?	6 months from what I have read and heard anecdotally but I don’t think the data is available yet.

Answers from Estonia, author Margus Lember:

Questions	Answers
What is the percentage of people declaring they intend to be vaccinated?	In public opinion polls in Estonia 50% of population has answered they are ready to get vaccination immediately, 21% do not have a clear position, 24% are against vaccination.
Rank the reasons why some people are reluctant or hesitant to vaccination?	The evaluation has been too short 1 No proven efficacy 3 High risk of side effects 2 Fear for the vaccin in general 4 or for a specific vaccine and if so which one Other reasons
Will the vaccine be provided for free?	Yes, until the end of 2021.
Is the vaccination program ruled by a national authority?	Yes
Will vaccination be mandatory – for the whole population? – for some categories? Which? – who will go first?	No No 1. Health care personnel 2. Nursing care personnel 3. Population over 70 years and persons with certain chronic diseases
Will people be able to choose their vaccine (if different brands are available)?	No decision, probably not.
When is vaccination planned to start?	“European solidarity demonstration” on Dec 27, in reality Dec 30, larger scale in January.
How much time will be needed to complete the entire vaccination program?	For health care workers by the end of March 2021. Ambition is to provide vaccination for the entire population during the first half of 2021, ultimately by the autumn 2021.
For how long will the vaccine give protection in your opinion?	Difficult to prognose. Current opinion: at least for 8 months.

Answers from Russia, author Valentin Kokorin:

Questions	Answers
What is the percentage of people declaring they intend to be vaccinated?	According to the public opinion poll results mid December it was approximately 42%.
Rank the reasons why some people are reluctant or hesitant to vaccination?	The evaluation has been too short 5 No proven efficacy 3 High risk of side effects 4 Fear for the vaccin in general 1 or for a specific vaccine and if so which one 2: We have only 1 available vaccine on the market at the moment Other reasons
Will the vaccine be provided for free?	Yes
Is the vaccination program ruled by a national authority?	Yes
Will vaccination be mandatory – for the whole population? – for some categories? Which? – who will go first?	No No First medical workers and teachers.
Will people be able to choose their vaccine (if different brands are available)?	At the moment there is no choice.
When is vaccination planned to start?	It started on December 5th 2020.
How much time will be needed to complete the entire vaccination program?	Nobody knows. In the first month only 50 000 people did get the vaccine in Moscow (approximtely 0.33% of the city population).
For how long will the vaccine give protection in your opinion?	There is no sufficient information on this issue. The developers of the vaccine “Sputnik V” expect the duration of the effect to be two years.

Answers from Finland, author Kim Petterson-Fernholm:

Questions	Answers
What is the percentage of people declaring they intend to be vaccinated?	According to a few surveys the figure is 70%.
Rank the reasons why some people are reluctant or hesitant to vaccination?	The evaluation has been too short 3 No proven efficacy 5 High risk of side effects 1 Fear for the vaccin in general 2 or for a specific vaccine and if so which one Other reasons 4: general reluctancy and in principle opposing vaccination
Will the vaccine be provided for free?	Yes
Is the vaccination program ruled by a national authority?	Yes
Will vaccination be mandatory – for the whole population? – for some categories? Which? – who will go first?	No No 1. People working with COVID-patients 2. Other health care staff 3. > 80-year-olds 4. > 70-year-olds 5. people with significant comorbidity
Will people be able to choose their vaccine (if different brands are available)?	No decisions have been taken on this issue as far as I know.
When is vaccination planned to start?	It started during week 53 end December 2020.
How much time will be needed to complete the entire vaccination program?	Some prognoses indicate this entire year depending on the amount of vaccine allocated to Finland.
For how long will the vaccine give protection in your opinion?	An optimistic view: 4-10 years. A pessimistic view: 6-12 months. My personal current opinion: 2 consequent shots will give the protection for 2-3 years.