The experts agree. Spain is approaching the vaccination plateau, understanding as such the moment in which the public health system has already successfully inoculated the entire regimen to the majority of the population, with the exception of those under 12 years of age – for whom there is no an approved injection– and the group that lags behind or is more reticent, a tiny number in our country compared to the environment. The percentage of fully immunized citizens reaches 73% and is ten points higher if children are excepted. The future “is very favorable,” said Fernando Simón, director of the Center for the Coordination of Health Alerts and Emergencies, in his reappearance at an Epidemiology Congress in León. Spain has just dropped the “high risk” level by lowering the cumulative incidence of 150.
The third dose to immunosuppressed starts and Health plans to increase the receptors
The Ministry of Health is aware that it is facing a new period in which “it costs more and more because there are fewer people to be vaccinated,” as recognized by the head of the portfolio, Carolina Darias, at the press conference after the Interterritorial Council of this Wednesday. Mass inoculations are beginning to lag behind and the number of doses is piling up in freezers. On September 6 there were 6.5 million compared to a million and a half in early August.
In the coming weeks, the autonomous communities hope to incorporate lagging citizens who have postponed vaccination for summer vacations into their data and put the second dose to young people and adolescents. Epidemiologists also expect to attract people with less initial confidence to inoculate, convinced by the evidence.
Spain has been the fourth country in the European Union to reach the goal of vaccinating 70% of its population with the complete regimen, after Malta, Portugal and Denmark. The figures are higher than 92% in the groups between 50 and 80 years. Vaccination of the last group, adolescents between 12 and 19 years old, is developing very rapidly. So much so that the proportion of people with the first dose (77.1%) is only three points from the age group between 20 and 49. At the current rate, the vaccine would reach 90% of the population in 66 days, although the slowdown is already marking this last stretch. In addition, group immunity has become a chimera in which almost no expert trusts and the scenario of living with an endemic, functionally controlled disease is imposed.
Darias has been clear: a new “stage” in vaccination strategy opens for Spain. This step has been inaugurated with the approval of the additional dose for some 100,000 immunosuppressed patients, to whom new groups with less immune response will be added rapidly. In our country, the proportion of people reluctant to get vaccinated is residual and Health is avoiding for the moment the debate on the obligation that has been imposed in other countries with lower adherence to the vaccine. In the United States, with only 53.4% of citizens with the complete guideline, financial incentives have been given.
Epidemiologists and immunologists are convinced that the next step is to check how the immunity generated by the vaccine behaves. It is precisely the decision that Health has announced today: it is preparing a new seroprevalence study. “It is urgent to monitor immunity to know who needs to be given a third dose,” says Alfredo Corell, Professor of Immunology at the University of Valladolid. The results of the last such study were released on December 15.
The researcher considers that the Government should initiate a study of the immunity conferred by the different brands – Modern has announced that it is developing a single booster dose against COVID-19 and the common flu – and how long it lasts, once it is known that injections prevent the virus from causing serious illness but do not completely prevent infection. Simón has advanced that Health is preparing to carry it out. Until then, “we are going to live in a situation of impasse“, considers Fernando Rodríguez Artalejo, professor of Preventive Medicine and Public Health.
The Ministry has to make complex technical decisions about who and when to vaccinate. It also has to face uncertain calculations about how many doses will be required in the medium term – the Government does not rule out the sale of vials for the same price that it bought them, in addition to the donation of vaccines to countries that are a few steps behind in the coverage of the population – while still insisting on maintaining the “culture of care” because the “virus continues to lurk”.
The first groups with the approved extra dose are transplants (organs and bone marrow) and patients treated with cd20 antibodies (lymphomas or multiple sclerosis). The third dose – which is not technically the same as the additional dose since it is only given to the immunosuppressed – will end up being authorized in Spain for the elderly institutionalized in nursing homes, according to the experts consulted. Several communities –the last one, Castilla-La Mancha– have requested it. The European Medicines Agency (EMA) has already pointed out that there is growing evidence that another dose should be considered in elderly people, but it does not clarify when. “They are not large groups, when they are covered, it will be necessary to see”, anticipates Fernando Rodríguez Artalejo, professor of Preventive Medicine and Public Health.
On the population that should have been vaccinated and has not, the Government provides little information. The latest data was recalled by the Minister of Health this Wednesday: 0.7% of the population mentioned until the end of August expressly rejected the injection.
Darias suggested that the group of those resistant to collaborating in the resolution of the public health problem is mainly concentrated between 20 and 49 years of age. As proof, he stated that in a few weeks, the percentage of adolescents and young people (12-19 years) with the first dose is about to reach the group between 20 and 49 years old. But the analysis is more complex.
The laggards are not, for the most part, deniers, but rather a population that does not perceive the virus as dangerous or that has cultural, language or labor difficulties to respond to the campaigns. The communities have been looking for new strategies to re-fish them for a few weeks, from the Canarian vacuguagua –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 while in Navarra they will do so for students from other communities.