66-79 year olds in no man's land for vaccination

BarcelonaWith the resumption this Wednesday of vaccination with AstraZeneca of the population aged between 55 and 65, now the segment that is most unprotected is those aged between 66 and 79, which will have to wait for more Pfizer vaccines to arrive, possibly in the month of May. However, experts believe that vaccination should be expedited in this group because they are people at risk. "It is worrying that they are not being vaccinated because they are the second most vulnerable group," says Quique Bassat, ICREA researcher at the Institute for Global Health in Barcelona (ISGlobal), a centre promoted by the La Caixa Foundation. "At the time you have covered the major dependents and those over 80 years - although they have not yet finished vaccinated, and this is also inexplicable - the next vulnerable group are people over 65 years," says Bassat, who points out that in many cases are more at risk because they are still active people and with "more mobility and exposure than people who are immobilized or in residences". The president of the College of Physicians of Barcelona, Jaume Padrós, also agrees in saying that they are a vulnerable group: "They are people who live at home, healthy, who are not in residences, who have comorbidities, which are those who fill the hospitals and are the cases that are complicated".

People who are between 56 and 75 years old are at greater risk of being admitted to intensive care units (ICU) in case of contracting covid because age, along with underlying pathologies, is a decisive factor in becoming seriously ill with coronavirus. For example, a 35-year-old person with coronavirus has a 0.2% chance of being admitted to ICU, while if he or she is between 55 and 64 years old, the risk rises to 3.4%. "I understand that it was used for professional groups such as health professionals, teachers and security forces, because it was unethical to have vaccines in the fridge and not use them, and they were not giving them to others because they could not receive them, but if you look at the current statistics most of those admitted to ICU are from this population group," says Bassat. That is why he and other professionals urge vaccination of those over 65 years of age. "The logical strategy is to protect the entire population over 60 years starting at the top and go down, but you have to protect them the sooner the better if you want to protect the health system," says the head of epidemiology at the Hospital Clinic, Antoni Trilla. The head of preventive medicine and epidemiology of the Vall d'Hebron, Magda Campins, was also in favour of administering the AstraZeneca vaccinate to the over 65s¡.

Those over 65 years with chronic pathologies or minority diseases, such as transplants, cancer patients treated with chemotherapy and people on dialysis are being vaccinated, but experts say it is a small percentage of the population.

Raising the age limit again

"There should be no age limit on AstraZenca vaccination, as the British have done," argues the president of the College of Physicians of Barcelona, Jaume Padrós. After weeks of asking the state to remove the 55-year age limit for AstraZeneca vaccination, now the next step is to lift any age limitation in order to also vaccinate those over 65. "We may have people who, because of their age, still have weeks left before getting vaccinated and we are concerned because this is a race between the virus and its variants and us and the vaccines and, at the moment, we have no advantage. Either we vaccinate the most at-risk population more quickly or the virus can run rampant again," says Trilla. He acknowledges that there is not enough vaccines for the entire population. "But do we have vaccines that could be used if the age cap were changed? We probably do. The evidence tells us that we need to vaccinate all groups. The British have shown that the AstraZeneca vaccine has coverage for the older population groups. With Pfizer's vaccine there were no studies in the over 90s either, and we vaccinated them in nursing homes. The evidence is constantly being generated," adds Padrós, who is optimistic and confident that it will be possible to meet the schedule set by the Department of Health and start the vaccination campaign in May mass vaccination campaign in Catalonia. The new Janssen vaccine, among others, is expected to be in the pipeline by May.

According to the Department of Health, the general population over 65 will be vaccinated with the Pfizer vaccine "as more doses arrive", unless the AstraZeneca age limit is lifted again, as other countries are doing and as Catalonia is requesting. "It makes no sense to vaccinate people under 50 years of age and not this population group," say sources from the Department of Health. As a result of the constant problems with vaccine supply in Europe, the secretary of Public Health, Josep Maria Argimon, suggested some days ago to the debate on the suitability of delaying the second doses to advance to the maximum the vaccinal coverage of the set of the population, applying the British strategy, but assured that it had to be a European debate. According to the data from the clinical trial that AstraZeneca has carried out in the United States, the Oxford vaccine is 79% effective in preventing symptomatic covid-19 and 100% effective in preventing serious diseases and hospitalisations. In participants over 65 years of age, the efficacy was 80%. The company has to update this data after the US has challenged the results.

Currently the European Medicines Agency has authorised the use of four vaccines on European territory. Pfizer injects to the over 80s, healthcare professionals and dependent elderly, and is expected to also be for the lower age bracket of 70-79 years. Moderna and AstraZeneca are the two that are being administered to essential professionals. The first has no age limit, while the second's limit has already gone from 55 to 65 years and the Interterritorial Council may even remove the cap.