The coronavirus vaccine, from rejection to Spanish success

Currently, Spain is one of the countries with the highest adherence to the Covid-19 vaccine presents and leads, together with Canada, the vaccination campaign in the world. According to a recent study, only 5% of the Spanish population reject the vaccine, compared to 28% in Russia, 19% in the United States and 13% in Germany. Moreover, Spain is the country that is most in favor of the fact that vaccination against Covid-19 is mandatory.

"If there is something good about this crisis, it is that it has vindicated the vaccines"

F. Martinón - WHO Advisor


This majority support for the vaccine explains that the vaccination campaign continues to advance in Spain, which is at the head of the European Union (EU) in percentage of immunized population, while in the rest of the community territory it is losing steam due to reluctance of citizens to be vaccinated. According to data from last week collected by the online publication developed at the University of Oxford Our World in Data, 57.6% of the Spanish population has received the complete guideline, followed by the United Kingdom, with 56.1%, Italy (52%) and Germany (51.5%). Far is France, where the rate of vaccinated does not even reach half (47.1%).

However, this has not always been the case. In the middle of the second wave of the pandemic and just a few months before the vaccination campaign began (December 27, 2020), many Spaniards rejected the injection and the country was the second European state with the least predisposition to be vaccinated. Only 13% of Spaniards stated that they would be vaccinated "immediately" if they had the vaccine against the global 22%, according to a survey carried out by Ipsos and the World Economic Fund of 18,526 people from 15 countries, interviewed between days 6 and October 13.

The new year, with the vaccination campaign already underway, brought a turnaround. According to a study carried out by the Foundation for Science and Technology (Fecyt), dependent on the Ministry of Science and Innovation, six out of ten Spaniards declared their intention to be vaccinated with complete confidence, and in June, 83% of the population expressed their confidence in vaccination, an attitude that was only affected when the thromboembolic events suffered by some people after receiving the first dose of AstraZeneca were reported, at which point those who refused to be vaccinated rose to 34.6%, according to a new survey carried out by the Fecyt.

"We are all protagonists of this pandemic and every vaccine counts"

Roi Piñeiro - Pediatrician


But what made the vaccine go from rejection to success in Spain in just a few months?

“The main enemy of vaccines is their own success. It is difficult to get vaccinated against a disease that you no longer see. People are now vaccinated against polio and measles, but they do not see polio patients or people dying from measles, so they are not afraid of them. On the other hand, in the case of Covid-19, everyone has died someone close to them or they themselves have suffered the disease and suffered its consequences, with which it is much easier to achieve adherence, "explains the committee member Vaccine Advisor to the World Health Organization (WHO) in Europe, Federico Martinón.

The facts speak

For this expert, the initial reluctance to vaccination was "purely theoretical." «There is no problem having doubts. Its normal. The important thing is, despite the doubts, to make the right decision and for that you need to have the right information and education. This pandemic will not end until the last person who has to be vaccinated in the world is vaccinated, "he says.

Dr. Martinón has no doubt about what has been the determining factor that has tipped the balance towards vaccination. “In the case of this pandemic, the main convincing factor has been the facts. People began to see how people stopped dying after getting vaccinated. If it can be said that there is something good in this pandemic, it is that it has given value to vaccines, "adds the WHO adviser.

In identical terms, Dr. Roi Piñeiro, head of the Pediatrics service of the General University Hospital of Villalba (Madrid) and an expert in vaccines, who assures that it is the effectiveness and safety of vaccines that end up generating confidence in the population. «To verify that the percentage of serious disease and complications among those vaccinated is very low compared to those who are not vaccinated, and the infinitesimal rate of serious side effects generates an evident individual desire when it comes to wanting to receive protection. In fact, the vast majority of citizens have received the doses with enthusiasm and joy, ”explains Dr. Piñeiro.

This expert adds another reason to the majority confidence that this drug enjoys in Spain. “In addition, there is another desire for collective protection, a hope of finally leaving the pandemic behind and returning as soon as possible to the best part of the old normality. It has been too long since we faced such a pandemic. Many of us have seen films about epidemics, but now we are the protagonists, and every vaccine counts, "he explains.

"The vaccine is being effective against the virus, its consequences and death"

Africa González - Immunologist


This expert stresses that, despite initial reluctance to the Covid vaccine, Spain has never been a "vaccinophobic" country. “We are an example for many countries in the world, achieving high coverage without the need, for now, to force it. However, not all societies are responding in the same way. Anti-vaccine movements were already powerful before the onset of the pandemic. Let's say that the situation has not improved much in countries like France, "adds Piñeiro.

Also the emeritus professor of Preventive Medicine and Public Health of the University of Santiago (USC) Juan Gestal highlights the irrelevant weight of the anti-vaccine movement in the country. "In Spain anti-vaccine groups do not have social support as in other countries such as France, and the population immediately realized that the way to protect themselves and solve the pandemic depended on vaccines," says the epidemiologist.

The new technologies used by vaccines, such as the mRNA of Pfizer and Moderna; the speed of clinical trials; the fear of possible serious side effects, and the hoaxes that circulate on social networks about vaccines are some of the factors that could favor the initial reluctance to vaccines against Covid. “We are the protagonists of this new pandemic, but nobody wants to play the role of the guinea pig, guinea pig or the laboratory animal on duty. When vaccinated people number in the millions, it is easier to take a step forward, ”explains Piñeiro.

The confidence gained in vaccines against COVID-19 faltered when the first information about thrombi emerged. 'Everyone started to calculate their own benefit / risk ratio. Unfortunately, some of those who tipped the balance towards the possible risk of vaccines are today hospitalized with severe forms of the disease, ”says this pediatrician.

"In Spain anti-vaccines do not have the social support of other countries"

Juan Gestal - Epidemiologist


The hoaxes, which have accompanied the pandemic since its inception, have also sown doubts and even fear among the population. «Creating a hoax is relatively easy. Spread it, even more so. It is enough to repeat it many times. Disproving it is so complicated that many health workers leave it as impossible. And worst of all, the creators of the hoax will go unpunished, starting with the fact that it would be practically impossible to identify them. The important thing about hoaxes is not to feed them, "says Dr. Piñeiro.

The third dose is already a fact in Israel

Israel has already begun to generally inject the third dose of Pfizer's vaccine against COVID-19 to adults over 60 years of age, thus becoming the first state in the world to follow the recommendation of the pharmaceutical company by inoculating a booster dose, a measure that has not yet been approved by the health authorities of the EU or the US. Experts consider that, to date, nothing seems to justify this booster dose, which the Minister of Health, Carolina Darias, pointed to on the 23rd. “For now, the data do not indicate that a third dose should be used globally. The two-dose vaccination schedule has proven to be very effective, generating very good responses and protecting against death, disease and sequelae, ”says the professor of Immunology, Africa González, who clarifies that in any case it could be necessary in some specific groups, as people with immunodeficiencies or in immunosuppressive treatment where the response they generated to the vaccines was not sufficient. Emeritus Professor of Preventive Medicine and Public Health Juan Gestal also does not believe that the timing of this third dose is very clear. «If we look at it from the point of view of the immunity generated by the infection or the vaccines, it seems that a third dose would not be necessary, for the moment, since it has been seen that both infection and vaccination generate immune memory and cellular immunity, limiting the need for a booster dose to immunosuppressed or immunosenescent people ”, he says. | ACE

Will adherence be maintained?

Although the anti-vaccination movement has little weight in Spain, in other countries such as France, Germany and the United States it has gained adherents in recent years. This rejection of vaccines could frustrate the long-awaited herd immunity (indirect protection against an infectious disease that gets a part of the population becomes immune to the pathogen). “Some countries have begun to adopt different mandatory or required measures to be vaccinated to access certain places or carry out certain activities. The second having very good results, "says epidemiologist Juan Gestal. The pediatrician Federico Martinón is in favor of implementing the compulsory nature of the Covid vaccine as an "exceptional or palliative" measure if the rejection is excessively high. “It is even legislated, although many want to look the other way and I think most people would accept it. If we have all made a choral effort to get out of this pandemic, there will come a point where it will not be me who has to stay locked up at home or my children while you are walking without a minimum quota of responsibility, "he says. The challenge may lie in maintaining adherence in the event that the vaccine becomes a regular measure. “With the flu vaccine it costs a lot. But the underlying problem is that no one respects the flu. It is a disease that we have totally socialized and trivialized. The thousands of deaths that continue to leave every year in spite of the reminders of the health personnel matter little. SARS-CoV-2 is new to everyone. The day it is socialized, we will surely lose adherence, "says Dr. Roi Piñeiro. | ACE


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