Why is a 29-year-old teacher vaccinated before her 80-year-old grandmother?

Barcelona"On Friday I have an appointment to get vaccinated, but the expectations are mixed with sadness, since my grandparents who are over 80 still have no date," laments Laia, a 29-year-old teacher. Hers is not an isolated case: teachers and essential groups such as firefighters or police are being vaccinated against covid before the population most at risk of contracting the virus, the elderly. Initially, however, after immunising the elderly living in nursing homes and health and social-health professionals, it was the turn of the population over 80 years of age. This apparent change in strategy has led to criticism of the health authorities. But why is a young and healthy population being vaccinated before the elderly, who are more at risk of suffering complications and even death?

Experts consulted by ARA claim that it is not a question of prioritisation as such, but a mere logistical issue. Delays in the arrival of doses considered appropriate for the elderly (especially Pfizer) and the ban on the use of the AstraZeneca vaccine for the over-55s have upset the government's plans, which for two weeks vaccinated essential groups "in parallel" to healthcare and care home staff, as well as care home residents. "The State elaborated a first prioritisation document based on the ideal situation. But this has to combine and adapt to the actual availability of vaccines. What we cannot do is to stay put," explains the immunologist Carlota Dobaño.

At the moment, vaccination of the elderly who do not live in nursing homes is in its initial phase, but vaccines have already begun to be administered to over-80s who have some degree of dependence or disability. Since the end of last week, primary care workers are calling the elderly at home to ask them if they want to be vaccinated and offer them an appointment. Thus, they say, you can organise routes to vaccinate at home and give the more mobile elderly an appointment at their healthcare centre.

Delivery of Pfizer and Moderna vaccines, the only ones that can be administered to the elderly, have experienced the largest fall. This is countered by AstraZeneca, who sends its doses more regularly. Dobaño recalls that at the beginning of January doses were only arriving from Pfizer and a month later it cut its production by half, which generated a bottleneck with weeks of delays. At the same time, on 29 January, the European Medicines Agency (EMA) approved AstraZeneca's vaccine. "Then a decision had to be made: did we wait for more doses from Pfizer or did we continue to vaccinate using the AstraZeneca doses?", says the researcher from the Barcelona Institute for Global Health (ISGlobal).

"We can't stop the machinery"

According to the experts, however, the real obstacle to the vaccination of older people is that in Spain the AstraZeneca vaccine cannot be administered to people over 55 years of age. "This forces us to administer the vaccine to those groups authorised by the Health Department and, among these, we have to prioritise those who can transmit it more due to exposure because we need them for us to continue functioning as a society," explains the epidemiologist Sílvia de Sanjosé. "Spain is erring on the side of caution when it would have to press the accelerator by vaccinating fragile population," denounces doctor and researcher at the University of Leicester Salvador Macip, who argues that the alteration in vaccination groups made by the Generalitat "is logical," since "you cannot save or throw away the doses".

Sanjosé stresses that with more doses of messenger RNA, ie, Pfizer and Moderna, "the elderly, dependents and patients at risk" of cardiovascular or pulmonary diseases, for example, could be vaccinated. "The most important thing is to vaccinate and not slow down the machinery. And if AstraZeneca had no age limit or if it could be put up to 65 years, we would vaccinate much more because we have the capacity to do so", says the epidemiologist. The lack of clinical trials in people over 55 years old made each government decide what age range to allow the vaccine for: while Spain only administers it in under-55s, Italy injects in all under-65s, whilst the United Kingdom has set no upper age limit.

In fact, Macip justifies the British position and ensures that it is the same as that defended by the EMA and the World Health Organization (WHO): "There is a lack of data, of course, but nothing suggests that it cannot work just as well. The researcher denounces that vaccines are given to young and healthy people, even if it is to shield second doses. "Studies in Israel show that with a single dose a protection of 85% is already achieved and this allows spacing the second doses without compromising its protective effect," he insists. Macip points to a "political and economic motivation" behind Europe's decision to limit both the administration of AstraZeneca, when it will be "the most important in the world because it is cheap, fast to manufacture and the one that can produce more doses".

The original plan drawn up between the Health Department and the autonomous communities, which are those who carry it out, organises vaccination around fifteen different groups. The residences and health centres are the first environments to be protected due to their vulnerability and exposure to the virus, respectively, and then the campaign to the over-65s, including dependents and with special attention to the over-80s. Progressively, more groups will be vaccinated.