Summer has reduced the rate of vaccination. August, the great month of the holiday movement, has coincided with the access to vaccines of the youth and adolescent population, the age group that has starred in the fifth wave infections. That factor, together with the slowdown in the flow of doses delivered to the autonomous communities, are the keys that explain a lethargy that will gradually stretch as September approaches.
Mass infections among young people do not put group immunity at risk
In early June and early July there were two peaks in the vaccination process that deflated in August. The fall has been so notable that it has gone from injecting an average of 578 thousand in the best week of July to 324 thousand in the worst week of August, the last one, a decrease of 43.9%. Experts consider this drop to be within expectations for the time of year. “Many people are not at home and that has meant a global slowdown”, explains Amós García Rojas, president of the Spanish Association of Vaccination. “We cannot say that vaccination is going badly. We are reaching spectacular figures, such as more than 30 million doses administered, which is the result of a brilliant exercise by professionals and a citizenry that has come en masse to get vaccinated,” he recalls.
63.9% of the population already has the complete pattern. When we look at the target population (those over 12 years of age, since there is no authorized vaccine for children), 71.8% have already received both doses (for cases in which a second injection is appropriate). On May 10, President Sánchez announced that he was 100 days away from attaining group immunity. The 100 days have been fulfilled this August 18 and it has not been arrived on time. In reality, with the entry into the scenario of the delta variant, many specialists believe that a higher percentage may be necessary to act as a barrier against contagion.
The population of 40 years and older is all over 80% of those vaccinated with a complete schedule. Thirty-somethings are at 57%, while the youngest, the most worrying group right now, is at low levels: 33% among twenty-somethings and 8.2% for those between 12 and 19 years old. Young people have been the last in priority for immunization because they are the least at risk. On the other hand, they are experiencing a summer of massive infections: the cumulative incidence among people aged 20 to 29 is 385 and for those aged 10 to 19 it is 382. However, the evolution, as in all age groups, it is descending, although in a slower way as they are not vaccinated for the most part.
At the gates of 70%
Most of the young people who are being infected now were close to being vaccinated and many of them have had to cancel their appointment without knowing exactly when they will get it back. The high incidence in these groups does not compromise herd immunity, since it is generated by the disease itself, but it may slightly delay the horizon that the Government had foreseen. “Herd immunity is the sum of the people who have passed the disease naturally and those immunized by the vaccine, although it is difficult to measure numerically,” warns García Rojas.
In analyzing the reasons for this slowdown, José Antonio Forcada, president of the National Association of Nursing and Vaccines, rules out that there is a problem of lack of toilets due to holidays: “It had already been organized in such a way that there was no shortage of personnel who I could attend all scheduled vaccinations, but we do know that in some places there have been up to 20% of people who have not kept their appointments, “he explains. For Forcada, the displacements of the target population are also the main handicap, since many have decided to “postpone it until they return from vacation.” “Big mistake, because when before we have people vaccinated, fewer infections and less incidence,” he adds.
It was known that putting the population in the dilemma of choosing between vacations and vaccinations was going to be problematic. That is why most communities opted for the self-appointment system as early as June, a formula that made it possible to plan punctures based on breaks. Thanks to this, 70% of the population between 20 and 29 years old and 50% between 12 and 19 years old have already received the first dose. A different case is that of the second, where the percentages fall to 33% and 8.2% in the respective groups.
The summer casuistry has been added to the relaxation messages of the administrations, which assured that there was no problem in delaying the second dose and that, in some cases, it was even better. An example of this was the Community of Madrid, which thus justified its calculation errors with the batches, insufficient to cover all those who had received the first batch from Pfizer 21 days before. Experts warned that lengthening the wait could compromise immunity against Delta, since it drops a lot without the full guideline. In addition, it ruined the vacation planning of many and caused hundreds of people to make a pilgrimage from hospital to hospital in search of leftover vials.
Mathematical errors aside, July and August have coincided with a notable decline in the arrival of Pfizer and Moderna vaccines. According to data from the European Center for Disease Prevention and Control (ECDC), European countries received around 25 million weekly doses of Pfizer during the month of June. In July that figure was cut to 15 million every 7 days. Health asked that the communities focus on completing the guidelines with the new lots so as not to incur the error of Madrid. This has brought the percentage of the first doses (63.2%) very close for the first time to that of the whole regimens (73.5%).
For August, the Government negotiated an extra batch of 3.4 million doses that would represent a sum of 16.5 million. The goal of that “extra” was to reach 70% immunization by the end of the month. Thus, many communities have started an open-door vaccination for anyone who comes without an appointment. But, as we have seen, achieving that goal depends on many things at once. At the current rate, it would take 18 days to vaccinate 70% of the population with two doses, so we would already be talking about September and not August, as the Government had assured.
Vaccination of the different age groups progresses at a different rate in each autonomous community. The Canary Islands, the Balearic Islands, Murcia, Catalonia, Andalusia, Cantabria and Madrid are in the queue. These seven territories are the ones that will reach the flying goal of 70% immunization later, if they fail to improve the pace. In youth vaccination, Cantabria (54.9%) and the Valencian Community (55.8%) have the furthest road ahead. “Communities with an older population profile are incorporating young people later”, analyzes the vaccinologist García Rojas, “to which it should be added that there are communities with different strategies when it comes to vaccinating their youth population”. that causes these imbalances. “We must work to vaccinate young people, even if it is in August, but we will undoubtedly see a rebound in this age in September,” he advances.
Back to normal in September
The “political” target of 70% has given a lot to talk about, both for being used for propaganda and as a thrown weapon. Epidemiologists and vaccinologists have long warned that the immunity needed to tackle the pandemic is at least 85% or 90%. A goal that, according to the usual rhythm, we will not achieve until Christmas. The good part is that in September the waters will return to their course. And, although Spain does not register daily records as in June, it will recover a part of the slowdown of August.
There are variables that are impossible to predict, such as the arrival of doses from the European Union. But in September the obstacles of summer will have disappeared and the regions are already preparing to design a parallel phase that is less massive and more focused, and just as effective. For example, experts propose to approach the vaccination of the youngest in educational centers in the same way that it was done with residences or health centers.
To the appointments open to everyone at any time, such as the current ones, will also be added repechage. That is, an approach to those laggards who did not get the vaccine in their day due to distrust, lack of information or inability to access and who can now resume it. For this, pedagogy and tracking work is needed that will not be easy, but that will help to recover a certain percentage of the people who were left behind. The Valencian Community has begun to summon 400,000 people who did not attend when they were summoned.
In addition to raising awareness, health authorities are implementing other strategies to speed up vaccination. Catalonia, Euskadi and Aragón have reduced the period for people who have suffered the disease recently to receive the vaccine. In the case of Catalonia and the Basque Country, it will go from six months to two for those under 65 years of age. On the other hand, Aragon will take only a month to appoint those who have been infected. In this way, a large population will have completed the pattern earlier than expected. According to the Deputy Minister of Health of the Basque Government, José Luis Quintas, the criterion for the wait until now to be prolonged for half a year was not “health”, but “equity”. With vaccines available, this adjustment will step on the accelerator in three communities that, with the exception of Catalonia, are not among the worst in the campaign.
The repechage of missed appointments is another of the resources of communities such as Valencia, where they seek to summon 400,000 people who did not attend when they were summoned and the 80,000 people who cannot be located via SMS, whom they will call by phone. “There are many vaccines, there are enough health personnel, what must be done is to improve recruitment and make people understand that, above their vacations, the priority is to be protected,” adds Forcada.