Maximum pressure from doctors for State authorisation of AstraZeneca vaccine for all ages

BarcelonaThe doctors of Catalonia redouble the pressure so that the AstraZeneca vaccine can be administered to people of all ages, the sooner the better. A preliminary study carried out in Scotland has shown that it has an efficacy comparable to that of Pfizer and reduces hospitalisations in people over 80 years of age by 81%. Countries such as Germany have already lifted this age restriction, but Spain is resisting on the grounds that there are still doubts about its efficacy from the age of 55 onwards. The veto forces Catalonia to postpone the vaccination of older people and, given this scenario, the College of Physicians of Barcelona (COMB) proposes to the Generalitat to allow the vaccine for all groups if there is no variation of the current ministerial criteria soon. "I ask that the indication be extended according to the ethical, clinical, risk and evidence criteria", the president of the COMB, Jaume Padrós, has proposed, who guarantees the support of the doctors to the Government if they take this decision.

Catalonia and other autonomous communities have been asking the ministry for weeks to reconsider the criteria to accelerate the current rate of vaccination and to extend vaccination with AstraZeneca to those who are up to 65 years of age. The Government advocates lifting all age restrictions as they do in the UK, which has already immunized 20 million people. The Minister of Health, Carolina Darias, admits that its position -vaccination up to 55 years- "is not immovable", but has not given an imminent deadline to announce a change in the criteria.

Catalan doctors describe the State's position as "unacceptable" and claim that it violates the prioritization criteria set by the European Union. Among other reasons, because it is depriving people at high risk of receiving a safe and effective vaccine. "It makes no sense to have a 30-year-old teacher vaccinated and a 62-year-old, who is at a higher risk, cannot be vaccinated"; this week the Secretary of Public Health, Josep Maria Argimon, stated. However, the head of the management of the epidemic completely rejected the confrontation and said that Catalonia would not act without the endorsement of the state in order to not generate "sterile controversies". His position remains unchanged despite the request of the doctors, according to sources in the Government.

"Spain will eventually understand that it has to authorise the use of AstraZeneca for those over 65. So far, it is erring on the side of caution by cutting off administration at the age of 55", explains Antoni Trilla, director of the preventive medicine and epidemiology service at Hospital Clínic, who is a member of the Covid committee advising the Spanish government. The epidemiologist assures that the British vaccine, which is produced and supplied more frequently, is very effective for all age groups where it is already being massively used, such as in the UK: "People who receive it are perfectly covered". 

Quique Bassat, an epidemiologist at the Hospital de Sant Joan de Déu, agrees with this and stresses that if a regulator as strict as the European Medicines Agency (EME) approves a vaccine it is because it is safe and effective. "All vaccines approved by Europe are good and hopeful", says the researcher at the Institute for Global Health in Barcelona (ISGlobal), which defends AstraZeneca has an efficacy of almost 80% after inoculation of the first dose and 94% when receiving the second. Results that make the reluctance to use the vaccine incomprehensible, he says.

The vaccine changes scenarios

For the moment, the vaccination has already radically changed the scenario in the environments where it has exceeded 50% of immunization: care homes and health centres. "The impact on the groups that have received the two doses is very evident. Not only have infections plummeted, but also mortality: in nursing homes we had twenty or more deaths a week and now we have one or two", explains Bassat.

Now care homes will be able to recover outings and family visits and will not have to quarantine if someone in their environment is infected. "It would not make sense to harm someone who is theoretically very well protected with a lockdown after another, with their respective tests, when their risk of infection is very low", says Bassat.

In care homes there have been very lethal outbreaks, 8,727 people have died, four out of ten victims in Catalonia so far - without counting the users who died in a hospital transferred from one of these centres. According to data from the Health Department, 14,632 people aged 80 or over have died, and 70% of these deaths are due to covid.

In health centres, where 60% of workers have received both vaccines, positive cases have also declined dramatically. Approximately 40% of health workers have been infected, according to Trilla, and this natural immunity - which can last between six and twelve months -, as well as the one induced by the vaccine, means that the virus has little margin for action. "At the Clínic we have vaccinated more than 6,000 professionals and the very few positive cases that we detect with periodic screening among those vaccinated, either have no symptoms or are very mild", he says.

The vaccine, then, is behaving as the experts expected it to: it reduces the number of infections or softens the disease, which translates into a reduction of hospital admissions and fewer deaths. "As we increase the population coverage to people over 80 years old and with a higher risk of disease, the health system will recover: hospitals will reduce the pressure for covid and severe covid, and in one or two months we will free up many beds", predicts Trilla, who stresses that although "they would like to vaccinate more and faster", the first effects are already being observed.

When will these successful results be reproduced in the rest of the population? Epidemiologists make it clear that we will not yet see a drop in population cases because vaccination is so low. "This will begin to be seen with 25% of the population vaccinated, and will be evident with 50%", says Bassat. Right now, between health workers and care home residents, only 3% of the Catalan population is immunized. "This vaccination still does not reduce community transmission. To control the curve, people who are more mobile and more exposed to the virus should be vaccinated", he says. And there are still weeks to go before this occurs.

Both epidemiologists warn that the population who is between 55 and 79 years old also has a high risk of getting sick if infected, and they begin to be nervous about not being able to access the vaccine. "It must be understood that these vaccinations have to be done quickly but well", says Trilla. "However, we also need to be clear about the deadlines for the elderly: if we vaccinate them earlier, better. And if not enough vaccines arrive, we will also explain it to them. The important thing is that they can see that they are making progress and that it will soon be their turn", adds Bassat.