March 7, 2021

who gets it, with what dose and in what order


The Ministry of Health has published the third update of the vaccination strategy against COVID-19, since it was approved in November by technicians from the Ministry, communities, and external parties. The decision that the same technicians made last week to recommend the third vaccine authorized in Spain, that of AstraZeneca, only to adults under 55 years of age, requires substantial changes. In the next few weeks there will be two strategies in parallel with the three vaccines available so far, all with double doses: the one followed with those of messenger RNA – with those of Pfizer (doses every 21 days) and those of Moderna (every 28 days) – ; and the one that is followed with that of AstraZeneca (every 10-12 weeks), which is for adenovirus. The strategy, they claim, is builds with principles of equity, necessity and reciprocity, and it is “alive”, it may change according to the context and the supply of vaccines that is arriving.

Health will vaccinate with AstraZeneca to health workers, police, military, firefighters and teachers

Health will vaccinate health workers, police, military, firefighters and teachers with AstraZeneca

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Who will each vaccine be directed to?

Therefore now two “simultaneous” routes are opened. Those who were in phase 1 that began on December 27, users of residences (1), first-line health and social-health workers (3A) and large dependents (4), and the first ones in phase 2, those older than 80 years (5) will receive the Pfizer and Moderna vaccines. The health workers who will receive these two include first the first-line workers who work in front of the patient, but then also the second-line workers from the hospital and Primary Care field and the dental, dental hygiene and other personnel who have direct contact . Social health workers include those in residences and those who visit the homes of large dependents. Due to “organizational reasons”, vaccinations may overlap, that is, for example dependents may be vaccinated at the same time as their caregivers.

AstraZeneca’s is reserved for two groups. One, a subgroup (3B) that has been considered within health and social health workers: personnel, health inspection services, legal and forensic medicine, private medical consultations, home help services, centers for minors and day centers, physiotherapists and occupational therapists, pharmacy office staff, dental technicians, speech therapists, and clinical psychology staff; and prison workers. The other, workers who have been classified as essential (6): Security Forces and Bodies, Emergencies and Armed Forces (Civil Guard, National, Autonomous and Local Police, Firefighters, technicians of the Security Forces and Bodies, civil Protection professionals , Emergencies and Armed Forces) (6A); Teachers and staff who serve early childhood education and special educational needs (6B); Primary and secondary education teachers and staff (6C). In the strategy they are placed in that order. You can also go to first line toilets who have not yet received a dose, and for large dependents under 55 if their condition allows it.

AstraZeneca’s is only for people under the age of 55. And always active staff. It also excludes those with severe immunosuppression (including cancer undergoing chemotherapy), uncontrolled cardiovascular disease, and severe liver, kidney, metabolic / endocrine or neurological disease.

What about people who have already passed the disease?

The technicians have decided that the vaccination in the case of people under 55 years of age who have already passed the disease be postponed for six months from the moment of COVID-19 diagnosis. That is to say, it applies to healthcare and social healthcare both first-line and other areas, and essential workers. It is justified in that “the vast majority of people infected by SARS-CoV-2 produce neutralizing antibodies in addition to stimulating the induction of T-cell response” and “current evidence indicates that reinfection is exceptional in the six months after a natural infection by SARSCoV-2 “. Although the latter “is less plausible in the most vulnerable people”, so it will not be done with the elderly and dependents and they will be vaccinated whether or not they have passed COVID-19.

The strategy mentions that there are publications that suggest that another option is to give only one dose to these people, but “until more solid information is available” and given that it is not known how long the protection lasts once the infection has passed, it is chosen the policy of postponement. Yes, only one dose will be given, it is decided along the same lines, to people up to 55 years of age who have developed COVID-19 in the space of time between the first dose and the second. All this is not irreversible, they are “provisional” recommendations, and could be modified later based on new evidence. Whether or not people have had the disease before vaccination will be known by their clinical diagnoses, since Health in the same document does not recommend that antibody tests be done before inoculating.

What about the big salespeople?

The Ministry has corrected a part of the previous updates that had been criticized in the dependency sector. Before, there was only talk of “large non-institutionalized dependents”, that is, people with a grade III dependency who lived in their homes, but now it specifies that this group includes “those who have applied for recognition” and also those who have not have applied yet but he is “medically accredited” for having illnesses that require intense support measures. The Association of Directors and Managers of Social Services calculated that, if people who did not have accredited dependency according to the Law were not taken into account, some 32,000 citizens were left out.

Although large dependents are within the group recommended to vaccinate with Pfizer and Moderna, their section does open the door for them and their caregivers to be vaccinated with AstraZeneca “depending on the age of the person and the feasibility “. The strategy continues to specify that the caregivers of large dependents who will be vaccinated will be professionals and non-professionals are excluded –Those who are cohabiting and family members–, something that has also been criticized in the sector.

Why isn’t AstraZeneca for seniors worth it?

“The three authorized vaccines have shown adequate levels of efficacy and safety, although they present different characteristics in terms of their logistics, efficacy, and population profiles in which they have been tested,” it reads. But clinical trials in laboratories assessed by the European Medicines Agency did not include people with high-risk diseases such as severe immunosuppression, uncontrolled cardiovascular disease, severe liver, kidney, metabolic / endocrine and neurological diseases, or pregnant women. The studies did include 39.3% of participants from people with other comorbidities, such as cardiovascular disease, respiratory disease or diabetes. There are also insufficient data on its efficacy in people over 55 years of age, for the same reason in the population sample.

France, Italy and Germany, among other European countries, have also chosen not to give it to these groups. The United Kingdom is managing it. From the Spanish Association of Vaccination they explained to this newspaper that perhaps in the near future the recommendation could change, since they would have data from the United Kingdom campaign.

Who are the following?

There are 15 population groups, many that overlap each other (for example, a teacher may have SARS-CoV-2 antibodies, or a person over 80 may live in a residence). But only those mentioned are hierarchical. The document does say 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, a priority group according to scientific societies to reduce mortality. And it is not clear what to do with essential workers between 55 and 65 years old.

Are immunization targets at risk?

Health has the first objective of reaching 80% of the population over 80 years old, health workers, large dependents and users of residences at the beginning of April, and 70% of the general population throughout the summer that the European Union has set. . This will 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”, Fernando Simón acknowledged. Between now and March 8.6 million doses are confirmed between the three companies, although in March there could be an increase. For the second objective it is hoped that this supply will increase, is an average of 2 million punctures per week –Now the health workers provide just under 100,000 a day– and specialists also believe that we depend on the quantities and new vaccines that may arrive.

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