Catalonia postpones vaccination of elderly people due to lack of doses

BarcelonaThe availability of the covid-19 vaccines and the characteristics of each of them have once again changed the Department of Health's plans for the vaccination campaign, which will not be able to continue for the time being among the elderly. From next Wednesday, the Department of Health hopes to start vaccinating some of the groups considered essential, such as the police, firefighters and other emergency groups, but it will not be until the end of February and until there are enough doses of the Moderna and Pfizer vaccines when the 24,850 dependent people and the 1.8 million elderly and chronically ill people who live in the country will be vaccinated. In addition, this Friday night the Ministry of Health decided that the AstraZeneca vaccine can only be administered to the population aged between 18 and 55, which complicates the Government's plans.

The reasons for prioritising essential groups over the elderly and dependent people are eminently logistical: Catalonia will receive a total of 112,000 doses next week; the first 31,000 from Oxford/AstraZeneca, the 60,000 weekly doses agreed by Pfizer and some 21,000 from Moderna, which will send 20% less than expected. The arrival of the AstraZeneca vaccines and the delay by Moderna have forced the Government to rethink the vaccination strategy, which until now had foreseen that in the first stage the next to be vaccinated, after nursing home users and health workers, would be the elderly and people over 80 years of age.

All these vulnerable people should receive the Moderna vaccine, but the lack of doses will postpone immunisation. The US company will cut deliveries by 20% throughout February and will not recover them until March, which is a new obstacle for the Catalan campaign. As there will be a shortage, the Secretary of Public Health, Josep Maria Argimon, has confirmed that Catalonia will make a strategic reserve of the doses distributed by Moderna until it has enough, approximately in March. The rest of the vaccines, if there are no setbacks, will be used up as they arrive, because the flow of shipments is expected to be more fluid.

The Regional Health Minister pointed out that AstraZeneca, for example, expects a fairly steady flow. This week some 31,000 vaccines should arrive, the following week they could reach 36,000 and then "even triple" the number of doses delivered. However, the fact that AstraZeneca's vaccine has not been shown to be sufficiently protective among people over the age of 65 - most trial participants were under 55 and the European Medicines Agency (EMA) recommends targeting younger, healthier people - will mean that for the time being Catalonia will move forward with immunising essential service workers and healthcare professionals who are not in close contact with covid patients.

What does this mean in concrete terms? It means that the second phase of vaccination (essential workers) will be launched next week without the second stage (dependents and chronically ill) of the first phase having been completed. In this way, the first phase - nursing home residents, health professionals and some 24,000 highly dependent people - could be completed by the end of March, while the second phase would already prioritise - around the end of February - essential staff and people at high risk.

The Health Department clarified that the core group does not include, for the time being, teachers and educators, and that Pfizer's vaccines will be used for second doses in hospitals, primary care centres and geriatric care.

"We will overlap vaccination stages".

Next week the Catalan refrigerators will have doses of the three approved vaccines, but as they have different characteristics, they will go to different segments of the population. The health authorities have explained that depending on the availability of the doses and their timing, vaccination of one group or another will be intensified. "We want to reduce mortality among the vulnerable population, reduce the burden of care on the system and achieve herd immunity. We cannot stop vaccinating", indicated the deputy director general of Health Promotion, Carmen Cabezas.

"We will overlap vaccination stages, as has already happened with nursing home residents and health professionals. And we will do so according to the availability of doses and the characteristics of each vaccine", Argimon stressed. This means that the established order will not be linear and that different groups of different priority will be vaccinated at the same time depending on how full the refrigerators are and, above all, on the vaccines that are available.

For example, AstraZeneca will for now only target essential workers and Moderna will be reserved for vulnerable people. However, there is nothing definitive in this vaccination campaign. In fact, the Catalan authorities are not yet considering moving on to the third stage of vaccination, because in order to vaccinate priority groups, some 5 million doses are needed and for now only 1.4 million have been committed in round figures. "To complete the first two stages alone, we would be almost 4 million doses short", Argimon acknowledged.

AstraZeneca only between ages 18 and 55 years old

The Ministry of Health has decided to authorise vaccination with AstraZeneca only for people between the ages of 18 and 55. With three days to go before the vaccines are due to land, Spain has decided to distance itself from the strategy of Germany and the majority of European countries, which will vaccinate those under 65, and will follow the guidelines of Italy, which will only vaccinate those under 55.

In this discussion, Catalonia had supported the German option - that of administering it until the age of 65 - as this is the range set by the regulatory agencies and the most practical route from a demographic point of view, as the working age extends to 65. Vergés, who had described it as "unprecedented" that the Spanish government had still not taken a decision a few days before the doses were in stock, had already warned that the organisation of the vaccination would be "much more complicated" if it was limited to 55 years of age.

Vaccinations in healthcare centres, museums and companies

Despite the adversities that have been occurring since the first day of the vaccination campaign, the Catalan Minister of Health has assured that Catalonia has the capacity to vaccinate 150,000 people a day "if enough vaccines are received". "We have done it with the flu vaccination, we have given 1.5 million doses in two months with peaks of 60,000 doses a day, and we are ready to carry out a mass vaccination campaign against covid", she said.

Vergés stated that the entire public system will prioritise vaccination against covid and that primary healthcare will be the central focus, although doses will not only be administered in primary healthcare centres but also in the 635 multi-purpose centres that have already been used for flu vaccinations and which local councils throughout the country have made available to the Health Department. "We will also vaccinate in other large spaces and facilities in the country, such as museums and companies, through the occupational health and occupational risk protection services", she confirmed. In no case, however, will shopping centre car parks be used, as in the United States.

Cabezas pointed out that the Health Ministry will also find a way to vaccinate severely disabled people at home, despite the difficulties involved in distributing the vaccines in multi-dose vials. In some cases, she anticipated, these people with dependency will be vaccinated in day centres if they are users and are able to travel. "We must have this population very well located and establish the routes for the nursing teams", she added. "What is clear is that none [of the vaccines] will be left in the fridge", Vergés said.

45% fewer outbreaks in care homes in ten days

Cabezas has remarked that vaccination in nursing homes is reducing the appearance of new outbreaks and that the incidence has been contained much more than among the general population: there are currently 459 active cases, 45% less than ten days ago, and 104 care homes with an active outbreak, while two days ago there were 146. "We see fewer and fewer outbreaks, has slowed the emergence of new cases," she said.

Cabezas has specified that the vaccination teams have already administered the first dose to 90% of residents and the second to 70%: "It is expected that next week the vaccination is completed in all care homes in the country". And he added: "This focus [on care homes], which has cost a lot of effort and specific resources, is already accompanied by good health results, but we have to move forward and we are prepared to extend the scope of vaccination to the rest of the population". Cabezas stressed that Health now wants to get "as close as possible" to the population through primary care, but also using the occupational health areas of companies.