Primary care regrets Health Department's new vaccination system does not prioritise medical criteria

BarcelonaPrimary care health professionals found out from their patients that the Department of Health was sending SMS messages to people aged between 60 and 65 to get vaccinated with AstraZeneca and that had set up a website to sign up. "They didn't warn us to begin with. And it is assumed that this has been done to lessen primary care's work burden, but we have been burdened with the job of giving information without having the tools to inform," laments Meritxell Sanchez-Amat, president of the Catalan Forum of Primary Care (FoCAP) and doctor of the Primary Care Center (CAP) Besòs. In this sense, an administrative worker in a primary care center complains that it "has been reported first to the press that the professionals", although they are the ones who finally help the users. Antoni Sisó, president of the Catalan Society of Family and Community Medicine (CAMFiC), confirms that the new registration system has generated a high volume of phone calls to CAPs and face-to-face visits asking for information and appointment for vaccination. "The professionals did not know anything, the patients explained it to us. This is no way to treat professionals. There is anxiety, people want to get vaccinated and I do not know if the SMS system is the best," he says.

Primary care, which is taking on the task of vaccination, warns that this new system is not using medical criteria to prioritise people who need the vaccine the most, since, although the Department of Health recommends waiting to receive an SMS to register on the web, people between 60 and 65 years are already registering on their own, regardless of their health status. "As the website has appeared in the media and the information is spreading, this is every man for himself," denounces Sánchez-Amat. This GP explains that in the case of vaccination of those over 80, the CAPs do have autonomy to prioritise patients to be vaccinated first according to "their pathology, if they are home patients or if they are more at risk," but now, however, they cannot apply medical criteria. "In primary care we know the people we serve and we can prioritise who has to be vaccinated first, although the problem remains the availability of vaccines, because we cannot vaccinate at the rate we would like, but in the case of the population group of 60 to 65 years they have not let us decide anything nor have we been consulted," admits Siso, who says he does not know what criteria has been followed to decide to send mass SMS messages.

Against the large vaccinating sites

Moreover, the primary care centres do not want to move the vaccination outside CAPs and into large facilities, such as fairgrounds or stadiums. "If we are talking about the general population, it would have to be done in a CAP," says Blanca de Gispert, a doctor at the CAP Trinitat Vella. The president of the CAMFiC warns that in large spaces such as sports stadiums or fairgrounds a "personalized attention" cannot be guaranteed. "They are not spaces prepared to preserve the safety of a person if they get dizzy or have an aversion to puncture, for example," he adds. He proposes the mass vaccination campaign to take place in CAPs, extending schedules, if necessary, or in other spaces such as civic centers with additional resources.

"We can open weekends, we have the capacity to decide to vaccinate much more than we are doing," adds Sanchez-Amat, who says that there are users who say they want to be vaccinated in their primary care center and not elsewhere. Faced with the avalanche of requests for appointments for vaccination, there are people who have not found a free place to get vaccinated in Barcelona and will have to move to another town. One patient from Barcelona will have to go to Badalona and another from Santa Coloma de Gramenet has only found an appointment 180km away in Tremp. The deputy director general of Health Promotion, Carmen Cabezas, acknowledged this morning that there may not be any free places to get vaccinated in places like Barcelona because 95% of the appointments available throughout Catalonia are taken. They hope to be able to expand them with the 17,000 doses of vaccine AstraZeneca that should arrive tomorrow. The 148,000 AstraZeneca vaccines were due to arrive next week, but will not arrive and will be delayed until at least Monday, April 5.

According to primary care, this new system via web also breaks "the principle of equity", since there are people who have technological difficulties to enrol, either because they do not have access to internet or because they do not know how use the website. "The way it has been done [sending an SMS to patients with a link to sign up] is a very bad strategy and we're facing a lot of queries and questions on a campaign that does not depend on us, of which we have not been notified" De Gispert explains. She believes the website has simply added a technological obstacle to an already difficult process.

An administrative worker, who wants to remain anonymous, explains how many of the users come to them without understanding the procedure to follow once they receive the SMS because they do not know how to use the webs and questions the fact that to make an appointment an email is required. "We have had to do the paperwork at the CAP and we have also encountered people who have had to go home to use their children's e-mails," she complains. "Doing it via the web is not very equitable, the same as online attention; there are people who send two or three e-consultations every day and others who cannot use the system," says Sanchez-Amat. Several primary care entities are planning to publish a joint position against the new vaccination system and large vaccinating sites.

Hour-long queue

In Martorell CAP about eighty people between 60 and 65 queue up patiently for the AstraZeneca vaccine. They explain that between Tuesday and Wednesday they received the SMS in which they were summoned and they could choose without problem the schedule and this center as first option (one of the system's oddities is that it allows to ask for an appointment anywhere in Catalonia independently of your census registration). "Scared? I'm more afraid of the coronavirus", answers Maria Cinta Nivera, diabetic for 41 of her 64 years. At her side, Francesc Domingo, 62, and Mercè Caudet, 61, who do not suffer any conditions making them "high risk", celebrate being among the first in the resumption of the vaccine and say they did not hesitate at all to register on the web, although they agree it could be "somewhat clearer".

CAP staff let patients in in small groups while other patients who continue to arrive to be cured, ask for information or visit. The queue is quite silent and it all has an air of religious liturgy in this wait for immunology. On the verge of their turn, Concepción Escolar's husband shouts for her to leave the shady corner where she waits and join the queue. Escolar, 62, suffers from fibromyalgia and ITP (idiopathic thrombocytopenic purpura), an autoimmune disease that can cause thrombi, and that's why she says she's not sure she'll be vaccinated. "When they called me they told me to explain it to them before I got the jab, so I've brought my medical history and I don't know...", she says, and complains that despite her appointment she had to stand for an hour in the sun. "They tell us that we shouldn't gather and we've been waiting in a queue for an hour," her husband complains.

Those who are already vaccinated know that they will have to return for the second dose in three months and have already been told that instead of at a CAP, they will get the jab in a room in the library, a few meters from there. Today it is being used to vaccinate the over-80s. "After all, we will have the second injection for San Juan. We'll have our AstraZeneca with cava," laughs Niverna, about to take the road home.