The COVID-19 vaccines and vaccination centres

“We have always been careful to ensure that the vaccination campaign could be conducted in a qualitative way. That was our biggest concern. We have been pragmatic, yet the quality always had to be 100 %”

The Directorate General Inspection of the FAMHP played an important role in the logistical development of the national COVID-19 vaccination campaign. Our inspectors and controllers of the DG Inspection shared their expertise in the training, start-up and evaluation of the vaccination centres. Nele Matthijs, in charge of the Distribution Division, and Margriet Gabriels, in charge of the Dispensing Division, were actively involved in the organisation of storage, distribution and delivery of the COVID-19 vaccines under the direction of Director General Ethel Mertens.

Ethel Mertens

The national COVID-19 vaccination campaign was a huge logistical mission. How did you prepare said campaign to ensure that all persons entitled to be vaccinated in Belgium could get their injection?
EM: At the end of 2020, the development of the COVID-19 vaccines has suddenly accelerated. Given the pandemic situation and the scale of the vaccination campaign, it soon became clear that our traditional methods for storage, distribution and dispensing weren’t suitable for the COVID-19 vaccines.

The vaccines came with very specific storage conditions, that differed from one vaccine to another. For instance, Pfizer’s vaccine had to be stored at -80 °C while Moderna’s had to be stored at -20 °C. The vaccines also had a very limited shelf life from the moment they were defrosted. So, we immediately started searching for a partner who had both the capacity and the special freezers to store the vaccines. The hospital pharmacies applied to take up this role. The vaccines are also packed in multidoses. The hospital pharmacists offered to divide the large packaging into smaller packages and distribute those to the residential care centres and later to the vaccination centres. Together, we have established procedures and protocols to manage the entire process properly.

MG: In December 2020, our inspectors did a first dry run with water-filled vials. We thoroughly tested the entire process, from the delivery of vaccines by the manufacturer to the hospital pharmacy down to the delivery in residential care centres, the prepping of individual doses and the on-site administration to residents and staff. Subsequently, several wet runs took place, including for the vaccination of hospital staff. Based on our findings, the procedures and scripts were adapted and optimised.

From March 2021 onwards, the general public was vaccinated. What role did you play in preparing the vaccination centres?
MG: At first, we helped to set up the vaccination centres, together with the Corona Commissariat. Initially everyone had very high ambitions to set up a vaccination centre in almost every village, but it quickly became clear that would impose a huge logistical burden on the municipalities, so expectations had to be downsized. In total, about one hundred and fifty vaccination centres have been set up across Belgium. The vaccination campaign is actually a competence of the federated entities. However, as they have limited experience with such a vaccination campaign, they asked the expertise of the FAMHP. We didn’t act as inspectors: we rather had a consulting and advisory role.

Margriet Gabriels

Nele Matthijs

NM: As a competent medicine’s authority, we are always responsible for the qualitative distribution of medicines, including vaccines. We have to check that all processes are compliant to the legislation and if the quality guidelines are properly followed. That was our main task in the vaccination centres, but we have also taken up many tasks that fall outside our scope, such as the quantitative distribution of vaccines and the necessary materials such as syringes and needles.

This logistical organisation was a huge challenge for us. Whenever fewer or no vaccines were delivered, we had to recalculate everything. We also had to ensure a balanced distribution among the different regions of our country. Also, a vaccination centre is not the same as a residential care centre, nor a hospital. The people who volunteered there, had to be trained.

What difficulties did you encounter?
EM: As the vaccination campaign progressed, things became more complex. For example, the fact that two doses of the same vaccine had to be administered with an interval of a few weeks didn’t make things any easier. You cannot assign a vaccine to a person if you are not sure they will receive the second dose in time; the effectiveness after one administration couldn’t be warranted. Another difficulty was that the manufacturers couldn’t guarantee a continuous supply. We often faced delays and, in some weeks, unexpectedly, less vaccines were delivered than expected or none at all. Also, in the beginning of the vaccination campaign, demands significantly exceeded supplies. A lot of people wanted to get vaccinated, but there just weren’t that many vaccines available yet. For some people, that was difficult to understand.

Once the vaccination campaign was well underway and all procedures had been thoroughly tested, you continued to provide support.
EM: That’s right. It was very intense, because of course we couldn’t be everywhere at the same time. To make sure that everyone in each vaccination centre received the same, most recent information, consultation meetings were systematically organised with all parties involved. Reports of those meetings were distributed to all pharmaceutical experts in the vaccination centres in order to have everyone on the same level. There were incidents that went far beyond our comfort zone. For example, we raised awareness about recruiting people in the market to get vaccinated. In case of problems, we always contacted those responsible to ensure that everything could be done in a qualitative manner. That was our biggest concern. We have been pragmatic, but the quality always had to be 100 %: we fiercely held onto that principle.

NM: As mentioned earlier, each Friday we held a meeting with those responsible for the vaccination centres, that was quite a success. When problems were detected during our checks or visits to vaccination centres, we could communicate that information to all centres at the same time. That meeting was a dialogue, where questions could be asked. It was nice to see how the experts in the centres even made presentations for their colleagues to share their knowledge.

The vaccination centres are now running on a slower rhythm. Are they ready to go back to full speed if necessary?
NM: We certainly keep monitoring the situation closely, not only within our inspection services, but also for everything related to medical devices, vaccines, medicines against COVID-19, all developments are closely monitored. All procedures and scripts are in place. We have also created a legal framework to manage the distribution of vaccines for group vaccination. Other COVID-19 vaccination channels, for instance through pharmacists in pharmacies, in doctors’ practices, on organised vaccination days … are now being further developed by the federated entities. It is in fact their responsibility to further organise the COVID-19 vaccination campaign, while we continue to share our expertise, of course.

EM: Despite the difficult period and circumstances we’ve been facing, theoretically speaking everything is put in place to restart COVID-19 vaccination whenever needed. My teams have worked very hard on that, and so did all our colleagues within the FAMHP. In any case, I can’t stress enough how proud I am of my team. I would like to thank them so much for all their work.

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