Tuesday 6 December 2022

Should the vaccination against covid-19 be opened?

Vaccinating whoever you want, regardless of age or risk, is not an easy matter for a country without sufficient provision of vaccines for the entire population

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QCOSTARICA – Six months after the start of vaccination against covid-19, will it be time to open the campaign to those who want to protect themselves against this disease, without age or risk limits?

Mass sessions, aimed at risk groups and according to age ranges, have become more frequent in recent weeks.

Five specialists were consulted: pediatric immunologist and director of the Hospital Nacional de Niños (Children’s Hospital), Olga Arguedas Arguedas; demographer and health worker, Luis Rosero Bixby; infectologist and former Minister of Health, María Luisa Ávila Agüero; epidemiologists Ronald Evans, coordinator of the Research Unit of the Universidad Hispanoamericana (UH); and Juan José Romero Zúñiga, of the Universidad Nacional (UNA).

These are their considerations.

Olga Arguedas: More vaccines are needed

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For the director of the Children’s Hospital, who is a specialist in Immunology, the opening of vaccination depends on an essential factor: the availability of vaccines.

For this reason, she explains, it has had to work in priority groups, vaccinating those who have a higher risk of mortality.

“If we had a significant arrival of vaccines, we could hypothesize that vaccination would open for this group (three) in an unrestricted manner,” says the immunologist.

Arguedas is not concerned about the organizational and logistical aspects that could be linked to that opening. Costa Rica, she said, has always had an excellent response in organizing vaccination programs.

Luis Rosero: ‘It must not be opened yet’

For demographer Luis Rosero Bixby, the vaccination should not be opened yet. These are the reasons, according to him:

  • Economic: “The vaccine is still very scarce with a demand much greater than the supply. When these situations of much more demand than supply occur, some mechanism is required to ration. In the markets, this mechanism is the price: the one who pays the most for it gets it.

    “But the vaccine is not going to go to market. How will the CCSS ration it if it opens? That people get to line up at dawn at vaccination sites? Make appointments online, like for driving tests? It is easy to imagine the problems that this form of rationing would cause. The hawks would probably benefit the most,” said Rosero.

  • Fairness or distributive justice: This means, he explains, that the vaccine does not reach first to the one who has the most or the most skilled with the Internet, but to those who need it most. The composition of the groups was done in part by this principle of equity, he explains.
  • Epidemiological or health reason: With the vaccine, the benefit for the health of the population should be maximized and that is achieved by vaccinating first those who cause the most death and pain from this disease, he clarifies.
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    “The most efficient way to identify these people who would suffer more or with a greater risk of dying is through age. You have to continue vaccinating in stages, from oldest to youngest, at least until you reach the age of 40.

    “Compared to people in their twenties, people in their fifties have a 20 times higher risk of dying if they catch it. Avoiding a contagion from a person in the fifties has, then, 20 times more value than avoiding one from a person in the twenties ”, affirms the demographer.

    “This comparison for people in their forties is 7 to 1; that is, even in that case there is a lot of benefit in following in order of age. When you consider people in their thirties, the benefit is not that great anymore: 2 to 1 compared to people in their twenties.

    “From this point of view, it seems to me that vaccination should not be opened before having covered, at least, 40-year-olds.”

María Luisa Ávila: ‘It’s time’

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Pediatric infectologist and former Minister of Health, María Luisa Ávila Agüero, believes that Health authorities should decide soon to open the vaccination against covid-19.

“If people are being called and there are people who do not want to be vaccinated, and there are others who are younger, without risk factors, but who can get sick and want to be vaccinated, I think that is a decision that must be taken as soon as possible.

“I would say yes. In the coming weeks, that decision has to be made, taking into account that many areas (of Health) are reporting that they are waiting for the people who were to be vaccinated, “said the Ávila.

Ávila clarifies that it is still necessary to go out to look for the elderly and those with some impediment to leave the houses. “We need 70% of the vaccinated population to reduce the risk,” she warned.

According to the former Minister of Health, the opening would eliminate the problems that have been occurring; such as the alteration of certificates on risk factors.

“It can be a 35-year-old person, without risk factors, who wants to be vaccinated … I believe that it is necessary to offer them that possibility,” said Ávila, for whom opening the campaign would have more advantages than disadvantages.

“There will always be people who criticize the measure, but we would avoid all the people who say they have a risk factor without having it; doctors who, unfortunately, are unscrupulously giving false opinions, taking the opportunity away from people who do need the vaccine.

“How do you solve all this? That there is already an opening of vaccination for those who want it, but saving vaccines for those people who are at risk,” she warned.

Ronald Evans: ‘It will depend on suppliers’

For the doctor and epidemiologist, Ronald Evans, the basic condition to even think about opening vaccination is to have more doses and more pharmaceutical houses.

“The problem I see is not only the wishes and the planning that the Ministry of Health or the Caja may have, but that everything will depend on the providers and the number of vaccines that we receive. Now we depend on two: Pfizer and AstraZeneca.

“It is a sine qua non that there is a diversification of vaccines. From the beginning, I have said that the Government should expand the range of contacts, not depend on one or two pharmaceutical houses. Other countries have been bolder.

“The Achilles heel is not in the operational capacity of the Caja Costarricense de Seguro Social (CCSS). In any case, if there were more vaccines, I’m sure there would be a national movement to support it, but if there was a product,” Evans said.

For the doctor, if the country intends to achieve herd immunity in the last quarter of the year, it must have more vaccines.

“The government should do the impossible to buy vaccines. If other countries are succeeding, why not us? It is the question that I ask myself.

“In addition, we must begin the procedures for that third dose, we do not know if now in December, or in the first months of next year because, unfortunately, this virus is here to stay,” he warned

Juan José Romero: ‘Logistics is not a problem’

“Undoubtedly, the possibility of opening vaccination to people of any age, with or without a risk factor, depends mainly on whether the vaccines arrive in the amount that this type of decision allows,” agrees Juan José Romero, an epidemiologist at UNA .

If the amount the country receives were to be exceeded, he said, the CCSS would have the support of many non-governmental organizations, companies and universities.

“I think definitely (the opening) is going to have a very positive effect. (…) Sure, we are talking about many doses of vaccines. We have already seen that even for group 3, with risk factors, mass vaccination campaigns have been a success, and this is what has allowed us to reach 230,000 or more people in a single week.

“I, on either hand, see it as extremely positive. I think it is possible to do it but it depends on the number of doses.

“In addition, the fact that the period between doses has been extended to 12 weeks would make it easier to cover a large part of the population, at least with the first vaccine, while the second is given a chance,” said Romero.

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