By Yoruk Bahceli
AMSTERDAM (Reuters) - Despite its wealth and reputation for efficiency, the Netherlands trails in the European Union vaccination rankings, its roll-out hampered by poor planning and a conservative strategy that kept more than 40% of its vaccines in storage rather than in people's arms.
The Netherlands only began vaccinating on Jan. 6, the last EU country to do so. It had wrongly assumed that the first vaccine to be approved would not require a deep freeze supply-chain and was slow to respond when it did.
It has ordered 85 million doses from eight drug makers and now aims to offer all adults in the population of 17 million a vaccine by the end of September.
But so far just 3.6 doses have been given per 100 people, ahead of Latvia, Croatia and Bulgaria in the 27-member EU, according to Oxford-based Our World in Data.
Data from the Dutch Institute for Public Health (RIVM) implies that percentage is closer to 4.6%, including estimates for vaccinations in care homes, but that would still be below an EU average of 5%.
Data from the European Centre for Disease Prevention and Control showed the Netherlands was the second slowest in the EU in administering vaccines, having used just 28.5% of those it had received as of Jan. 29.
"At a certain moment in time, there were 400,000 vaccines in storage and they just sat there," said health consultant Herman van der Weide, who managed the Dutch vaccine programme against swine flu in 2009.
But the pace has picked up. EU approval of more vaccines and an end to the policy of storing second doses have reduced the stockpile, with Dutch authorities estimating that 57% of over 1 million doses received had been used as of Feb. 14.
The difficulty counting vaccinations highlights the challenges the Dutch government has faced with its COVID-19 response in the run-up to elections on March 17, from IT problems to a major legal setback when a court said its night curfew should be scrapped.
Ministers have faced hours of questioning in parliament, but have survived votes of no confidence.
Responding to criticism that it had moved too slowly, the RIVM last month started to include an estimate for vaccinations in care homes, which were thought to be underreporting shots due to IT problems.
That boosted vaccinations by over 100,000 doses overnight, but this was corrected the next day because 17,550 had been counted twice.
Health ministry spokesman Marcel van Beusekom said the system for registering care home vaccinations should be sorted out in the coming weeks.
The low overall vaccination rate in the Netherlands, which has recorded more than a million cases and nearly 15,000 deaths, compares to 78% in Israel, 24% in Britain and 7% in Denmark, according to Our World in Data, which only includes confirmed vaccinations for the Netherlands, for comparability with other countries.
Dutch vaccine experts point to logistical missteps, weak leadership and a decentralized health system poorly equipped to respond to such a vast crisis.
"I think it's probably the million dollar question," said Jan Fransoo, a professor of logistics at Tilburg University, who advises the RIVM, which runs the vaccination programme.
The Dutch healthcare system normally works well "but as soon as there's a pandemic, this is not necessarily the best system to have. There is no central line of command", Fransoo said.
Van Beusekom defended the strategy of having the RIVM, rather than independent logistics experts, lead the vaccine programme, rejecting criticism that it hampered distribution.
RIVM spokeswoman Charlotte Menten stressed that this was the ministry's choice.
"The minister is very much involved with the implementation itself and the choices made," van Beusekom added.
(Graphic: Dutch lag EU vaccination rankings - https://fingfx.thomsonreuters.com/gfx/mkt/jbyprdqrrpe/x0ANP-dutch-lag-eu-coronavirus-vaccination-rankings.png)
Changes in the way vaccination are being sequenced mean some healthcare workers are waiting longer for their shots.
Bert de Haas of FNV, the Federation of Dutch Trade Unions, said it's impossible for carers, whether at homes for the elderly or the disabled, to maintain distance when washing, cleaning and dressing clients, putting everyone at risk.
He said all carers should be given priority for vaccines.
Tim van der Ham, who mentors mentally disabled clients, had been promised a vaccine in January, but he is still waiting.
"When you are standing in your protective clothing and the client no longer knows and grabs onto you and damages your protective clothing, then that is very scary," he said in an interview.
"We cannot close our care home. We can't say 'we'll see in a month'. The clients need people to care for them 24 hours a day," he said.
A desire to work within existing healthcare structures, the misplaced bet on the AstraZeneca vaccine and reluctance to adjust plans caused a late and slow start to the campaign.
"We were insufficiently agile in accommodating the changes," Health Minister Hugo de Jonge told parliament in January.
But logistics expert Fransoo expects the Dutch to catch up in coming weeks.
"We have taken the position that we are not looking back. At the stage where we are now, this is totally unproductive. What we do is look forward," he said.
(The story corrects paragraph 4 to say 3.6 doses given per 100 people, not 3.6% of population received at least one dose)
(Reporting by Yoruk Bahceli; Editing by Anthony Deutsch and Giles Elgood)