Apoyo militar a los planes europeos de vacunación frente a las pandemias

Military support to European vaccination plans against pandemics

Moderador / Chair: coronel Med. María del Carmen Ybarra de Villavicencio. España. Spain.

Relator / Rapporteur: coronel Med. María del Carmen Ariñez. España. Spain.

Conferencias / Conferences:

Figura 13. Tercera mesa redonda. 

Transporte de vacunas COVID-19 para operaciones multinacionales. Teniente coronel Far. Luc Van Parys. Bélgica / COVID-19 vaccines transport for multinational operations

Pauwels G., Deputy Responsible Person, Pharmacist Captain (OF-2), Belgian Defence; Van Parys L¹., Responsible Person, Pharmacist Lieutenant colonel (OF-4), Belgian Defence

The European Union (EU) has authorised four COVID-19 vaccines, and their acquisition was coordinated at EU-level. Each individual nation decides on its own vaccination strategy, meaning also that vaccination of troops deployed in a multinational operation is according to the respective national strategy. Belgium started vaccinating its deployed troops in theatre from March 2021.

For vaccination in theatre, the vaccine, the vaccinator and the target population need to be present at the same time and place, thus close planning of each national Medical Operational -Command is required. Each vaccination campaign needs a preliminary assessment that takes into account the characteristics of the vaccine (multi-dose, temperature conditions and scheme), the number of persons to be vaccinated and the availability of a facility with medical supervision (cfr. pre-vaccination checklist, anaphylaxis). Any spillage of scarce (national) vaccines and secondary transports in theatre must be avoided.

For each campaign, a risk assessment of the transport lane is performed by comparison of the estimated total transport time versus the guaranteed storage conditions in the transport box. Different (active and passive cooling) transport boxes were available, each evaluated by the vendor (ISTA Standard) and qualified by the own Quality Department. Secondly, the chain of custody is assured by recording each transaction (handover) during transport. An accompanying person keeps «two eyes on the box» and intervenes in case of unexpected events, e.g., flight delay. Thirdly, the transport is temperature monitored from «fridge to fridge». On destination, the data are sent for immediate analysis by the Responsible Person to confirm that the quality of the vaccines was guaranteed during transport (cfr. Good Distribution Practices [GDP]).

Transports for all campaigns were successfully completed from Belgium (Military Hospital, primary storage site of the vaccines) to the different theatres (Africa, Middle East and Europe). All transports started by configuring the appropriate transport box for road transport to the airport or harbour. The transport boxes used were «Peli BioThermal Golden Hour Mobile Series 4 - 2 L» (passive, 2-8 °C), «Electrolux RCB 25E» (passive, 2-8 °C), «va-Q-tec va-Q-proof 11 Standard» (passive, -20 °C) and «Fiocchetti Portable Refrigerator C65» (active, 2-8 °C and -20 °C).

La contribución farmacéutica a la pandemia de la COVID-19. Comandante Far. Martinne Van Innis. Bélgica / The pharmacist’s contribution to the COVID-19 pandemic

Van Innis M., Delapas A.¹, Olivier G.²

In order to fight the COVID-19 spreading, Belgium started a huge vaccine campaign as soon as the first vaccine was available. Rapidly, the medical logistics were launched. The Belgian government inventoried the capacity of vaccines’ storage and designated the medical Hubs. Since the Military Hospital owns ultra-low temperature freezers and because of the capacity of Defence to deploy many people quickly, the Military Hospital was requested to help the nation for the COVID-19 vaccination. The hospital pharmacy was put in charge to supervise the delivery of the vaccines in straight collaboration with the local administration of Brussel area, as well as to draw up individual doses.

From end December 2020 onwards, the main function of the hospital was to store the vials of mRNA-based COVID-19 vaccines following the GDP, manage the defrosting and deliver it to care homes. As the first authorized mRNA-based COVID-19 vaccine had to be stored at -80 °C, administered within 5 days and contained 5 to 7 doses, a good coordination with the government was essential not to waste any doses of the precious vaccines. The vials’ traceability was ensured by the pharmacy, and the government managed all transports as well as the distribution of the vials.

The second phase began in January 2021 which consisted in the vaccination of the population following a prioritization determined by the government. During this phase, the Military Hospital stored the four authorized vaccines, prepared the injections as well as performed and traced the vaccination. Members from other armed forces units i.e., also nonmedical personnel came in support to the hospital staff.

The main job of the pharmacy, in particular, consisted of the vaccine syringes preparation. All was done following the Good Hospital Pharmacy Practice. Each vaccine’s syringe was made in a sterile environment in a vertical-flow hood. The pharmacists of Defence came helping in turns and were trained by the hospital pharmacy team. Their work consisted in writing protocols, managing the multidoses vials thawing, handling the speed of making syringes (considering the stability of each vaccine at room temperature), controlling the labelling and encoding the batches’ references to ensure traceability.

COVID-19: compromiso del Ministerio de las Fuerzas Armadas francesas de vacunar su comunidad y a la población francesa. Teniente coronel Far. Sophie Salle. Francia / COVID-19: commitment of French ministry of the armed forces to vaccinate its community and the French population

Salle S.¹, Vittori E., Tournier J.-N.²

Since the beginning of 2020, COVID-19 pandemic paralyzes the world. Up to date, vaccination is the most effective tool to fight the COVID-19 outbreak and, in a military context, to protect operational capabilities of the armed forces. In a general context of a limited availability of vaccines, the French government established its vaccination policy to protect the most vulnerable and exposed populations. Thus, the vaccination has been gradually accessible to oldest, people with comorbidities and health care workers. For the national vaccination campaign, the French Military Health Service (SSA) has been involved along two main operation lines.

By October 2020, a task force has been set up to plan the military vaccination campaign. Thanks to a dialogue with the interministerial vaccination Task force, the military campaign started as soon as January 2021 to vaccinate essential operations members. The Comirnaty mRNA vaccine solution was selected because it provided a shorter completion schedule, allowing a faster protection for a force projection under short notice. By April 2021, vaccination campaign operated by SSA began in accordance to the national policy while considering military operational requirements. This vaccination has gradually become mandatory for military operations over the metropolitan territory. Since June, this campaign is open to all the people of the Armed forces (military and civilian population and their families), with special focus on professional transfers out of metropolitan territory. The military medical supply and public-health care actors were strong partners to deliver the vaccine and report the campaign, respectively.

The national campaign for civilian population started as soon as early January 2021. Seven military hospitals and the medical military school in Lyon hold vaccination centres with the support of the Armed forces resources. The SSA contribution increased by May 2021 with a daily capacity of over 1 000 vaccinations, for each vaccination centre.

The strong commitment of all SSA components in those vaccination campaigns and the organization agility confirmed the role of the armed forces in Nation resiliency. The SSA reaffirmed the crucial role of the medical advice to command to organize a national response in such a health crisis.

Actividades militares relacionadas con la vacunación de la COVID- 19. Coronel Med. María del Carmen Ariñez Fernández. España. / Military COVID-19 vaccination related activities

Ltc. Ariñez C., Ltc. Mayo E., Maj. Suárez A., Cap. Colmenar G., Cap. Escuredo L., Cap. Navarrete E.

Defence Military Preventive Medicine Institute IMPDEF

Spain’s coronavirus vaccination campaign began at the end of December 2020. It was a country-wide strategy driven by an ethical framework based, on equity and aligned with the common European plans. The objective of this campaign was to reduce the morbidity and mortality caused by this disease, protecting the most vulnerable groups through vaccination.

Population priority groups focused on elderly people, residents, and personnel of long-term care facilities, healthcare workers, social care personnel, and people with certain comorbidities. Priority vaccination groups were updated subsequently based on the scientific evidence and the availability of vaccines.

Ministry of Defense published a vaccination strategy -harmonised with the main lines established by the national strategy. The objectives were to maintain the operativity of the Force and set the priority immunization groups within the Armed Forces.

Vaccination of the military personnel started at the beginning of January 2021 in the Defense Preventive Medicine Institute. In line with national priority groups, front line health care personnel in military hospitals, and medical personnel assigned to military units were the preference.

The following groups were the military emergency unit and soldiers that took part in operations abroad, as one of the best -measures of force health protection to maintain their operativity. Another -objective of the vaccination campaign was not to introduce virus SARS-CoV-2 in the different countries and, therefore, spread the virus among other contingents and local population. Although vaccination is not mandatory in Spain, vaccination refusal rate was negligible.

Vaccination of military personnel was registered in a purpose-built information system named CENDALA. All data reordered were shared with the national health registry. Therefore, this information was also valid to issue the EU Digital COVID-19 Certificate to military personnel.

The Defense Military Preventive Medicine Institute was an advisor to the Armed Forces and to the Surgeon General as regards COVID-19 epidemiological surveillance, prevention and vaccination activities. Since the implementation of COVID-19 vaccines in the Armed Forces, figures on COVID-19 cases and outbreaks decreased, and there were no COVID-19 medical evacuations from operations abroad.

This Institute also developed some health promotion activities with the aim of increasing adherence to the vaccination campaign.

Actividades de promoción y educación de la salud desarrolladas por el plan de vacunación del IMPDEF, perspectiva psicológica. Capitán Psi. Leticia Escuredo Jiménez. España / Health promotion and educational activities developed by the IMPDEF vaccination plan, psychological perspective

Cap. Psy. Escuredo Jiménez L. Spain. Defence Military Preventive Medicine Institute IMPDEF

Among its main purposes, the Defense Military Preventive -Medicine Institute has to promote continuous information programs on health issues and study and prevent risk situations for the Spanish Armed Forces. Along the pandemic situation, with a multidisciplinary spirit, some health promotion actions have been developed in which the psychological approach is taken into account.

The perceptions and attitudes of our staff towards health preventive measures have been reviewed to minimize the risks to which they are exposed in the fulfilment of their mission.

During this time, the strategic lines of communication on vaccines against COVID-19, proposed by the World Health -Organization, have been followed. In order to support the work of military health professionals, various guides, infographics, and video material have been designed and available for use on the Institute’s website. With the aim of changing the decrease in risk perception, a special effort has been dedicated to health promotion and pandemic fatigue, in order to reinforce prevention measures and overcome tiredness.

Improving adherence to public health recommendations, among which vaccination is a priority, medical education is one of the main purposes of this Institute.

Enfermería militar, clave de la campaña de vacunación de la COVID-19 para el personal militar. Capitán Enf. Gema Colmenar Jarillo. España / Military nursing, cornerstone of the COVID-19 vaccination campaign for military personnel

Cap. Colmenar G¹, Ltc. Pérez V², Col. Ariñez C¹, Maj. Moreno A², Maj. Suárez A¹, Cap. Robledo MA²

When the military nurses face the vaccination of our military personnel we follow the action protocols marked in a technical instruction based in turn on higher-ranking regulations.

Among these rules, there is one that allows duly accredited military nurses to prescribe, among others, vaccines inside vaccination campaigns.

This has allowed military nurse to face a mass vaccination campaign unprecedented in history, on the one hand, administering the vaccines prescribed by medicine and by the other hand and simultaneously, to have ability to prescribe themselves the vaccines that they will administer later.

Thanks to the tools now available by nurses, which enables the indication and administration of vaccines without the essential presence of a medical officer in the barracks. With this fact has been possible to make much faster progress in the vaccination coverage of Ministry of Defense staff.

To arrive at this event long awaited by patients, previously the military nurses had to face an overload of management and logistics work, in order to provide quality care, and so that it is not wasted a single dose of vaccines against COVID-19.

Once this logistical challenge was overcome, there was, the challenge of vaccinating the priority groups marked in the vaccination strategy of the Ministry of Defense on a massive and time trial.

Under these criteria, complying with all the steps of a vaccines act, from anamnesis and prescription, informing the patient before signing his informed consent, the administration of the vaccines, the registration of it, and the observation of adverse reactions, has been administered 170,978 doses of vaccines, with a total of 91,763 personnel with at least one dose and 85,506 personnel with the complete schedule according to the current vaccination criteria (data from January 5^th to September 15^th, 2021). Although -Cendala System has registered a greater number of vaccines belonging to the doses that have been administered outside the Ministry of Defense.