Nurse’s union boss: We will not reach herd immunity by September

Malta began rolling out the Pfizer COVID-19 vaccine on 27 December – starting first with healthcare professionals, and residents of care homes, expanding now to over 85s. However, the health authorities have received criticism from unions about the slow roll-out.

Health Minister Chris Fearne has told Euronews that Malta is looking to vaccinate 70% of the population by the end of September, with a closer objective being to vaccinate medical workers and all those over 80 years of age by March.

Malta Union of Midwives and Nurses president, Paul Pace answered MaltaToday’s questions regarding the vaccination roll-out: the process, workforce capabilities, and what could be done to speed up the roll-out.

How is the COVID-19 vaccine prepared? 

It takes 15-20 minutes to prepare five COVID-19 (Pfizer) doses, six if speed is picked up. But on average it is five doses. “You cannot shorten the time. Pfizer stipulates it. It’s not like a normal influenza vaccine – far from it. It’s a tiring procedure.”

It takes four nurses to prepare five vaccine doses. “One nurse needs to input information into the system – a clerk cannot do this; it needs to be done by a nurse. Again, this is stipulated by Pfizer and the EU. Then, it takes two nurses to prepare the vaccination. The last nurse is solely focused on administering the vaccine. There is also a limited amount of time to give it, in a matter of six hours they must all be administered.”

What is the current COVID-19 roll-out strategy?

The nurses in hospitals are themselves vaccinating hospital staff. That means every hospital organizes the vaccination of their own staff. But the vaccination of the general public is itself much more challenging. 

“In the beginning, we were under the impression that the pharmacists would be the ones preparing the vaccines for us (nurses). Unfortunately, with the health department’s blessing, the pharmacists opted out of preparing the vaccine, so that administering the vaccine fell upon the nurses to handle.

“When it comes to the hospitals, I have to say things are going quite well. Since every hospital has a small consignment, nurses are coping quite well in vaccinating the staff, and in some cases even the patients. I think by the end of February, most of the staff, if not all, will have been vaccinated.”

The biggest challenge is the general public. “With the current strategy, vaccinations occur between 10am to 3pm for over-85s – which means 50 doses a day at each health centre. The 3pm-6pm slot has been reserved for frontliners. We’re not giving anything beyond that. If we were to do, for example, from 10-6 pm, we could administer 80 doses.”

Why do you think the strategy has not been changed? 

“Right now we’re going at a very slow pace. The issue is not the workforce. We do not have enough vaccines in the country to do a proper roll-out, especially with what is happening today – three healthcare centres, with no patient lists.”

Pace said that right now there are healthcare centres which are overworked, and others that have no patient lists. “Obviously nurses are still going about their usual tasks. Still, we need a more balanced approach: we need to maximize our workforce more, but we do not have the vaccine doses to allow us to do that.”

Right now, workforce is not an issue, but do you foresee it being an issue down the road?

“Yes. Nurses have to be removed from previous tasks and put full time on vaccinations. We don’t have that luxury in Malta. There are nurses in the health centres, but they all already have others tasks to do. So we have to rely on overtime, which nurses are not eager to do – especially female nurses with children. Overtime is very limited. There are very few nurses opting for overtime. So if we think overtime is the easy solution, it is not – at the rate we’re going, it’s going to take over a year.”

Only a small portion of nurses ever work overtime, Pace says, even before COVID. “In primary healthcare, 80% of nurses do not bother working overtime. I don’t blame them; they have families, they have commitments – overtime is an option, not a must.”

Pace says to facilitate reassigning nurses to healthcare centres, other services had to be closed down. “So now, there will be no nurses assisting doctors at the diabetics clinic. And still, there isn’t enough, so we have to rely on overtime. This is worrying because overtime fluctuates – one day you might have enough nurses, then in the spring and summer, nurses might have had enough of doing overtime. This is not something like influenza when it’s just a month or two. It’s going to take a year – you don’t expect never to have an off-day. But we’re not robots.”

Overtime also decreases in the summertime, when vacation requests skyrocket. “70% of the workforce are female nurses, and around 50% of them are raising children. There are also huge limitations from private contractors getting nurses.”

The ideal would be also to enlist the pharmacists and compounders.

“Were I the government, I would use them to prepare the vaccine. And have nurses focused on administering the vaccine – the more people you get involved, the better.”

Will there be herd immunity by September?

“No, unless there isn’t a change in strategy, which we don’t know about. There will never be even close to 70% herd immunity.

“The issue is, and the minister is not saying, is when the rest of the vaccinations will be available? It doesn’t appear to be in the short term. If they’re coming in a month, that’s one thing, but if they’re coming in June/July/August, that’s another thing.”

Should the private sector be allowed to get involved? 

Pace says involving the private sector could cause a problem.

“The government has no intention of having private hospitals offering the vaccine. None of the governments in Europe gave it to the private sector. Even in countries where they do not have free health care, vaccinations are still free. 

“The private sector is very limited; there are no extra nurses in the private sector. This idea the private sector will solve the issue is not the case. The biggest workforce is government. In care homes, the nurse-patient ratio is low; you can’t remove the few nurses there are there.”