COVID Authentic Vaccines: Ensuring Safety at Vaccination Sites

[harjunmaa]

Falsified vaccines are not uncommon, as far as I know. How do they know a vaccine is authentic at a vaccination site that has no laboratory?

 

[berkeman]

Welcome to PF.

Falsified vaccines are not uncommon, as far as I know.

Can you provide a reference for that?

How do they know a vaccine is authentic at a vaccination site that has no laboratory?

By the distribution chain tracking I would imagine.

 

[PeroK]

Falsified vaccines are not uncommon, as far as I know. How do they know a vaccine is authentic at a vaccination site that has no laboratory?

The question applies to any medicines, either administered at a medical centre or bought over the counter. How do you know what you're buying really is ibuprofen, for example?

 

[Tom.G]

The question applies to any medicines, either administered at a medical centre or bought over the counter. How do you know what you're buying really is ibuprofen, for example?

I think the important part of the question bears on the severity of the consequences.

 

[PeroK]

I think the important part of the question bears on the severity of the consequences.

You mean that fake medicine can only harm or kill you if it's a fake vaccine? Fake antibiotics, malaria tablets or painkillers are much safer?

 

[Tom.G]

You mean that fake medicine can only harm or kill you if it's a fake vaccine? Fake antibiotics, malaria tablets or painkillers are much safer?

I was thinking in terms of ineffectiveness, which is at least, or perhaps more, likely.
Sorry if there was a lack of clarity there.

 

[harjunmaa]

Here's a reference. Understandably, the people who work on this want to keep a low profile. Let's help them keep it that way.

 

[russ_watters]

You mean that fake medicine can only harm or kill you if it's a fake vaccine? Fake antibiotics, malaria tablets or painkillers are much safer?

Are fake homeopathics safer or more dangerous than real ones?

Falsified vaccines are not uncommon, as far as I know. How do they know a vaccine is authentic at a vaccination site that has no laboratory?

Per the pointedly snarky response above, in developed countries the way to ensure authenticity is to get the vaccine from reputable sources, just like you do any other medicine. Per your source, you shouldn't go to some random dude with a website to get the vaccine. This is the entire reason the FDA and other countries' equivalent agencies exist and should be fairly obvious.

Here's a reference. Understandably, the people who work on this want to keep a low profile. Let's help them keep it that way.

Huh? Why would they need to keep a low profile? No, I don't think we should. The issue of fake vaccines will be more of a problem as less developed countries start distributing the vaccine. And Russia.

 

[hutchphd]

My response to the Moderna vaccine (in the US) was short and distinct. As an affirmative indicator I believe it could be useful. My second shot produced a distinct malaise and about 24 hr elevated body temperature. It would be difficult to replicate these responses with an inert surrogate.

 

[Vanadium 50]

Are fake homeopathics safer or more dangerous than real ones?

Yes.

It would be difficult to replicate these responses with an inert surrogate.

While I agree in general (modulo the placebo effect), the better question is "why"? To cover their tracks? That only works until people start getting sick.

One can take the "why" another level - how does anyone make any money from this? If you're going to commit a crime, shouldn't there be a payoff? In the US, the federal government buys the vaccine directly from the manufacturer. Why would anybody buy counterfeit vaccine when they can get the real stuff for free?

Furthermore, how much is a dose? A few dollars. Why would someone want to go into the business of counterfeiting vaccine when they can get more money for less risk for counterfeiting Gucci handbags?

 

[berkeman]

Yes.

What a watered down reply...

 

[harjunmaa]

Keeping a low profile is because we do not want to help counterfeiters. They can be smart, too.

 

[TeethWhitener]

One can take the "why" another level - how does anyone make any money from this? If you're going to commit a crime, shouldn't there be a payoff? In the US, the federal government buys the vaccine directly from the manufacturer. Why would anybody buy counterfeit vaccine when they can get the real stuff for free?

Furthermore, how much is a dose? A few dollars. Why would someone want to go into the business of counterfeiting vaccine when they can get more money for less risk for counterfeiting Gucci handbags?

Can you provide a reference for that?

Well, regardless, it’s happening:
https://www.google.com/amp/s/www.bbc.com/news/world-56844149.amp
https://www.google.com/amp/s/www.ws...-criminals-exploit-vaccine-demand-11619006403
Apparently they were charging something like $2500 per dose (for what turned out to be anti-wrinkle medicine?) and advertising on social media groups.

I guess it’s easier and cheaper to fill a syringe with saline and charge a few grand for it than to make a fake designer handbag (or substitute a designer label in a cheap handbag?—gotta be honest, I haven’t thought too much about how run a designer handbag scam).

 

[harjunmaa]

Yes.While I agree in general (modulo the placebo effect), the better question is "why"? To cover their tracks? That only works until people start getting sick.

One can take the "why" another level - how does anyone make any money from this? If you're going to commit a crime, shouldn't there be a payoff? In the US, the federal government buys the vaccine directly from the manufacturer. Why would anybody buy counterfeit vaccine when they can get the real stuff for free?

Furthermore, how much is a dose? A few dollars. Why would someone want to go into the business of counterfeiting vaccine when they can get more money for less risk for counterfeiting Gucci handbags?

Supposing you find empty vials, it is easy to refill them with saline and sell shots at your shady clinic at $99 a shot.

 

[harjunmaa]

Supposing you find empty vials, it is easy to refill them with saline and sell shots at your shady clinic at $99 a shot.

Sorry, "you" form is passive, not implying that you have a shady clinic! Difficulties of the English language.

 

[berkeman]

Supposing you find empty vials, it is easy to refill them with saline and sell shots at your shady clinic at $99 a shot.

"you find" is not a likely scenario, unless you are a worker in the "Sharps Waste" chain. So I suppose you need to add in bribery and conspiracy to the scenario.

Vaccine vials are generally disposed of in the same Sharps Containers where the hypodermic needles are tossed, and those Sharps Containers are disposed of per safety protocols. You won't find used vaccine vials in the trash bins at your local hospital, if that's what you are thinking.

https://bwaste.com/resources/the-kn...updates/how-properly-dispose-covid-19-vaccine

Syringes, Needles, and Empty Vaccine Vials

These items should be placed in an FDA-approved sharps container. These containers are made from rigid, puncture-proof plastic and prevent injury and spread of infectious waste. Never discard needles or other sharp objects in the trash or loose into the biohazardous waste box/container.

https://en.wikipedia.org/wiki/Sharps_waste

Disposal of sharps waste

Extreme care must be taken in the management and disposal of sharps waste. The goal in sharps waste management is to safely handle all materials until they can be properly disposed of. The final step in the disposal of sharps waste is to dispose of them in an autoclave. A less common approach is to incinerate them; typically only chemotherapy sharps waste is incinerated. Steps must be taken along the way to minimize the risk of injury from this material, while maximizing the amount of sharps material disposed.[citation needed] Strict hospital protocols and government regulations that instruct health care providers on how to manage sharps waste help ensure that the waste is handled as effectively and safely as possible.

Disposal methods vary by country and locale, but common methods of disposal are either by truck service or, in the United States, by disposal of sharps through the mail. Truck service involves trained personnel collecting sharps waste, and often medical waste, at the point of generation, and hauling it away by truck to a destruction facility. Similarly, the mail-back sharps disposal method allows generators to ship sharps waste to the disposal facility directly through the U.S. mail in specially designed and approved shipping containers. Mail-back sharps disposal allows waste generators to dispose of smaller amounts of sharps more economically than if they were to hire out a truck service. Recent[when?] legislation in France has stated that pharmaceutical companies supplying self injection medications are responsible for the disposal of spent needles. Previously popular needle clippers and caps are no longer acceptable as safety devices, and either sharps box or needle destruction devices are required.[citation needed]

 

[Vanadium 50]

Supposing you find empty vials, it is easy to refill them with saline and sell shots at your shady clinic at $99 a shot.

Did you read what I wrote?

Why sell them at $99 at "your shady clinic" when you can get the real stuff for free?

 

[TeethWhitener]

You could always just buy new empty vials from pretty much anywhere, fill them with saline, slap a fake label on them, and charge for them. Most people don’t know what authentic vaccine vials or labels look like. As pointed out earlier, fake vaccines have already been identified in two countries, and according to this article:
https://www.google.com/amp/s/www.cb...e-covid-19-vaccine-counterfeit-mexico-poland/
People are in fact buying empty discarded vials on the dark web.

OP’s question is legitimate, but I don’t have a really great answer for folks outside the US. In the US, the COVID vaccines are free, but there have been some concerns that, because people are used to being screwed over by private insurers, they are more susceptible to scams that demand payment for a vaccine. HHS, among others, has already put out scam warnings (though admittedly not directly tied with actual distribution of a fake vaccine).

Edit: the HHS alert is for COVID testing scams. The FTC just put something out about vaccine scams: https://www.healthline.com/health-news/ftc-warns-of-covid-19-vaccine-scam-what-to-know

 

[russ_watters]

Why sell them at $99 at "your shady clinic" when you can get the real stuff for free?

So this business is both illegal and unlikely to be profitable? Sign me up for a franchise!

 

[Vanadium 50]

So this business is both illegal and unlikely to be profitable?

Crime doesn't pay.

 

[pinball1970]

Second jab in two hours. Hopefully the real thing.

 

[bhobba]

Why sell them at $99 at "your shady clinic" when you can get the real stuff for free?

Exactly. There is zero incentive. Plus, at least in Aus, we have an audited trail that a clinic, hub etc., gets. I suppose someone could do it, but you are getting into the same territory as Feynman and Flying Saucers:


Thanks
Bill

 

[neilparker62]

Authenticity is certainly a concern if one is living outside the US/UK/ first world generally although to say so will probably risk howls of opprobium. Perhaps Pfizer , J&J , AZ etc should take some steps to ratify 'kosher' distribution outlets in countries they sell to. Or have serial numbers such that one can at least confirm (via website entry of the vial serial no) your vaccine was not from an already used vial. Or perhaps a more sophisticated cellphone scanning system so that you are given paperwork which you can scan and verify direct with (say) Pfizer that your vial was a genuine Pfizer product. Some governments might object to citizens being suspicious of vaccine authenticity but at the same time scanning should not worry them if they have nothing to hide.

 

[Vanadium 50]

There are serial numbers today. They appear to be by the batch, not the individual dose. Look at your receipt. If I were paranoid, I could check to see if this batch went to the place I got vaccinated. But I ask again - how does someone make money off a counterfeit if the real stuff is free?

"We lose a little on every transaction, but we make it up in volume."

Oh, and I checked to see how much the vaccinatrix (is that a word?) billed my insurance company. $2.59 per dose.

 

[TeethWhitener]

But I ask again - how does someone make money off a counterfeit if the real stuff is free?

Have you really never been promised something for free only to find out later that it wasn’t? Is it really so inconceivable that a government or healthcare provider would be untrustworthy enough to engage in such a practice? If the government (or whoever) had previously lost your trust, would you really find it much of a stretch to believe that somehow they’ll eventually charge you for this vaccine that they claim is free?

 

[russ_watters]

Have you really never been promised something for free only to find out later that it wasn’t? Is it really so inconceivable that a government or healthcare provider would be untrustworthy enough to engage in such a practice? If the government (or whoever) had previously lost your trust, would you really find it much of a stretch to believe that somehow they’ll eventually charge you for this vaccine that they claim is free?

I'm having trouble engaging my imagination sufficiently to understand what you are getting at, except for that last bit; No, the vaccine is bought and paid for, and that's it. "The government or whoever" can't go back and charge us more for it any more than a used car dealer can jack up the price of a car a week/month after you bought it.

So, yes, it is inconceivable, at least to me. Unless you can point to a past occurrence or describe better what you are imagining.

 

[russ_watters]

But I ask again - how does someone make money off a counterfeit if the real stuff is free?

In developed nations, no. And while we don't know until we know, we can speculate what might happen in 3rd world countries. I suspect there are going to be significant problems, with hijackings, substitutions, magically multiplying supplies, etc. The UN, WHO, Red Cross, etc should probably be setting up their own clinics to combat that. Would you trust a dose of Pfizer vaccine administered to you by the government of Zimbabwe? Or CZS Pharmacy in Zimbabwe?

 

[TeethWhitener]

Unless you can point to a past occurrence or describe better what you are imagining.

Well, I’ve supplied at least three links to news stories indicating that fraudulent vaccine scams are already happening. I’m not sure what else you want.

Note that the OP didn’t ask whether these practices were happening, or how one would make such an endeavor profitable. (Those questions were the result of several not-OPs hijacking the thread and the resulting pile-on.) The OP asked how one knows they’re not getting a fake vaccine. In the US, it’s pretty easy: the vaccines are free and generally regulated to only be available through licensed pharmacies, all of which can be checked readily. But in general, given the lack of trust in the medical and governmental infrastructure in some places, this is not a trivial problem to solve. How do you instill enough trust in the literally billions of people in Asia and Africa who, often justifiably, do not trust anything their government says? How do you even get the message to them that vaccines are free and forthcoming if they receive information about the wider world only sporadically at best? How do you get that info to them and get them to trust you before scammers get to them with their snake oil?

 

[russ_watters]

Well, I’ve supplied at least three links to news stories indicating that fraudulent vaccine scams are already happening. I’m not sure what else you want.

Actually, there was a new claim you made, that I was questioning: you suggested it would be possible for the government and insurance companies to re-charge us for the vaccine we already bought and used.

To answer the quoted claim directly: No, I've never received(not "promised" -- I've/we've already received the vaccine) something that was free and then been charged for it.

This is an entirely different issue from fake vaccines/vaccine scams.

 

[Ygggdrasil]

Actually, there was a new claim you made, that I was questioning: you suggested it would be possible for the government and insurance companies to re-charge us for the vaccine we already bought and used.

To answer the quoted claim directly: No, I've never received(not "promised" -- I've/we've already received the vaccine) something that was free and then been charged for it.

This is an entirely different issue from fake vaccines/vaccine scams.

It's fairly common for patients at hospitals to be promised that procedures would be covered by insurance only to be told after the fact that they owe much more than previously told because "out-of-network" doctors were used in the procedure. Some studies estimate that as many as one in five ER visits are subjected to surprise medical bills, and they affect millions of Americans per year. (note this practice was recently made illegal by congress, which will take effect in 2022).

 

[russ_watters]

It's fairly common for patients at hospitals to be promised that procedures would be covered by insurance only to be told after the fact that they owe much more than previously told because "out-of-network" doctors were used in the procedure.

Totally understand that, but that's not the same situation. V50 provided the actual/final cost to him(his insurance company) that the insurance company actually paid/charged for the vaccine. What is being suggested (on the insurance company side) is akin to retracting that EOB and issuing a new one.

 

[russ_watters]

Oh, and I checked to see how much the vaccinatrix (is that a word?) billed my insurance company. $2.59 per dose.

I did not receive an EOB for my vaccines. The CDC seems to contradict it self on who pays:

The federal government is providing the vaccine free of charge to all people living in the United States, regardless of their immigration or health insurance status...

COVID-19 vaccination providers can:

• Seek appropriate reimbursement from the recipient’s plan or program (e.g., private health insurance, Medicare, Medicaid) for a vaccine administration fee

I have a major insurance provider and provided that information to the vaccinatrix prior to getting the vaccine.
Regardless, if the federal government is paying, why is your insurance company being charged? Do they then back-charge the federal government? If it is the insurance company paying, then it is being paid for by your premiums as opposed to your taxes (wonder which costs you more?).

Also, $2.59 seems unlikely. It would be hard to even pay the salaries of the stickers at that rate.

 

[Vanadium 50]

would you really find it much of a stretch to believe that somehow they’ll eventually charge you for this vaccine that they claim is free?

If they try, what are they going to do? Repossess my white blood cells?

But in any event, you are describing an entirelu different kind of scam. If someone is trying to get me to pay for something that has already been paid for, why do they also need to make the vaccine worthless?

 

[TeethWhitener]

Alright. You win. I’m too tired to try to convince you that scams happen and that people fall for them.

To the OP, I think the question you actually asked is a legitimate one. I’m sorry I don’t have a great answer for it, but you might want to direct your question toward your country’s health ministry, if it can be trusted, or potentially look for information from the companies producing the vaccines about how they maintain the integrity of their distribution. Best of luck.

 

[Vanadium 50]

the government of Zimbabwe

No such thing.

Zimbabwe has vaccinated 10,000 people. Zimbabwe being Zimbabwe, these are probably 10,000 people you don't want to mess with.

But suppose once they get going, people still want to push fake vaccine. You have exactly the same problem: the government has alraedy paid for it, and you're competing with "free". You also have the additional problem that you will have stolen Zimbabwe dollars, which are worthless.

If it is the insurance company paying, then it is being paid for by your premiums as opposed to your taxes (wonder which costs you more?)

The vaccine is free. The drugstore is allowed to charge my health insurance (actually, my pharmaceutical insurance) for the shot itself. If some uninsured comes in, it's still free to them. I don't know who, if anyone, they charge.

Yes, it looks low to me as well. It works out to $31/hour, assuming 5 minutes per dose. That seems to be about their throughput. I suspect that this is a negotiated rate - "You want $2.59 or do you want nothing?" But in any event, that's what it says. Also, the drugstore can throttle the number of doses they administer to ensure they don't need to bring on extra staff, so the $31 is close to pure profit.

 

[BillTre]

The vaccine is free. The drugstore is allowed to charge my health insurance (actually, my pharmaceutical insurance) for the shot itself. If some uninsured comes in, it's still free to them. I don't know who, if anyone, they charge.

If I were setting this up from the higher level of national government, I would want something that would be quick and easy to set (for reasons of pandemic emergency), would provide the institutions doing the injections with a reasonable reimbursement, and distribute that pay in a simple (for the government) manner.
Therefore, it seems likely to me that the organization doing the injects (drug store or other retail places, or health care organizations of some kind, would be "billing" and passing that up in an efficient manner, to where the government could easily pay for it (or at least part of it).
This seems most likely to be send the bill (for compensation) to an insurance company (which are way smaller in number vs. drugstores and hospitals) and the government pays them.
It is also reusing an already established billing mechanism, to serve a slightly different purpose. So it should be easy to get it to work quickly.
I am guessing there are a lot of already established formulae for cost and expense of standard medical billing.

The uninsured would just be billed (with a special code) to an insurance company which would pass it on to the government.
Its all quick to set up and should work for a shared purpose that has life and death implications.
That should cut them some slack in allowing them to do certain things, but an economic entity (company) always wants more money, as a basic selective drive in the economic world (two opposed tensions on the determination of compensation).

Also, $2.59 seems unlikely. It would be hard to even pay the salaries of the stickers at that rate.

I was thinking about that. Off the top of my head, I wasn't sure if it would or not.
As far as I could tell, these not nurses, but something like a nursing assistant or trainee.
These are very easy injections to do. Intra Muscular in the arm. Can't miss that. Not easy to do harm.
Where I went, each injectee dealt with several people (greeters/informers/card checkers (probably a good fraction volunteer), someone telling the next person what station to go to, injector (sub-nurse in my experience), card filling out station/waiting area (probably had a nurse somewhere on site where I was (a central injection site)).
At each step there was one person dealing with the whole crowd, but there were maybe 10 sites doing the injections. So other than the injector labor, the accounting of labor of the other stations would be reduced by ~10.
In the drug store, its a single pharmasist, or a pharmacist aid, doing the injection at about 1/4 of the rate (my flu shot experience).
The people doing the injections may not get much of a wage, being low down on the health care hierarchy.
It might even be training situation. Learn how to deal with people, while you doing a really simple procedure and develop confidence and experience, but not getting much a wage.

However, I don't know what wages in healthcare are like for these kinds of employees.

When I employed a lot of people at a university where I worked, we would budget their labor at: cost of paying them plus 0.5 of the salary to account for all their benefits (on average) bundled together.
That's how we budgeted our labor cost (rate).
The university, however, had very good benefits, so the extra expenses would be less elsewhere.

 

[Vanadium 50]

I don't know if the government is reimbursing the health insurance company or not. However it's set up, it doesn't feel like the "how will we get paid" question is driving the incidence of vaccination.

Neither of my vaccinatrices (is that really a word?) said they were nurses. One seemed too young to be a nurse. Possibly too young to drive. :)

 

[BillTre]

Neither of my vaccinatrices (is that really a word?) said they were nurses. One seemed too young to be a nurse. Possibly too young to drive. :)

I like this version better: vaccinatrix, but I guess you doing plural now.
Seems like its feminine gender, but I'm not sure.

 

[russ_watters]

I was thinking about that. Off the top of my head, I wasn't sure if it would or not.
As far as I could tell, these not nurses, but something like a nursing assistant or trainee.
These are very easy injections to do. Intra Muscular in the arm. Can't miss that. Not easy to do harm.
Where I went, each injectee dealt with several people (greeters/informers/card checkers (probably a good fraction volunteer), someone telling the next person what station to go to, injector (sub-nurse in my experience), card filling out station/waiting area (probably had a nurse somewhere on site where I was (a central injection site)).
At each step there was one person dealing with the whole crowd, but there were maybe 10 sites doing the injections. So other than the injector labor, the accounting of labor of the other stations would be reduced by ~10.
In the drug store, its a single pharmasist, or a pharmacist aid, doing the injection at about 1/4 of the rate (my flu shot experience).
The people doing the injections may not get much of a wage, being low down on the health care hierarchy.
It might even be training situation. Learn how to deal with people, while you doing a really simple procedure and develop confidence and experience, but not getting much a wage.

However, I don't know what wages in healthcare are like for these kinds of employees.

Both of mine were at chain pharmacies. For the first there were two injection stations, a supervisor (who relieved one of the injectresses for a few minutes and acted as a "floater") and a greeter/card checker. For the second there was one injectress and a floater. Though also, someone at the pharmacy counter checked me in. At mass vaccination sites they likely do better than a 2:1 ratio.

There's a questionnaire filled out by the injectress before you get vaccinated which takes a few minutes,* and then the vaccine itself.

I'm guessing the rate is maybe 5 min per vaccination, or 12 per hour per station. That's $31 an hour in revenue for two people. Glassdoor tells me a pharmacy assistant averages about $16 / hr so it would be tough to pay salaries alone at that rate. And none of that has anything to do with the cost of the vaccine itself.

*At my vaccination site the floater took a passport photo for the woman ahead of me which slowed her down by about 30 seconds, but I would think that isn't a common occurrence.

 

[Tom.G]

Actually, there was a new claim you made, that I was questioning: you suggested it would be possible for the government and insurance companies to re-charge us for the vaccine we already bought and used.

Think Deficit Spending and the subsequent interest payments.

As for individuals making a profit, shortly after the vaccine(s) became available there were newspaper reports of people with more money than ethics paying US$250 for a shot. Just so they didn't have to wait for the high-risk folks to get theirs first!

Cheers,
Tom

 

[russ_watters]

No such thing.

Zimbabwe has vaccinated 10,000 people. Zimbabwe being Zimbabwe, these are probably 10,000 people you don't want to mess with.

I've been. Those 10,000 are at least less likely to infect you with COVID than anyone else in the country. Beyond that? ...evidently the guy with the assault rifle near the ATM was on my side, even if the guy driving slowly past it may not have been.

But suppose once they get going, people still want to push fake vaccine. You have exactly the same problem: the government has already paid for it, and you're competing with "free".

How do I know the government has paid for it? And even if I accept that the government has already paid for it -- paid whom?

I do think the OP and @TeethWhitener have a point at least that we may lack imagination for how countries with less than functional governments may be corrupted. They're really, really good at it. When I first saw the thread I was thinking about the US/other developed countries. While it's not impossible that an extremely rich and dumb person or two has been scammed in developed countries for vaccines, it really does take some effort to fall victim to a scam. But my initial read of the OP wasn't for lack of imagination, it was based on the assumption that we live in developed countries and aren't idiots.

 

[bhobba]

It's fairly common for patients at hospitals to be promised that procedures would be covered by insurance only to be told after the fact that they owe much more than previously told because "out-of-network" doctors were used in the procedure. Some studies estimate that as many as one in five ER visits are subjected to surprise medical bills, and they affect millions of Americans per year. (note this practice was recently made illegal by congress, which will take effect in 2022).

As I know only too well. The only way to avoid it in Australia is to go to a public hospital. Even if you do not have insurance, it is free. But if you do not have insurance, the issue is getting in. They may have beds etc. but are running low on money. If you have insurance, the insurance company pays for everything, no ifs or buts, everything. I could go into the difference in 'culture' between private and public in Aus, but that is way off-topic. Health and how to pay for it is a complicated issue.

Thanks
Bill

 

[bhobba]

Neither of my vaccinatrices (is that really a word?) said they were nurses. One seemed too young to be a nurse. Possibly too young to drive. :)

Had that one as well. The doctor said to a very young nurse - nurse give him an insulin shot. She was young and obviously not at ease. The doctor said - I will supervise while you do it, and there were no problems. I found out later junior nurses are not supposed to give injections unless a senior nurse or doctor supervises. Here they are called enrolled nurses. They have done a one-year diploma and complete their bachelors part-time over the next 3-4 years.

Thanks
Bill