The few hours it took to give the first coronavirus vaccine shots to 14 residents of the John XXIII nursing home – named after a pope and not far from the birthplace in eastern France of vaccine pioneer Louis Pasteur – took weeks of preparation. The home’s director, Samuel Robbe, first had to chew his way through a dense 61-page vaccination protocol, one of several hefty guides from the French government that exhaustively detail how to proceed, down to the number of times (10) that each flask of vaccine should be turned upside down to mix its contents. “Delicately,” the booklet stipulates. “Do not shake.” As France tries to figure out why its vaccination campaign launched so slowly, the answer lies partly in forests of red tape and the decision to prioritize vulnerable older people in nursing homes. They are perhaps the toughest group to start with, because of the need for informed consent and difficulties explaining the complex science of fast-tracked vaccines. Claude Fouet, still full of vim and good humor at age 89 but with memory problems, was among the first in his Paris care home to agree to a vaccination. But in conversation, it quickly becomes apparent that his understanding of the pandemic is spotty. Eve Guillaume, the home’s director, had to remind Fouet that in April he survived his own brush with the virus that has killed more than 66,000 people in France. “I was in hospital,” Fouet slowly recalled, “with a dead person next to me.” Guillaume says that getting consent from her 64 residents – or their guardians and families when they are not fit enough to agree themselves – is proving to be the most labor-intensive part of her preparations to start inoculations later this month. Some families have said no, and some want to wait a few months to see how vaccinations unfold before deciding. “You can´t count on medicalized care homes to go quickly,” she says. “It means, each time, starting a conversation with families, talking with guardians, taking collegial steps to reach the right decision. And that takes time.” At the John XXIII home, between the fortified town of Besancon and Pasteur’s birthplace in Dole, Robbe has had a similar experience. After the European Union green-lighted use of the BioNTech-Pfizer vaccine in December, Robbe says it took two weeks to put together all the pieces to this week vaccinate 14 residents, just a fraction of his total of more than 100. Getting consent was the biggest hurdle for a doctor and a psychologist who went from room to room to discuss vaccinations, he says. The families of residents were given a week over the December holidays to approve or refuse, a decision that had to be unanimous from immediate family members. When one woman’s daughter said yes but her son said no, a shot wasn’t given because “they can turn against us and say, `I never agreed to that,´” Robbe explained. “No consensus, we don’t vaccinate.” Only by cutting corners and perfunctorily getting residents to agree could the process go quicker, he says.