“I, the truth, is that I did not want to be vaccinated yet.” Angel, 25, and his brother Helder, 28, have about five minutes to wait in case the dose of Janssen they have just been given reacts. “I have read many theories, you know? And I wanted to wait a little longer. But my dad sent me by WhatsApp that today they were in the neighborhood and in the end I made up my mind,” he adds. The neighborhood is Trinitat Vella, in Barcelona, one of those with the lowest vaccination coverage in the city. Only 46% with complete guideline.
Which communities have promoted and which have weighed down the goal of 70% vaccinated
In the most central square of the neighborhood, a device was set up this Thursday to capture for injection those who, for whatever reason, have not yet responded to the Administration’s call. Once the milestone of 70% of the vaccinated population in all of Spain has been exceeded, but knowing that it will be necessary to exceed 80% to reach a certain normality due to the delta variant, the autonomous communities begin to deploy strategies like this to reach the laggards.
From the outset, most of them released their appointments weeks ago and began to pull calls and SMS to insist on them. But now they begin to add actions of all kinds, from the vacuguagua Canary Islands –a traveling bus– to the campaigns for seasonal workers in the Basque and Riojan harvests. In Cantabria they are studying taking doses to university campuses for the beginning of the course, while in Navarra they will do so for students from other communities.
Experts and health authorities warn that, once good vaccination levels are reached among minors – they already exceed 70% with the first dose -, the period of mass immunizations will have ended and it will be the turn of Primary Care to reach the most refractory population. Although Spain is one of the most advanced countries in the world in this regard, the number of citizens who have been able to request an appointment for months and have not done so are beginning to worry. Today, the vaccination centers have thousands of appointments available without filling out. Among the age group of 40 to 49 years, for example, who can be vaccinated long before the summer, there is still 14% that has not been taken for granted. In Catalonia, the Canary Islands and the Balearic Islands, the percentage rises to around 20%.
But who exactly are the ones who have not yet undergone the COVID-19 jab? They have not wanted to do it or have not been able to?
For now, there is no study in Spain that has identified exactly and with real data what the profiles of these population groups are. The only thing that is done by the Administration is to record those who reject the appointment when it is offered, but their reasons are not recorded. According to the latest survey by the CIS, July 2021, 10.5% did not want to be vaccinated when their turn came. Within this group, 28% took this position because they distrusted the drug and 19% did so out of fear of side effects.
Consulted doctors and nurses of Primary Care, as well as public health technicians, all agree that the profiles are very varied, but they can be fit into four categories. To begin with, there are those who cannot be vaccinated for medical reasons (multiallergic or terminal, for example). Then the most staunch vaccines. “These are the irreducible ones and we are hardly going to convince them, but I think they are a minority”, observes Jaume Sellarès, director of the Sardenya Primary Care Team (EAP), in the Catalan capital.
But the other two remaining groups are the key, according to health workers, to continue advancing in vaccination. There are, on the one hand, groups from disadvantaged or marginalized backgrounds. Those who do not have internet access, or who do not speak the language or who have little relationship with the health system. These, often a migrant population, are the ones that largely explain the great difference in coverage between neighborhoods in large cities. In Barcelona today it is still more than 20 points between the richest and the poorest neighborhoods.
Finally, the last is the heterogeneous group of those who do not fear the virus. They are the ones who are not in a hurry to make an appointment. Some show a certain distrust towards the vaccine, but above all there is little concern about what may happen to them. “They are those of the apathy effect,” they were recently baptized by the Secretary of Public Health of the Generalitat, Carmen Cabezas.
“Among those who refuse to make an appointment, the most common are those who do not give enough importance to the disease. They are often young people who perceive it as mild, and that is why we keep repeating that the idea that all ages can have complications and income, “Cabezas insisted this week. “They can be convinced, and you have to do it from the proximity, because I don’t think they watch public television or pay attention to advertising campaigns,” adds Pepi Estany, nurse and member of the Generalitat’s Vaccination Advisory Council Catalan.
A survey of the Kaiser Family Foundation for the population of the United States provides data in this regard. There it is estimated that those who say no definitely to the vaccine they are 14% of the total, a percentage that has not varied too much over time. But that the callers wait and see (“I wait to see”, in Spanish) they were almost 40% at the beginning and now they are close to 10%. Regarding the latter, 35% believe that the vaccine is more dangerous than COVID-19 and 50% believe the opposite.
Not being able to get vaccinated for work reasons
In the Trinitat Vella neighborhood, the vaccination target this Thursday was “those with access barriers”, summarizes from the same square Eli Díez, head of the Service and Prevention Programs of the Barcelona Public Health Agency (ASPB). Only for the four hours – from 10:00 a.m. to 2:00 p.m. – in which the tents were enabled, the Department of Health of the Generalitat and the City Council have mobilized two nurses, two administrative staff, five professionals for coordination, three intercultural technicians, two educators of the streets – who are kicking the neighborhood to announce the campaign – and half a dozen volunteers from the Red Cross.
Díaz manages a folder with detailed vaccination data for the neighborhood, which even includes vaccination coverage for each nationality, so that intercultural technicians can work with community leaders and convince as many people as possible. “The two days prior to setting up the tents are key to making this appeal,” says Díez.
Two weeks ago they carried out a similar operation in the Rambla del Raval and immunized 154 people, most of them migrants. In the Public Health Agency they were already aware of the existence of the digital or language divide, but then they realized the importance of the labor barrier. Of the 80 vaccinated people under 40 who asked why they had not made an appointment until then, 35, that is, 43%, answered that it was because of work. Either they couldn’t due to schedules or they were afraid of having side effects and not being able to go to work the next day.
Additional incentives, a debate to open
Víctor, 33, from Horta, had been delaying the time to get vaccinated for months. It’s not that he doesn’t believe in the benefits of serum, it’s that he has a terrible injection phobia. “Do you mind if I talk with the mask down? It’s just that I had an anxiety attack a while ago,” he warns. He has managed to overcome the bad drink just over ten minutes ago and waits with his mother on a bench in the Trinitat Nova square. “In the end I decided for two reasons: one, because here they put the Janssen, of a single dose, and the other, because soon I start a new job and it gives me the feeling that the vaccine will be requested more and more as a requirement for many things “, argues this young man from Barcelona.
What about Víctor is just an intuition, but it arises from the public debate that has taken place in Spain and other countries regarding the vaccination certificate to access certain spaces or activities. To travel, for example, or to enter discos and other nightlife venues. The latter has been ruled out for now. As Spain is one of the countries that has vaccinated the fastest, so far all strategies for capturing the laggards have consisted of making the vaccine easier and more accessible. The experts, in this sense, do not have a clear position on the certificates, although they do think that they should be evaluated in the near future.
“Vaccination certificates can be very useful, but they are controversial because they bring us closer to a model of obligation”, reflects Estany, who recalls that in Spain vaccination campaigns are always usually a success despite being optional. “At the moment, by crushing these groups day by day, it is possible that we will advance a lot,” he says. Sellarès agrees and adds that this will be seen especially when the burden of vaccination progressively falls back on Primary Care health centers. ” Where they should never have come from, “he concludes.