© Provided by The GuardianPhotograph: Thomas Samson/EPA
Authorities in Germany and France are under pressure to come up with creative solutions to shift the AstraZeneca vaccine at higher speed in order to avoid a pile-up of unused doses over the coming weeks.
On Monday, France's medical regulator reversed its advice not to use the AstraZeneca jab on over-65s, and Germany's vaccination committee is coming under increasing pressure to follow suit or even scrap prioritisation altogether.
Both countries have been slow to administer the Oxford-developed vaccine, subject to an acrimonious tug-of-war over delayed deliveries between its Swedish-British producer and the European commission in January.
In France, only 16% of 1.7m AstraZeneca doses had been administered by the end of last week, while in Germany two-thirds of 1.4m delivered doses remained in storage on Monday.
In search of an explanation, much has been made of anecdotal reports of a reluctant public in both countries holding out for BioNTech's "Rolls Royce vaccine", which in early trials had shown a higher efficacy in battling Covid-19 infections.
© Photograph: Thomas Samson/EPAOlivier Véran, the French health minister, speaks to people waiting to receive a Covid vaccine. Véran said France should deliver 6m first jabs in March.
In the western German city of Duisburg, for example, a spokesperson said 50% to 70% of appointments for an injection with the AstraZeneca jab had either been not taken up or cancelled.
But on closer inspection, AstraZeneca scepticism appears to be a local phenomenon restricted to specific regions, with logistical problems likely to play a much bigger part.
In Germany's second largest city, Hamburg, authorities said they had experienced barely any reluctance among those who were offered the Oxford jab, but conceded that the decision to clear the vaccine only for those under 65 had created "not inconsiderable logistical problems".
"We'd hoped that the AstraZeneca vaccine would be one of the key drivers of our programme, since its modest storage requirements meant we could have administered it via doctors' practices before the BioNTech or Moderna vaccines," said Martin Helfrich, a spokesperson for the northern city state's health ministry.
The German decision not to clear the vaccine for over-65s meant authorities had to actively seek out younger people in the top priority group. Finding essential workers such as medical staff or firefighters was relatively quickly done through unions and labour associations.
But reaching younger people with pre-existing conditions was a more laborious task, with the state having to invite them by post to book an appointment over the phone, causing considerable delays.
Related: Germany set to give AstraZeneca jab to older people
Some cities have started trialling creative ways to shift unwanted stock: for every dose currently left over in Duisburg, specially developed software sends out text messages to three people on a list of interested volunteers. The first to respond is given an appointment to get the jab.
In France, reports of AstraZeneca hesitancy have similarly overshadowed flaws in the design of the country's rollout strategy.
While a handful of doctors have said publicly they are not recommending the jab, and some healthcare workers have reportedly been reluctant to take it because of the side-effects experienced by some colleagues, there is little evidence that the AstraZeneca vaccine is being actively refused by the general public.
Analysts have said the large number of unused AstraZeneca doses seems to be more a result of the government focusing exclusively - and, critics argue, inflexibly - on vaccinating the oldest and most at-risk groups, such as care home residents, for whom the shot had not been approved, with no back-up plan for using spare doses.
Like most EU countries, France has also not followed the UK in extending the gap between the first and second doses of the Covid vaccine beyond the manufacturer's recommended period, meaning it has to keep more in reserve for early second doses.
As millions of doses by AstraZeneca, BioNTech and Moderna are due to arrive across the EU this month, the problem in France and Germany is shifting from one of under-supply to that of doctors not being able to get the vaccine into people's arms quickly enough.
If Germany were to continue vaccinating people at its current pace, Die Welt newspaper calculated on Monday, the country would have piled up almost 5m unused doses by the third week of March.
France's slow rollout is set to accelerate significantly, with general practitioners authorised to administer shots since last week and pharmacies following suit this week after a ruling by the country's health regulator on Tuesday.
The French health minister, Olivier Véran, said France should deliver 6m first jabs in March, double the number given during the first two months of the inoculation campaign. The prime minister, Jean Castex, said last week that all over-50s would be offered a jab by mid-May.
In Germany, too, GPs will eventually be drawn into the vaccination rollout, though not until the country receives about 3m doses a week, meaning doctors will not be in a position to choose some of their patients over others.
In Hamburg, the health ministry spokesperson said he expected there to be a "tetchy period" in early April, when the city's vaccination centres are running at full capacity but there are not yet enough doses to supply to GPs.
In the meantime, there is still room for making the German operation run more efficiently in its current form. Six of the country's 16 states on Monday were reported to have vaccinated no people on Sunday whatsoever.