193,800 doses of the AstraZeneca COVID-19 vaccine have already been in Spain for a week, but they will not be able to be used as we believed a couple of months ago. The laboratory does not have enough data on its efficacy in people over 55 years of age, so in Spain it will not be given to them. The Ministry of Health does open the door to do so when results come from the United Kingdom – which is administering it – or from the US clinical trial, surely favorable, but at the moment it does not see it possible.
Questions and answers about the new vaccination strategy: whose turn it is, with what dose and in what order
That opens two simultaneous processes. On the one hand, we continue with the doses of Pfizer (we have 2.5 million) and Moderna (192,000) with users of residences, health and social care and large dependents, and begins with those over 80 who live at home. On the other hand, AstraZeneca starts with remaining toilets and other subgroups of social health workers, and with essential workers (police, firefighters, military and teachers). The objectives are twofold: to reach 80% of the population over 80 in April, which, together with the other first groups, would comprise some 4.5 million people; and to 70% of the Spanish population throughout the summer, 35 million between adults and children. This is where we are to get them.
What rhythm do we take and what do we need?
From Thursday, February 4 to Thursday, February 11, 2021, 455,165 doses were injected in Spain, that is, a daily average counting weekends of approximately 65,000. To have 70% of the Spanish population immunized (with a double dose that almost all trials need) on September 21, at the end of summer, they need about 2.1 million punctures per week, 300,000 a day. They will be less if the Janssen vaccine is authorized, which is a single dose and only needs one prick, that is, half to vaccinate the same people.
How many vaccines do we have safe?
The Ministry of Health expects to receive, from December 27 until March 31, 6,217,965 doses of Pfizer. Throughout February 1.7 and throughout March 2.7. From Moderna, 600,000 were expected in six weeks, starting in January, and in February they reach 412,000. And from AstraZeneca, 1.8 million in all of February. They total 8.6 million doses for the 4.5 million people in the first target. As all vaccines are double doses, it would take about 9, so with what has been confirmed so far it is very fair, although it is practically certain that Moderna and AstraZeneca will add new amounts between February and March. Of course, for the elderly, the 1.8 of AstraZeneca does not work.
How many do we wait?
Health and specialists trust that from March and April the supply will increase. Both from Pfizer and Moderna and AstraZeneca. From Pfizer the European Union has committed 300 million doses, Spain has 30, 10% per population, with no clear date commitment. From Moderna, 160 million, 16 for Spain. From AstraZeneca there were 400 million, 40 for Spain, but AstraZeneca cut them in half at the last minute.
And there are three laboratories with contracts signed with the EU that have yet to complete their tests, predictably in the first half of the year. Sanofi-GSK, 300 million doses for the EU, 30 for Spain; Janssen / Johnson & Johnson, 200 million, 20 for Spain, with the possibility of doubling; and CureVac, 225 million for the continent, 22.5 for Spain, which may reach 400. There are very advanced conversations with two others, Novavax and Valneva. The authorization of Sputnik V has not been requested by Russia from the EU.
What advantages will other vaccines give us?
About Janssen we spoke with Dr. José Luis del Pozo, director of the Infectious Diseases and Microbiology Service of the Clínica Universidad de Navarra, where the phase III trial of this vaccine is carried out: “The great advantage of Janssen is that with a A single dose has been shown to be 85% effective in protecting against severe disease. With a second dose, it could increase. The other advantage is that it does not require such critical conservation or special syringes. The forecast is that it will be before summer, It is the only thing that is clear. But the trials are going so fast that it is not risky to say that it may be in March. Then it will depend on the European Medicines Agency, but it also speeds up its procedures, as has been seen. This week, Minister Darias placed it, perhaps, in the first week of March.
The German CureVac is messenger RNA, the same innovative technology from Pfizer and Moderna, but does not require deep freezing or reconstituting the liquid. “It is a good vaccine”, summarizes José Antonio Forcada, general secretary of the Spanish Association of Vaccination (AEV) and president of Nursing and Vaccines (ANENVAC), both involved in the state plan. Dr. Luis Enjuanes, director of the CSIC coronavirus laboratory, further commented on the possibility that the Germans could “Transferring their stabilization technology at that temperature to Pfizer and Moderna, for an economic amount. It would be fantastic.”
Who are the following?
There are 15 population groups divided by Health, many that overlap each other (for example, a person over 80 years of age who lives in a residence) and not all have yet been ranked by priority. The national strategy document does explain that, once those over 80 have been vaccinated, “later, and as vaccines become available, other age groups will be included, starting with people between 70 and 79 years old.” For now, the general population of any age with risk pathologies has been left out, despite the fact that several scientific societies asked that it be a priority group to reduce mortality. Also essential workers who do not enter the Health groups such as supermarket cashiers. And it is not clear what to do with essential workers between 55 and 65 years old.
Will some go for some groups and others for others?
The example of Pfizer and Moderna versus AstraZeneca is the clearest: the first two should go for now for those over 55, the other for minors. “All will complement each other,” say the experts. There are two groups that, for the moment, are left out: children, and pregnant and lactating women. This is because, by protocol, they are not usually included in the first trials of any drug. Pfizer, Moderna and AstraZeneca are already beginning to test them with them, because for group immunity they will also be necessary.
How will failure to vaccinate older adults with AstraZeneca affect targets?
“It is a stick in the wheel more,” Forcada answers. “It would have been easier to use it”, Amós García Rojas, president of AEV, also abounds, because its logistics are much simpler: it does not need deep freezing (like that of Pfizer and Moderna) or that the toilet mix serums (like that of Pfizer ). Which is a great advantage if you are vaccinated in homes that you have to travel to. But the problem is corrected with planning, “if you know how many homes you are going to visit and distribute the number of vials well,” Forcada explains. “Spain has a lot of experience vaccinating different groups with different vaccines”, recalls García Rojas, “every year a different type of flu is used for people over 65, another for minors … there should be no problem.”
Are immunization targets at risk?
Health has as its first objective to reach 80% of the population over 80 years of age, health workers, large dependents and users of residences at the beginning of April, and as a second the one set by the European Union to reach 70% of the general population throughout the summer. With the first one, it will be possible to significantly reduce hospitalizations and deaths. They continue to trust that the supply of Pfizer and Moderna, with which all these groups will be vaccinated, will be sufficient, although “probably” due to the limitations of AstraZeneca and shipments “it cannot be advanced”, acknowledged the spokesman Fernando Simon.
Specialists also believe that we depend on the quantities and new vaccines that may arrive. The example they usually give is that more than 10 million citizens are vaccinated with the flu in less than two months each fall. “Due to lack of interest from the health workers, it will not be, we have a tight muscle”, adds García Rojas. The supply “will be fair, but I trust that from March there will be a notable increase in pace. We should not consider reaching a specific percentage in April, but vaccinate as many people in the shortest possible time.”